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Management of Sepsis and Septic Shock

  • Rommel SaganaEmail author
  • Robert C. Hyzy
Chapter
  • 6 Downloads

Abstract

Despite advances in modern medicine, sepsis and septic shock continue to be a leading cause of death worldwide. The United States alone has over 750,000 reported cases per year. It is estimated that severe sepsis is diagnosed in 2% of all hospital admissions resulting in 10% of all ICU admissions. The diagnosis and management of sepsis have greatly evolved with the creation of care “bundles” such as Early Goal Directed Therapy incorporated into the Surviving Sepsis Campaign. Research results continue to refine the proposed guidelines in the treatment of this disease.

Keywords

Sepsis Severe sepsis Septic shock Early goal directed therapy Bundles Surviving sepsis campaign Infection 

Supplementary material

Video 60.1

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References

  1. 1.
    Surviving Sepsis Campaign. Society of Critical Care Medicine. [Revised 4/2015 by the SSC Executive Committee]. http://www.survivingsepsis.org/Bundles/Pages/default.aspx.
  2. 2.
    Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2004;30(4):536–55.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.CrossRefGoogle Scholar
  4. 4.
    Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
  6. 6.
    Finfer S, Bellomo R, Boyce N, et al. SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247–56.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Caironi P, Togoni G, Masson S, et al. ALBIOS Study Investigators. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370(15):1412–21.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369(13):1243–51.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012;308:1566–72.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Young P, Bailey M, Beasley R, et al. Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial. JAMA. 2015;314:1701–10.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Semler MW, Self WH, Rice TW, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;378(20):1951.  https://doi.org/10.1056/NEJMc1804294.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Self WH, Semler MW, Wanderer JP, et al. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med. 2018;378(9):819–28.  https://doi.org/10.1056/NEJMoa1711586. Epub 2018 Feb 27CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367(20):1901–11.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Holst LB, Haase N, Wetterslev J, et al. Transfusion requirements in septic shock (TRISS) trial – comparing the effects and safety of liberal versus restrictive red blood cell transfusion in septic shock patients in the ICU: protocol for a randomized controlled trial. Trials. 2013;14:150.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Park DW, Chun BC, Kwon SS, et al. Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis. Crit Care Med. 2012;40(12):3140–5.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ebert RV, Stead EA. Circulatory failure in acute infections. J Clin Invest. 1941;20:671–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ait-Oufella H, Lemionne S, Boelle P, et al. Mottling score predicts survival in septic shock. Intensive Care Med. 2011;37(5):801–7.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Cawcutt K, Peters S. Severe sepsis and septic shock: clinical overview and update on management. Mayo Clin Proc. 2014;89(11):1572–8.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34:1402–7.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Marik P, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–7.CrossRefGoogle Scholar
  21. 21.
    Michard F, Warltier DC. Changes in arterial pressure during mechanical ventilation. Anesthesiology. 2005;103(2):419–28.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Stawicki SP, Ej A, Eiferman ES, et al. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? J Trauma Acute Care Surg. 2014;76(4):956–64.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Seymour C, Rosengart M. Septic shock: advances in diagnosis and treatment. JAMA. 2015;314(7):708–17.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739–46.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779–89.CrossRefGoogle Scholar
  26. 26.
    Investigators VASST. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358(9):877–87.CrossRefGoogle Scholar
  27. 27.
    Khanna A, English SW, Wang XS, et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017;377(5):419–30.  https://doi.org/10.1056/NEJMoa1704154.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Schein M, Marshall J. Source control. A guide to the management of surgical infections. Heidelberg: Springer; 2002.Google Scholar
  29. 29.
    Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5(1):4–11.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Gamacho-Montero J, Gutierrez-Pizarraya A, Escoresca-Ortega A, et al. De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock. Intensive Care Med. 2014;40(1):32–40.CrossRefGoogle Scholar
  32. 32.
    Kollef MH. What can be expected from antimicrobial de-escalation in the critically ill? Intensive Care Med. 2014;40(1):92–5.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Ginde AA, Moss M. Lung-protective ventilation in emergency department patients with severe sepsis. Acad Emerg Med. 2014;21(1):96–7.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Russell JA. Management of sepsis. N Engl J Med. 2006;355(16):1699–713.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;354(19):1359–67.CrossRefGoogle Scholar
  36. 36.
    Study Investigators NICE-SUGAR, Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.CrossRefGoogle Scholar
  37. 37.
    Arabi YM, Tamim HM, Dhar GS, et al. Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial. Am J Clin Nutr. 2011;93(3):569–77.CrossRefGoogle Scholar
  38. 38.
    Investigators PCESS, Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683–93.CrossRefGoogle Scholar
  39. 39.
    ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371(16):1496–506.CrossRefGoogle Scholar
  40. 40.
    ProMISe Investigators, Mouncey P, Osborn T, Power S, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–11.CrossRefGoogle Scholar
  41. 41.
    Angus DC, Barnato AE, Bell D, et al. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. Intensive Care Med. 2015;41(9):1549–60.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Kaukonen KM, Bailey M, Suzuki S, et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311(13):1308–16.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Dellinger RP, Levy MM, Rhodes A, Annane D, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840–51.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862–71.CrossRefGoogle Scholar
  46. 46.
    Moreno R, Sprung C, Annane D, et al. Time course of organ failure in patients with septic shock treated with hydrocortisone: results of the Corticus study. In: Applied physiology in intensive care medicine, vol. 1. Heidelberg: Springer; 2012. p. 423–30.CrossRefGoogle Scholar
  47. 47.
    Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med. 2018;378(9):797–808.  https://doi.org/10.1056/NEJMoa1705835.CrossRefGoogle Scholar
  48. 48.
    Annane D, Renault A, Brun-Buisson C. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med. 2018;378(9):809–18.  https://doi.org/10.1056/NEJMoa1705716.CrossRefGoogle Scholar
  49. 49.
    Kaukonen KM, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372:1629–38.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Investigators SEPSISPAM. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370:1583–93.CrossRefGoogle Scholar
  51. 51.
    Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34:344–53.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Boyd J, Forbes J, Nakada T, et al. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39:259–65.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Hospital Quality Initiative, Outcome Measures. Centers for Medicare and Medicaid Services. [Last Modified: 09/29/2015]. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/outcomemeasures.html.
  55. 55.
    Cooper J, Walley K, Wiggs B, et al. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. Ann Intern Med. 1990;112:492–8.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Jaber S, Paugam C, Furier E, et al. Sodium bicarbonate for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomized controlled, phase 3 trial. Lancet. 2018;392:31–40.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Morelli A, Ertmer C, Westphal M, et al. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock. JAMA. 2013;310:1683–91.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Marik PE, Khangoora V, Rivera R, et al. Hydrocortisone, vitamin C, and thiamine for the treatment of severe Sepsis and septic shock: a retrospective before-after Study. Chest. 2017;151(6):1229–38.  https://doi.org/10.1016/j.chest.2016.11.036.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Iwashyna TJ, Ely EW, Smith DM, et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787–94.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Regazzoni CJ, Zamora RJ, Petrucci E, et al. Hospital and 1-year outcomes of septic syndromes in older people: a cohort study. J Gerontol A Biol Sci Med Sci. 2008;63(2):210–2.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Balas MC, Vasilevskis EE, Olsen KM, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024–36.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Barr J, Fraser G, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Critical Care Medicine Unit, Division of Pulmonary and Critical Care MedicineUniversity of MichiganAnn ArborUSA

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