Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades?

Kamath, Shiwani; Hammad Altaq, Hiba; Abdo, Tony

doi:10.3390/microorganisms11092231

Cited by 13 publications

(5 citation statements)

References 202 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with septic shock pose a challenge for us because of their high mortality. We have witnessed many changes and debates in the diagnosis and treatment of our patients over the past 25 years [205]. This review aimed to review some cutting-edge treatment possibilities and provide an overview of the approach to the most at-risk septic patients.…”

Section: Discussionmentioning

confidence: 99%

Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies

Ramasco,

Nieves-Alonso,

García-Villabona

et al. 2024

JPM

View full text Add to dashboard Cite

Sepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; however, there are aspects that have changed. This narrative review highlights current and avant-garde methods of handling patients experiencing septic shock based on the experience of its authors and the best available evidence in a context of uncertainty. Following the first recommendation of the Surviving Sepsis Campaign guidelines, it is recommended that specific sepsis care performance improvement programs are implemented in hospitals, i.e., “Sepsis Code” programs, designed ad hoc, to achieve this goal. Regarding hemodynamics, the importance of perfusion and hemodynamic coherence stand out, which allow for the recognition of different phenotypes, determination of the ideal time for commencing vasopressor treatment, and the appropriate fluid therapy dosage. At present, this is not only important for the initial timing, but also for de-resuscitation, which involves the early weaning of support therapies, directed elimination of fluids, and fluid tolerance concept. Finally, regarding blood purification therapies, those aimed at eliminating endotoxins and cytokines are attractive in the early management of patients in septic shock.

show abstract

Section: Discussionmentioning

confidence: 99%

Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies

Ramasco,

Nieves-Alonso,

García-Villabona

et al. 2024

JPM

View full text Add to dashboard Cite

show abstract

“…According to the Surviving Sepsis Campaign (SSC), initial management of septic shock is measuring lactate levels caused by tissue hypoxia and hypoperfusion and carrying out blood cultures. Next, resuscitation with crystalloid fluids of 10-20ml/KgBW and broad spectrum antibiotics is carried out, followed by administration of vasopressors until the MAP is >65 mmHg (Brown & Semler, 2019;Evans et al, 2021;Farrell & Casserly, 2018;Gyawali et al, 2019;Kamath et al, 2023;Rudd et al, 2020). This patient did not undergo blood culture, BGA and lactic acid examination because the time estimate could not be done quickly.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Management on Septic Condition et Causa General Peritonitis: Case Report

Handoko,

Gemawan,

Muhammad Rizal Hadi Pratama

et al. 2023

Jember Medical Journal

View full text Add to dashboard Cite

Sepsis is a life-threatening systemic pathological condition. Based on WHO, there were 48.9 million cases with 11 million related deaths worldwide in 2017, which is almost 20% of all deaths from disease. Nearly half of all sepsis cases globally occurred in children, with an estimated 20 million cases and 2.9 million deaths. One of the conditions that can cause sepsis is generalized peritonitis. This study is a case report. Primary data was obtained through anamnesis, physical examination, laboratory test and radiology examination. In this case report, a 13-year-old child patient with generalized peritonitis was found due to obstructive ileus causing intestinal perforation, accompanied by sepsis, and underwent laparotomy and colostomy. Appropriate perioperative management is necessary to maintain hemodynamic stability and adequate oxygenation given the presence of sepsis in the patient.

show abstract

“…For cases before 2016, this definition was applied retrospectively. Septic shock was defined as sepsis requiring vasopressors after adequate fluid resuscitation to maintain mean arterial pressure (MAP) ≥ 65 mmHg and blood lactate concentration ≥ 2 mmol/L [ 1 , 13 ]. ARDS was diagnosed according to the Berlin Definition (2012) [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study

Wang,

Jia,

Zheng

et al. 2024

BMC Pulm Med

View full text Add to dashboard Cite

Background Both sepsis and acute respiratory distress syndrome (ARDS) are common severe diseases in the intensive care unit (ICU). There is no large-scale multicenter study to clarify the attributable mortality of ARDS among septic patients. This study aimed to evaluate the excess mortality of ARDS in critically ill patients with sepsis. Methods The data were obtained from a multicenter, prospective cohort study in 18 Chinese ICUs between January 2014 and August 2015. The study population was septic patients after ICU admission. The patients were categorized into two groups: those who developed ARDS (ARDS group) within seven days following a sepsis diagnosis and those who did not develop ARDS (non-ARDS group). Applying propensity score matching (PSM), patients were matched 1:1 as ARDS and non-ARDS groups. Mortality attributed to ARDS was calculated. Subsequently, we conducted a survival analysis to estimate the impact of ARDS on mortality. The primary endpoint was 30-day mortality after sepsis diagnosis. Results 2323 septic patients were eligible, 67.8% developed ARDS. After PSM, 737 patients with ARDS were matched 1:1 with 737 non-ARDS patients. ARDS’s overall 30-day attributable mortality was 11.9% (95% CI 7.5–16.3%, p < 0.001). Subgroup analysis showed that the 30-day attributable mortality of mild, moderate, and severe ARDS was 10.5% (95% CI 4.0-16.8%, p < 0.001), 11.6% (95% CI 4.7–18.4%, p < 0.001) and 18.1% (95% CI 4.5–30.9%, p = 0.006), respectively. ARDS was an independent risk factor for 30-day mortality, with adjusted hazard ratios of 1.30 (95% CI 1.03–1.64, p = 0.027), 1.49 (95% CI 1.20–1.85, p < 0.001), and 1.95 (95% CI 1.51–2.52, p < 0.001) for mild, moderate, and severe ARDS, respectively. Conclusions The overall 30-day attributable mortality of ARDS among critically ill patients with sepsis was 11.9%. Compared with mild and moderate ARDS, severe ARDS contributed more to death. ARDS was significantly associated with an increase in the 30-day mortality.

show abstract

Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades?

Cited by 13 publications

References 202 publications

Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies

Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies

Perioperative Management on Septic Condition et Causa General Peritonitis: Case Report

Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study

Contact Info

Product

Resources

About