High CVP during sepsis

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    Hi. Does anyone know why a patient would have elevated CVP during sepsis? Is it just the initial stages of septic shock (high output)? Thanks!
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    SEPTIC SHOCK-- HYPER DYNAMIC OR WARM SHOCK
    Septic shock is caused by Gram Positive or Gram Negative bacterial infection. Septic shock is most commonly caused by Gram Negative bacteria. Gram positive bacterial infection can easily be controlled so a septic shock caused by gram positive bacterial infection is less dangerous.
    Septic shock is mostly caused by the gram negative bacterial infection arising from-genitourinary, pulmonary, hepatobiliary and gastrointestinal tract.

    Septic shock causes derangement of
    Cardiac function
    Capillary permeability
    Vascular resistance
    Cellular metabolism
    Gram Negative bacterial infections causing Septic shock are-
    E.coli, klebsiella, proteus, pseudomonas and bacteroids.
    Enodotoxins are the constituents of bacterial call wall, which are released when the bacteria dies.

    Enodoxin causes-
    1. Release of kinins and histamine which are vasoactive peptides.
    2. Endothelial damage causing increased microvascular permeability resulting in fluid loss from intravascular spaceto extra vascular space. Loss of blood volume resulting in decreased venous filling, fall in CVP. Cardiac output falls resulting in hypotension. Hypotension is further aggravated by kinens, histamines and other vasoactive peptides which causes peripheral vaso dilation.

    The endotoxin released by the bacteria causes activation of coagulation DIC. There is fall in coagulation factor and platelets. Leading to haemorrhage from various sites. There is upper GI, lower GI bleeding, hematuria.etc.
    The Septic Shock effects nearly all the organs systems of the body but the pulmonary, cardiovascular, renal and hepatic system are the target organs.

    At first there is hyper dynamic state. There is increased cardiac output and trachycardia, warm and dry skin. The endothelium becomes damaged and endotoxins leaks into the circulation leading to a generalized inflammatory state.


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