Which of the following statement(s) is/are true concerning septic shock?
A. The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents B. The circulatory derangements of septic shock precede the development of metabolic abnormalities C. Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance D. Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary
Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary-the clinical findings in sepsis and septic shock represent the host response to infection. gram-positive and gram-negative bacteria, viruses, fungi, rickettsiae, and protozoa have all been reported to produce a clinical picture of septic shock, but the overall response is independent of the specific type of invading organism. septic shock develops as a consequence of the combination metabolic and circulatory derangements accompanying the systemic infection. it appears that the circulatory deficits are preceded by the metabolic abnormalities induced by infection. in fact, the circulatory changes in hyperdynamic sepsis appear to be an adaptive response to the underlying metabolic dysfunction. cardiac output is high and systemic vascular resistance low in hyperdynamic septic shock. however, splanchnic vasoconstriction is pronounced even in the absence of systemic hypotension and even though systemic vascular resistance is reduced. expansion of circulating blood volume can occur through either transcapillary refill or fluid resuscitation. due to the ongoing inflammatory mediator-induced increases in capillary permeability and continued loss of intravascular volume, exogenous volume resuscitation must be provided to restore venous return and ventricular filling.