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October 1964

Hypothermia in Bacteremic Shock

Arch Surg. 1964;89(4):619-629. doi:10.1001/archsurg.1964.01320040035006

The syndrome of bacteremic shock has long been recognized as a serious clinical problem. While the most common offending microorganisms belong to the coliform group, this usually fatal malady can be precipitated by Gram-positive bacteria, by rickettsiae, by viruses, and by spirochetes.1 The pathophysiology is generally pictured as vascular failure or collapse and is believed to be due directly or indirectly to endo- or exotoxins.2,3 The pattern of physiologic dysfunction is essentially similar with both toxins. It is estimated that about 12%-15% of clinical bacteremias develop hypotension and the shock syndrome.1 At one time the mortality rate was 100%. With the introduction of antibiotics, supportive therapy, and proper surgical intervention, the mortality rate has been reduced to 60%-70% in Gramnegative bacteremic shock and to 75%-80% in Gram-positive shock.

The management of bacteremic shock ideally is directed to the offending agent. The complex changes in the host which