Actual aspects of sepsis and septic shock

2014 ◽  
Vol 5 (2) ◽  
pp. 81-87
Author(s):  
Danila Viktorovich Strukov ◽  
Yuriy Stanislavovich Alexandrovich ◽  
Andrey Glebovich Vasiliev
Keyword(s):  
Septic Shock ◽  
Nitrogen Oxide ◽  
Shock Therapy ◽  
Infection Process ◽  
Nitrogen Oxide Synthase ◽  
Adults And Children ◽  
Contemporary Medicine ◽  
Sepsis And Septic Shock ◽  
Oxide Synthase

He review presents an analysis of up-to-date views on sepsis and septic shock. Results of consenting conferences are given with classification of sepsis in adults and children. Mortality indexes are presented in patients’ group with sepsis. Basic pathogenesis links are examined i.e. bacteriemia, microbe toxemia, endo(auto)toxicosis, systemic destructive vasculitis, growing hypercoagulation transforming into coagulopathia, consumption trombocytopenia with trombohemorrhagic syndrome and severe immunesuppression. Pathogenesis of septic shock is divided into processes developing in various organs and tissues as well as into intracellular ones: such as oxidative stress and mitochondrial insufficiency. The role of pathogen-associated molecular images - patterns is portrayed in the development of generalized acyclic infection process. A scheme of up-to-date septic shock therapy is presented. An important role of nitrogen oxide in the development of stabile hypotonia resistant to vasopressin therapy is proven. The potency of nitrogen oxide to produce free-radical peroxinitrite inducing lipids peroxide oxidation in membranes is reflected. Its ability to react with non-hem iron- and zink- containing proteins is mentioned. Key factors contributing to activation of genes responsible for inducible nitrogen oxide synthase operation are revealed. Extremely severe sepsis and septic shock are believed to be the most serious problem of contemporary medicine thus necessitating to produce new medicines affecting the most drug-resistant links of its pathogenesis. In many a countries trials are continuing to introduce new medicines like nitrogen oxide synthase inhibitors for the treatment of patients with septic shock.

Misdirected Sympathy: The Role of Sympatholysis in Sepsis and Septic Shock

2017 ◽  
Vol 33 (2) ◽  
pp. 74-86 ◽  
Author(s):  
Jason A. Ferreira ◽  
Brittany D. Bissell
Keyword(s):  
Septic Shock ◽  
Cardiovascular Effects ◽  
Shock Therapy ◽  
Selective Inhibition ◽  
Sympathetic Tone ◽  
Autonomic Tone ◽  
Prevalent Disease ◽  
Sepsis And Septic Shock ◽  
The Impact

The spectrum of sepsis and septic shock remains a highly prevalent disease state, carrying a high risk of morbidity and mortality. The sympathetic nervous system (SNS) plays an important role in this initial cascade, enabling the host to respond to invading pathogens; however, prolonged activation can become pathological. The potential for unregulated sympathetic tone to become of detriment in patients with sepsis has fueled interest in the role and impact of sympatholysis, the selective inhibition of sympathetic tone. The cornerstone of septic shock therapy for decades has been the supplementation of catecholamines and thus potential further perpetuation of this sympathetic dysregulation. Although the theory of sympatholysis circulates around cardiovascular effects and stroke volume optimization, the impact of augmenting the SNS may extend well beyond this, including the impacts on the immune system, inflammatory cascade, and even gene transcription. Presently, the most robust clinical evidence involves the use of the cardioselective β-blocker esmolol in patients with septic shock with persistent tachycardia secondary to catecholamine use. Evidence is isolated only to animal models with α-agonists. Future evidence stands to elucidate the balance of sympathetic and autonomic tone as well as the potential role of redirecting and maximizing sympathetic activity.

The Role of Histones and Heparin in Sepsis: A Review

2021 ◽  
pp. 088506662199232
Author(s):  
Xiaojuan Zhang ◽  
Xin Li
Keyword(s):  
Septic Shock ◽  
Multiple Organ ◽  
Clinical Settings ◽  
The Past ◽  
Life Saving ◽  
Extracellular Histones ◽  
Sepsis And Septic Shock ◽  
Development And Management ◽  
Made In

Septic shock with multiple organ failure is a devastating situation in clinical settings. Through the past decades, much progress has been made in the management of sepsis and its underlying pathogenesis, but a highly effective therapeutic has not been developed. Recently, macromolecules such as histones have been targeted in the treatment of sepsis. Histones primarily function as chromosomal organizers to pack DNA and regulate its transcription through epigenetic mechanisms. However, a growing body of research has shown that histone family members can also exert cellular toxicity once they relocate from the nucleus into the extracellular space. Heparin, a commonly used anti-coagulant, has been shown to possess life-saving capabilities for septic patients, but the potential interplay between heparin and extracellular histones has not been investigated. In this review, we summarize the pathogenic roles of extracellular histones and the therapeutic roles of heparin in the development and management of sepsis and septic shock.

NF-κB activation as a pathological mechanism of septic shock and inflammation

2006 ◽  
Vol 290 (4) ◽  
pp. L622-L645 ◽  
Author(s):  
Shu Fang Liu ◽  
Asrar B. Malik
Keyword(s):  
Septic Shock ◽  
Human Subjects ◽  
Myocardial Dysfunction ◽  
Multiple Organ ◽  
Organ Injury ◽  
Pathological Mechanism ◽  
Proinflammatory Gene ◽  
Intensive Investigation ◽  
Sepsis And Septic Shock

The pathophysiology of sepsis and septic shock involves complex cytokine and inflammatory mediator networks. NF-κB activation is a central event leading to the activation of these networks. The role of NF-κB in septic pathophysiology and the signal transduction pathways leading to NF-κB activation during sepsis have been an area of intensive investigation. NF-κB is activated by a variety of pathogens known to cause septic shock syndrome. NF-κB activity is markedly increased in every organ studied, both in animal models of septic shock and in human subjects with sepsis. Greater levels of NF-κB activity are associated with a higher rate of mortality and worse clinical outcome. NF-κB mediates the transcription of exceptional large number of genes, the products of which are known to play important roles in septic pathophysiology. Mice deficient in those NF-κB-dependent genes are resistant to the development of septic shock and to septic lethality. More importantly, blockade of NF-κB pathway corrects septic abnormalities. Inhibition of NF-κB activation restores systemic hypotension, ameliorates septic myocardial dysfunction and vascular derangement, inhibits multiple proinflammatory gene expression, diminishes intravascular coagulation, reduces tissue neutrophil influx, and prevents microvascular endothelial leakage. Inhibition of NF-κB activation prevents multiple organ injury and improves survival in rodent models of septic shock. Thus NF-κB activation plays a central role in the pathophysiology of septic shock.

scholarly journals Interplay between Nox2 Activity and Platelet Activation in Patients with Sepsis and Septic Shock: A Prospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Giusy Tiseo ◽  
Elena Cavarretta ◽  
Arianna Forniti ◽  
Cristina Nocella ◽  
Sebastiano Sciarretta ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Septic Shock ◽  
Platelet Aggregation ◽  
Platelet Activation ◽  
Healthy Controls ◽  
Sample Collection ◽  
Oxidative Stress Status ◽  
Sepsis And Septic Shock ◽  
A Prospective Study

Background. Although preclinical studies highlighted the potential role of NADPH oxidase (NOX) in sepsis, only few studies evaluated the oxidative stress in patients with sepsis and septic shock. The objective of the study is to appraise the oxidative stress status and platelet function in patients with sepsis and septic shock compared to healthy controls. Methods and Results. Patients with sepsis or septic shock admitted to the hospital Policlinico Umberto I (Sapienza University, Rome) underwent a blood sample collection within 1 hour from admission. Platelet aggregation, serum thromboxane B2 (TxB2), soluble NOX2-derived peptides (sNox2-dp), and hydrogen peroxide breakdown activity (HBA) were measured and compared to those of healthy volunteers. Overall, 33 patients were enrolled; of these, 20 (60.6%) had sepsis and 13 (39.4%) septic shock. Compared to healthy controls ( n = 10 , age 67.8 ± 3.2 , male 50%), patients with sepsis and septic shock had higher platelet aggregation (49% (IQR 45-55), 60% (55.75-67.25), and 73% (IQR 69-80), respectively, p < 0.001 ), higher serum TxB2 (77.5 (56.5-86.25), 122.5 (114-131.5), and 210 (195-230) pmol/L, respectively, p < 0.001 ), higher sNox2-dp (10 (7.75-12), 19.5 (17.25-21), and 33 (29.5-39) pg/mL, respectively, p < 0.001 ), and lower HBA (75% (67.25-81.5), 50% (45-54.75), and 27% (21.5-32.5), respectively, p < 0.001 ). Although not statistically significant, a trend in higher levels of serum TxB2 and sNox2-dp in patients who died was observed. Conclusions. Patients with septic shock exhibit higher Nox2 activity and platelet activation than patients with sepsis. These insights joined to better knowledge of these mechanisms could guide the identification of future prognostic biomarkers and new therapeutic strategies in the scenario of septic shock.

scholarly journals Role of Steroid in Adult Patients of Septic Shock - A Critical Analysis

KYAMC Journal ◽  
2017 ◽  
Vol 4 (2) ◽  
pp. 409-414
Author(s):  
Rajib Hasan ◽  
Humayun Kabir ◽  
Taposh Chandra Roy ◽  
Javed Sharoar Chowdhury ◽  
Farzana Yeasmin
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critical Analysis ◽  
Adult Patients ◽  
Evidence Based ◽  
Icu Patients ◽  
Evidence Based Practices ◽  
Sepsis And Septic Shock

" Sepsis and septic shock is the condition which has been with intensive care units from long before. In fact, it is one of the highly ranked diseases causing mortality in ICU patients. There are currently many evidence based practices in the management of septic shock and use of steroid is one of them. The aim of this article is to critically evaluate the evidences regarding the role of steroids in adult patients of septic shock. This article has also evaluated all the current evidences regarding details of the role of steroids including their formulation, dosage, duration and route of administration in patients of septic shock.KYAMC Journal Vol. 4, No.-2, Jan 2014, Page 409-414

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