Sepsis: new strategies for management
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KeywordsSelenium Severe Sepsis Macrolides Severe Pneumonia Selenium Supplementation
Sepsis: New Strategies for Management
Jordi Rello, Marcos I Restrepo
This is a relatively short book, which, from the title, purports to cover new approaches to the management of sepsis. Many of the international team of authors (American, Spanish, and Australian) are well-established experts in this field, and the book covers some important aspects. For example, the genetic basis of sepsis is discussed in Chapter 3 with special emphasis on the major groups of genes that have been implicated in predisposition to sepsis and adverse outcomes from sepsis. The major challenges to genetic studies in sepsis are also covered. Various components of the immune response are also reviewed, including the pattern recognition molecules, the important inflammatory and anti-inflammatory mediators, and the coagulation pathway proteins.
Two chapters review general issues associated with antibiotic therapy in patients with severe sepsis. One chapter covers optimal antibiotic use in patients with severe community-acquired pneumonia. The second chapter deals with important, and often neglected, pharmacodynamic considerations in relation to antibiotic use in patients with severe sepsis and septic shock, providing a comprehensive review of applied pharmacology, detailing the antibiotics most commonly used and practical issues related to their indication and dosage adjustment in patients with severe sepsis. Specific therapies are also discussed in separate chapters, including the use of macrolides in community-acquired pneumonia, the use of statins in severe sepsis, the use of corticoids in severe pneumonia, and the nonspecific removal of sepsis mediators through blood-purification approaches.
Although the individual chapters tackle their topics comprehensively and there are some useful summary tables and illustrations, the book as a whole does not present an exhaustive review of all of the new strategies for management of sepsis. Some important issues related to the management of sepsis have also been overlooked by the editors or have come to the fore since the book was published, including recent arguments about the safety of colloids and tight glycaemic control in patients with severe sepsis and the role of biomarker-guided antibiotic therapy. It may also have been useful in this context to discuss the recent debates about the use of activated protein C, selenium supplementation, and adherence to guidelines in severe sepsis. These issues are of greater interest to clinicians than hypothetical therapies, which may be of more interest to researchers. In addition, several chapters in this book are specifically dedicated to pneumonia (four chapters out of eight), especially community-acquired pneumonia, and may not be relevant to other forms of sepsis.
Who is the book intended for? Intensivists with special interest in clinical research.
Why should anybody read this book? To acquire basic knowledge about sepsis therapy and to plan for future studies in this area.
Is it an important book? The book is relatively useful but has a very narrow scope.