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.

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.

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.

scholarly journals Validation of PELOD-2 score as a predictor of life-threatening organ dysfunction in pediatric sepsis

2020 ◽  
Vol 60 (5) ◽  
pp. 227-32
Author(s):  
Yuyun Romaria Simanjuntak ◽  
Indra Saputra ◽  
Silvia Triratna ◽  
Achirul Bakri ◽  
Yulia Iriani
Keyword(s):  
Organ Dysfunction ◽  
Roc Curve ◽  
Area Under The Curve ◽  
Youden Index ◽  
International Consensus ◽  
Failure Assessment ◽  
Life Threatening ◽  
Sepsis Definition ◽  
Pediatric Sepsis ◽  
Sepsis And Septic Shock

Background The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction due to immune dysregulation against infection. It recommends the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score to evaluate life-threatening organ dysfunction. But the SOFA tool has not been adjusted for pediatric patients.  The Indonesian Pediatrics Society (IPS) uses the same sepsis definition and recommends using the PELOD-2 score as an indicator of life-threatening organ dysfunction in children.     Objective To evaluate the validity of the PELOD-2 score for predicting life-threatening organ dysfunction in pediatric sepsis. Methods A prospective cohort study was conducted in children with sepsis who were admitted to the PICU.  Subjects were taken consecutively with inclusion criteria of 1 month-18 years of age, with organ dysfunction, having two or more symptoms of systemic inflammatory response syndrome (SIRS), and suspected or proven infection.  PELOD-2 score, with and without lactate result, of each subject were plotted to receiver operating characteristic (ROC) curve, then we determined the most optimal cut off point to predict the life-threathneing organ dysfunction in pediatric sepsis based on the sensitivity and specificity of each score. Results Sixty-six patients were analyzed, with 40 males and 26 females aged 2 to 183 months (median 11 months).  Twenty patients died while in the PICU. A PELOD-2 score (with lactate) cut-off ≥ 7 was determined by ROC curve, with sensitivity of 80% and specificity of 78%. The area under the curve (AUC) of PELOD-2 score (with lactate) was 84.8% (95%CI 74.7 to 95.9%).  A PELOD-2 score (without lactate) ≥ 7  was the most optimum cut off based on its Youden index, it haD 70% of sensitivity and 80% of specificity. Conclusion PELOD-2 score ≥ 7 , with or without lactate component is the optimal cut-off for predicting life-threatening organ dysfunction in pediatric sepsis. 

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 Sepsis: an update in 2018

2019 ◽  
pp. S99-S101
Author(s):  
Muhammad Fuad Bangash
Keyword(s):  
Organ Dysfunction ◽  
Host Response ◽  
The United States ◽  
Review Article ◽  
Source Control ◽  
Metabolic Dysfunction ◽  
Vasoactive Agents ◽  
Sepsis Management ◽  
Failure Assessment ◽  
Life Threatening

Sepsis remains a major source of morbidity and mortality not only in the United States but worldwide. The key to save lives of these patients is to have a multi-pronged approach to the management of sepsis. In this review article we shall go through the specifics of this approach. Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. The septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction. Patients with sepsis (formerly severe sepsis) should still be identified by the same organ dysfunction criteria (including lactate level > 2 mmol/L). Organ dysfunction may also be identified using the ‘quick Sepsis-Related Organ Failure Assessment’ (qSOFA). Appropriate source control and immediate treatment with IV antibiotics is a cornerstone of sepsis management. The next step is to resuscitate patients with sepsis-induced hypoperfusion with at least 30 ml/kg of intravenous crystalloid fluid. If the patient is hypotensive despite adequate fluid resuscitation, then use of vasoactive agents like norepinephrine and vasopressin is indicated.Citation: Bangash MF. Sepsis: an update in 2018. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S99-S101

scholarly journals CXCL5-mediated recruitment of neutrophils into the peritoneal cavity of Gdf15-deficient mice protects against abdominal sepsis

2019 ◽  
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 ◽  
Growth Differentiation Factor 15 ◽  
Life Threatening ◽  
Pathogen Control ◽  
Circulating Levels ◽  
Deficient Mice

AbstractSepsis 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-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 that Gdf15-deficient animals 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 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.

scholarly journals CORRELATION BETWEEN PRESEPSIN AND SEQUENTIAL [SEPSIS-RELATED] ORGAN FAILURE ASSESSMENT (SOFA) SCORE AS AN ORGAN DYSFUNCTION MARKER IN SEPSIS

2019 ◽  
Vol 25 (1) ◽  
pp. 47
Author(s):  
Stevi Dwiyani ◽  
Agnes Rengga Indrati ◽  
Leni Lismayanti ◽  
Adhi Kristianto S
Keyword(s):  
Organ Dysfunction ◽  
Sofa Score ◽  
Host Response ◽  
Early Stage ◽  
Cross Sectional Study ◽  
Innate Immune ◽  
Cross Sectional ◽  
Failure Assessment ◽  
Life Threatening ◽  
Cluster Of Differentiation

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The latest consensus in 2016 (Sepsis-3) identified organ dysfunction as an acute change in total SOFA score ≥2 points. An ideal laboratory examination is expected to detect sepsis in an early stage and correlated with the degree of infection. Presepsin or Soluble Cluster of Differentiation 14 Sub Type (sCD14-ST) is a proteolysis product of CD14 that is produced in 1-2 hour after innate immune activation during infections. The aim of this study was to determine the correlation of presepsin and SOFA score as an organ dysfunction marker in sepsis. This research was an observational, analytical cross-sectional study conducted in the Dr. Hasan Sadikin Hospital (RSHS) Bandung from September 2016 until July 2017. The subjects were 42 patients from the Emergency Department diagnosed as sepsis by clinicians using criteria of SOFA score ≥2 points. The serum sample was collected and measured for presepsin concentration. A correlation test was analyzed with Spearman analysis. This study showed the increasing of presepsin concentration associated with SOFA score (p=0.000; r=0.660). There was a positive correlation between presepsin and SOFA score as an organ dysfunction marker

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 Renal Replacement Techniques in Septic Shock

2021 ◽  
Vol 22 (19) ◽  
pp. 10238
Author(s):  
Tapio Hellman ◽  
Panu Uusalo ◽  
Mikko J. Järvisalo
Keyword(s):  
Septic Shock ◽  
Organ Dysfunction ◽  
Patient Outcomes ◽  
Host Response ◽  
Kidney Injury ◽  
Polymyxin B ◽  
Critically Ill Patient ◽  
Proinflammatory Mediators ◽  
Actual Outcome ◽  
Life Threatening

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection; it carries a risk for mortality, considerably exceeding that of a mere infection. Sepsis is the leading cause for acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) in intensive care unit (ICU) patients. Almost every second critically ill patient with sepsis will develop AKI. In septic shock, the dysregulated host response to infectious pathogens leads to a cytokine storm with uncontrolled production and release of humoral proinflammatory mediators that evoke cellular toxicity and promote the development of organ dysfunction and increased mortality. In addition to treating AKI, RRT techniques can be employed for extracorporeal adsorption of inflammatory mediators using specifically developed adsorption membranes, hemoperfusion sorbent cartridges or columns; these techniques are intended to decrease the level and early deleterious effects of circulating proinflammatory cytokines and endotoxins during the first hours and days of septic shock treatment, in order to improve patient outcomes. Several methods and devices, such as high cut-off membranes, the Oxiris®-AN69 membrane, CytoSorb® and HA380 cytokine hemoadsorption, polymyxin B endotoxin adsorption, and plasmapheresis have been examined in small study series or are under evaluation as ways of improving patient outcomes in septic shock. However, to date, the data on actual outcome benefits have remained controversial, as discussed in this review.

Sign in / Sign up

Export Citation Format

Share Document