Uncomplicated circulatory shock: a narrative review

• Published in: Einstein (São Paulo, Brazil) Brazil), 2024-01, Vol.22 (spe1)
• Main Authors: de Oliveira, Mauro Dirlando Conte, dos Santos, Oscar Fernando Pavão, Colombo, Giancarlo, Corrêa, Thiago Domingos, Cendoroglo, Miguel
• Format: Article
• Language: English
• Subjects: Adrenal insufficiency; Anaphylaxis; Cardiac output; Cardiac tamponade; Fluid therapy; Hemodynamic monitoring; Hemodynamics; Intensive care units; MEDICINE, GENERAL & INTERNAL; Pulmonary embolism; Shock; Shock, cardiogenic; Shock, hemorrhagic; Shock, septic
• ISSN: 1679-4508; 2317-6385; 2317-6385
• DOI: 10.31744/einstein_journal/2024RW0775

ABSTRACT Circulatory shock is a common fatal condition. Despite this, information on this syndrome in the current medical literature is fragmented and esoteric. Adherence to each basic element of care can have a profound impact on patient outcomes. Disturbances in pumping (cardiogenic), content/container relationship (hypovolemic and vasoplegic), or blockage in blood circulation (obstructive) can induce tissue hypoperfusion, causing hemodynamic shock. If not quickly reversed, hypoperfusion progresses to irreversible multi-organ failure. The course can be fatal even before reaching this stage in cases of obstructive and anaphylactic shock in which the therapeutic window may last for only a few minutes. Thus, it is essential to conduct a joint analysis of clinical data and routine diagnostic tests to infer the probable cause of shock and avoid delays in the diagnosis of diseases that can deteriorate quickly. Point-of-care ultrasonography and echocardiography are the most valuable non-invasive diagnostic tools. Although lactate-guided management has proven to be effective, the use of capillary refill time, other biochemical markers of perfusion, and preload-directed resuscitation have the potential to avoid volume overload and improve outcomes. Faster intravenous fluid infusion and early use of vasopressors have a strong rational appeal. However, in hemorrhagic shock, finding a balance between avoiding excessive crystalloid administration and maintaining adequate perfusion pressure until hemostasis is achieved remains challenging. This review provides an accessible description of bedside management of shock, including the treatment of the main causes. The most relevant information has been organized into tables for quick reference.