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October 1964

The Management of Experimental Endotoxin ShockThe Circulatory Effects of Levarterenol, Hydrocortisone, Phenoxybenzamine Hydrochloride, and Blood Volume Expansion

Arch Surg. 1964;89(4):630-636. doi:10.1001/archsurg.1964.01320040046007

Shock associated with infection is a serious cardiovascular complication associated with a high mortality. Many facets of this complex circulatory disturbance remain obscure; however, the clinical features are quite characteristic. Bacterial shock is often observed in patients with Gram-negative infections. Cardiovascular collapse usually follows the abrupt onset of hyperpyrexia and chills, suggesting the entrance of bacteria or bacterial products into the blood stream. Despite intensive treatment, the mortality rate in this type of shock is uniformly high.

Current therapy has been directed toward the control of the initiating infection. Supportive measures have included the use of vasopressors, pharmacological doses of corticosteroids,* and plasma volume replacement. Vasodilator drugs have been suggested since they have been successful in lowering mortality in pretreated animals subjected to endotoxic shock.

Despite the widespread use of the therapeutic agents listed above, little specific data is available regarding their effect on circulatory dynamics in the management of