Circulatory shock associated with purulent peritonitis.

The relative roles of bacterial infection, fluid loss and myocardial failure were investigated in 24 patients in whom circulatory shock appeared as a complication of purulent peritonitis. The 13 acute survivors, including 6 hospital survivors, had strikingly lower initial plasma volumes and total blood volumes than the 11 patients who died. Differences in blood volume were not explained by differences in previous treatment or in duration of peritonitis. Acute survivors promptly improved after fluid repletion, whereas the patients who died failed to respond to the infusion of equivalent volumes of fluid. In contrast to acute survivors, the fatal cases demonstrated disproportionate increases in both right- and left-sided filling pressure, increases in pulmonary vascular resistance and decreased right and left ventricular work capability. These observations in patients complement experimental studies in which biventricular cardiac failure was implicated in the fatal progression of septic shock.