[Septic shock in intensive care]. / Septisk shock på intensivafdeling.

INTRODUCTION: Patients in septic shock have a 33-42% 30-day mortality, but characteristics and outcome have not been assessed in Danish intensive care units (ICUs). MATERIAL AND METHODS: This is a cohort study with prospective registration over a 3-month period of all patients suffering from septic shock at six Danish ICUs. We registered admission-, disease- and treatment characteristics during the first day after the diagnosis and 30- and 90-day mortality. RESULTS: A total of 132 patients with a median age of 64 years (range 15-92 years) were included. Patients were primarily admitted from general wards (n = 56), operation- (31) and emergency rooms (25) and other hospitals (19). Most were diagnosed at ICU admittance. Abdominal focus of infection was most frequent (n = 47) followed by pneumonia (45), soft tissue (14), urinary tract (8), other (6) and unknown (11). Most patients were resuscitated with a combination of crystalloids and colloids (98) and noradrenalin (119), and 100 had broad-spectrum antibiotics prior to the diagnosis, while 27 received such medication 120 (2-450) mins. after diagnosis. Mortality at 30 and 90 days was 33 and 41%, respectively - and highest for patients with abdominal infection 42 and 55%, respectively. CONCLUSION: Patients in septic shock in Danish ICUs are admitted from different hospital locations, have abdominal or pulmonary foci, but the treatment is relatively uniform. The mortality is high, but at par with the best results from other countries.

Hypersensitivity to noradrenaline in human omental vein but not artery isolated from a patient with idiopathic orthostatic hypotension.

We investigated the smooth muscle contraction in response to noradrenaline (NA), endothelin-1 (ET) and 5-hydroxytryptamine (5-HT) in the omental artery and vein segments from a 67-year-old woman with idiopathic orthostatic hypotension. The blood vessels were obtained during the abdominal surgery and investigated in vitro. Noradrenaline, endothelin-1 and 5-hydroxytryptamine all induced a contraction in the artery and vein segments. Compared to the literature, the sensitivity to noradrenaline was 10 times higher than expected in the vein. In the artery, the sensitivity to noradrenaline and in both the artery and vein, the sensitivity to endothelin-1 and 5-hydroxytryptamine was similar to that reported in the literature. These results suggest that the patient had developed an isolated hypersensitivity to noradrenaline in the veins, probably due to an impairment of the sympathetic activity.