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The Veterinary Clinics of North... Nov 1989Septic shock is a life-threatening condition that results from the combined effects of bacteria and the host's chemical mediators of inflammation. Of particular... (Review)
Review
Septic shock is a life-threatening condition that results from the combined effects of bacteria and the host's chemical mediators of inflammation. Of particular detriment is the hyperdynamic and hypodynamic vasomotor instability that severely compromises the patient prior to the onset of overt bacteremia. The principles of therapy include (1) a prompt diagnosis, (2) removing the source of sepsis, (3) maintaining normal blood pressure through the use of parenteral fluids and inotropes, (4) selecting the appropriate antimicrobial agent, and (5) stringent patient monitoring. Sometimes, despite the optimal use of diagnostic tests and high-quality treatment, the prognosis remains guarded to grave.
Topics: Adrenal Cortex Hormones; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Fluid Therapy; Shock, Septic
PubMed: 2688290
DOI: 10.1016/s0195-5616(89)50137-2 -
Lancet (London, England) May 1998
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Clinical Obstetrics and Gynecology Jun 1973
Review
Topics: Animals; Anti-Bacterial Agents; Bacteria; Blood Coagulation; Dogs; Female; Glucocorticoids; Haplorhini; Hemodynamics; Humans; Papio; Pregnancy; Shock, Septic; Vasoconstrictor Agents
PubMed: 4197324
DOI: 10.1097/00003081-197306000-00004 -
Critical Care Clinics Apr 2010
Topics: Humans; Shock, Septic
PubMed: 20381717
DOI: 10.1016/j.ccc.2010.02.001 -
Emergency Medicine Clinics of North... Aug 2013Early recognition of sepsis and septic shock in children relies on obtaining an attentive clinical history, accurate vital signs, and a physical examination focused on... (Review)
Review
Early recognition of sepsis and septic shock in children relies on obtaining an attentive clinical history, accurate vital signs, and a physical examination focused on mental status, work of breathing, and circulatory status. Laboratory tests may support the diagnosis but are not reliable in isolation. The goal of septic shock management is reversal of tissue hypoperfusion. The therapeutic end point is shock reversal. Mortality is significantly better among children when managed appropriately. Every physician who cares for children must strive to have a high level of suspicion and keen clinical acumen for recognizing the rare but potentially seriously ill child.
Topics: Age Factors; Cardiovascular System; Child; Humans; Receptor-Interacting Protein Serine-Threonine Kinase 2; Respiratory System; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome
PubMed: 23915595
DOI: 10.1016/j.emc.2013.04.006 -
Hospital Practice (1995) Dec 2018Septic shock represents a serious complication occurring between 6% and 30% of all hospitalized patients; Candida septic shock represents a challenge for clinicians due... (Review)
Review
Septic shock represents a serious complication occurring between 6% and 30% of all hospitalized patients; Candida septic shock represents a challenge for clinicians due to the absence of specific risk factors, diagnostic tests, and management. Identification of specific risk factors and use of biomarkers are useful tools considering that differentiation of Candida from bacterial septic shock is demanding. Early effective antifungal treatment, preferably with echinocandins with an adequate source control, represents the best approach for improving survival of patients with septic shock due to Candida. Given the importance of adequate therapy and source control in septic shock attributable to Candida clinical strategies and pathways are needed. This review will focus on epidemiology of septic shock in patients with invasive candidiasis with special attention to diagnostic pathways and treatment strategies.
Topics: Candidiasis; Critical Pathways; Humans; Shock, Septic
PubMed: 30170000
DOI: 10.1080/21548331.2018.1518104 -
Minerva Anestesiologica Nov 2015We present a review of the hemodynamic management of septic shock. Although substantial amount of evidence is present in this area, most key decisions on the management... (Review)
Review
We present a review of the hemodynamic management of septic shock. Although substantial amount of evidence is present in this area, most key decisions on the management of these patients remain dependent on physiological reasoning and on pathophysiological principles rather than randomized controlled trials. During primary (early) resuscitation, restoration of adequate arterial pressure and cardiac output using fluids and vasopressor and/or inotropic drugs is guided by basic hemodynamic monitoring and physical examination in the emergency department. When more advanced level of monitoring is present in these patients, i.e. during secondary resuscitation (later phase in the emergency department and in the ICU), hemodynamic management can be guided by more advanced measurements of the macrocirculation. Our understanding of the microcirculation in septic shock is limited and reliable therapeutic modalities to optimize it do not yet exist. No specific hemodynamic treatment strategy, be it medications including fluids, monitoring devices or treatment algorithms has yet been proved to improve outcome. Moreover, there is virtually no data on the optimal management of the resolution phase of septic shock. Despite these gaps in knowledge, the data from observational studies and trials suggests that mortality in septic shock has been generally decreasing during the last decade.
Topics: Fluid Therapy; Hemodynamics; Humans; Shock, Septic; Vasoconstrictor Agents
PubMed: 25369134
DOI: No ID Found -
The Journal of Surgical Research Apr 2015Septic shock is a frequent complication in intensive care unit that can result in multiple organ failure and death. In addition, recent data suggested that severe sepsis... (Review)
Review
BACKGROUND
Septic shock is a frequent complication in intensive care unit that can result in multiple organ failure and death. In addition, recent data suggested that severe sepsis and septic shock represent an economic burden. Therefore, septic shock is an important public health problem.
METHOD
In this review, we will focus on the recent evidences concerning the stages of septic shock, the complex macrocirculation and microcirculation relationship, and the importance of those evidences for future resuscitation goals and therapeutic strategies during late septic shock.
RESULT
Recently, two stages of septic shock are suggested. In early stage, hypovolemia is the main contributing factor. During this stage, macrocirculatory and microcirculatory changes run parallel, and fluid resuscitation seems to be effective in restoring the hemodynamic parameters. Late stage of septic shock is characterized by complex microcirculation and macrocirculation relationship.
CONCLUSIONS
Although early goal-directed therapy is a stepwise approach in the treatment of septic shock, tissue perfusion remains an important factor that contributes to septic shock outcome. Because appropriate monitoring of tissue perfusion is a matter of debt, the ideal therapeutic strategy remains a controversial issue that needs further investigations.
Topics: Blood Circulation; Endothelium, Vascular; Humans; Shock, Septic; Vascular Resistance; Vasoconstrictor Agents
PubMed: 25596653
DOI: 10.1016/j.jss.2014.12.014 -
Current Opinion in Anaesthesiology Feb 2023To describe sepsis-induced cardiomyopathy. Discuss indications and current evidence of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) in setting of... (Review)
Review Meta-Analysis
PURPOSE OF REVIEW
To describe sepsis-induced cardiomyopathy. Discuss indications and current evidence of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) in setting of sepsis-induced cardiomyopathy.
RECENT FINDINGS
Recent data suggests a survival benefit with the use of VA-ECMO in patients with septic shock complicated by septic-induced cardiomyopathy with severe left ventricular systolic dysfunction. VA-ECMO was associated with poor outcomes in adults with septic shock without severe systolic dysfunction. The evidence is generated from retrospective and meta-analysis of observational studies.
SUMMARY
Sepsis-induced cardiomyopathy is an increasingly recognized entity characterized by reversible ventricular dysfunction in the setting of sepsis. When hypotension persists despite standard management of septic shock (e.g. adequate fluid resuscitation, vasopressors, inotropes) and there is evidence of severe cardiac systolic dysfunction and end-organ hypoperfusion, VA-ECMO should be considered as a bridge therapy to recovery. VA-ECMO should not be used for isolated vasodilatory septic shock without significant myocardial dysfunction.
Topics: Adult; Humans; Shock, Septic; Retrospective Studies; Extracorporeal Membrane Oxygenation; Hypotension
PubMed: 36550604
DOI: 10.1097/ACO.0000000000001206 -
Reviews on Recent Clinical Trials 2018Sepsis and septic shock remain a major cause of morbidity and mortality globally. In recent years, the outcome of patients with sepsis and septic shock has gradually... (Review)
Review
BACKGROUND
Sepsis and septic shock remain a major cause of morbidity and mortality globally. In recent years, the outcome of patients with sepsis and septic shock has gradually improved, in part due to early recognition and timely appropriate management. Bedside physical examination can be of limited value to identify the source of infection and to decide appropriate management. Moreover, the clinical status of these patients can change rapidly, as a part of disease progression or in response to treatment or intervention.
METHODS
Research articles, review papers and online contents related to point-of-care ultrasound for the management of patients with sepsis and septic shock were reviewed.
RESULTS
Point-of-care ultrasonography can be a valuable bedside tool to rapidly identify the potential source of infection and associated organ dysfunction. It can also help to guide management to predict fluid responsiveness by assessing the variation of inferior venacava with respiration, ventricular size and aortic flow variation. Response to various interventions like a fluid challenge or administration of inotropes can be assessed at the bedside. Point-of-care ultrasound can also enhance safety and increase the success of bedside procedures like central venous cannulation and drainage of pleural effusion.
CONCLUSION
Bedside ultrasound can help to individualize management of patients with sepsis and septic shock and may potentially improve patient outcome.
Topics: Humans; Point-of-Care Systems; Shock, Septic; Ultrasonography
PubMed: 29651944
DOI: 10.2174/1574887113666180412165405