Shock: aetiology, pathophysiology and management.

The term 'shock' is used to describe a complex, life-threatening clinical condition that arises from acute circulatory failure. Shock is a pathological state that results when the circulation is unable to deliver sufficient oxygen and nutrients to the cells and tissues. The resulting hypoxia, tissue hypoperfusion and cellular dysfunction can lead to multi-organ failure; if this is not treated in a timely and appropriate manner, it can lead to death. This article gives an introduction to shock with an overview of the condition and its physiological impact on patients. Focusing on the aetiology and underlying causes, discussion will highlight the different types, stages and general pathophysiology of shock, as well as providing a guide to treatment options and nursing interventions.

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey.

PURPOSE: To survey haemodynamic monitoring and management practices in intensive care patients with the coronavirus disease 2019 (COVID-19). METHODS: A questionnaire was shared on social networks or via email by the authors and by Anaesthesia and/or Critical Care societies from France, Switzerland, Belgium, Brazil, and Portugal. Intensivists and anaesthetists involved in COVID-19 ICU care were invited to answer 14 questions about haemodynamic monitoring and management. RESULTS: Globally, 1000 questionnaires were available for analysis. Responses came mainly from Europe (n = 460) and America (n = 434). According to a majority of respondents, COVID-19 ICU patients frequently or very frequently received continuous vasopressor support (56%) and had an echocardiography performed (54%). Echocardiography revealed a normal cardiac function, a hyperdynamic state (43%), hypovolaemia (22%), a left ventricular dysfunction (21%) and a right ventricular dilation (20%). Fluid responsiveness was frequently assessed (84%), mainly using echo (62%), and cardiac output was measured in 69%, mostly with echo as well (53%). Venous oxygen saturation was frequently measured (79%), mostly from a CVC blood sample (94%). Tissue perfusion was assessed biologically (93%) and clinically (63%). Pulmonary oedema was detected and quantified mainly using echo (67%) and chest X-ray (61%). CONCLUSION: Our survey confirms that vasopressor support is not uncommon in COVID-19 ICU patients and suggests that different haemodynamic phenotypes may be observed. Ultrasounds were used by many respondents, to assess cardiac function but also to predict fluid responsiveness and quantify pulmonary oedema. Although we observed regional differences, current international guidelines were followed by most respondents.