Refractory Shock. Casuistics

Shock Syndrome is an acute progressive circulatory insufficiency where the Heart is unable to circulate the blood in time unit, for supplying with O2 to the cells and to take out from them CO2 and other final and intermediate toxic metabolites. Shock is acute inadequate organ perfusion to meet the tissue’s oxygenation demand. Shock means: an Acute suffering of cells and organ`s tissues of organism. The term refractory shock is applied when, in spite of apparently adequate therapy, the shock state continues. There are three types of refractory shock: Refractory (or Irreversible) shock, Refractory (Septic) shock, Refractory (Cardiogenic) shock (RCS). Diagnosis Evaluation should focus on the identification of the primary cause and reversible secondary contributors, such as hypovolemia, pump failure, or obstruction that is causing shock. Differential diagnosis must be done with: septic shock, vasodilatory shock and cardiogenic shock. Treatment Coronary PP > 50 mm Hg, Improve myocardial function, C.I. < 3.5 is a risk factor, 2.5 may be sufficient. Fluids first, then cautious pressors. Remember aortic DIASTOLIC pressures drives coronary perfusion (DBP-PAOP = Coronary Perfusion Pressure) .If inotropes and vasopressors fail, intra-aortic balloon pump Temporary circulatory support with extracorporeal membrane oxygenation (ECMO). Sol. natrium bicarbonat 8.4% (PH ≤7.2). Recomandation Refractory shock which is mainly caused by cardiogenic shock and Septic shock are severe conditions that cause increased mortality in patients with such conditions. Advances in the treatment of these serious conditions have enabled the healing of these patients and the relative reduction of Mortality.