Septic Shock

Septic shock is the most severe stage of sepsis, a life-threatening condition that occurs when your body’s response to an infection spirals dangerously out of control, causing extremely low blood pressure and organ failure.

Table of contents

• What is septic shock?
• Causes and risk factors
• Symptoms
• Diagnosis
• Treatment
• Complications
• Prevention
• Recovery and life after septic shock

What is septic shock?

Septic shock is a serious medical condition that can occur when an infection in your body causes extremely low blood pressure and organ failure due to sepsis, which happens when your immune system overreacts to an infection.^[1] Septic shock is life-threatening and requires immediate medical treatment.^[1]

Septic shock is the last and most dangerous stage of sepsis. Sepsis can be divided into three stages. The first stage is sepsis itself, which is life-threatening and happens when your immune system overreacts to an infection. The second stage is severe sepsis, when sepsis causes your organs to malfunction, usually because of low blood pressure resulting from inflammation throughout your body. The third stage is septic shock, defined by extremely low blood pressure despite lots of fluids given directly into a vein.^[1]

Each year, at least 1.7 million adults in the United States develop sepsis, and at least 350,000 adults who develop sepsis die during their hospitalization or are discharged to hospice.^[7] Almost 1.7 million people in the U.S. develop sepsis every year, and even with modern treatments, it still kills nearly 270,000 of those.^[18] The mortality rate from septic shock is approximately 25-50%.^[5]

Causes and risk factors

Any infection can lead to sepsis, which can then develop into septic shock if it worsens. Not every infection will lead to sepsis or septic shock. But if an infection causes enough inflammation, it can develop into sepsis.^[1] Most of the common infections are from bacteria, but both viruses and fungi can also cause infections and sepsis.^[1]

Bacterial infections cause most sepsis cases. But sepsis can also result from other infections, including viral infections such as COVID-19 or the flu.^[18] Infections can start anywhere but commonly begin in your lungs, bladder, or stomach.^[1] Common infections that may lead to septic shock if severe enough include appendicitis, pneumonia, bacteremia (bacteria in the blood), diverticulitis, pyelonephritis (kidney infection), meningitis (infection of the membranes surrounding the brain and spinal cord), pancreatitis (inflammation of the pancreas), necrotizing fasciitis (a serious bacterial skin infection), and others.^[5]

Your septic shock risk increases if you have a weakened immune system, which increases your risk for sepsis. People with weakened immune systems include newborns, those over age 65, pregnant women, people who use recreational drugs, and people with artificial joints or heart valves.^[1]

People with chronic medical conditions have an increased risk of sepsis. These conditions include AIDS, diabetes, leukemia or lymphoma, and immune disorders.^[1] Septic shock occurs most often in the very old and the very young. It may also occur in people with weakened immune systems.^[4]

In addition, people who have had recent infections, surgeries, transplants, or medical devices implanted have an increased risk of sepsis.^[1] Other risk factors include diseases of the genitourinary system, biliary system, or intestinal system, indwelling catheters (those that remain in place for extended periods, especially intravenous lines and urinary catheters, and plastic and metal stents used for drainage), long-term use of antibiotics, recent or current use of steroid medicines, recent chemotherapy for any type of cancer, and solid organ or bone marrow transplantation.^[4]

Symptoms

Septic shock is the third stage of sepsis. Early signs of sepsis can include fast heart rate, fever or hypothermia (low body temperature), shaking or chills, warm, clammy or sweaty skin, confusion or disorientation, hyperventilation (rapid breathing), and shortness of breath.^[1]

When sepsis turns to septic shock, you may experience additional symptoms. These include very low blood pressure, lightheadedness, little or no urine output, heart palpitations (feeling like your heart is racing or pounding), cool and pale limbs, and skin rash.^[1]

Symptoms of sepsis may include change in mental status, fast, shallow breathing, sweating for no clear reason, feeling lightheaded, shivering, and symptoms specific to the type of infection, such as painful urination from a urinary tract infection or worsening cough from pneumonia. Symptoms of sepsis are not specific. They can vary from person to person, and sepsis may appear differently in children than in adults.^[2]

Septic shock can affect any part of the body, including the heart, brain, kidneys, liver, and intestines. Symptoms may include cool, pale arms and legs, high or very low temperature, chills, lightheadedness, little or no urine, low blood pressure especially when standing, palpitations, rapid heart rate, restlessness, agitation, lethargy, or confusion, shortness of breath, skin rash or discoloration, and decreased mental status and confusion.^[4]

Diagnosis

Your healthcare provider may suspect sepsis if you have had an infection and you suddenly develop a fever or hypothermia, rapid heart rate or breathing rate, or low blood pressure.^[1] Sepsis is diagnosed through a medical assessment performed by a healthcare provider using physical findings such as fever, increased heart rate, low blood pressure, and trouble breathing.^[7]

Your healthcare provider may run blood tests to check for presence of bacteria and/or infection, complete blood count, blood chemistries including lactate (a substance that builds up when tissues don’t get enough oxygen), blood oxygen levels, and organ malfunction.^[1] Healthcare providers also perform tests that check for signs of infection or organ damage.^[7]

Blood tests may be done to check for infection in or throughout the body, complete blood count and blood chemistry, presence of bacteria or other organisms, low blood oxygen level, disturbances in the body’s acid-base balance, and poor organ function or organ failure.^[4]

Your healthcare provider may also collect samples of your urine, saliva, tissues, and/or cerebrospinal fluid (fluid that surrounds the brain and spinal cord) for further tests.^[1] Other tests may include a chest x-ray to look for pneumonia or fluid in the lungs, a urine sample to look for infection, and a CT scan or ultrasound of different parts of the body where a source of infection might be suspected.^[4]

Some of these tests are used to identify the germ that caused the infection that led to sepsis. This testing might include blood cultures looking for bacterial infections, fungal infections, or tests for viral infections like influenza.^[7] Additional tests, such as blood cultures, may not become positive for several days after the blood has been taken, or for several days after the shock has developed.^[4]

Treatment

Septic shock is a medical emergency. In most cases, people are admitted to the intensive care unit of the hospital.^[4] Healthcare providers should immediately evaluate and treat people who might have sepsis.^[7] Sepsis needs treatment in hospital straight away because it can get worse quickly. You should get antibiotics within 1 to 6 hours of arriving at hospital.^[16]

Treatment may include breathing machine (mechanical ventilation), dialysis, medicines to treat low blood pressure, infection, or blood clotting, high volume of fluids given directly into a vein, oxygen, sedatives, surgery or tube insertions to drain infected areas if needed, and antibiotics or other agents to treat viral or fungal infections.^[4]

Research shows that rapid, effective sepsis treatment includes giving appropriate treatment, including antibiotics, as soon as possible, maintaining blood flow to organs, and sometimes surgery is required to remove tissue damaged by the infection.^[7] Treatment with antibiotics begins as soon as possible. Broad-spectrum antibiotics, which are effective against a variety of bacteria, are used initially.^[11]

You may need other tests or treatments depending on your symptoms, including treatment in an intensive care unit, a machine to help you breathe (ventilator), and surgery to remove areas of infection. You may need to stay in hospital for several weeks.^[16]

The pressure in the heart and lungs may be checked. This is called hemodynamic monitoring. This can only be done with special equipment and intensive care nursing.^[4] Judicious and early antimicrobial administration, sepsis care bundle use, and early goal-directed therapies have significantly and positively impacted sepsis-related mortality. However, early identification remains the best therapeutic tool for sepsis treatment and management.^[3]

Complications

Septic shock is a very serious medical condition. It’s the most severe stage of sepsis. Septic shock can lead to brain damage, lung failure, heart failure, kidney failure, gangrene, and death.^[1] Respiratory failure, cardiac failure, or any other organ failure can occur. Gangrene may occur, possibly leading to amputation.^[4]

Septic shock has a high death rate. The death rate depends on the person’s age and overall health, the cause of the infection, how many organs have failed, and how quickly and aggressively medical therapy is started.^[4] One in three people who dies in a hospital had sepsis during their hospital stay.^[7]

Prevention

Prompt treatment of bacterial infections is helpful. Vaccination could help prevent some infections. However, many cases of septic shock cannot be prevented. Take steps to prevent the possibility of infection, especially if you have a weakened immune system.^[4]

You can take specific steps to reduce your risk of sepsis. These include taking antibiotics or other antimicrobials if prescribed and finishing the entire course of medications. Do not take antibiotics you do not need, or take someone else’s antibiotics. Using antibiotics wisely can help reduce the chances of developing antibiotic-resistant infections.^[19]

Frequent and thorough handwashing with soap and water for at least 20 seconds is important. Ask your doctor, nurse, or other healthcare professional to wash their hands if you have not seen them do so. Get an annual flu immunization and other immunizations as recommended by a trusted healthcare professional.^[19]

Other prevention measures include coughing into your elbow, not your hand (to help prevent spreading of germs if you are sick), getting recommended vaccines, practicing good hygiene, keeping cuts clean and covered until healed, and taking good care of chronic conditions.^[7][19]

Recovery and life after septic shock

Most people make a full recovery from sepsis. But it can take time. You might continue to have physical and emotional symptoms. These can last for months, or even years, after you had sepsis. These long-term effects are sometimes called post-sepsis syndrome.^[16]

Many people who survive sepsis recover completely and their lives return to normal. However, as with some other illnesses requiring intensive medical care, some patients have long-term effects.^[14] You may experience the following physical symptoms upon returning home: breathlessness, brittle nails, difficulty moving around, difficulty sleeping, dry and itchy skin that may peel, general body pains or aches, general to extreme weakness and fatigue, hair loss, and weight loss, lack of appetite, food not tasting normal.^[14]

Post-sepsis syndrome can include feeling very tired and weak and difficulty sleeping, lack of appetite, getting ill more often, changes in your mood or anxiety or depression, nightmares or flashbacks, and post-traumatic stress disorder (PTSD).^[16] You might also experience the following feelings once you are at home: confusing reality, feeling depressed, angry, unmotivated, feeling anxious, more worried than usual, flashbacks, bad memories, frustration at not being able to do everyday tasks, poor concentration, unsure of yourself, and wanting to be alone, avoiding friends and family.^[14]

Most symptoms of post-sepsis syndrome should get better on their own. But it can take time. There are things you can do to help with some long-term effects. Ask your work about changes to your working hours or conditions while you’re recovering. Do some gentle, easy exercises to build your strength. Get regular sleep. Try to prevent infections, for example by washing your hands regularly. Try to eat little and often if you have a small appetite. Do not try to rush your recovery – give yourself time.^[16]

Recovery from sepsis generally includes physical therapy and rehabilitation starting in the hospital, including moving around and getting back to being able to perform daily activities like bathing, sitting up/standing, walking, and going up/downstairs. Always start slowly and once strength is built up, increase activity as tolerated.^[21]

Get plenty of rest and build up strength gradually. Set small, achievable goals for each week, such as taking a bath, dressing yourself, or walking up stairs. Slowly increase activity and exercise as tolerated. Maintain a healthy sleeping routine. To prevent dehydration, drink plenty of fluids. Eat a healthy diet. Include fruits, vegetables, and whole grains in your diet every day.^[21]

You have been seriously ill, and your body and mind need time to get better. Work with a healthcare provider to determine the most appropriate rehabilitation plan and what activities are safe for you.^[14] Within the first 30 days following hospital discharge, one in five sepsis survivors will be readmitted to the hospital, and one in three will be readmitted within 90 days.^[20]

Talk with a healthcare provider if you or your caregivers are concerned about any physical symptoms or feelings you are experiencing. They can also help determine the most appropriate rehabilitation plan and what activities are safe for you.^[14]