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August 18, 2015

Septic Shock: Advances in Diagnosis and Treatment

Author Affiliations
  • 1Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Pittsburgh, Pennsylvania
  • 3Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA. 2015;314(7):708-717. doi:10.1001/jama.2015.7885

Importance  Septic shock is a clinical emergency that occurs in more than 230 000 US patients each year.

Observations and Advances  In the setting of suspected or documented infection, septic shock is typically defined in a clinical setting by low systolic (≤90 mm Hg) or mean arterial blood pressure (≤65 mm Hg) accompanied by signs of hypoperfusion (eg, oliguria, hyperlactemia, poor peripheral perfusion, or altered mental status). Focused ultrasonography is recommended for the prompt recognition of complicating physiology (eg, hypovolemia or cardiogenic shock), while invasive hemodynamic monitoring is recommended only for select patients. In septic shock, 3 randomized clinical trials demonstrate that protocolized care offers little advantage compared with management without a protocol. Hydroxyethyl starch is no longer recommended, and debate continues about the role of various crystalloid solutions and albumin.

Conclusions and Relevance  The prompt diagnosis of septic shock begins with obtainment of medical history and performance of a physical examination for signs and symptoms of infection and may require focused ultrasonography to recognize more complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of intravenous fluids and vasoactive medications aimed at restoring adequate circulation, and the limitations of protocol-based therapy, as guided by recent evidence.

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