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.

scholarly journals Importance of haemodynamic stability and adjuvant therapy in the treatment of patients with sepsis and septic shock

2020 ◽  
Vol 45 (4) ◽  
pp. 153-158
Author(s):  
Vesna Marjanović ◽  
Ivana Budić ◽  
Saša Ignjatijević ◽  
Marija Stević ◽  
Dušica Simić
Keyword(s):  
Septic Shock ◽  
Adjuvant Therapy ◽  
Isotonic Saline ◽  
Fluid Replacement ◽  
Initial Assessment ◽  
Hemodynamic Stability ◽  
Threatening Condition ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Vasoactive Medications

Sepsis represents a life-threatening condition that requires prompt recognition, detailed initial assessment and energetic administration of therapy. Guidelines published in 2016 emphasized the importance of early fluids replacement and infection control together with assessment based on laboratory parameters and precise monitoring of hemodynamic status of septic patients within the first 3-6 hours after diagnosis. Revision that followed in 2018 stressed that all therapeutic actions should be initiated within the first hour after diagnosis. Urgent administration of isotonic saline and balanced crystalloids in a dose of 30ml/kg should provide adequate hemodynamic stability of septic patients. If the fluid replacement fails to achieve hemodynamic stability and mean arterial pressure >65 mmHg, addition of vasopressors is mandatory. The vasopressor of choice for septic patients is norepinephrine. It may be used alone or in combination with other vasopressors such as epinephrine, vasopressin, terlipresine or phenylephrine. Septic patients with inadequate cardiac output after fluid replacement, and cardiomyopathy induced by sepsis or those with combined shock may need treatment with inotropic medication such as epinephrine or dobutamine. Adjuvant therapy with steroids, immunoglobulins, anticoagulants, statins, vitamin C and Bl, may be useful, but no benefit regarding the overall outcome was observed. In conclusion, early detection of sepsis and septic shock within the first hour and immediate adequate fluid administration with vasoactive medications to maintain hemodynamic stability, are crucial for achievement of better outcome of these patients.

Cardiac Tamponade

2019 ◽  
pp. 66-75
Author(s):  
Todd Novak ◽  
Silas Hoxie
Keyword(s):  
Cardiac Tamponade ◽  
Early Recognition ◽  
Hemodynamic Instability ◽  
Pericardial Fluid ◽  
Anesthetic Techniques ◽  
Physiological Changes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Cardiac Filling

Cardiac tamponade is a life-threatening condition that occurs when accumulating pericardial fluid results in impaired cardiac filling and hemodynamic instability. Most of the clinical features of tamponade are subtle and nonspecific and may not be appreciated until cardiovascular collapse is imminent. Understanding the physiological changes that occur during tamponade are essential for early recognition and intervention. While cardiac tamponade is a clinical diagnosis, echocardiography is the modality of choice in facilitating the prompt identification of extraneous pericardial contents and the determination of the hemodynamic significance. This chapter discusses the presentation, pathophysiology, and echocardiographic signs of tamponade, as well the differential diagnosis and confounding conditions most pertinent to the anesthesiologist. Both medical and surgical management are also addressed, including a review of perioperative and anesthetic techniques.

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 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.

Alcohol Related Non-traumatic Rhabdomyolysis and Compartment Syndrome

2007 ◽  
Vol 6 (1) ◽  
pp. 33-34
Author(s):  
JPL Ong ◽  
◽  
LA Thomas ◽  
Keyword(s):  
Skeletal Muscle ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Lower Extremity ◽  
Compartment Syndrome ◽  
Early Recognition ◽  
Clinical Entity ◽  
Threatening Condition ◽  
Life Threatening ◽  
Renal Support

Rhabdomyolysis is a serious and life-threatening condition in which skeletal muscle is damaged, commonly resulting in acute renal failure. The causes of this clinical entity can be traumatic and non-traumatic. In the latter group, alcohol is the commonest cause. This report describes the case of a 25 year old man who presented with rhabdomyolysis leading to acute renal failure after an alcohol binge. He presented with painful legs and lower extremity compartment syndrome. The patient recovered with surgical fasciotomy and renal support. This case illustrates the importance of early recognition and treatment of alcohol related non-traumatic rhabdomyolysis and compartment syndrome.

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.

scholarly journals Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

2019 ◽  
Vol 9 (1) ◽  
pp. 46 ◽  
Author(s):  
Caspar Mewes ◽  
Carolin Böhnke ◽  
Tessa Alexander ◽  
Benedikt Büttner ◽  
José Hinz ◽  
...  
Keyword(s):  
Septic Shock ◽  
Protective Effect ◽  
Cox Regression ◽  
Obese Patients ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Threatening Condition ◽  
Life Threatening ◽  
Caucasian Patients ◽  
Patient Prognosis

Septic shock is a frequent life-threatening condition and a leading cause of mortality in intensive care units (ICUs). Previous investigations have reported a potentially protective effect of obesity in septic shock patients. However, prior results have been inconsistent, focused on short-term in-hospital mortality and inadequately adjusted for confounders, and they have rarely applied the currently valid Sepsis-3 definition criteria for septic shock. This investigation examined the effect of obesity on 90-day mortality in patients with septic shock selected from a prospectively enrolled cohort of septic patients. A total of 352 patients who met the Sepsis-3 criteria for septic shock were enrolled in this study. Body-mass index (BMI) was used to divide the cohort into 24% obese (BMI ≥ 30 kg/m2) and 76% non-obese (BMI < 30 kg/m2) patients. Kaplan-Meier survival analysis revealed a significantly lower 90-day mortality (31% vs. 43%; p = 0.0436) in obese patients compared to non-obese patients. Additional analyses of baseline characteristics, disease severity, and microbiological findings outlined further statistically significant differences among the groups. Multivariate Cox regression analysis estimated a significant protective effect of obesity on 90-day mortality after adjustment for confounders. An understanding of the underlying physiologic mechanisms may improve therapeutic strategies and patient prognosis.

scholarly journals Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Alessio Arrivi ◽  
Gaetano Tanzilli ◽  
Paolo Emilio Puddu ◽  
Giovanni Truscelli ◽  
Marcello Dominici ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Early Recognition ◽  
Type A ◽  
Type A Aortic Dissection ◽  
Catheterization Laboratory ◽  
Arterial Complication ◽  
Threatening Condition ◽  
Life Threatening ◽  
Previously Treated ◽  
Pathophysiologic Mechanisms

Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

scholarly journals Sepsis—Pathophysiology and Therapeutic Concepts

2021 ◽  
Vol 8 ◽  
Author(s):  
Dominik Jarczak ◽  
Stefan Kluge ◽  
Axel Nierhaus
Keyword(s):  
Paradigm Shift ◽  
Host Response ◽  
Disease Burden ◽  
Therapeutic Approaches ◽  
Immunological Mechanisms ◽  
Therapeutic Concepts ◽  
Threatening Condition ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Evidence Based Therapy

Sepsis is a life-threatening condition and a global disease burden. Today, the heterogeneous syndrome is defined as severe organ dysfunction caused by a dysregulated host response to infection, with renewed emphasis on immune pathophysiology. Despite all efforts of experimental and clinical research during the last three decades, the ability to positively influence course and outcome of the syndrome remains limited. Evidence-based therapy still consists of basic causal and supportive measures, while adjuvant interventions such as blood purification or targeted immunotherapy largely remain without proof of effectiveness so far. With this review, we aim to provide an overview of sepsis immune pathophysiology, to update the choice of therapeutic approaches targeting different immunological mechanisms in the course of sepsis and septic shock, and to call for a paradigm shift from the pathogen to the host response as a potentially more promising angle.

scholarly journals Deep Learning Model for Screening Sepsis Using Electrocardiography

2021 ◽  
Author(s):  
Joon-myoung Kwon ◽  
Ye Rang Lee ◽  
Min-Seung Jung ◽  
Yoon-Ji Lee ◽  
Yong-Yeon Jo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Deep Learning ◽  
Characteristic Curve ◽  
External Validation ◽  
Medical Emergency ◽  
Validation Dataset ◽  
Internal Validation ◽  
Significant Difference ◽  
Life Threatening ◽  
Sepsis And Septic Shock

Abstract Background: Sepsis is a life-threatening organ dysfunction and is a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, it is difficult to screen the occurrence of sepsis. In this study, we propose an artificial intelligence based on deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG).Methods: This retrospective cohort study included 46,017 patients who admitted to two hospitals. 1,548 and 639 patients underwent sepsis and septic shock. The DLM was developed using 73,727 ECGs of 18,142 patients and internal validation was conducted using 7,774 ECGs of 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs of 20,101 patients from another hospital to verify the applicability of the DLM across centers.Results: During the internal and external validation, the area under the receiver operating characteristic curve (AUC) of an DLM using 12-lead ECG for screening sepsis were 0.901 (95% confidence interval 0.882–0.920) and 0.863 (0.846–0.879), respectively. During internal and external validation, AUC of an DLM for detecting septic shock were 0.906 (95% CI = 0.877–0.936) and 0.899 (95% CI = 0.872–0.925), respectively. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs were 0.845–0.882. A sensitivity map showed that the QRS complex and T wave was associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who admitted with infectious disease, The AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793–0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs 0.574, p<0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs 0.725, p=0.018).Conclusions: The DLM demonstrated reasonable performance for screening sepsis using 12-, 6-, and single-lead ECG. The results suggest that sepsis can be screened using not only conventional ECG devices, but also diverse life-type ECG machine employing the DLM, thereby preventing irreversible disease progression and mortality.

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