Abstract

PIP: Records of all patients with a clinical diagnosis of septic shock were reviewed retrospectively; cases occurred from August 1968-July 1971 in a general teaching hospital with 667 beds. In the 3-year period, 80 patients (38 males and 42 females) presented with 82 episodes of septic shock; this represented 14% of total hospital admissions to Intensive Care. The age range was from 15-78 years, with a mean of 52+ or -16 years. The incidence of the syndrome increased with age, reaching a maximum in the 7th decade. 66 (0f 71) of the surgical/gynecological referrals followed operative procedures, of which 1/2 were undertaken electively. By the time of referal to the Intensive Care Unit, pyrexia, hyperventilation, cyanosis, vasoconstriction, pallor, and sweating were commonly present, although 16 patients presented with warm hypotension; moderate hypotension was present in 48 patients, and severe hypotension was present in 18. Dehydration, oliguria, and azotemia were frequently present on admission. Abnormalties in serum electrolytes were common. Blood gas analysis on admission revealed that marked hypoxemia was commonly present in association with hypocapnia and metabolic acidosis. Blood cultures were performed in 62 patients and positive results were obtained in 38 on at least 1 occasion. Of a total of 47 positive blood cultures, 33 were gram-negative organisms and 5 were gram-negative anaerobic bacilli. The former were sensitive to gentamisin and the latter were resistant to both the cephalosporins and ampicillin. Gram-positive organisms were sensitive to cloxacillin and cephalosporins. Initial mortality was 64%, which increased to 70% including late deaths after return to wards. Nonsurvivors were significantly older than survivors (P .005); they were more frequently dehydrated (P .005); and they were more subject to the development of tachycardia and cardiac arrhythmias. Nonsurvivors were also considerably more hypoxemic than survivors. There was a marked difference between nonsurvivors and survivors in mode of presentation and infection source; nonsurvivors were characterized by either mediastinitis as a consequence of leakage of an esophageal anasotmosis or fecal peritonitis.