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

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      Abstract

      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.
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