CLINICAL PHYSIOLOGY OF LATE (REFRACTORY) GRAM-NEGATIVE BACTEREMIC SHOCK

Gram-negative bacteremic shock in late stages is characterized by relatively higher cardiac outputs and lower vascular resistance in patients with the poorest prognoses. The cuff arterial pressure is not a reflection of the actual pressure present. Lactacidemia proved to be the consistent abnormality and further served as a suggestive index of the degree of shock and patient's prognosis. Hypocapnia and respiratory alkalosis were consistent features, but bore no relationship to hemodynamics and further had no bearing on the patient's outcome. All patients had been referred as being in refractory shock on the basis primarily of the status of arterial pressure with respect to vasopressors and adequate" fluid therapy. Analysis by hemodynamic and metabolic criteria indicated that less than 50 per cent were in true physiologic refractory shock. Alpha adrenergic drugs proved deceptive in patient evaluation and likely contributed to deterioration. © 1969."