Treating Septic Shock Depends on Goals

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.

Age, Parkinson's Affected Outcome

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 Options Depend on Ultimate Goal

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.

"There are new agents available that, when combined with early aggressive treatment, can substantially reduce the mortality from severe sepsis and septic shock," said Dr. Ivor Douglas, director of the Medical Intensive Care Unit at Denver Health Medical Center.

When aggressive treatment is not considered appropriate, however, the patient's comfort prior to death is addressed with medication to treat pain and shortness of breath.

Septic Shock: A Worldwide Problem

Septic shock is a larger health problem than many people believe.

"Septic shock kills hundreds of thousands of people here in the United States," said Douglas. "It's an under-recognized and a leading cause of death in developing countries."

Douglas adds that the ailment is usually the result of another illness like pneumonia or, in the pope's case, a urinary tract infection.

According to Douglas, recent research indicates there may be a genetic predisposition to the community-acquired sepsis. This occurs when people with a normal immune system have an overwhelming response to an ordinary infection.

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