Treating Septic Shock Depends on Goals

April 1, 2005 — -- While septic shock is always a serious health issue, for an elderly patient with complicating factors like Parkinson's disease, the illness presents extremely grave concerns.

Vatican officials announced Thursday that Pope John Paul II suffered septic shock as well as heart problems after falling ill with a urinary tract infection.

"Someone with this combination of problems can have multi-organ system failure," said Dr. Peter Salgo, associate director of the intensive care unit at Columbia University Medical Center in New York.

When a urinary tract infections enters the blood stream, the condition is known as bacteremia, or sepsis. The resulting bacterial infection, says Salgo, causes the blood vessels to expand. Blood pressure then drops, causing septic shock.

The drop in blood pressure hinders the heart's ability to pump blood to critical organs like the brain, the kidneys and even the heart itself.

"If you are a young person, your cardiovascular system pumps more blood back into the blood system," said Salgo.

But for elderly patients like the pontiff, septic shock is not easily addressed. "As you get older and more debilitated, the window of opportunity to fix this shrinks," said Salgo.

"The heart begins to starve," he said, adding that a weakened heart has even less ability to pump blood to the body's organs. "It's a nasty, vicious cycle."

Parkinson's disease, a neurological disorder marked by muscle weakness and tremors, further complicates the pope's condition.

"As you begin to lose weight and lose [muscle] strength," Salgo said, "you lose the ability to fight off infection."

Treatment for septic shock focuses on two fronts. First, the underlying bacterial infection is addressed with antibiotics. Second, medication like adrenaline or Levophed is used to increase blood pressure so that blood can reach organs.

But decisions about how to treat severe sepsis often depend on the ultimate goal of treatment: cure, which would lead to recovery, or comfort, indicating the patient is not expected to live.