Types of Shock: Practical Approach in Intensive Care Unit

Abstract

Introduction: Shock is a complex cardiovascular emergency, characterized by a reduction in tissue perfusion and oxygen supply below the minimum levels necessary to meet tissue requirements. Objective: To define the types of shock and establish the current management in intensive care. Methods: 55 scientific medical articles were selected, which responded with the objective and met the inclusion criteria, through a search in databases such as PUBMED, Elsevier, Wiley, journals such as NEJM, BMJ. Results: An international randomized trial (CLASSIC) demonstrated that, in septic shock, intravenous fluid restriction did not result in fewer deaths at 90 days than standard intravenous fluid therapy. Regarding the management of hemorrhage during extracorporeal life support, it is advisable to reduce heparin, until coagulation is normalized, when bleeding from the tube, selective clamping of one side of the endotracheal tube where bleeding is evident can be performed. In cases of cardiogenic shock due to thyrotoxicosis, plasmapheresis can be used to reduce thyroid hormone levels and the overload it causes to the heart. Patients with undifferentiated shock point-of-care ultrasound (POCUS) protocols have been shown to improve outcomes. In cases of anaphylactic shock, management is with epinephrine, salbutamol, corticosteroids, intravenous fluids, vasopressors, and antihistamines. Conclusions: The initial approach to the state of shock requires prioritizing actions to restore tissue perfusion, with close hemodynamic and metabolic monitoring. Diagnostic and therapeutic attitudes must be kept in mind given the seriousness of the situation, first ruling out life-threatening conditions with timely recognition and corresponding action to improve the prognosis of the critically ill patient