PREVALENCE, PATTERN AND CLINICAL OUTCOME OF CIRCULATORY SHOCK IN CRITICALLY ILL PATIENTS IN MEDICAL ICU

Abstract

ABSTRACT

Background: To study the epidemiology of circulatory shock secondly to assess different pattern of circulatory shock among adult critically ill patients admitted to medical ICU of internal medicine department Zagazig University during the study period and finally to study the clinical outcome (morbidity and mortality) of different pattern of circulatory shock.

Methods and subjects: The current Cross-sectional cohort study had been carried out on 694 patients with circulatory shock who were admitted in medical ICU with criteria of peripheral circulatory failure. The included patients were subdivided into three groups according to the provisional and definitive diagnosis of type of circulatory shock depending on CVP, echocardiography, cardiac output and laboratory investigations as follow: Group1: hypovolemic shock group ,Group 2: cardiogenic shock group and Group 3: septic shock group. All patients were subjected to thorough medical and clinical history taking and full clinical assessment. Blood samples were withdrawn for routine investigations (Complete blood count, Kidney function tests, Liver function tests, CRP, INR, Arterial blood gases (ABG), Mean saturation of central venous oxygen (ScvO2) and serum lactate. Shock severity was assessed by using APACHE IV score and SOFA score.

Results: The frequency of circulatory shock patients is 13.9% per year. Hypovolemic shock was the major cause of circulatory failure in the studied population followed by septic shock and finally cardiogenic shock. The severity assessment parameters including APPACHE IV score , SOFA score, length of hospital stay and GCS were statically significant difference among the three studied groups, with significant increase in APPACHE IV score and SOFA score in cardiogenic group. APPACHE IV score and SOFA score were significant independent predictor of survival. The outcome measures of our populations during their ICU stay and after discharge to the medical words shows that mortality increase progressively with increase the length of ICU stay, there was significant difference in survival among the three groups, the most favorable outcome is hypovolemic group, and the worst was observed in the cardiogenic shock group.

Conclusions: Circulatory shock is a life threatening condition associated with high mortality so early recognition and early intervention will decrease morbidity and mortality in critically ill patients. CVP, echocardiography and laboratory investigations especially serum lactate and SCVO2 are easy, reliable and available in all emergency departments. All can help in early diagnosis of type of circulatory shock. Calculation of APPACHE IV score and SOFA score were easy and reliable which potentially allow one to diagnose life-threatening condition and treat them before laboratory results are back.

Key words: Circulatory Shock, medical ICU