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.

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.

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.

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.

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.

scholarly journals Traditional Chinese Medicine Diagnosis “Yang-Xu Zheng”: Significant Prognostic Predictor for Patients with Severe Sepsis and Septic Shock

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Sunny Jui-Shan Lin ◽  
Yung-Yen Cheng ◽  
Chih-Hung Chang ◽  
Cheng-Hung Lee ◽  
Yi-Chia Huang ◽  
...  
Keyword(s):  
Septic Shock ◽  
Regression Analysis ◽  
Severe Sepsis ◽  
Host Response ◽  
Multivariate Logistic Regression Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Multivariate Logistic Regression ◽  
Sepsis Mortality ◽  
Sepsis And Septic Shock

Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM)Zhengdiagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCMZhengdiagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor-α, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency ofNutrient-phase heat, andQi-XuandYang-Xu Zhengswere significantly higher in nonsurvivors. The multivariate logistic regression analysis identifiedYang-Xu Zhengas the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and withoutYang-Xu Zhengrevealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs ofYang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis “Yang-Xu Zheng” may provide a new mortality predictor for septic patients.

scholarly journals CXCL5-mediated recruitment of neutrophils into the peritoneal cavity ofGdf15-deficient mice protects against abdominal sepsis

2020 ◽  
Vol 117 (22) ◽  
pp. 12281-12287 ◽  
Author(s):  
Isa Santos ◽  
Henrique G. Colaço ◽  
Ana Neves-Costa ◽  
Elsa Seixas ◽  
Tiago R. Velho ◽  
...  
Keyword(s):  
Septic Shock ◽  
Organ Dysfunction ◽  
Peritoneal Cavity ◽  
Host Response ◽  
Abdominal Sepsis ◽  
Neutrophil Recruitment ◽  
Life Threatening ◽  
Pathogen Control ◽  
Circulating Levels ◽  
Deficient Mice

Sepsis is a life-threatening organ dysfunction condition caused by a dysregulated host response to an infection. Here we report that the circulating levels of growth and differentiation factor-15 (GDF15) are strongly increased in septic shock patients and correlate with mortality. In mice, we find that peptidoglycan is a potent ligand that signals through the TLR2-Myd88 axis for the secretion of GDF15, and thatGdf15-deficient mice are protected against abdominal sepsis due to increased chemokine CXC ligand 5 (CXCL5)-mediated recruitment of neutrophils into the peritoneum, leading to better local bacterial control. Our results identify GDF15 as a potential target to improve sepsis treatment. Its inhibition should increase neutrophil recruitment to the site of infection and consequently lead to better pathogen control and clearance.

scholarly journals Tegmen Tympani Defect and Brain Herniation Secondary to Mastoid Surgery: Case Presentation

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Oguz Kadir Egilmez ◽  
Fatih Mehmet Hanege ◽  
M. Tayyar Kalcioglu ◽  
Tuncay Kaner ◽  
Numan Kokten
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Relevant Literature ◽  
Chronic Otitis Media ◽  
Diagnosis And Treatment ◽  
Brain Herniation ◽  
Case Presentation ◽  
Tegmen Tympani ◽  
Life Threatening ◽  
Mastoid Surgery

Brain herniation into the middle ear is very rarely seen. In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma. Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect. In this paper, diagnosis and treatment of a brain herniation case due to iatrogenic tegmen defect were described along with relevant literature.

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.

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