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Sepsis and Septic Shock

  • Anand Kumar
  • Victor Tremblay
Chapter

Abstract

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection according to the 2016 Sepsis-3 consensus statement. The diagnosis of septic shock additionally requires hypotension despite adequate fluid resuscitation and high lactate. The diagnosis of sepsis requires both a suspected infection and signs of organ dysfunction. It is a very common cause of hospitalization and death. Management strategies include (1) early adequate antimicrobials, (2) aggressive resuscitation, (3) timely source control, (4) adjunctive therapies, and (5) appropriate de-escalation of therapies once the patient has stabilized.

Keywords

Sepsis Septic shock Shock Antimicrobials Vasopressors Source control 

References

  1. 1.
    Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–10.CrossRefGoogle Scholar
  2. 2.
    Kadri SS, Rhee C, Strich JR, Morales MK, Hohmann S, Menchaca J, et al. Estimating ten-year trends in septic shock incidence and mortality in United States academic medical centers using clinical data. Chest. 2017;151(2):278.CrossRefGoogle Scholar
  3. 3.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–10.CrossRefGoogle Scholar
  4. 4.
    Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372(17):1629–38.CrossRefGoogle Scholar
  5. 5.
    Atkinson PR, McAuley DJ, Kendall RJ, et al. Abdominal and cardiac evaluation with sonography in shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. Emerg Med J. 2009;26:87–91.CrossRefGoogle Scholar
  6. 6.
    Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: rapid ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am. 2010;28:29–56, vii.CrossRefGoogle Scholar
  7. 7.
    Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7(3):210.CrossRefGoogle Scholar
  8. 8.
    Suetrong B, Walley KR. Lactic acidosis in Sepsis : it’s not all anaerobic: implications for diagnosis and management. Chest. 2016;149(1):252–61.CrossRefGoogle Scholar
  9. 9.
    Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, Osborn TM, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the surviving sepsis campaign database. Crit Care Med. 2015;43(3):567.CrossRefGoogle Scholar
  10. 10.
    Kumar A, Roberts D, Wood KE, Light B, Parillo JE, Sharma S, 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.CrossRefGoogle Scholar
  11. 11.
    Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376:2235–44.CrossRefGoogle Scholar
  12. 12.
    Kanji Z, Dumaresque C. Time to effective antibiotic administration in adult patients with septic shock: a descriptive analysis. Intensive Crit Care Nurs. 2012;28(5):288–93.CrossRefGoogle Scholar
  13. 13.
    Paul M, Shani V, Muchtar E, et al. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother. 2010;54:4851–63.CrossRefGoogle Scholar
  14. 14.
    Kumar A, Zarychanski R, Light B, Parrillo J, Maki D, Simon D, et al. Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis. Crit Care Med. 2010;38(9):1773–85.CrossRefGoogle Scholar
  15. 15.
    Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304.CrossRefGoogle Scholar
  16. 16.
    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;345:1368–77.CrossRefGoogle Scholar
  17. 17.
    The Arise Investigators and Anzics Clinical Trials Grou. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496.  https://doi.org/10.1056/NEJMoa1404380.
  18. 18.
    ProCESS Investigators. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;371:1683–93.CrossRefGoogle Scholar
  19. 19.
    Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–11.CrossRefGoogle Scholar
  20. 20.
    Bloos F, Thomas-Rüddel D, Rüddel H, et al. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Crit Care. 2014;18:1.CrossRefGoogle Scholar
  21. 21.
    Parrillo JE, Dellinger RP. Critical care medicine: principles of diagnosis and management in the adult. 4th ed. Philadelphia: Elsevier; 2014.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Anand Kumar
    • 1
  • Victor Tremblay
    • 2
  1. 1.Section of Critical Care Medicine, Section of Infectious DiseasesUniversity of ManitobaWinnipegCanada
  2. 2.Section of Critical Care MedicineUniversity of ManitobaWinnipegCanada

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