What is one of the leading causes of death in the intensive care unit due to endotoxic shock?

Endotoxic shock, which is a form of septic shock, is primarily associated with the presence of Gram-negative bacteria. These bacteria can lead to severe systemic inflammatory response syndrome (SIRS) due to the release of lipopolysaccharides (LPS) from their outer membrane. LPS acts as an endotoxin, triggering a cascade of immune responses that can result in widespread inflammation, vasodilation, increased vascular permeability, and ultimately circulatory collapse and multi-organ failure.

In contrast, although Gram-positive bacteria also play a role in sepsis, they do not release endotoxins in the same manner as Gram-negative bacteria. Other organisms, such as fungi or specific mediators like cachectin (which is also known as tumor necrosis factor-alpha and involved in inflammation and immune response), are less commonly associated with endotoxic shock specifically. Thus, Gram-negative bacteria are recognized as the leading contributors to this dangerous condition in the intensive care setting.