Autonomic dysfunction in shock

Abstract

Circulatory shock is accompanied, and likely to be preceded, by profound alterations in autonomic function. In stable conditions, sympathetic and parasympathetic limbs of the autonomic nervous system work in a highly coordinated manner, by virtue of physical and biochemical afferent signals being transduced into coordinated neural activity to maintain homeostasis in multiple organs innervated by specialized autonomic nerves. In this chapter, we assess how normal autonomic activity is regulated and the practical implications of how perturbation of the autonomic nervous system fuels further detrimental changes in shock. We will also highlight how autonomic regulation of cardiovascular and extra-cardiovascular physiology contributes to circulatory shock and define autonomic dysfunction practically in a clinical context.