scholarly journals Septic Shock and Sepsis Syndrome in Obstetric Patients

1994 ◽  
Vol 2 (4) ◽  
pp. 190-201
Author(s):  
Peter G. Pryde ◽  
Bernard Gonik
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Tissue Perfusion ◽  
Sepsis Syndrome ◽  
Clinical Syndrome ◽  
Pharmacological Intervention ◽  
Systemic Response ◽  
Clinical Criteria ◽  
Diagnostic Studies ◽  
Microbial Toxins

Septic shock is a life-threatening clinical syndrome that, despite its rare occurrence in obstetrics, remains a leading cause of maternal mortality. Its pathophysiology is explained by a profound systemic response to a complex variety of host cellular and humoral mediators elaborated after exposure to microbial toxins. Early recognition, prompt diagnostic workup, and immediate initiation of therapy improve outcomes. Therefore, recent publications have popularized the concept of the “sepsis syndrome,” a preshock list of clinical criteria associated with progressive sepsis. Needed diagnostic studies should never be withheld because of “pregnancy concerns.” With critically ill patients, the risk-to-benefit ratio supports the use of these diagnostic studies in almost all circumstances. Standard therapy is directed principally at restoring tissue perfusion by intravascular volume expansion and in some instances vasoactive pharmacological intervention. Simultaneously, identification of the source of infection and commencement of appropriate empiric antibiotic treatment are critical. In some cases, surgical abscess drainage or debridement of infected necrotic tissue will need to be considered. Novel approaches to treatment that attempt to reduce the systemic response to microbial toxins are promising and under active investigation. Pregnancy-specific considerations include the following: 1) initial signs or symptoms of septic shock may be masked by normal physiologic alterations of pregnancy; 2) a mixed polymicrobial group of organisms, consistent with lower genital tract flora, should be anticipated; and 3) initial therapy should be directed at maternal concerns since adverse fetal effects are most likely the result of maternal decompensation.

Sepsis Syndrome

2012 ◽  
pp. 274-279
Author(s):  
Andrew D Badley
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Physical Examination ◽  
Supportive Care ◽  
Tissue Injury ◽  
Tissue Perfusion ◽  
Sepsis Syndrome ◽  
Systemic Response ◽  
Immune Mediated ◽  
Patient’S History

Systemic inflammatory response syndrome (SIRS) is the specific host systemic response that may be elicited by various stimuli, including infection, burns, pancreatitis, ischemia, trauma, hemorrhage, immune-mediated tissue injury, and exogenous stimuli. 2. Sepsis is SIRS resulting from infection. Sepsis syndrome is sepsis with altered tissue perfusion of vital organs (resulting in oliguria, hypoxemia, elevated levels of lactate, or altered mentation or any combination of these conditions) When a patient has SIRS, the objective is to define its cause. If SIRS is caused by infection, appropriate antibiotics must be administered and supportive care guided by the patient's history and physical examination.

scholarly journals A prospective observational study on assessment of types of shock in children and requirement of inotropes in treatment of shock in tertiary care hospital

2021 ◽  
Vol 8 (5) ◽  
pp. 835
Author(s):  
Jhansi Rani Kotha ◽  
Hari Krishna Kothapally ◽  
Sai Chand Pinnoju ◽  
Sudheer Kumar
Keyword(s):  
Septic Shock ◽  
Mortality Rate ◽  
Cardiogenic Shock ◽  
Early Recognition ◽  
Tertiary Care ◽  
Hypovolemic Shock ◽  
Oxygen Demand ◽  
Tissue Perfusion ◽  
Care Hospital ◽  
Demand And Supply

Background: Shock is a state of impaired tissue perfusion which result in an imbalance between oxygen demand and supply. This reduction in effective tissue perfusion causes insufficient or improper delivery and distribution of oxygen and nutrients. There is sparse date regarding epidemiology of shock in paediatrics. In this study we were aimed to assess the types of shock and treatment of shock with Inotropes.Methods: Children of age 1 month to 12 years with a clinical diagnosis of shock were included.Results: Out of 155 children admitted with shock 72.2% had septic shock, 25.8% had hypovolemic shock, 1.2% had cardiogenic shock, 0.6% had dengue shock. In this study the mortality rate was 8.39% of total patients. The mortality rate of septic shock, hypovolemic shock, cardiogenic shock was 84%, 7.69%, 7.69% respectively. 74.33% of patients were treated with two Inotropes, 5.3% were treated with more than two Inotropes, 11.5% were treated with single Inotropes and 0.88% was treated with no inotrope.Conclusions: In the present study, among all types of shock the prevalence and mortality rate was more with Septic shock. As shock has high mortality rate in children the early recognition and patient education is required.

scholarly journals How to choose the therapeutic goals to improve tissue perfusion in septic shock

2015 ◽  
Vol 13 (3) ◽  
pp. 441-447 ◽  
Author(s):  
Murillo Santucci Cesar de Assuncao ◽  
Thiago Domingos Corrêa ◽  
Bruno de Arruda Bravim ◽  
Eliézer Silva
Keyword(s):  
Septic Shock ◽  
New Technologies ◽  
Early Recognition ◽  
Tissue Perfusion ◽  
Successful Outcome ◽  
Tissue Blood Flow ◽  
Metabolic Demand ◽  
Therapeutic Goals ◽  
Sepsis And Septic Shock ◽  
The Impact

The early recognition and treatment of severe sepsis and septic shock is the key to a successful outcome. The longer the delay in starting treatment, the worse the prognosis due to persistent tissue hypoperfusion and consequent development and worsening of organ dysfunction. One of the main mechanisms responsible for the development of cellular dysfunction is tissue hypoxia. The adjustments necessary for adequate tissue blood flow and therefore of oxygen supply to metabolic demand according to the assessment of the cardiac index and oxygen extraction rate should be performed during resuscitation period, especially in high complexity patients. New technologies, easily handled at the bedside, and new studies that directly assess the impact of macro-hemodynamic parameter optimization on microcirculation and in the clinical outcome of septic patients, are needed.

scholarly journals Effects of capillary refill time-vs. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ricardo Castro ◽  
Eduardo Kattan ◽  
Giorgio Ferri ◽  
Ronald Pairumani ◽  
Emilio Daniel Valenzuela ◽  
...  
Keyword(s):  
Septic Shock ◽  
Randomized Controlled Trial ◽  
Fluid Resuscitation ◽  
Controlled Trial ◽  
Tissue Perfusion ◽  
Capillary Refill Time ◽  
Capillary Refill ◽  
Randomized Controlled ◽  
Microcirculatory Flow ◽  
The Impact

Abstract Background Persistent hyperlactatemia has been considered as a signal of tissue hypoperfusion in septic shock patients, but multiple non-hypoperfusion-related pathogenic mechanisms could be involved. Therefore, pursuing lactate normalization may lead to the risk of fluid overload. Peripheral perfusion, assessed by the capillary refill time (CRT), could be an effective alternative resuscitation target as recently demonstrated by the ANDROMEDA-SHOCK trial. We designed the present randomized controlled trial to address the impact of a CRT-targeted (CRT-T) vs. a lactate-targeted (LAC-T) fluid resuscitation strategy on fluid balances within 24 h of septic shock diagnosis. In addition, we compared the effects of both strategies on organ dysfunction, regional and microcirculatory flow, and tissue hypoxia surrogates. Results Forty-two fluid-responsive septic shock patients were randomized into CRT-T or LAC-T groups. Fluids were administered until target achievement during the 6 h intervention period, or until safety criteria were met. CRT-T was aimed at CRT normalization (≤ 3 s), whereas in LAC-T the goal was lactate normalization (≤ 2 mmol/L) or a 20% decrease every 2 h. Multimodal perfusion monitoring included sublingual microcirculatory assessment; plasma-disappearance rate of indocyanine green; muscle oxygen saturation; central venous-arterial pCO2 gradient/ arterial-venous O2 content difference ratio; and lactate/pyruvate ratio. There was no difference between CRT-T vs. LAC-T in 6 h-fluid boluses (875 [375–2625] vs. 1500 [1000–2000], p = 0.3), or balances (982[249–2833] vs. 15,800 [740–6587, p = 0.2]). CRT-T was associated with a higher achievement of the predefined perfusion target (62 vs. 24, p = 0.03). No significant differences in perfusion-related variables or hypoxia surrogates were observed. Conclusions CRT-targeted fluid resuscitation was not superior to a lactate-targeted one on fluid administration or balances. However, it was associated with comparable effects on regional and microcirculatory flow parameters and hypoxia surrogates, and a faster achievement of the predefined resuscitation target. Our data suggest that stopping fluids in patients with CRT ≤ 3 s appears as safe in terms of tissue perfusion. Clinical Trials: ClinicalTrials.gov Identifier: NCT03762005 (Retrospectively registered on December 3rd 2018)

Septic Shock

1992 ◽  
Vol 7 (2) ◽  
pp. 90-100 ◽  
Author(s):  
Margaret M. Parker ◽  
Mitchell P. Fink
Keyword(s):  
Septic Shock ◽  
Supportive Care ◽  
Antimicrobial Therapy ◽  
Clinical Manifestations ◽  
Sepsis Syndrome ◽  
Adjunctive Treatment ◽  
Cardiovascular Changes ◽  
The Past ◽  
Sepsis And Septic Shock ◽  
Very High

The incidence of sepsis and septic shock has been increasing dramatically over the past 10 years. Despite advances in antimicrobial therapy, the mortality of septic shock remains very high. We review the clinical manifestations of sepsis and septic shock and describe the cardiovascular manifestations. Pathophysiology of the cardiovascular changes is discussed, and mediators believed to be involved in the pathogenesis are reviewed. Management of septic shock is also discussed, including antimicrobial therapy, supportive care, and adjunctive treatment aimed at affecting the mediators involved in producing the sepsis syndrome.

scholarly journals Influence of arterial pressure on tissue perfusion in septic shock

Critical Care ◽  
2009 ◽  
Vol 13 (Suppl 1) ◽  
pp. P154
Author(s):  
E Tishkov ◽  
O Bukaev
Keyword(s):  
Septic Shock ◽  
Arterial Pressure ◽  
Tissue Perfusion

Lactate Clearance Versus Base Deficit Correction in Monotoring of Septic Shock

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Adel Mikhail Fahmy ◽  
Ahmed Kamal ◽  
Wael Abd Elmonem Mohamed Abdelwahab ◽  
Ameer Shokry Ahmed
Keyword(s):  
Septic Shock ◽  
Clinical Utility ◽  
Tissue Perfusion ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Base Deficit ◽  
Mortality And Morbidity ◽  
Survivor Group ◽  
Prediction Of Mortality ◽  
Group I

Abstract Background Tissue perfusion and oxygenation monitoring is the fundamental of management to immediately identify and properly manage (impending) organ dysfunction in septic shock. This is a study of a prospective randomized trial that aims to comparing the prognostic value of lactate clearance versus base deficit correction as an indicator of tissue perfusion in septic shock, trying to prove the superiority of one over the other. Objective To assess the clinical utility of lactate clearance and arterial base deficit correction in predicting mortality in septic shock. Patients and Methods This is a Prospective randomized observational study that was conducted to assess the clinical utility of lactate clearance and arterial base deficit in predicting mortality in septic shock. This study included forty patients who were divided into two equal groups; each of twenty patients, group I (non-survivors), and group II (survivors). Results In this study, the base deficit values revealed statistically notable difference between the two groups at admission, 18 hours, 24 hours and 2 days of admission. The values revealed no notable difference at the 3rd. 4th, and 5th day of admission. At the 6th and 7th day of admission, the base deficit started to increase again in the non-survivor group with statistically notable increase in the values as compared to the survivor group. The cutoff point of base deficit to differentiate between nonsurvivors from survivors was > 11.43 with 62% sensitivity and 100% specificity. In this study, initial serum lactate levels at admission revealed higher accuracy in prediction of mortality as compared with initial base deficit. Conclusion Lactate clearance is a better predictor of mortality and morbidity than base deficit correction.

scholarly journals Performance of scores in the prediction of clinical outcomes in patients admitted from the emergency service

2021 ◽  
Vol 29 ◽  
Author(s):  
Luana Matuella Figueira da Silva ◽  
Luciano Passamini Diogo ◽  
Letícia Becker Vieira ◽  
Fabiano Da Costa Michielin ◽  
Michelle Dornelles Santarem ◽  
...  
Keyword(s):  
Septic Shock ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Clinical Outcomes ◽  
Emergency Service ◽  
Emergency Services ◽  
Early Recognition ◽  
Systemic Inflammatory Response ◽  
The Relationship

Objective: to evaluate the performance of the quickSOFA scores and Systemic Inflammatory Response Syndrome as predictors of clinical outcomes in patients admitted to an emergency service. Method: a retrospective cohort study, involving adult clinical patients admitted to the emergency service. Analysis of the ROC curve was performed to assess the prognostic indexes between scores and outcomes of interest. Multivariate analysis used Poisson regression with robust variance, evaluating the relationship between variables with biological plausibility and outcomes. Results: 122 patients were selected, 58.2% developed sepsis. Of these, 44.3% had quickSOFA ≥2 points, 87% developed sepsis, 55.6% septic shock and 38.9% died. In the evaluation of Systemic Inflammatory Response Syndrome, 78.5% obtained results >2 points; of these, 66.3% developed sepsis, 40% septic shock and 29.5% died. quickSOFA ≥2 showed greater specificity for diagnosis of sepsis in 86% of the cases, for septic shock 70% and for mortality 64%, whereas the second score showed better results for sensitivity with diagnosis of sepsis in 87.5%, septic shock in 92.7% and death in 90.3%. Conclusion: quickSOFA showed by its practicality that it can be used clinically within the emergency services, bringing clinical applicability from the risk classification of patients for the early recognition of unfavorable 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.

scholarly journals Assessment of clinical parameters and immediate outcome of children with shock in a tertiary care hospital ASRAM, Eluru, Andhra Pradesh, India

2017 ◽  
Vol 4 (2) ◽  
pp. 586
Author(s):  
Arigela Vasundhara ◽  
Manas Ranjan Sahoo ◽  
Sai Silpa Chowdary
Keyword(s):  
Septic Shock ◽  
Cardiogenic Shock ◽  
Tertiary Care ◽  
Hypovolemic Shock ◽  
Oxygen Demand ◽  
Tissue Perfusion ◽  
Multiple Organ ◽  
Cellular Damage ◽  
Care Hospital ◽  
A Prospective Study

Background: Shock is a state of impaired tissue perfusion resulting in an imbalance between oxygen demand and supply. This widespread reduction in effective tissue perfusion causes insufficient or improper delivery and distribution of oxygen and nutrients, the end result of which is an altered cellular and sub cellular function leading to anaerobic metabolism and accumulation of lactic acid, and consequently cellular damage, multiple organ dysfunction and finally cardiovascular collapse.Methods: The present study was conducted in the department of Pediatrics at Alluri Sitarama Raju Academy of Medical Sciences hospital, Eluru, between December 2014 and June 2016. It is a prospective study. Children aged 1 month to 12 years with a clinical diagnosis of shock were included after written consent from parents.Results: Out of 75 children admitted with shock, 69.33% had septic shock, 25.33% had hypovolemic shock, 2.66% had distributive shock, 2.66% cardiogenic shock. Most common age group admitted with shock was 1 month-1 year 38.666%. Among 75 children with shock, 74.66% children survived and 25.33% children died. Mortality rate in cardiogenic shock was 100%, in septic shock 28.84%, in hypovolemic shock 10.52%.Conclusions: Septic shock was the most common type of shock. Most common cause for septic shock was pneumonia. Septic shock has got highest mortality in the present study.Need for inotropes and mechanical ventilaton indicates poor prognosis in shock.

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