Recovery following prolonged gram-negative shock and “shock lung”

      This paper is only available as a PDF. To read, Please Download here.


      A case of gram-negative shock due to Escherichia coli sepsis is presented. With the use of antibiotics, intravenous fluids, high molecular weight dextran, massive corticosteroid therapy and isoproterenol there was complete hemodynamic recovery. Subsequent development of acute pulmonary distress, with dyspnea and cyanotic mucous membranes, accompanied by the roentgenographic appearance of bilateral pulmonary infiltrates resembling pulmonary edema, raised the question of “shock lung” syndrome. Further extension of the infiltrates despite adequate therapy for pulmonary edema, with clinical improvement and restoration of normal central venous pressure, supported either infectious pneumonitis or “shock lung” as the cause of this picture. Roentgenographic resolution within seven days and negative sputum cultures excluded fungal or bacterial pneumonitis from consideration. The patient ultimately recovered.
      The studies of Hardaway and the pathologic description of lungs of patients dying from acute respiratory insufficiency following recovery from protracted shock provide the basis for suspecting this case to be another example of “shock lung.”
      Some of the principles of management are discussed. The use of massive corticosteroids, dextran and isoproterenol, together with the usual measures is recommended in the treatment of patients with protracted shock due to gram-negative septicemia.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McHenry M.C.
        • Martin W.J.
        • Wellman W.E.
        Bacteremia due to gram-negative bacilli: review of 113 cases encountered in 5-year period 1955 through 1959.
        Ann. Int. Med. 1962; 56: 207
        • Weil M.H.
        • Shubin H.
        • Biddle M.
        Shock caused by gram-negative microorganisms: analysis of 169 cases.
        Ann. Int. Med. 1964; 60: 384
        • Weinstein L.
        • Kainer A.S.
        Medical intelligence: management of emergencies. IV. Septic shock—pathogenesis and treatment.
        New England J. Med. 1966; 274: 950
        • Hardaway R.M.
        • James P.M.
        • Anderson R.W.
        • Bredenberg C.E.
        • West R.L.
        Intensive study and treatment of shock in man.
        J.A.M.A. 1967; 199: 779
        • Udhoji V.N.
        • Weil M.H.
        • Sambhi M.P.
        • Rosoff L.
        Hemodynamic studies on clinical shock associated with infection.
        Am. J. Med. 1963; 34: 461
        • Lillehei R.C.
        • Longerbeam J.K.
        • Bloch J.H.
        • Manax W.G.
        Modern treatment of shock based on physiologic principles.
        Clin. Pharmacol. & Therap. 1964; 5: 63
        • Lillehei R.C.
        • Longerbeam J.K.
        • Bloch J.H.
        • Manax W.G.
        Nature of irreversible shock: experimental and clinical observations.
        Ann. Surg. 1964; 160: 682
        • Melby J.C.
        Corticosteroids in shock in man and animals.
        New Physician. 1964; 13: 426
        • Sambhi M.P.
        • Weil M.H.
        Acute hemodynamic effects of dexamethasone in patients with circulatory shock.
        Clin. Res. 1962; 10: 75
        • Sambhi M.P.
        • Weil M.H.
        • Udhoji V.N.
        Acute pharmacodynamic effects of glucocorticoids. Cardiac output and related hemodynamic changes in normal subjects and patients in shock.
        Circulation. 1965; 31: 523
        • Weissman G.
        New England J. Med. 1965; 273: 1143
        • Replogle R.L.
        • Gazzaniga A.B.
        • Gross R.E.
        Use of corticosteroids during cardiopulmonary bypass: possible lysosome stabilization.
        Circulation. 1966; 33: 86
        • Lillehei R.C.
        Experimental aspects of shock due to hemorrhage, infection, and myocardial failure.
        New Physician. 1964; 13: 419
        • Shubin H.
        • Weil M.H.
        Failure to confirm pressor effect of corticosteroid hormone in treatment of circulatory shock.
        Circulation. 1965; 32: 196
        • Sullivan T.J.
        • Cavanagh D.
        Corticosteroids in endotoxin shock. Effect on renal vasomotion.
        Arch. Surg. 1966; 92: 732
        • Kardos G.G.
        Isoproterenol in the treatment of shock due to bacteremia with gram-negative pathogens.
        New England J. Med. 1966; 274: 868
        • Krasnow N.
        • Rolett E.L.
        • Yurchak P.M.
        • Hood Jr., W.B.
        • Gorlin R.
        Isoproterenol and cardiovascular performance.
        Am. J. Med. 1964; 37: 514
        • MacLean L.D.
        • Duff J.H.
        • Scott H.M.
        • Peretz D.I.
        Treatment of shock in man based on hemodynamic diagnosis.
        Surg. Gynec. & Obst. 1965; 120: 1
        • MacCannell K.L.
        • McNay J.L.
        • Meyer M.B.
        • Goldberg L.I.
        Dopamine in the treatment of hypotension and shock.
        New England J. Med. 1966; 275: 1389
        • Sawyer R.B.
        • Moncrief J.A.
        • Canizaro P.C.
        Dextran therapy in thrombophlebitis.
        J.A.M.A. 1965; 191: 740
        • Bloom W.L.
        • Harmer D.S.
        • Bryant M.F.
        • Brewer S.S.
        Coating of vascular surfaces and cells: new concept in prevention of intravascular thrombosis.
        in: Proc. Soc. Exper. Biol. & Med.115. 1964: 384
        • Patterson J.H.
        • Pierce R.B.
        • Amerson J.R.
        • Watkins W.L.
        Dextran therapy of purpura fulminans.
        New England J. Med. 1965; 273: 734
        • Solis R.J.
        • Downing S.E.
        Effects of E. coli endotoxin on ventricular performance.
        Am. J. Physiol. 1966; 211: 307
        • Rosky L.P.
        • Rodman T.
        Medical progress: medical aspects of open-heart surgery.
        New England J. Med. 1966; 274: 833
        • Schramel R.
        • Schmidt F.
        • Davis F.
        • Palmisano D.
        • Creech Jr., O.
        Pulmonary lesions produced by prolonged partial perfusion.
        Surgery. 1963; 54: 224
        • Hardaway R.M.
        Syndromes of Disseminated Intravascular Coagulation: With Special Reference to Shock and Hemorrhage. Charles C Thomas, Springfield, Ill1966: 290