KEDİLERDE SEPTİK ŞOKUN DEĞERLENDİRİLMESİ: KEDİLERDE SEPSİS

Öz

Kedilerde şok sık olarak karşılaşılan bir problem olup şok durumunun erken aşamada şok durumunun belirlenmesiyle sağaltım planları hızlı bir şekilde yapılmaktadır. Şok vücuttaki organ ve dokuların yeterince besin ve oksijen alamaması ile karakterizedir ve yüksek mortalite oranıyla seyretmektedir. Sistemik enfeksiyonlara karşı konakçı immun sistem tarafından kontrolsüz yanıtla şekillenen sepsis ciddi sağlık problemlerine yol açmaktadır. Sepsisli hastalarda genellikle hiperlaktatemi, sıvı uygulamasına dirençli hipotansiyon, mukozalarda kirli hiperemi gibi önemli klinik bulgular görülmektedir. Şok durumundaki hastaların belirlenmesinde birçok indeks veya parametre kullanılmaktadır. Kalp atım hızının sistolik arteriyel kan basıncına bölünmesi ile hesaplanan şok indeksi, şoklu hastaların erken aşamada belirlenmesine olanak sağlayarak hastanın multiple organ yetmezliğine girmesini önlemede avantaj sağlayabilmektedir. Sonuç olarak Şok indeksi ile şokun erken aşamada tespit edilmesi daha planlı ve uygun sağaltım yapılabilmesine olanak sağlamaktadır.

Anahtar Kelimeler

• Kedi
• Kollaps
• Sepsis
• Şok indeks

Kaynakça

1. Ait-Oufella, H. & Bakker, J. (2016). Understanding clinical signs of poor tissue perfusion during septic shock. Intensive Care Med., 42(12), 2070–2072. DOI: https://doi.org/10.1007/s00134- 016-4250-6 İstanbul Rumeli Üniversitesi Sağlık Bilimleri Dergisi (The Journal of Istanbul Rumeli University Health Sciences) Cilt: 4, Sayı: 2, 2025
2. Antonelli, M., Levy, M., Andrews, P. J., Chastre, J., Hudson, L. D., Manthous, C., Meduri, G.U. et al. (2007). Hemodynamic monitoring in shock and implications for management: International Consensus Conference, Paris, France, 27–28 April 2006. Intensive Care Med., 33, 575–590. DOI: https://doi.org/10.1007/s00134-007-0531-4
3. Babyak, J.M. & Sharp, C.R. (2016). Epidemiology of systemic inflammatory response syndrome and sepsis in cats hospitalized in a veterinary teaching hospital. J Am Vet Med Assoc., 249, 65–71. DOI:10.2460/javma.249.1.65
4. Becker, L., Prado, K., Foppa, M., Martinelli, N., Aguiar, C., Furian, T., Clausell, N. et al. (2012). Endothelial dysfunction assessed by brachial artery ultrasound in severe sepsis and septic shock. J Crit Care, 27(3), 316.e9. DOI: https://doi.org/10.1016/j.jcrc.2011.08.002
5. Berger, T., Green, J., Horeczko, T., Hagar, Y., Garg, N., Suarez, A., Panacek, E. et al. (2013). Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med., 14(2), 168. DOI: 10.5811/westjem.2012.8.11546
6. Carcillo, J.A., Han, K., Lin, J. & Orr, R. (2007). Goal-directed management of pediatric shock in the emergency department. Clin Pediatr Emerg Med., 8(3), 165–175. DOI: https://doi.org/10.1016/j.cpem.2007.07.002
7. Daviaud, F., Grimaldi, D., Dechartres, A., Charpentier, J., Geri, G., Marin, N., Chicheet, JD. al. (2015). Timing and causes of death in septic shock. Ann Intensive Care, 5, 1–9. DOI:https://doi.org/10.1186/s13613-015-0058-8
8. De Backer, D., Orbegozo Cortes, D., Donadello, K. & Vincent, J.L. (2014). Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence, 5(1), 73– 79. DOI:https://doi.org/10.4161/viru.26482

9. de Laforcade, A. & Silverstein, D.C. (2015). Shock. In: Silverstein D.C., Hopper K. (Eds.),Small Animal Critical Care Medicine (2nd ed., pp. 26–30). St. Louis: Saunders.
10. Diaztagle Fernández, J.J., Gómez Núnez, W.A. & Plazas Vargas, M. (2016). Utilización del índice de shock en el manejo de pacientes con sepsis severa y choque séptico: una revisión sistemática. Acta Colomb Cuid Intensivo, 16, 262–269. DOI: https://doi.org/10.1016/j.acci.2016.08.005
11. Dinarello, C.A., Okusawa, S. & Gelfand, J.A. (1989). Interleukin-1 induces a shock-like state in rabbits: synergism with tumor necrosis factor and the effect of cyclooxygenase inhibition. Prog Clin Biol Res., 286, 243–263. DOI:10.5935/0103-507X.20180027.
12. Donati, P.A., Rabelo, R.C., Araos, J., Tunesi, M., Mouly, J., Londoño, L., Jensen, M. et al. (2022). Retrospective evaluation of jugular venous blood variables and mortality in critically ill hospitalized cats. J Vet Emerg Crit Care (San Antonio), 32(6), 777–783. DOI:https://doi.org/10.1111/vec.13232
13. Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C.M., French, C., Machado F.R. et al. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med., 49(11), e1063–e1143. DOI:10.1097/CCM.0000000000005337
14. Fadel, L., Rabelo, R.C., Fantoni, D.T., Machado, G., Duarte, M.C., Schaefer, G.C., Oliveira, M.P. et al. (2025). Assessment of shock index in healthy cats and in cats presenting to an emergency room with shock. J Vet Emerg Crit Care (San Antonio), 35(1), 34–40. DOI:https://doi.org/10.1111/vec.13446
15. He, H.W., Liu, D.W., Wang, X.T., Long, Y., Chai, W.Z., Zhou, X., Li, X. et al. (2013). Value of peripheral perfusion index in the assessment of reactive hyperemia in septic patients. Zhonghua Yi Xue Za Zhi, 93(41), 3265–3268. DOI: 10.5935/0103-507X.20180027.
16. Hernandez, G., Bruhn, A., Castro, R., Pedreros, C., Rovegno, M., Kattan, E., Veas, E. et al. (2012). Persistent sepsis‐induced hypotension without hyperlactatemia: A distinct clinical and physiological profile within the spectrum of septic shock. Crit Care Res Pract., 2012(1), 536852. DOI:https://doi.org/10.1155/2012/536852
17. Ince C., Mayeux P.R., Nguyen T., Gomez H., Kellum J.A., Ospina-Tascon, GA., Hernandez, G. et al. (2016). The endothelium in sepsis. Shock, 45(3), 259–270. DOI: 10.1097/SHK.0000000000000473
18. Knotzer, H., Pajk, W., Dünser, M.W., Maier, S., Mayr, A.J., Ritsch, N., Friesenecker, B. et al. (2006). Regional microvascular function and vascular reactivity in patients with different degrees of multiple organ dysfunction syndrome. Anesth Analg., 102(4), 1187–1193. DOI:10.1213/01.ane.0000198587.10553.c1
19. Knovich, M.A., Storey, J.A., Coffman, L.G., Torti, S.V., & Torti, F.M. (2009). Ferritin for the clinician. Blood Rev., 23(3), 95–104. DOI:https://doi.org/10.1016/j.blre.2008.08.001
20. Kubli S., Boëgli Y., Dalle Ave A., Liaudet L., Revelly J.P., Golay, S., Broccard, A. et al. (2003). Endothelium-dependent vasodilation in the skin microcirculation of patients with septic shock. Shock, 19(3), 274–280.
21. Lachmann G., Knaak C., Vorderwülbecke G., La Rosée P., Balzer F., Schenk, T., Schuster, FS. et al. (2020). Hyperferritinemia in critically ill patients. Crit Care Med., 48(4), 459–465. DOI:10.1097/CCM.0000000000004131
22. Levy B., Collin S., Sennoun N., Ducrocq N., Kimmoun A., Asfar, P., Perezet, P. al. (2010). Vascular hyporesponsiveness to vasopressors in septic shock: from bench to bedside. Intensive Care Med., 36, 2019–2029. DOI:10.1007/s00134-010-2045-8
23. Lima, A. & Takala, J. (2014). Clinical significance of monitoring perfusion in non-vital organs.
24. Intensive Care Med., 40, 1052–1054. DOI: https://doi.org/10.1007/s00134-014-3345-1 Lima, A.P., Beelen, P., & Bakker, J. (2002). Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med., 30(6), 1210–1213. DOI:10.1097/CCM.0b013e31819869db
25. Martin, H., Olander, B. & Norman, M. (2001). Reactive hyperemia and interleukin 6, interleukin 8, and tumor necrosis factor-α in the diagnosis of early-onset neonatal sepsis. Pediatrics, 108(4), e61. DOI: https://doi.org/10.1542/peds.108.4.e61
26. Menezes, I.A.C.D., Santos, M.R.V. & Cunha, C.L.P.D. (2014). Evaluation of endothelial function on atherosclerosis using perfusion index from pulse oximeter. Arq Bras Cardiol., 102, 237–244. DOI: https://doi.org/10.5935/abc.20140010
27. Middleton, D.J., Smith, T.O., Bedford, R., Neilly, M. & Myint, P.K. (2019). Shock index predicts outcome in patients with suspected sepsis or community-acquired pneumonia: a systematic review. J Clin Med., 8(8), 1144. DOI: https://doi.org/10.3390/jcm8081144.
28. Murphy, K. & Hibbert, A. (2013). The flat cat: 1. A logical and practical approach to management of this challenging presentation. J Feline Med Surg., 15(3), 175–188. DOI:https://doi.org/10.1177/1098612X13477538
29. Ospina-Tascón, G.A., Teboul, J.L., Hernandez, G., Alvarez, I., Sánchez-Ortiz, A.I., Calderón- Tapia, LE., Manzano-Nunez, R. et al. (2020). Diastolic shock index and clinical outcomes in patients with septic shock. Ann Intensive Care, 10, 1–11. DOI: https://doi.org/10.1186/s13613- 020-00658-8
30. Peterson, K.L., Hardy, B.T. & Hall, K. (2013). Assessment of shock index in healthy dogs and dogs in hemorrhagic shock. J Vet Emerg Crit Care (San Antonio), 23(5), 545–550. DOI: https://doi.org/10.1111/vec.12090
31. Piechota, M., Banach, M., Irzmanski, R., Barylski, M., Piechota-Urbanska, M., Kowalski, J. & Pawlicki, L. (2007). Plasma endothelin-1 levels in septic patients. J Intensive Care Med., 22(4), 232-239. DOI:https://doi.org/10.1177/08850666073014
32. Porter, A.E., Rozanski, E.A., Sharp, C.R., Dixon, K.L., Price, L.L. & Shaw, S.P. (2013). Evaluation of the shock index in dogs presenting as emergencies. J Vet Emerg Crit Care (San Antonio), 23(5), 538–544. DOI:https://doi.org/10.1111/vec.12076
33. Rady, M.Y., Nightingale, P., Little, R.A. & Edwards, J.D. (1992). Shock index: a re- evaluation in acute circulatory failure. Resuscitation, 23(3), 227–234. DOI:https://doi.org/10.1016/0300- 9572(92)90006-X