Management of septic shock in the critically ill

2016 ◽  
Author(s):  
Sandra L. Peake ◽  
Matthew J. Maiden
Keyword(s):  
Septic Shock ◽  
Cell Function ◽  
Response To Therapy ◽  
Medical Emergency ◽  
Definitive Treatment ◽  
Source Of Infection ◽  
Lactate Levels ◽  
Treatment Priorities ◽  
Vasoactive Medications ◽  
Venous O2 Saturation

The management of septic shock is a medical emergency. Following prompt recognition, treatment priorities are haemodynamic resuscitation, empirical antimicrobials, urgent control of the source of infection and monitoring the response to therapy. Haemodynamic resuscitation is focused on maintaining an adequate macrocirculation, while also ensuring adequacy of microcirculatory blood flow to the cells. Intravenous fluids and catecholamines have been the mainstay of therapy. However, the amount and type of fluids, choice of vasoactive medications, and the appropriate resuscitation endpoints have been questioned. Greater awareness of the importance of resuscitating the microcirculation and cell function have led to endpoints such as venous O2 saturation and changes in lactate levels becoming resuscitation targets. Urgent definitive treatment of the infection is also crucial. This requires prompt broad-spectrum empirical antimicrobial therapy, draining infected collections and removing infected medical devices. Despite extensive research, no new therapies have improved survival from septic shock.

scholarly journals Empiric Antimicrobial Therapy in Critically Ill Septic Patients

2021 ◽  
Author(s):  
Ahlem Trifi ◽  
Sami Abdellatif ◽  
Sameh Trabelsi ◽  
Salah Ben Lakhal
Keyword(s):  
Septic Shock ◽  
Severity Of Illness ◽  
Signs And Symptoms ◽  
Antibiotic Use ◽  
Medical Emergency ◽  
Source Of Infection ◽  
Epidemiological Risk ◽  
Threatening Condition ◽  
Life Threatening ◽  
Saving Decisions

Sepsis is a medical emergency and life-threatening condition due to a dysregulated host response to infection, which is time-dependent and associated with unacceptably high mortality. At the bedside of a patient with sepsis or septic shock, clinician must make immediate life-saving decisions including empirical initiation of broad-spectrum antimicrobials; the most likely to be appropriate. The empiric regimen should be initiated within the first hour of diagnosis and determined by assessing patient and epidemiological risk factors, likely source of infection based on presenting signs and symptoms, and severity of illness. Optimizing antibiotic use is crucial to ensure successful outcomes and to reduce adverse antibiotic effects, as well as preventing drug resistance. All likely pathogens involved should be considered to provide an appropriate antibiotic coverage. Herein, we tried to make suggestions of empirical therapeutic regimens in sepsis/septic shock according to most likely pathogens in cause and sepsis source based on the recent recommendations of learned societies. Some suggestions were adapted to an environment of low-resource regions where the ecology of multi drug resistant organisms is of concern.

Disseminated mycobacterial septicemia presented as acute abdomen: a surgeon’s perspective on Landouzy’s sepsis

2020 ◽  
Vol 13 (12) ◽  
pp. e237574
Author(s):  
Lokesh Vellore Dasarathan ◽  
Pranay Gaikwad ◽  
Ramesh Babu Telugu
Keyword(s):  
Bone Marrow ◽  
Septic Shock ◽  
Acute Abdomen ◽  
Clinical Condition ◽  
Cross Sectional ◽  
Pulse Steroid Therapy ◽  
Source Of Infection ◽  
Antituberculosis Therapy ◽  
Pulse Steroid ◽  
Multi Organ Dysfunction Syndrome

A 20-year-old man presented in emergency with fever, abdominal pain and obstipation. On evaluation, he was found to have an acute abdomen with septic shock. The cross-sectional abdominal imaging revealed hepatosplenomegaly, pleural effusion and ascites with retroperitoneal lymphadenopathy. He was resuscitated and started on broad-spectrum antibiotics. There was no other source of infection identified elsewhere. While bacterial and fungal cultures were negative, the sputum, blood, bone marrow and ascitic fluid were positive for Mycobacterium tuberculosis following which he was started on antituberculosis therapy. Despite therapy, the patient’s clinical condition continued to deteriorate requiring critical care. In view of Landouzy’s sepsis, pulse steroid therapy was started. However, the patient’s clinical condition continued to deteriorate and developed systemic inflammatory response syndrome and multi-organ dysfunction syndrome. Despite the best efforts, the patient expired.

scholarly journals Longitudinal high-dimensional analysis identifies biomarkers of response to anti-PD-1 immunotherapy

2021 ◽  
Author(s):  
Run-Ze Li ◽  
Xing-Xing Fan ◽  
Ze-Bo Jiang ◽  
Jumin Huang ◽  
Hu-Dan Pan ◽  
...  
Keyword(s):  
Clinical Response ◽  
Mononuclear Cells ◽  
Cell Function ◽  
Immune Cell ◽  
Response To Therapy ◽  
High Dimensional ◽  
Meso Scale Discovery ◽  
Peripheral Blood Mononuclear ◽  
Poor Outcomes ◽  
Nsclc Patients

Abstract The response to immunotherapy could be better predicted by using a wide set of biomarkers, including serum tumor markers; however, robust immune markers associated with efficacy have yet to be validated. In this study, changes in immune cell subsets from NSCLC patients treated with anti-PD1 therapy were longitudinally monitored by high-dimensional cytometry by time of flight (CyTOF) and Meso Scale Discovery (MSD) multi-cytokines kits. The frequencies of circulating CD8+ and CD8+CD101hiTIM3+ (CCT T) subsets were significantly correlated with clinical response and survival. Enrichment of these populations in peripheral blood mononuclear cells (PBMCs) indicated a poor clinical response to ICB therapy. Cell function assays revealed that these subsets were remarkably impaired, which supported the poor outcomes observed. Additionally, longitudinal analysis showed that KLRG1 expression and cytokines were associated with the response to therapy. Overall, our results provide novel potential biomarkers for guiding the management of NSCLC patients eligible to anti-PD-1 therapy, and contribute insights for new therapeutic strategies.

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.

scholarly journals Unusual presentations of a severe type 2 leprosy reaction mimicking sepsis induced by helminth infection

2021 ◽  
Vol 15 (7) ◽  
pp. e0009453
Author(s):  
Sri Linuwih Menaldi ◽  
Anastasia Asylia Dinakrisma ◽  
Hok Bing Thio ◽  
Iris Rengganis ◽  
Salma Oktaria
Keyword(s):  
Septic Shock ◽  
Unusual Case ◽  
Helminth Infection ◽  
Endoscopic Examination ◽  
Course Of Illness ◽  
Source Of Infection ◽  
Helminth Infections ◽  
History Of ◽  
Severe Type

We describe an unusual case of type 2 leprosy reaction (T2R) with septic shock–like features induced by helminth infection in a 31-year-old Moluccan male patient with a history of completed treatment of WHO multidrug therapy (MDT)–multibacillary (MB) regimen 2 years before admission. During the course of illness, the patient had numerous complications, including septic shock, anemia, and disseminated intravascular coagulation (DIC). Nevertheless, antibiotic therapies failed to give significant results, and the source of infection could not be identified. Helminth infection was subsequently revealed by endoscopic examination followed by parasitological culture. Resolution of symptoms and normal level of organ function–specific markers were resolved within 3 days following anthelmintic treatment. This report demonstrated the challenge in the diagnosis and treatment of severe T2R. Given that helminth infections may trigger severe T2R that mimics septic shock, health professionals need to be aware of this clinical presentation, especially in endemic regions of both diseases.

scholarly journals Antimicrobial utilization pattern in Systemic Inflammatory Response Syndrome positive septicemia: a prospective study in an apex hospital in South Delhi

2019 ◽  
Vol 8 (3) ◽  
pp. 557
Author(s):  
Anwer Habib ◽  
Razi Ahmad
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
High Risk Patient ◽  
Systemic Inflammatory Response ◽  
Early Initiation ◽  
Source Of Infection ◽  
Sepsis And Septic Shock ◽  
Sirs Criteria

Background: Despite significant advances in critical care, mortality and morbidity in severe sepsis and septic shock remain high, this may be explained by the fact that in sepsis bacterial infection triggers the innate immune response, setting in motion a cascade of pro-inflammatory and anti-inflammatory cytokines leading to what we recognize as the systemic inflammatory response syndrome (SIRS). It has been thought that this self-propagating cascade drives the progression to severe sepsis and septic shock with increasing degrees of cellular injury and end-organ dysfunction, therefor early initiation of empirical antimicrobial agent is crucial and life-saving atleast in high risk patient. This study aimed to see the outcome (recover or mortality) of patients diagnosed by using SIRS criteria.Methods: Total of 105 patients of suspected sepsis fulfilling SIRS criteria (SIRS ≥2), were included in study. Study population were administered appropriate empirical antimicrobial depending on the source of infection and followed till the final outcome (complete recovery or death).Results: Out of 105 patients included in study based on SIRS criteria, 87 (82.85%) were confirmed to be having septicemia on further evaluation. In majority of patient primary source of infection were respiratory tract (44.76%) and most commonly employed and effective empirical antimicrobial were a combination piperacillin with tazobactum and amikacin (40%). 92.39% patients recovered with empirical antimicrobial, with total in-hospital mortality rate of 7.61%.Conclusions: Early initiation of appropriate antimicrobial by using SIRS as an indicator for the early diagnosis of septicemia is crucial in the management of septicemia and prevention of development of severe sepsis, septic shock.

scholarly journals Drotrecogin Alpha (Activated) in Two Patients with the Hantavirus Cardiopulmonary Syndrome

2006 ◽  
Vol 13 (5) ◽  
pp. 272-274 ◽  
Author(s):  
Robert C McDermid ◽  
RT Noel Gibney ◽  
Ronald J Brisebois ◽  
Neil M Skjodt
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Definitive Diagnosis ◽  
Endothelial Injury ◽  
Capillary Leak ◽  
Hypoxemic Respiratory Failure ◽  
Vasoactive Medications ◽  
Drotrecogin Alpha

Hantavirus cardiopulmonary syndrome (HCPS) is associated with rapid cardiopulmonary collapse from endothelial injury, resulting in massive capillary leak, shock and severe hypoxemic respiratory failure. To date, treatment remains supportive and includes mechanical ventilation, vasopressors and extracorporeal membrane oxygenation, with mortality approaching 50%. Two HCPS survivors initially given drotrecogin alpha (activated) (DAA) for presumed bacterial septic shock are described. Vasoactive medications were required for a maximum of 52 h, whereas creatinine levels and platelet counts normalized within seven to nine days. Given the similar presentations of HCPS and bacterial septic shock, empirical DAA therapy will likely be initiated before a definitive diagnosis of HCPS is made. Further observations of DAA in HCPS seem warranted.

Association between Source of Infection and Hospital Mortality in Patients Who Have Septic Shock

2014 ◽  
Vol 189 (10) ◽  
pp. 1204-1213 ◽  
Author(s):  
Aleksandra Leligdowicz ◽  
Peter M. Dodek ◽  
Monica Norena ◽  
Hubert Wong ◽  
Aseem Kumar ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Source Of Infection
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