2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department

Guarino, Matteo; Perna, Benedetta; Cesaro, Alice Eleonora; Maritati, Martina; Spampinato, Michele Domenico; Contini, Carlo; Giorgio, Roberto De

doi:10.3390/jcm12093188

Cited by 68 publications

(29 citation statements)

References 208 publications

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“…Sepsis is a dysregulated host response to infection that results in life-threatening organ dysfunction. Septic shock occurs when a patient with sepsis also has hypotension that persists despite adequate volume resuscitation, and it requires treatment with vasopressors [ 27 ]. Leukopenia can also occur during the immunosuppressive phase of sepsis due to reduction in bone marrow production or increased destruction of granulocytes [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Gingival Necrosis Related to Sepsis-Induced Agranulocytosis Due to Pseudomonas aeruginosa Bacteraemia: A Case Report

Tan,

Teo,

et al. 2024

JCM

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Background: There have been no reports of sepsis-induced agranulocytosis causing gingival necrosis in otherwise medically healthy patients to the authors’ best knowledge. Even though there are several case reports of gingival necrosis secondary to medication-induced agranulocytosis, they have not systematically described the natural progression of agranulocytosis-related gingival necrosis. Methods: This paper presents a case report of a 29-year-old female Indian patient with generalised gingival necrosis and constitutive signs of intermittent fever, nausea, and vomiting. She also complained of abdominal pains. Blood counts showed agranulocytosis, and the patient was admitted for a workup of the underlying cause. Parenteral broad-spectrum antibiotics were administered, which brought about clinical resolution. Results: Her gingival necrosis was attributed to sepsis-induced agranulocytosis triggered by Pseudomonas aeruginosa bacteraemia, and upon clinical recovery, spontaneous exfoliation left behind exposed bone. Secondary healing over the exposed alveolar bone was noted after a year-long follow-up, albeit with some residual gingival recession. Conclusions: Oral manifestations of gingival necrosis, when present with concomitant constitutive symptoms, could indicate a serious underlying systemic condition that could be potentially life-threatening if left untreated. Dentists should be cognizant of this possibility so that timely intervention is not delayed.

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Section: Discussionmentioning

confidence: 99%

Gingival Necrosis Related to Sepsis-Induced Agranulocytosis Due to Pseudomonas aeruginosa Bacteraemia: A Case Report

Tan,

Teo,

et al. 2024

JCM

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“…SSC Guideline 2023, the second point of management of sepsis patients is fluid resuscitation. 14 Sepsis, accompanied by severe vasoplegia, is a secondary problem due to the release of glycocalyx so that patients can experience distributive shock. Administration of drugs to improve hemodynamics is essential for the survival of patients with septic shock.…”

Section: Fluid Administration In Critical Patientsmentioning

confidence: 99%

Fluid Management for Critically Ill Patients, Based on the ROSE Concept, an Old Method but Effective Enough

Agustina,

Wisudarti,

Widodo

2024

JAP

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Fluid therapy is one of the most essential things in managing critical patients, such as ICU patients. Although it seems simple, this is difficult to do in this group of patients. The fluid needs of ICU patients vary according to the course of the disease. Therefore, fluids must be given according to individual needs, and each phase of the disease must be reassessed. To support this, there is a conceptual model that explains fluid administration based on the phases of the disease that the patient is going through. The ROSE concept (resuscitation, optimization, stabilization, and evacuation) describes the phases of a patient's illness and how fluids should be administered. In the resuscitation phase, the goal is lifesaving and is achieved by positive fluid balance. In the optimization phase, fluid balance is neutral and aims to save organs. In the stabilization phase, the fluid balance has started to move in a negative direction and aims to support the organs. Finally, in the evacuation phase, fluid balance is negative and organ repair has occurred. By implementing this model, it is hoped that ICU patients will have better outcomes

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“…This explains why there are still no FDA-approved treatment options available that improve sep- Although TLR signaling is well described (see chapter 3), LPS effects are more complex and multifaceted, and the underlying mechanisms are far from understood. This explains why there are still no FDA-approved treatment options available that improve sepsis survival, despite significant advancements in therapeutic management and over 100 therapeutic trials [18,19]. Further exploration of the endothelial cell response to LPS and possible interference with the negative effects might provide clues for new targets for adjuvant therapies aimed at protecting the endothelium against damage and preventing the breakdown of the endothelial barrier.…”

Section: Sepsismentioning

confidence: 99%

Dose-Dependent Effects of Lipopolysaccharide on the Endothelium—Sepsis versus Metabolic Endotoxemia-Induced Cellular Senescence

Merk,

Cox,

Jakobs

et al. 2024

Antioxidants

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The endothelium, the innermost cell layer of blood vessels, is not only a physical barrier between the bloodstream and the surrounding tissues but has also essential functions in vascular homeostasis. Therefore, it is not surprising that endothelial dysfunction is associated with most cardiovascular diseases. The functionality of the endothelium is compromised by endotoxemia, the presence of bacterial endotoxins in the bloodstream with the main endotoxin lipopolysaccharide (LPS). Therefore, this review will focus on the effects of LPS on the endothelium. Depending on the LPS concentration, the outcomes are either sepsis or, at lower concentrations, so-called low-dose or metabolic endotoxemia. Sepsis, a life-threatening condition evoked by hyperactivation of the immune response, includes breakdown of the endothelial barrier resulting in failure of multiple organs. A deeper understanding of the underlying mechanisms in the endothelium might help pave the way to new therapeutic options in sepsis treatment to prevent endothelial leakage and fatal septic shock. Low-dose endotoxemia or metabolic endotoxemia results in chronic inflammation leading to endothelial cell senescence, which entails endothelial dysfunction and thus plays a critical role in cardiovascular diseases. The identification of compounds counteracting senescence induction in endothelial cells might therefore help in delaying the onset or progression of age-related pathologies. Interestingly, two natural plant-derived substances, caffeine and curcumin, have shown potential in preventing endothelial cell senescence.

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2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department

Cited by 68 publications

References 208 publications

Gingival Necrosis Related to Sepsis-Induced Agranulocytosis Due to Pseudomonas aeruginosa Bacteraemia: A Case Report

Gingival Necrosis Related to Sepsis-Induced Agranulocytosis Due to Pseudomonas aeruginosa Bacteraemia: A Case Report

Fluid Management for Critically Ill Patients, Based on the ROSE Concept, an Old Method but Effective Enough

Dose-Dependent Effects of Lipopolysaccharide on the Endothelium—Sepsis versus Metabolic Endotoxemia-Induced Cellular Senescence

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