scholarly journals Sepsis: source control

2021 ◽  
Vol 18 (5) ◽  
pp. 89-96
Author(s):  
V. V. Kulabukhov ◽  
N. A. Zubareva ◽  
P. A. Yartsev
Keyword(s):  
Successful Treatment ◽  
Randomized Trials ◽  
Source Control ◽  
Optimal Timing ◽  
Source Of Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Moment ◽  
Sepsis And Septic Shock ◽  
Time Of Intervention

Sepsis is a life-threatening condition, which is manifested by the development of organ dysfunction due to generalized inflammation caused by the infection of various nature. Timely lesion debridement combined with adequate antibiotic therapy are important components of the successful treatment of sepsis. At the moment, there is no consensus about the volume and time of intervention in the development of surgical sepsis. The article discusses modern approaches to solving the problem of adequate sanitation of the source of infection. The results of few randomized trials in this area are presented.Source control is absolutely essential for the successful treatment of sepsis. However, it is difcult to create a unifed algorithm for surgical control for all cases due to different approaches depending on the infection location. Properly designed clinical trials are necessary to determine the optimal timing of surgery for sepsis and septic shock as least.

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.

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 Severe Acute Liver Injury Related to Heat Stroke

2020 ◽  
Author(s):  
Fani Ribeiro ◽  
Mário Bibi ◽  
Marta Pereira ◽  
Sofia Ferreira ◽  
Helena Pessegueiro ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Injury ◽  
Acute Liver Injury ◽  
Heat Stroke ◽  
Multiple Organ ◽  
Optimal Timing ◽  
Hepatocellular Injury ◽  
Severe Liver ◽  
Threatening Condition ◽  
Life Threatening

Heat stroke (HS) is a life-threatening condition characterized by hyperthermia and multiple organ failure. Mild to moderate hepatocellular injury is a well-documented complication but severe liver injury and acute liver failure are rare. There are neither established criteria nor optimal timing for liver transplantation and conservative management seems to be the cornerstone treatment. The authors report a case of a patient with severe liver injury related to HS who recovered completely under conservative treatment.

Comparison of Initial and Postlavage Bacterial Culture Results of Septic Peritonitis in Dogs and Cats

2018 ◽  
Vol 54 (5) ◽  
pp. 257-266
Author(s):  
Sarah Ruth Kalafut ◽  
Pamela Schwartz ◽  
Rachael Leigh Currao ◽  
Andrew Scott Levien ◽  
George E. Moore
Keyword(s):  
Peritoneal Lavage ◽  
Positive Culture ◽  
Source Control ◽  
Bacterial Isolates ◽  
Common Life ◽  
Significant Difference ◽  
Septic Peritonitis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Susceptibility Profiles

ABSTRACT Septic peritonitis is a common, life-threatening condition encountered in dogs and cats. Efficacy of peritoneal lavage has not been proven in veterinary studies. Our objective was to evaluate differences in bacterial identity and susceptibility in samples obtained pre- and postlavage in animals who underwent laparotomy for treatment of septic peritonitis and to assess the effect of empirical antimicrobial selection on survival. Culture samples were collected from the peritoneal surface pre- and postlavage from dogs and cats treated surgically for septic peritonitis. Culture results were compared for each patient with regard to bacterial isolates and bacterial susceptibility profiles. Survival to discharge was evaluated. Microbial growth occurred in at least one culture in 88.6% of patients. There was no significant difference in bacterial isolates or susceptibility profiles pre- versus postlavage. Positive culture pre- or postlavage and appropriate antimicrobial selection did not significantly affect survival. For individual animals, culture results differed between pre- and postlavage samples, although no definitive effect of peritoneal lavage was seen for the population as a whole. Antimicrobials most commonly effective against isolates were Cefotaxime, Ceftazidime, and Imipenem. If prompt surgical source control is employed, antibiotic choice may not affect clinical outcome.

scholarly journals Use of Intravenous Immunoglobulins in Sepsis Therapy—A Clinical View

2020 ◽  
Vol 21 (15) ◽  
pp. 5543
Author(s):  
Dominik Jarczak ◽  
Stefan Kluge ◽  
Axel Nierhaus
Keyword(s):  
Intravenous Immunoglobulins ◽  
Coagulation Cascade ◽  
Optimal Timing ◽  
Evidence Based ◽  
Promising Therapeutic Approach ◽  
Sepsis Therapy ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Anti Inflammation

Sepsis is a life-threatening organ dysfunction, defined by a dysregulated host immune response to infection. During sepsis, the finely tuned system of immunity, inflammation and anti-inflammation is disturbed in a variety of ways. Both pro-inflammatory and anti-inflammatory pathways are upregulated, activation of the coagulation cascade and complement and sepsis-induced lymphopenia occur. Due to the manifold interactions in this network, the use of IgM-enriched intravenous immunoglobulins seems to be a promising therapeutic approach. Unfortunately, there is still a lack of evidence-based data to answer the important questions of appropriate patient populations, optimal timing and dosage of intravenous immunoglobulins. With this review, we aim to provide an overview of the role of immunoglobulins, with emphasis on IgM-enriched formulations, in the therapy of adult patients with sepsis and septic shock.

scholarly journals Emergency management of Ludwig’s angina: a case report

2017 ◽  
Vol 2 (3) ◽  
pp. 201
Author(s):  
Nur H. Alimin ◽  
Endang Syamsuddin
Keyword(s):  
Source Control ◽  
Airway Patency ◽  
Source Of Infection ◽  
Hospital Emergency Room ◽  
Life Threatening ◽  
Infection Source ◽  
Mandibular Region ◽  
Ludwig’S Angina ◽  
Spread Of Infection ◽  
Ludwig's Angina

Objective: Ludwig’s angina is a severe diffuse cellulitis in mandibular region that commonly caused by odontogenic infection. Due to its acute on onset, spread rapidly, involving the submandibular, sublingual region bilaterally and submental region, this condition consider as an emergency because it can cause airway obstruction.Methods: A 40 years old male patient came to Dr. Hasan Sadikin hospital emergency room with pain and swelling at lower jaw, drooling, hard to breath and limitation in opening his mouth. He was diagnosed with sepsis and Ludwig’s angina. Tracheostomy was performed to secure the airway, continued with teeth extraction, incision and drainage to eliminate the source of infection. Combination of intravenous antimicrobial was administered.Results: An advanced case of Ludwig’s angina and its management was reported. The patient showed a good response to the treatment and the condition was improved.Conclusion: Ludwig’s angina is a rare emergency condition which potentially life-threatening. Patient showed a significant recovery due to immediate and rapid management in securing airway patency and infection source control to prevent the spread of infection and further complications.

scholarly journals Hydroxychloroquine as Treatment for Inflammatory Subglottic Stenosis: A Second Successful Case

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
G. Desuter ◽  
A. Gregoire ◽  
Q. Gardiner ◽  
F. Houssiau
Keyword(s):  
Medical Treatment ◽  
Treatment Option ◽  
Successful Treatment ◽  
Subglottic Stenosis ◽  
Therapeutic Challenge ◽  
Successful Case ◽  
Threatening Condition ◽  
Life Threatening

Inflammatory sub-glottic stenosis is a life threatening condition that represents a therapeutic challenge. Recently, hydroxychloroquine has been suggested as one efficient medical treatment option. This report describes the second case of successful treatment of inflammatory sub-glottic stenosis using hydroxychloroquine.

scholarly journals LATE PRESENTING CONGENITAL DIAPHRAGMATIC HERNIA – A CASE SERIES

2019 ◽  
Vol 5 (4) ◽  
pp. 199-203
Author(s):  
R. C. Datu ◽  
Olivia Stanciu ◽  
T. Enache ◽  
M. Andriescu
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Case Series ◽  
Signs And Symptoms ◽  
Diaphragmatic Defect ◽  
Clinical Aspects ◽  
X Rays ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Moment

With an incidence of 1 to 2500 to 1 to 5000 births, congenital diaphragmatic hernia (CDH) can be a life-threatening condition. In 5-25% of the cases, CDH can present at older ages with non-specific signs and symptoms. The aim of our study was to assess the clinical aspects, the diagnosis and management of the patients with this affliction as well as increase the level of awareness on late-presenting CDH. Five patients older than 1 year of age at the moment of diagnosis of CDH were included in the study. The patients presented either for respiratory symptoms or gastrointestinal one. In all the cases, during initial assess, plain chest or abdominal x-rays were performed leading to the diagnosis of congenital diaphragmatic hernia. After further imaging studies (CT scans, ultrasound) all the patients underwent surgery for defect closure, 3 of them by the classic approach, 1 by laparoscopy and 1 by thoracoscopy. Three patients had left diaphragmatic defect and 2 had an anterior diaphragmatic defect. We extensively present the case of a 14-year-old female patient with a posterolateral diaphragmatic defect, in which gastric necrosis was found during surgery, leading to partial gastric resection and esogastric anastomosis. In this case, the postoperative evolution was critical and thepatient died in the 9th day postoperatively. The evolution of the other 4 patients was uneventful.

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.

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