Question

A 65-year-old man is admitted to the critical care unit with a diagnosis of septic shock. He has been receiving chemotherapy for lung cancer. His skin is warm and dry, and he is restless. His white blood cell count is elevated above normal. Hemoglobin, hematocrit, and red blood cell count are normal.

Vital signs are blood pressure 80/50 mm Hg, heart rate 120 beats/min and regular, respiratory rate 32 breaths/min and regular, and temperature 39° C.

Arterial blood gases reveal the following:
pH7.25PaO₂60 mm HgPaCl₃25 mm HgHCO₃13 mEq/LOxygen saturation86

Dobutamine is started at 10 mcg/kg/min. Normal saline is infusing at 150 ml/hr. Which of the following would be most indicative of improvement in this patient?
1) Increase in venous oxygen saturation (SvO₂)
2) Decrease in arterial lactate
3) Increase in cardiac output
4) Increase in urine output

Answer 1

An increase in urine output is a key indication of improvement in a patient with septic shock because it suggests better kidney function and an overall recovery in circulatory system performance.

Step-by-step explanation:

The most indicative sign of improvement in a patient with septic shock and the given clinical scenario would be an increase in urine output. When a patient’s circulatory system is unable to maintain adequate blood flow, as in the case of shock, urine output can dramatically fall. Therefore, an increase in urine output generally signifies better kidney function and indicates that the circulatory system is recovering, thus improving blood flow to the tissues, including the kidneys.

Other important indicators of improvement could include a decrease in arterial lactate, which can signal a reduction in anaerobic metabolism due to better tissue perfusion, and an increase in venous oxygen saturation (SvO₂), which suggests better oxygen delivery and utilization. An increase in cardiac output would also demonstrate improved blood flow, but may not directly correlate with improvement in tissue perfusion and oxygenation as well as increased urine output does.