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The New England Journal of Medicine Aug 2013
Review
Topics: Humans; Incidence; Resuscitation; Risk Factors; Sepsis; Shock, Septic
PubMed: 23984731
DOI: 10.1056/NEJMra1208623 -
JPEN. Journal of Parenteral and Enteral... Nov 2021Septic shock is a public health burden and defined as a subset of sepsis whereby abnormalities in microcirculatory and cellular metabolism manifest as acute circulatory... (Review)
Review
Septic shock is a public health burden and defined as a subset of sepsis whereby abnormalities in microcirculatory and cellular metabolism manifest as acute circulatory failure. At the level of the gut, septic shock impairs epithelial barrier function (EBF), and the gut initiates proinflammatory responses contributing to multiple organ dysfunction syndrome. The timing and dose of enteral nutrition (EN) in septic shock remains a conundrum. On the one hand, early EN preserves EBF. On the other hand, serious gastrointestinal complications such as bowel necrosis may limit EN initiation in septic shock. We (1) describe the pathophysiologic conundrum septic shock poses for EN initiation, (2) outline guideline-based recommendations for EN in septic shock, (3) identify the role of parenteral nutrition in septic shock, and (4) identify and appraise postguideline literature on the timing, dose, and titration of EN in septic shock.
Topics: Enteral Nutrition; Humans; Microcirculation; Parenteral Nutrition; Parenteral Nutrition, Total; Shock, Septic
PubMed: 34897735
DOI: 10.1002/jpen.2246 -
Journal of Global Antimicrobial... Sep 2017Sepsis and septic shock are common life-threatening pathologies associated with high mortality and substantial costs for healthcare system. Clinical guidelines and... (Review)
Review
Sepsis and septic shock are common life-threatening pathologies associated with high mortality and substantial costs for healthcare system. Clinical guidelines and bundles for the management of patients with sepsis have recently been updated. Herein, we review the history of sepsis and related conditions definitions from the first consensus conference in 1991 to nowadays, the epidemiologic data resulting from worldwide studies on incidence and mortality, the diagnostic approaches including the microbiological assessment of infection and the use of several prognostic and diagnostic biomarkers and finally we review the main therapeutic measures as the intravenous immunoglobulin therapy and the administration of appropriate antibiotic treatment to provide patients with sepsis a favourable outcome in the antibiotic-resistance era.
Topics: Anti-Bacterial Agents; Biomarkers; Health Planning Guidelines; Humans; Immunization, Passive; Prognosis; Risk Factors; Sepsis; Shock, Septic
PubMed: 28743646
DOI: 10.1016/j.jgar.2017.06.013 -
Lancet (London, England)Septic shock, the most severe complication of sepsis, is a deadly disease. In recent years, exciting advances have been made in the understanding of its pathophysiology... (Review)
Review
Septic shock, the most severe complication of sepsis, is a deadly disease. In recent years, exciting advances have been made in the understanding of its pathophysiology and treatment. Pathogens, via their microbial-associated molecular patterns, trigger sequential intracellular events in immune cells, epithelium, endothelium, and the neuroendocrine system. Proinflammatory mediators that contribute to eradication of invading microorganisms are produced, and anti-inflammatory mediators control this response. The inflammatory response leads to damage to host tissue, and the anti-inflammatory response causes leucocyte reprogramming and changes in immune status. The time-window for interventions is short, and treatment must promptly control the source of infection and restore haemodynamic homoeostasis. Further research is needed to establish which fluids and vasopressors are best. Some patients with septic shock might benefit from drugs such as corticosteroids or activated protein C. Other therapeutic strategies are under investigation, including those that target late proinflammatory mediators, endothelium, or the neuroendocrine system.
Topics: Animals; Hormones; Humans; Shock, Septic
PubMed: 15639681
DOI: 10.1016/S0140-6736(04)17667-8 -
International Journal of Molecular... Nov 2023Endotoxin, also referred to as lipopolysaccharide (LPS), is a potent stimulator of the inflammatory cascade which may progress to sepsis and septic shock. The term... (Review)
Review
Endotoxin, also referred to as lipopolysaccharide (LPS), is a potent stimulator of the inflammatory cascade which may progress to sepsis and septic shock. The term endotoxic septic shock has been used for patients who have a clinical phenotype that is characterized by high endotoxin activity in addition to a high burden of organ failure; especially a pattern of organ failure including hepatic dysfunction, acute kidney injury, and various forms of endothelial dysfunction. Endotoxic septic shock has been a target for drug therapy for decades with no success. A likely barrier to their success was the inability to quantify endotoxin in the bloodstream. The Endotoxin Activity Assay (EAA) is positioned to change this landscape. In addition, medical devices using adsorptive technology in an extra-corporeal circulation has been shown to remove large quantities of endotoxin from the bloodstream. Focusing on the use of EAA to determine high concentrations of endotoxin will allow patients with endotoxic septic shock to be identified quickly and these patients may benefit most from removal of endotoxin using extracorporeal methods.
Topics: Humans; Shock, Septic; Sepsis; Endotoxins; Lipopolysaccharides
PubMed: 38003374
DOI: 10.3390/ijms242216185 -
Ethiopian Medical Journal Jan 2003Septic shock remains an important cause of death and serious morbidity in medical, surgical and obstetric illness. Many patients with septic shock succumb despite... (Review)
Review
Septic shock remains an important cause of death and serious morbidity in medical, surgical and obstetric illness. Many patients with septic shock succumb despite aggressive therapy. Any microorganism can initiate septic shock; the pathophysiology of the disease is not clear; the clinical manifestation is not specific; and there is no reliable laboratory result to diagnose septic shock before it is late. Moreover, despite increasingly complex modes of mechanical ventilation, sophisticated respiratory and hemodynamic monitoring, and a continually expanding array of potent antibiotics, the overall mortality from septic shock remained constant. Better outcome is more likely when recognition is early and treatment is much more aggressive. Therefore, where there is suspicion of septic shock: commence fluid resuscitation, administer oxygen, take blood, urine, and other fluids for culture, commence intravenous broad-spectrum antibiotics, pass a urethral catheter, determine the cause of sepsis and remove if possible, consult for expert medical advice and possible patient transfer to intensive care units, and provide supportive care to involved organ systems.
Topics: Anti-Bacterial Agents; Disseminated Intravascular Coagulation; Fluid Therapy; Hemodynamics; Humans; Inflammation; Multiple Organ Failure; Oxygen Consumption; Resuscitation; Shock, Septic; Systemic Inflammatory Response Syndrome; Vasoconstrictor Agents
PubMed: 12765004
DOI: No ID Found -
Obstetrics and Gynecology Clinics of... Sep 2022Septic shock and cardiac arrest during pregnancy, despite being uncommon, carry a high mortality rate among pregnant individuals. Basic initial management strategies are... (Review)
Review
Septic shock and cardiac arrest during pregnancy, despite being uncommon, carry a high mortality rate among pregnant individuals. Basic initial management strategies are fundamental to improve clinical outcomes; obstetricians and maternal-fetal medicine specialists need to be familiar with such interventions.
Topics: Female; Heart Arrest; Humans; Obstetrics; Pregnancy; Shock, Septic
PubMed: 36122979
DOI: 10.1016/j.ogc.2022.02.002 -
BMC Infectious Diseases Jun 2023Coccidioidomycosis is a fungal infection endemic to the southwestern United States and regions of Latin America. Disseminated disease occurs in < 1% of cases. Septic... (Review)
Review
BACKGROUND
Coccidioidomycosis is a fungal infection endemic to the southwestern United States and regions of Latin America. Disseminated disease occurs in < 1% of cases. Septic shock is even rarer, with high mortality despite therapy. We describe two cases of coccidioidal septic shock. Both patients were older men of Filipino ancestry presenting with respiratory failure and vasopressor-dependent shock. Antifungal drugs were initiated after failure to improve with empiric antibiotics; in both, Coccidioides was isolated from respiratory cultures. Despite aggressive care, both patients ultimately died of their infections. We provide a review of the published literature on this topic.
CONCLUSIONS
Most of the 33 reported cases of coccidioidal septic shock occurred in men (88%) of non-white race and ethnicity (78%). The overall mortality rate was 76%. All survivors received amphotericin B as part of their treatment. Coccidioidomycosis-related septic shock is a rare disease with poor outcomes; delays in diagnosis and treatment are common. Improved diagnostic testing for coccidioidomycosis could enhance recognition of this disease in the future. Although data are limited, early treatment with amphotericin B in cases of coccidioidal septic shock may reduce mortality.
Topics: Male; Humans; Aged; Coccidioidomycosis; Amphotericin B; Shock, Septic; Antifungal Agents; Coccidioides
PubMed: 37365503
DOI: 10.1186/s12879-023-08379-6 -
Clinical Science (London, England :... Jan 2014Septic shock results from the dysregulation of the innate immune response following infection. Despite major advances in fundamental and clinical research, patients... (Review)
Review
Septic shock results from the dysregulation of the innate immune response following infection. Despite major advances in fundamental and clinical research, patients diagnosed with septic shock still have a poor prognostic outcome, with a mortality rate of up to 50%. Indeed, the reasons leading to septic shock are still poorly understood. First postulated 30 years ago, the general view of septic shock as an acute and overwhelming inflammatory response still prevails today. Recently, the fact that numerous clinical trials have failed to demonstrate any positive medical outcomes has caused us to question our fundamental understanding of this condition. New and sophisticated technologies now allow us to accurately profile the various stages and contributory components of the inflammatory response defining septic shock, and many studies now report a more complex inflammatory response, particularly during the early phase of sepsis. In addition, novel experimental approaches, using more clinically relevant animal models, to standardize and stratify research outcomes are now being argued for. In the present review, we discuss the most recent findings in relation to our understanding of the underlying mechanisms involved in septic shock, and highlight the attempts made to improve animal experimental models. We also review recent studies reporting promising results with two vastly different therapeutic approaches influencing the renin-angiotensin system and applying mesenchymal stem cells for clinical intervention.
Topics: Animals; Disease Models, Animal; Humans; Mesenchymal Stem Cell Transplantation; Prognosis; Renin-Angiotensin System; Shock, Septic
PubMed: 24020445
DOI: 10.1042/CS20120668 -
Critical Care Clinics Jul 1997Although our understanding of molecular events in septic shock is growing exponentially, bedside management has changed only incrementally over the last 20 years. In... (Review)
Review
Although our understanding of molecular events in septic shock is growing exponentially, bedside management has changed only incrementally over the last 20 years. In pediatric and adult patients alike, treatment continues to be largely supportive. Morbidity and mortality, though gradually improving, continue to be high. The major similarities, as well as the minor differences, between pediatric and adult septic shock are reviewed in this article, with an emphasis on current clinical practice and recent clinical investigations of novel therapies.
Topics: Adult; Age of Onset; Causality; Child; Child, Preschool; Critical Care; Hemodynamics; Humans; Infant; Infant, Newborn; Resuscitation; Shock, Septic
PubMed: 9246530
DOI: 10.1016/s0749-0704(05)70328-6