What is uncompensated shock?
If the shock state progresses without interruption, the patient’s compensatory mechanisms eventually fail. Hypoperfusion of organ systems causes acidosis and further release of inflammatory mediators. As blood flow to the brain decreases, the patient can become irritable or stuporous and eventually slips into coma. Likewise, decreased renal blood flow causes decreased urine output and finally results in anuria. The gastrointestinal tract is similarly affected, so the patient often has decreased bowel motility followed by distention and edema of the bowel wall. As tissue ischemia and acidosis progress, the inflammatory mediators cause diffuse vascular injury and capillary leakage. The pulmonary bed is especially sensitive to this type of injury. Damage to the pulmonary tissues exacerbates tissue hypoxemia. The ultimate result of progressive shock is multiorgan system failure and acute respiratory distress syndrome. At some point during this process the patient’s blood pressure falls.
