Ultimate survival from septic shock.

Detailed hemodynamic course during prolonged (less than 12 h) septic shock was studied in 23 patients, of whom 12 ultimately died from sepsis. Hemodynamic presentation was similar in fatalities and in survivors, except for a higher heart rate and a markedly higher blood lactate in fatalities (8.4 +/- 1.4 vs. 3.7 +/- 0.4 mEq/l, P less than 0.01). During fluid resuscitation, the pulmonary artery occlusive pressure associated with the highest left ventricular stroke work was usually around 17 mmHg, but in some patients above 20 mmHg. During the course of septic shock, left ventricular function improved in both fatalities and survivors, so that an altered cardiac function had no ultimate pejorative implication. The higher blood lactate in the absence of a different hemodynamic pattern tends to indicate that peripheral distributive defect remains the essential anomaly in septic shock. Arterial lactate appears to represent the most reliable indicator of ultimate prognosis in septic shock.