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The hypotensive patient 

The hypotensive patient
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date: 26 February 2020

Shock remains a major cause of intensive care unit admission. Initially categorized into hypovolaemic, cardiogenic, and distributive shock, understanding of the pathophysiology has recently evolved such that tissue hypoperfusion in all shock states leads to a dysregulated inflammatory response. After 24 hours, septic shock and ischaemiareperfusion related to hypovolaemic and cardiogenic shock share similar haemodynamic and pro-inflammatory profiles. Vascular hyporesponsiveness to catecholamines is a major consequence of this common pathophysiology, which is focused upon activation of NF-κ‎b with subsequent NO overproduction. Myocardial dysfunction is a frequent complication of the cytokine storm that follows septic shock and ischaemiareperfusion. It may worsen haemodynamic status, but nevertheless, remains transient and totally reversible.

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