-
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue Nov 2020After adequate fluid resuscitation in the early stage of septic shock, excessive accumulation of fluid in the body leads to organ dysfunction, which prolongs... (Review)
Review
After adequate fluid resuscitation in the early stage of septic shock, excessive accumulation of fluid in the body leads to organ dysfunction, which prolongs hospitalization, mechanical ventilation time, and renal replacement therapy time, and is associated with poor prognosis. The fluid de-escalation therapy is an important fluid management strategy performed in the late stage of septic shock. It aims to clear excess fluid by restricting fluid infusion, using diuretics and renal replacement therapy to achieve a negative fluid balance. The fluid de-escalation therapy contributes to improve clinical outcome of septic shock patients and reduce the mortality. This review mainly discusses the current researches and application progress of the fluid de-escalation therapy of abdominal infection-induced septic shock through clarifying its origin, time and endpoint, method of the therapy, the relationship with the control of the source of abdominal infection and its impact on organ function and clinical outcome. Our study intends to provide guidance for the treatment of abdominal infection-induced septic shock in the late stage, and explore the novel research directions.
Topics: Fluid Therapy; Humans; Intraabdominal Infections; Renal Replacement Therapy; Shock, Septic
PubMed: 33463507
DOI: 10.3760/cma.j.cn121430-20200714-00519 -
Virulence Jan 2014The advent of modern antimicrobial therapy following the discovery of penicillin during the 1940s yielded remarkable improvements in case fatality rate of serious... (Review)
Review
The advent of modern antimicrobial therapy following the discovery of penicillin during the 1940s yielded remarkable improvements in case fatality rate of serious infections including septic shock. Since then, pathogens have continuously evolved under selective antimicrobial pressure resulting in a lack of significant improvement in clinical effectiveness in the antimicrobial therapy of septic shock despite ever more broad-spectrum and potent drugs. In addition, although substantial effort and money has been expended on the development novel non-antimicrobial therapies of sepsis in the past 30 years, clinical progress in this regard has been limited. This review explores the possibility that the current pathophysiologic paradigm of septic shock fails to appropriately consider the primacy of the microbial burden of infection as the primary driver of septic organ dysfunction. An alternate paradigm is offered that suggests that has substantial implications for optimizing antimicrobial therapy in septic shock. This model of disease progression suggests the key to significant improvement in the outcome of septic shock may lie, in great part, with improvements in delivery of existing antimicrobials and other anti-infectious strategies. Recognition of the role of delays in administration of antimicrobial therapy in the poor outcomes of septic shock is central to this effort. However, therapeutic strategies that improve the degree of antimicrobial cidality likely also have a crucial role.
Topics: Anti-Infective Agents; Bacterial Infections; Humans; Shock, Septic; Systemic Inflammatory Response Syndrome
PubMed: 24184742
DOI: 10.4161/viru.26913 -
Journal of Cardiothoracic Anesthesia Apr 1989
-
Critical Care (London, England) Oct 2022
Topics: Humans; Intensive Care Units; Intubation, Intratracheal; Patient-Centered Care; Prospective Studies; Shock, Septic
PubMed: 36192759
DOI: 10.1186/s13054-022-04152-4 -
Intensive Care Medicine 1990Both peripheral vascular abnormalities and changes in myocardial function are hallmarks of septic shock. Their complex interactions result in inadequate and... (Review)
Review
Both peripheral vascular abnormalities and changes in myocardial function are hallmarks of septic shock. Their complex interactions result in inadequate and maldistributed microcirculatory flow and progressive organ dysfunction. Inappropriate vasodilation, microembolization and endothelial cell injury are proposed mechanisms that may induce maldistribution of flow in the microcirculation and inefficient, defective peripheral oxygen extraction. Abnormal myocardial function is manifested by diminished right and left ventricular ejection fractions, ventricular dilatation, altered Frank-Starling curves and diastolic pressure-volume relationships. These changes are already observed in an early stage of septic shock and are entirely reversible in survivors.
Topics: Blood Circulation; Hemodynamics; Humans; Myocardial Contraction; Oxygen Consumption; Shock, Septic; Vascular Resistance
PubMed: 2289987
DOI: 10.1007/BF01709697 -
Postgraduate Medicine Jan 1990Septic shock is a difficult and complex condition that requires a thorough and thoughtful approach in all aspects of care. The most likely cause may become apparent by... (Review)
Review
Septic shock is a difficult and complex condition that requires a thorough and thoughtful approach in all aspects of care. The most likely cause may become apparent by considering the clinical presentation of the patient and information from the history, physical examination, and appropriate laboratory tests. Appropriate antibiotic therapy should be initiated as soon as possible. Only an aggressive diagnostic and therapeutic approach can reduce the mortality and morbidity of this condition.
Topics: Acute Disease; Adult; Anti-Bacterial Agents; Cardiac Output; Cross Infection; Diagnosis, Differential; Female; Humans; Immune Tolerance; Medical History Taking; Monitoring, Physiologic; Physical Examination; Shock, Septic; Vascular Resistance
PubMed: 2404268
DOI: 10.1080/00325481.1990.11704519 -
Ryoikibetsu Shokogun Shirizu 1999
Review
Topics: Anti-Bacterial Agents; Diagnosis, Differential; Fluid Therapy; Humans; Infections; Positive-Pressure Respiration; Shock, Septic
PubMed: 10088385
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Mar 2006The medical consultant should have a high index of suspicion for sepsis. Early goal-directed therapy is recommended and includes early, aggressive fluid resuscitation,... (Review)
Review
The medical consultant should have a high index of suspicion for sepsis. Early goal-directed therapy is recommended and includes early, aggressive fluid resuscitation, antibiotics, and vasoactive agents, if needed. CVO2 may be helpful in guiding therapy, but targeting supranormal levels of oxygen delivery is not necessary. Empiric use of steroids and early use of activated protein C also need to be considered. Vasopressin should be considered if hypotension persists or if the situation requires escalating doses of norepinephrine.
Topics: Decision Making; Humans; Postoperative Complications; Practice Guidelines as Topic; Shock, Septic
PubMed: 16570552
DOI: 10.3949/ccjm.73.suppl_1.s67 -
AORN Journal Jan 2007Septic shock is a severe inflammatory response to one or more pathogenic micro-organisms. When a person's immune response is excessively intense, a cascade of phenomena... (Review)
Review
Septic shock is a severe inflammatory response to one or more pathogenic micro-organisms. When a person's immune response is excessively intense, a cascade of phenomena may be activated that ultimately is harmful. Appropriate management of septic shock may include surgical intervention to remove or neutralize the septic focus in an effort to treat the inflammatory response cascade. This is the first of two articles presenting current information on the role of surgery in the management of a patient with septic shock. This article describes extra-abdominal sources of sepsis.
Topics: Catheters, Indwelling; Fasciitis, Necrotizing; Humans; Perioperative Nursing; Prostheses and Implants; Shock, Septic
PubMed: 17223404
DOI: 10.1016/S0001-2092(07)60019-2 -
JAMA Internal Medicine Dec 2020
Topics: Humans; Inpatients; Patient Care Bundles; Sepsis; Shock, Septic
PubMed: 32865559
DOI: 10.1001/jamainternmed.2020.2768