Avanços no diagnóstico e tratamento da sepse

Abstract

Objective: To present a critical and updated review about sepsis, focusing especially on diagnosis and treatment. Sources of data:Literature review of Medline, including review articles, clinical trials and original research. Summary of the findings:The International Sepsis Definitions Conference amplified the list of possible clinical and laboratory signs of sepsis, which may allow for more efficacious suspicion and management. In terms of laboratory evaluation, in addition to the research for infectious agents, many inflammatory response markers, such as inflammatory cytokines and procalcitonin, have been identified. However, they lack sensitivity and specificity for safe diagnosis. In terms of treatment, early intervention to prevent hemodynamic disturbances is still essential for a positive outcome, together with the appropriate use of antimicrobials. The value of treatments to remove toxins and to increase the innate immune response has not yet been established. The use of isolated inflammatory response blockers, at any stage of sepsis, does not decrease mortality. The use of corticosteroid makes a comeback with encouraging results, even in patients without sepsis-related adrenal insufficiency. A large study on activated protein C (drotrecogin-α) reports a 6% decrease in mortality in a selected sample, suggesting the possibility of a better prognosis for sepsis patients. Conclusions:In comparison to the advances of the past few years, little has been achieved in terms of decreasing sepsis-related mortality due to the complexity of the pathogen-host relationships. The individual regulation of host reactions did not have the expected effects. The benefits of some known strategies were confirmed. Other types of treatment, such as corticosteroids and activated protein C therapies, are emerging as promising alternatives. Research indicates that the combination of immune modulator therapies is probably the best choice to improve outcomes in sepsis.J Pediatr (Rio J) 2003;79(Suppl 2):S195-S204: Sepsis, systemic inflammatory response syndrome, critical care. Advances in sepsis diagnosis and treatment

Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil

“…Several studies report that the lack of knowledge of such aspects contributes to the increase of morbidity and mortality of patients affected by this infection. 6,9,10 In 2004, Dellinger 30 proposed a Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock in order to establish a model based on better scientifi c evidences available to manage patients with sepsis and septic shock. According to him, not changing medical behavior practice at bedside, despite the alarming levels of BSI incidence and mortality, means an unforgivable failure.…”

“…The mortality rates associated with severe sepsis and septic shock described in literature are 25% to 30% and 40% to 70%, respectively. 7,8 Localizing the source of infection is primordial, considering that the mortality rate may vary between 15.4% and 41.2%, depending on its origin, 9 and that empirical antibiotics Table 1 shows demographic characteristics of the sample, such as gender, age, and origin, number of samples analyzed, kind of clinical condition, and place of admission. The episodes of bacteremia or candidemias in the study meant 68% in all positive culture recorded in the headquarters hospital in the research during the period studied.…”

Reposição Volêmica em cães portadores de sepse grave: Revisão de Literatura

“…Vários inibidores da cicloxigenase parecem ter efeito benéfico em pontos específicos da cascata inflamatória quando utilizados antiinflamatórios não esteroidais, apesar de não possuir efeito sobre o TNF e IL-1, desta forma os corticosteroides ressurgem com resultados animadores em pacientes com insuficiência adrenal (CIRCI-Critical Illness-Related Corticosteroid Insufficiency) relacionada a sepse e mesmo naqueles em que não apresentam, utilizando para estes casos a hidrocortisona na dosagem de 0,5 mg/kg/IV a cada seis horas durante quatro dias, com a redução para a cada oito horas por três dias e posteriormente a cada 12 horas por mais três dias. (CARVALHO;TROTTA, 2003;PAIXÃO, 2005).…”

Copaiba oil effect under different pathways in mice subjected to sepsis

“…The incidence of severe sepsis increased 91.3% over the past 10 years occurring in 1 to 3 per 1000 individuals in different regions, with annual growth of 1% per year 1,5 , representing still a severe public health problem in the world, both from the point of view of social and economic terms 6 . Brazil is appointed, along with the United Kingdon, as one of the countries with the highest rate of occurrence of sepsis in ICU, responsible for occupying about one quarter of the ICU beds 3 .…”