What is septic shock?
Septic shock is the most severe form of sepsis, a toxic response to an infection by the body’s immune system. Septic shock occurs when someone has sepsis and their blood pressure drops to severely low levels. This reduces blood flow to vital organs and can result in tissue death and the organs shutting down.
Septic shock is a systemic response, meaning it affects the whole body. Anyone can go into septic shock, but people at higher risk of contracting infections are also at higher risk of developing sepsis and septic shock. These include people who have weakened immune systems, such as those who take medications that affect their immune responses.
Septic shock can come on very quickly and is life-threatening. It is a medical emergency and about 40% of people with septic shock die. Half of survivors live with long-term complications, both physical and mental. The only way to reduce the risk of septic shock is to recognize the signs of sepsis in the earlier stages and to seek help as quickly as possible to prevent it progressing to septic shock.
What are the symptoms of septic shock?
When a person contracts an infection, their body’s immune system fights the microbes (germs) to eliminate the danger. For unknown reasons, sometimes the immune system goes into overdrive and instead of attacking the microbes, it starts to attack the body itself. This causes an inflammatory response, sepsis, throughout the body.
If it is not treated in the early stages, sepsis progresses to severe sepsis. This is when organ damage starts to occur. It can then advance to the most severe form, septic shock, when blood pressure drops to life-threatening levels.
In outlining symptoms of sepsis, the Sepsis Alliance uses the acronym “TIME”:
Temperature: high fever or lower than normal body temperature
Infection: signs of an infection, such as high fever, oozing from a wound, and pain
Mental decline: changes in mental status, difficulty waking up, confusion
Extremely ill: feelings of severe pain, difficulty breathing, and rapid heartbeat
The most common symptom of septic shock, in addition to the sepsis symptoms, is dangerously low blood pressure.
Septic shock is a life-threatening condition. If you show a combination of any signs of sepsis listed above, seek immediate medical care (call 911). Tell the operator you are concerned about sepsis, and why. This will put the emergency services technicians on notice to watch for sepsis.
What causes septic shock?
Sepsis is caused by an infection. It could be bacterial (the most common cause), viral, fungal, or even parasitic. The infection can be minor, like an infected bug bite or paper cut; localized, like pneumonia; or systemic, like the flu.
It is possible to develop sepsis and not know you have an infection. This happens when people are asymptomatic (have no symptoms). In some cases, doctors are never able to establish the initial infection.
Since septic shock is the last stage of sepsis, the cause of septic shock is sepsis.
Catching and treating sepsis early helps reduce the risk of septic shock.
What are the risk factors for septic shock?
Doctors do not understand why two people may get the same infection, but one develops sepsis and the other does not. What is understood is people who are at higher risk of contracting an infection are also at higher risk of developing sepsis and septic shock.
Not all people with risk factors will develop septic shock. Risk factors for infections that can lead to septic shock include:
Chronic illnesses like diabetes
Long-term hospital or long-term care facility stays
Recent surgery, invasive procedures, or injuries that punctured the skin
Use of invasive devices, like urinary catheters, central lines, and intubation for ventilators
Very young (infant) or very old age
Weakened immune system from illness, organ transplants, treatment, or not having a spleen
How do you prevent septic shock?
The only way to prevent septic shock is to prevent sepsis from occurring in the first place. Should sepsis occur, rapid and effective treatment should be initiated as quickly as possible to reduce the risk of progressing to severe sepsis and septic shock.
There are several infection prevention steps that will reduce the risk:
Clean wounds thoroughly, and keep them clean and protected while healing.
Consult your healthcare provider if you show any signs of an infection.
Contact your healthcare provider if there is no improvement in an infection or it seems to be getting worse.
Finish any medications, such as antibiotics, prescribed for an infection, even if you feel better before the full course is done.
Stay up-to-date on recommended vaccinations.
Wash your hands thoroughly and frequently.
How do doctors diagnose septic shock?
There is no specific test to diagnose septic shock or sepsis. They are diagnosed based on what the doctor sees (patient presentation), medical history, and tests to look for infection and rule out other illnesses. Generally, someone in septic shock will be too ill to answer questions, so the information will have to come from whoever is able to provide the information.
To diagnose sepsis or septic shock, the doctor or licensed healthcare practitioner will ask several questions:
Have there been any signs of an infection?
What are the symptoms?
When did the symptoms begin?
Do they have any other medical problems, such as diabetes, previous surgeries or injuries?
Have they had sepsis before?
The medical exam may include:
What are the treatments for septic shock?
Patients in septic shock are treated in the intensive care unit (ICU) as they are generally the sickest patients in the hospital. Treatment relies heavily on providing intravenous (IV) fluids to bring up the dangerously low blood pressure. Medications called vasopressors constrict the blood vessels and encourage the blood to circulate to the organs. This also increases blood pressure.
Other treatments may be necessary, depending on which organs are affected. They could include:
Anticoagulants (blood thinners) to prevent or break up blood clots
Antimicrobial medications (antibiotics, antivirals, antifungals, or antiparasitics)
Supplemental oxygen via mask or nasal cannula
Surgery to remove infected or gangrenous tissue, including amputations
Ventilator to help with breathing
How does septic shock affect quality of life?
If ICU septic shock treatment is successful, patients are moved to another part of the hospital for continued care. They are no longer considered to be in septic shock. However, up to half of septic shock and severe sepsis survivors develop post-sepsis syndrome (PSS).
Sepsis and septic shock survivors also have a higher risk of being readmitted to the hospital within a month of being discharged from the hospital, often because of repeat infections or continued or worsening organ dysfunction.
PSS comprises long-lasting issues that many survivors experience, which can differ widely from person to person. Although there are many, some of the more common PSS symptoms include:
Frequent repeat infections
Joint and muscle pain
Post-traumatic stress disorder (PTSD)
PSS can have a strong impact on quality of life because the effects can be invisible, and those around the survivor may not understand why they have not bounced back and or are not acting as they did before they were ill. The survivors themselves may have difficulty getting help because the syndrome is not well understood.
People who live with PSS can seek out help from various healthcare professionals, including:
Dietitians to help increase nutrition
Medical doctors to manage chronic physical symptoms
Mental health professionals to help manage symptoms from PTSD and other mental effects
Occupational and physical therapists to learn or relearn how to do specific tasks
Support groups, either online or in-person, that focus on surviving serious illness may also be helpful.
What are the potential complications of septic shock?
Treatment for septic shock can result in complications later. One serious complication is amputation. People with septic shock may develop blood clots in their blood vessels. These block blood flow to the extremities and can cause tissue death and gangrene. Vasopressors, to raise blood pressure, also pull blood away from the extremities to redirect it to the organs. This can also contribute to lack of nutrients to the tissues. If this occurs on a limb or digit (fingers or toes), a surgeon may have to amputate, to stop the spread of the gangrenous tissue.
Other complications include organ damage, which can occur due to blood clots, inflammation in the body, or side effects from drugs. Some examples include:
Brain: Cognitive function can decline, particularly among the very old.
Kidneys: Another frequent complication is acute kidney injury. The kidneys lose their ability to effectively filter urine. Survivors may need dialysis, although it may only be temporary.
Liver: The liver may not properly filter toxins out of the body.
Lungs: A common complication is called acute respiratory distress syndrome, or acute lung injury. Survivors may need supplemental oxygen when discharged from the hospital.
As many as half of septic shock survivors live with long-lasting effects, but by recognizing the issues and seeking help, therapy can help lessen the impact of PSS and other complications.