Circulatory Shock: A Conceptual and Practical Approach

Before presenting the circulatory shock as a vasoplegic endothelium dysfunction, the classical conceptual and practical approach is, at least, a good editorial choice. The focus of the present abstract begins with the best definition of circulatory shock. Perhaps the best approach to defining the cardiocirculatory shock is that of Robert Hardaway, who begins his discussion by stating, “What shock is not”: (1) low blood pressure; (2) acidosis; (3) low cardiac output; (4) adrenal gland failure, and (5) hypovolemia. This approach is interesting because it demonstrates the entire evolution of the circulatory shock concept as the pathophysiological concepts have changed. So, in search of a universal definition, it was concluded that the best definition of the shock state would be “inadequate capillary perfusion” or, simply, “bad tissue perfusion.” Shock treatment should be aggressive and started early. The fundamental therapy objective is to treat the cause, correct the hemodynamic change, and, at the same time, neutralize abnormalities resulting from poor tissue perfusion. Based on these concepts, the pivotal role of vascular endothelium is made clear.