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Why does a sharp drop in blood pressure trigger multiple organ failure? How can this kind of shock leave you hanging by a thread!
In the medical world, shock symptoms caused by a sudden drop in blood pressure are an urgent medical emergency, such as vasodilatory shock. This condition is not unique and shares the same risks with cardiogenic shock, septic shock, allergen-induced shock, and hypovolemic shock. When blood vessels suddenly relax, it causes them to dilate, followed by a sudden drop in blood pressure, which in turn reduces blood flow. If blood pressure cannot be maintained, the body's organs will be damaged due to a lack of adequate blood flow and oxygen.
"If vasodilatory shock lasts for more than a few minutes without appropriate treatment, the lack of oxygen to the organs will cause lasting damage."
Vasodilatory shock, if not treated quickly, may lead to multiple organ dysfunction and even death. Treatment includes the use of vasoconstrictors, inotropes, fluid replacement, and necessary resuscitation steps. However, in some cases, even with high doses of vasoconstrictors, the patient may not be able to restore blood pressure, and this is called refractory vasodilatory shock. This development triggered in-depth discussions on the situation in the industry.
Signs of blood circulation collapse
Symptoms of vasodilatory shock may be diverse and include, but are not limited to:
- Confusion or decreased alertness
- Loss of consciousness
- Continuous rapid heartbeat
- Sweating
- Pale skin
- Weak pulse
- Shortness of breath
- Reduced urine output or anuria
- Cold hands and feet
Causes of vasodilatory shock
The possible causes of vasodilatory shock range widely, including:
- Bacterial infections in the bloodstream
- Severe allergic reaction (anaphylactic shock)
- Systemic inflammatory response syndrome
- Injury to the nervous system (brain or nerves)
"The most common cause of vasodilatory shock is sepsis."
Over time, almost all types of distributive shock, such as septic shock, neurogenic shock, etc., may evolve into refractory vasodilatory shock. In addition to sepsis, conditions such as acute pancreatitis and hypotension after cardiopulmonary bypass surgery may also be hidden triggers.
Physiology, pathology and diagnosis
Unlike cardiogenic shock and acute hemorrhagic shock, in vasodilatory shock, the smooth muscle of peripheral blood vessels is difficult to contract. This disorder may result from a deficiency in the antidiuretic hormone vasopressin, resulting in a malfunction of the patient's physiological compensatory mechanisms.
"Early recognition and prompt treatment are critical to saving lives."
According to the 2018 American Society of Chest Medicine definition, refractory shock can be diagnosed when high doses of vasoconstrictors fail to restore the patient's blood pressure. The first priority of treatment is to reverse the underlying cause of vasodilatory shock to protect the organs from the effects of ischemia and hypoxia.
Treatment and Management Strategies
Treatment usually focuses first on raising blood pressure with norepinephrine and dopamine, followed by the introduction of vasoconstrictors. Caution is then required when using high doses of the drug, as this may cause excessive vasoconstriction, which may affect cardiac output. In some cases, such as vasodilatory shock due to hypocalcemic cardiomyopathy, treatment with calcium and active vitamin D may need to be considered.
"Successful treatment requires close collaboration among a multidisciplinary team."
In the nursing process, in addition to critical care physicians and infectious disease specialists, respiratory therapy, nursing and pharmacy professions also play an important role. Effective collaboration will significantly improve treatment effectiveness.
Epidemiology and prognosis
Observational studies suggest that approximately 6% to 7% of severely ill patients may develop refractory shock. Through early recognition and prompt treatment, the chance of survival can be improved; otherwise, just a brief period of hypotension may cause damage to the heart and kidneys, exacerbating mortality in severe cases.
In the case of refractory shock, the all-cause mortality rate within one month exceeds 50%. Why do we often fail to warn against this deadly risk hidden behind seemingly common illnesses?
