Not all Shock States Are Created Equal: A Review of the Diagnosis and Management of Septic, Hypovolemic, Cardiogenic, Obstructive, and Distributive Shock

Sarah Khorsand; Mada F Helou; Veena Satyapriya; Rafal Kopanczyk; Ashish K Khanna

doi:10.1016/j.anclin.2022.11.002

Not all Shock States Are Created Equal: A Review of the Diagnosis and Management of Septic, Hypovolemic, Cardiogenic, Obstructive, and Distributive Shock

Anesthesiol Clin. 2023 Mar;41(1):1-25. doi: 10.1016/j.anclin.2022.11.002.

Authors

Sarah Khorsand¹, Mada F Helou², Veena Satyapriya³, Rafal Kopanczyk³, Ashish K Khanna⁴

Affiliations

¹ Department of Anesthesiology and Pain Management, University of Texas at Southwestern Medical Center, 3605 Vancouver Drive, TX 75229, USA.
² Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
³ Department of Anesthesiology, The Ohio State University Wexner Medical Center, N437 Doan Hall, 410 W. 10th Avenue, Columbus, OH 43210, USA.
⁴ Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, 9th Floor Janeway Tower, Winston-Salem, NC 27157, USA; Perioperative Outcomes and Informatics Collaborative (POIC), 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA; Outcomes Research Consortium, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: akhanna@wakehealth.edu.

PMID: 36871993
DOI: 10.1016/j.anclin.2022.11.002

Abstract

Shock in the critically ill patient is common and associated with poor outcomes. Categories include distributive, hypovolemic, obstructive, and cardiogenic, of which distributive (and usually septic distributive) shock is by far the most common. Clinical history, physical examination, and hemodynamic assessments & monitoring help differentiate these states. Specific management necessitates interventions to correct the triggering etiology as well as ongoing resuscitation to maintain physiologic milieu. One shock state may convert to another and may have an undifferentiated presentation; therefore, continual re-assessment is essential. This review provides guidance for intensivists for management of all shock states based on available scientific evidence.

Keywords: Diagnosis; Intervention; Management; Shock; Types.

Publication types

Review

MeSH terms

Humans
Hypovolemia*
Physical Examination*
Resuscitation