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Revue de L'infirmiere 2020The amputation of multiple limbs is a rare but serious consequence of septic shock. It concerns young and active populations. The aim of rehabilitation is to enable... (Review)
Review
The amputation of multiple limbs is a rare but serious consequence of septic shock. It concerns young and active populations. The aim of rehabilitation is to enable patients to regain their independence and former everyday life. An overview of this specific care is presented here through a clinical case.
Topics: Amputation, Surgical; Humans; Shock, Septic
PubMed: 32600592
DOI: 10.1016/S1293-8505(20)30148-2 -
Archives of Internal Medicine Mar 1984
Review
Topics: Amino Acids, Branched-Chain; Glucose; Hemodynamics; Humans; Shock, Septic
PubMed: 6367681
DOI: No ID Found -
JAMAThe mortality from septic shock continues to range between 40% to 60% despite advances in cardiovascular support and antibiotic therapy. Impairment of host defenses... (Review)
Review
The mortality from septic shock continues to range between 40% to 60% despite advances in cardiovascular support and antibiotic therapy. Impairment of host defenses predisposes to the development of both severe infection and septic shock. The activation of a myriad of cellular and plasma mediators by microbial toxins produces the systemic and metabolic manifestations of sepsis. The clinical presentation includes characteristic clinical, hemodynamic, and laboratory abnormalities. Multiple organ systems are involved during septic shock, with outcome dependent on the circulatory response and the development of sequential organ failures. Initial resuscitation is directed at restoring tissue perfusion with fluids and vasoactive drugs, guided by assessment of the patient's hemodynamic status. Identification of the site of infection and choice of appropriate antibiotics are critical to the success of therapy. Newer therapeutic modalities include immunologic interventions that attenuate mediator activity and modulate the immune response. Pharmacologic therapies are also being developed that are aimed at blocking the actions of specific mediators.
Topics: Energy Metabolism; Hemodynamics; Humans; Multiple Organ Failure; Shock, Septic
PubMed: 2061983
DOI: No ID Found -
Intensive Care Medicine 2001
Review
Topics: Blood Transfusion; Cardiotonic Agents; Fluid Therapy; Hemodynamics; Humans; Shock, Septic; Vasoconstrictor Agents
PubMed: 11307372
DOI: 10.1007/pl00003799 -
The New England Journal of Medicine May 1993
Review
Topics: Animals; Cardiovascular System; Endotoxins; Humans; Multiple Organ Failure; Myocardial Ischemia; Shock, Septic
PubMed: 8479467
DOI: 10.1056/NEJM199305203282008 -
British Journal of Haematology Feb 2011Patients with a variety of haematological conditions are at risk of infection and its most serious complication: septic shock. Mortality for septic shock remains high... (Review)
Review
Patients with a variety of haematological conditions are at risk of infection and its most serious complication: septic shock. Mortality for septic shock remains high and especially so in patients with haematological malignancy and following bone marrow transplantation. However, advances in the treatment of severe sepsis have improved mortality rates even though evidence for the management of severe sepsis in haematology patients is limited. Wherever possible this review will concentrate on evidence directly applicable to haematology patients but inevitably will have to extrapolate evidence from other patient groups. The Surviving Sepsis Guidelines 2008 provide information on best practice in the management of patients with severe sepsis and septic shock and are broadly applicable though not specific to haematology patients. This review summarizes a practical approach to the management of severe sepsis in haematology patients and highlights areas of research which may bring new treatments in the future. The review is limited to the management and initial resuscitation of septic shock in adult haematology patients and will not address the detailed intensive care management of these patients or the management of severe sepsis in children.
Topics: Adult; Anti-Infective Agents; Diagnosis, Differential; Hematologic Neoplasms; Humans; Resuscitation; Shock, Septic
PubMed: 21210777
DOI: 10.1111/j.1365-2141.2010.08550.x -
Critical Care (London, England) Aug 2014Intravenous fluids (IVFs) represent a basic therapeutic intervention utilized in septic shock. Unfortunately, the optimal method for administering IVFs to maximize... (Review)
Review
Intravenous fluids (IVFs) represent a basic therapeutic intervention utilized in septic shock. Unfortunately, the optimal method for administering IVFs to maximize patient outcomes is unknown. A meta-analysis of four randomized trials of goal-directed therapy did not demonstrate a significant reduction in mortality (odds ratio 0.609; 95% confidence interval 0.363 to 1.020; P = 0.059), whereas 18 trials with historical controls showed a significant increase in survival (odds ratio 0.580; 95% confidence interval 0.501 to 0.672; P < 0.0001). Based on these data, clinicians should be aware of the potential for harm due to the excessive administration of IVFs to patients with septic shock.
Topics: Body Fluids; Fluid Therapy; Humans; Observational Studies as Topic; Randomized Controlled Trials as Topic; Shock, Septic; Treatment Outcome
PubMed: 25185073
DOI: 10.1186/s13054-014-0481-5 -
Current Vascular Pharmacology 2016Septic shock is represented by severe hemodynamic changes which are manifested with failure of organ systems and high mortality. Early diagnosis together with timely and... (Review)
Review
INTRODUCTION
Septic shock is represented by severe hemodynamic changes which are manifested with failure of organ systems and high mortality. Early diagnosis together with timely and appropriate treatment is important to attain better outcome.
OBJECTIVES
We reviewed the diagnostic approach of septic shock in relation to the microcirculatory abnormalities, novel biomarkers, monitoring, interventions, and therapy.
METHODS
A narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines.
RESULTS
Septic shock is characterized by extensive microcirculatory alterations. These changes are diverse in nature and lead to inconsistency of response to various interventions. The severity of these abnormalities correlates with the patient prognosis. The pathophysiology of septic shock is highly complex which requires better understanding of disease progression and risk-stratification based on potential sepsis biomarkers such as lactic acid, procalcitonin, C-reactive protein, cytokines, and novel molecular markers. The newly identified candidate biomarkers include soluble Triggering Receptor Expressed on myeloid cells-1, presepsin, soluble urokinase-type Plasminogen Receptor and pro-adrenomedullin, but their clinical utilities still need to be validated by large prospective clinical trials. A number of promising therapies for the management of severe sepsis and septic shock has been proposed with potential implications.
CONCLUSION
It is crucial to improve microvascular perfusion through targeted interventions using patient-centred approach. Moreover, systems biology approach could play a promising role in understanding the immune complexity, characterization of gene expression patterns, and recognition of novel therapeutic targets which could be used as clinical decision making tool in the future.
Topics: Animals; Biomarkers; Early Diagnosis; Humans; Microcirculation; Predictive Value of Tests; Shock, Septic; Treatment Outcome
PubMed: 26916399
DOI: 10.2174/1570161114666160226145732 -
Critical Care Medicine May 1991This review article examines the pathophysiology of septic shock, with special attention to the concept of supply-dependent consumption and the implications this concept... (Review)
Review
This review article examines the pathophysiology of septic shock, with special attention to the concept of supply-dependent consumption and the implications this concept has for therapy. Patients with septic shock require higher levels of oxygen delivery (DO2) to maintain aerobic metabolism. When DO2 is inadequate, peripheral tissues switch to anaerobic metabolism and oxygen consumption decreases. The lactic acidosis that occurs is a reasonable clinical marker of supply dependency and inadequate tissue perfusion. Maximizing DO2 is an important part of the hemodynamic resuscitation of patients with septic shock. To achieve this goal, intravascular volume must be restored and the myocardial depression associated with sepsis must be treated to optimize cardiac output. The normalization of arterial lactate concentration is a reasonable goal of resuscitative efforts.
Topics: Bacterial Infections; Hemodynamics; Humans; Oxygen Consumption; Shock, Septic
PubMed: 2026029
DOI: 10.1097/00003246-199105000-00013 -
European Journal of Clinical... Apr 2016During the past decade, global human movement created a virtually "borderless world". Consequently, the developed world is facing "forgotten" and now imported infectious... (Review)
Review
During the past decade, global human movement created a virtually "borderless world". Consequently, the developed world is facing "forgotten" and now imported infectious diseases. Many infections are observed upon travel and migration, and the clinical spectrum is diverse, ranging from asymptomatic infection to severe septic shock. The severity of infection depends on the etiology and timeliness of diagnosis. While assessing the etiology of severe infection in travelers and migrants, it is important to acquire a detailed clinical history; geography, dates of travel, places visited, type of transportation, lay-overs and intermediate stops, potential exposure to exotic diseases, and activities that were undertaken during travelling and prophylaxis and vaccines either taken or not before travel are all important parameters. Tuberculosis, malaria, pneumonia, visceral leishmaniasis, enteric fever and hemorrhagic fever are the most common etiologies in severely infected travelers and migrants. The management of severe sepsis and septic shock in migrants and returning travelers requires a systematic approach in the evaluation of these patients based on travel history. Early and broad-spectrum therapy is recommended for the management of septic shock comprising broad spectrum antibiotics, source control, fluid therapy and hemodynamic support, corticosteroids, tight glycemic control, and organ support and monitoring. We here review the diagnostic and therapeutic routing of severely ill travelers and migrants, stratified by the nature of the infectious agents most often encountered among them.
Topics: Case Management; Critical Care; Humans; Shock, Septic; Transients and Migrants; Travel
PubMed: 26825315
DOI: 10.1007/s10096-016-2575-2