Sepsis (DRAFT)

2018 ◽  
Author(s):  
Munish H. Lapsia ◽  
David T. Huang
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Fluid Resuscitation ◽  
Host Response ◽  
Rapid Response Team ◽  
Failure Assessment ◽  
Response Team ◽  
Life Threatening ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This chapter focuses on the first 30 minutes of care for those patients with sepsis in the context of the rapid response team (RRT) activation. The definitions, etiology, incidence, and risk factors for sepsis are reviewed. Recognition of infection, sepsis, and septic shock is also reviewed while highlighting the use of sequential sepsis related organ failure assessment (SOFA) and quick SOFA (qSOFA) scores for diagnosis of sepsis. This chapter also discusses the initial fluid resuscitation, antibiotics, vasopressors, and investigations including lactate levels as a part of management of the patient in sepsis.

scholarly journals diagnosis and trEatmEnt of patiEnts in sEptiC shoCK

New Medicine ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 31-36
Author(s):  
Jacek wadełek
Keyword(s):  
Septic Shock ◽  
Organ Dysfunction ◽  
Host Response ◽  
Signs And Symptoms ◽  
Intravenous Fluids ◽  
Failure Assessment ◽  
Acute Change ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Clinical Emergency

sepsis and septic shock are a clinical emergency. sepsis is defined as a life-threatening organ dysfunction due to a dysregulated host response to infection, and organ dysfunction is defined as an acute change in sequential organ failure assessment (sofa) score greater than 2 points secondary to an infectious cause. septic shock is defined as sepsis with persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mm hg or higher, and blood lactate level greater than 2 mmol/l (18 mg/dl) despite adequate volume resuscitation. the diagnosis of septic shock begins with medical history and physical examination focused on the signs and symptoms of infection, with the aim of recognizing complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of antibiotics, vasopressors and intravenous fluids aimed at restoring adequate circulation. they should also be aware of the limitations of the protocol-based therapy.

scholarly journals Agents to reduce cytokine storm

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2909 ◽  
Author(s):  
Herwig Gerlach
Keyword(s):  
Septic Shock ◽  
Clinical Trials ◽  
Host Response ◽  
Inflammatory Diseases ◽  
Therapeutic Strategies ◽  
Cytokine Storm ◽  
Clinical Investigations ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Insight Into

The increasing insight into pathomechanisms of dysregulated host response in several inflammatory diseases led to the implementation of the term “cytokine storm” in the literature more than 20 years ago. Direct toxic effects as well as indirect immunomodulatory mechanisms during cytokine storm have been described and were the basis for the rationale to use several substances and devices in life-threatening infections and hyperinflammatory states. Clinical trials have been performed, most of them in the form of minor, investigator-initiated protocols; major clinical trials focused mostly on sepsis and septic shock. The following review tries to summarize the background, pathophysiology, and results of clinical investigations that had implications for the development of therapeutic strategies and international guidelines for the management of hyperinflammation during syndromes of cytokine storm in adult patients, predominantly in septic shock.

scholarly journals A current appraisal of evidence for the approach to sepsis and septic shock

2019 ◽  
Vol 6 ◽  
pp. 204993611985651 ◽  
Author(s):  
Jack Varon ◽  
Rebecca M. Baron
Keyword(s):  
Septic Shock ◽  
Clinical Management ◽  
Host Response ◽  
Relevant Literature ◽  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
A Current

Sepsis is a life-threatening syndrome of a dysregulated host response to infection. Despite advances in diagnosis and treatment, sepsis remains a significant cause of morbidity and mortality. Many aspects of the diagnosis and clinical management of sepsis require further study and remain controversial. This review aims to summarize relevant literature and controversies regarding the evaluation and management of sepsis and septic shock.

Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

2021 ◽  
pp. 105477382199968
Author(s):  
Anas Alsharawneh
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Emergency Setting ◽  
Extended Length ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Timely Treatment

Sepsis and neutropenia are considered the primary life-threatening complications of cancer treatment and are the leading cause of hospitalization and death. The objective was to study whether patients with neutropenia, sepsis, and septic shock were identified appropriately at triage and receive timely treatment within the emergency setting. Also, we investigated the effect of undertriage on key treatment outcomes. We conducted a retrospective analysis of all accessible records of admitted adult cancer patients with febrile neutropenia, sepsis, and septic shock. Our results identified that the majority of patients were inappropriately triaged to less urgent triage categories. Patients’ undertriage significantly prolonged multiple emergency timeliness indicators and extended length of stay within the emergency department and hospital. These effects suggest that triage implementation must be objective, consistent, and accurate because of the several influences of the assigned triage scoring on treatment and health outcomes.

scholarly journals SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

2021 ◽  
Vol 11 (3) ◽  
pp. 164
Author(s):  
Mahmoud Al-Obeidallah ◽  
Dagmar Jarkovská ◽  
Lenka Valešová ◽  
Jan Horák ◽  
Jan Jedlička ◽  
...  
Keyword(s):  
Septic Shock ◽  
Body Temperature ◽  
Sofa Score ◽  
Porcine Model ◽  
Venous Blood ◽  
Mixed Venous Blood ◽  
Mechanically Ventilated ◽  
Multiple Parameters ◽  
Failure Assessment ◽  
Sepsis And Septic Shock

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

scholarly journals Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock

2020 ◽  
Vol 7 (6) ◽  
pp. 1213
Author(s):  
Rashmi Patil ◽  
Chikkanarasareddy P. S. ◽  
Mallesh K.
Keyword(s):  
Septic Shock ◽  
Clinical Decision Making ◽  
Early Recognition ◽  
Early Stage ◽  
Therapeutic Option ◽  
Lactate Clearance ◽  
Plasma Lactate ◽  
Risk Of Death ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are the major causes of admission and deaths in the ICU, killing one in four (and often more) and increasing in incidence. In order to improve the clinical outcomes in these patients, it is crucial to obtain early recognition of patients who are at risk of death and to optimize the clinical decision making in a timely manner. In order to monitor the metabolic consequences of shock and hemodynamic management, plasma lactate levels can be used in critical illness. Objective of the study is to estimate plasma lactate and lactate clearance in sepsis and septic shock patients and to correlate plasma lactate and lactate clearance as predictors of mortality.Methods: This study is a prospective observational study conducted over 18months. Children with age of 1 month to 18 years admitted to the Paediatric intensive care unit with sepsis and septic shock were enrolled in the study. ABG at admission to document plasma lactate and lactate repeated at 6 and 24 hrs. Lactate clearance calculated at 6 and 24 hrs. The final outcome in terms of survival or death will be recorded.Results: Majority of the children fall in the class between 1-6 months 51(48.11%). Male comprises 69(65.09%). Among these, Sepsis 36(33.96%); followed by Pneumonia 34(32.07%). Survivors group were 35(33.02%) and non-survivor was 71(66.98%). The Non survivor group was observed to have lower mean values of lactate clearance and found to be statistically significant. Specificity of Lactate clearance was 63.52% and Sensitivity 76.02% respectively. The results were positively associated with lactate level at 24 hours found to be significant effect of survivability when compared to non-survivor.Conclusions: Lactate clearance is vital and markable sign for screening of septic shock at early stage for therapeutic option. Further, 24-hours lactate estimation (cut off values) clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.

Sepsis

2020 ◽  
Author(s):  
Steven P LaRosa ◽  
Steven M. Opal
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Organ Dysfunction ◽  
Fluid Resuscitation ◽  
Multiorgan Failure ◽  
Sepsis Management ◽  
The Past ◽  
Sepsis And Septic Shock

Sepsis, along with the multiorgan failure that often accompanies this condition, is a leading cause of mortality in the intensive care unit. Although modest improvements in the prognosis have been made over the past two decades and promising new therapies continue to be investigated, innovations in the management of septic shock are still required. This chapter discusses the definitions, epidemiology, and pathogenesis (including microbial factors, host-derived mediators, and organ dysfunction) relating to sepsis. Management of severe sepsis and septic shock is also described.  This review contains 5 figures, 11 tables, and 99 references. Keywords:Organ dysfunction, sepsis, septic shock, infection, bacteremia, fluid resuscitation, vasopressor

Assessment and care of the patient with sepsis

2020 ◽  
pp. 225-257
Author(s):  
Kevin Barrett
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Scoring Systems ◽  
Cardiovascular Responses ◽  
Physiological Changes ◽  
Assessment Framework ◽  
Threatening Condition ◽  
Life Threatening ◽  
Support Mechanisms ◽  
Sepsis And Septic Shock

There has been considerable recent focus on sepsis in both the clinical arena and within the general public to raise awareness of the importance of early recognition of this potentially life-threatening condition. The early recognition of sepsis by ward nurses can both reduce progression of this lethal disease and improve survival for patients in hospital. This chapter focuses on definitions of sepsis and septic shock, physiological changes associated with inflammatory and cardiovascular responses to sepsis, and a clinical assessment framework to guide practice. There is also a discussion of the use of scoring systems and how to escalate support mechanisms for patients with sepsis and septic shock.

Hypotension

2018 ◽  
pp. 163-167
Author(s):  
Angela Creditt
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Organ Failure ◽  
Broad Spectrum ◽  
Signs And Symptoms ◽  
Intravenous Fluids ◽  
Key Points ◽  
Life Threatening ◽  
New Guidelines ◽  
Sepsis And Septic Shock

Sepsis is a complex and potentially life-threatening sequela of infection that commonly occurs and can be difficult to identify. If unrecognized or undertreated, sepsis can progress to severe sepsis, septic shock, characterized by hypotension and multisystem organ failure, and ultimately death. This case illustrates classic signs and symptoms of sepsis and septic shock in a postoperative patient. Recognizing these symptoms, rapidly initiating resuscitation with intravenous fluids and broad-spectrum antibiotics and aggressive management of these patients is imperative to prevent further decompensation. In 2017, the Surviving Sepsis campaign published new guidelines to assist with the management of patients with sepsis and septic shock. Key points from these guidelines will be highlighted within this case.

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