Recent advances in the pathophysiology and management of sepsis: a review

Abstract

Sepsis is a syndrome consisting of physiological, pathological and biochemical anomalies caused by infectious agents. It causes clinical organ dysfunction, which is identified by an acute increase in the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score of two or more points. SOFA score is a score of three components that can be easily used at the bedside to track the clinical status of a patient while on admission, and these are altered respiratory rate of ≥ 22 breaths/minute, altered mental status, and systolic blood pressure of ≤ 100 mmHg. A patient with SOFA score of ≥ 2 has an attributable 2 - 25-fold increased risk of mortality compared to a patient with SOFA score of ˂ 2. This present review provides information on the new definition of sepsis and septic shock, aetiology, pathophysiology, biochemical, pathological and haematological changes, morbidity and mortality parameters, management, andprognostic factors in patients with sepsis.
 Key words: Sepsis, septic shock, SOFA score, pathophysiology, management bundles

Intensive care nurses’ awareness of identification of early sepsis findings

“…In patients with septic shock requiring vasopressors, the mean PCT level was observed as 32.7 ng per ml and 9.6 ng per ml in patients with sepsis and without shock (Yunus et al, 2018). CRP and PCT levels are more commonly used to monitor response to treatment and provide guidance for antibiotic discontinuation, particularly in bacterial pneumonia (Adegboro et al, 2021; Gauger et al, 2020).…”

“…Although the rate of nurses (20.8%) who used a measurement tool in diagnosing sepsis was low, the most frequently used measurement tools were SOFA, q‐SOFA, blood findings, vital signs and blood culture results. Blood culture is defined as the ‘gold standard’ in the literature for the diagnosis of sepsis (Adegboro et al, 2021). In the study, whether the nurses used the sepsis protocol in the ICU was not questioned, but it is thought that these protocols will contribute to the early recognition of sepsis.…”

“…In patients with septic shock requiring vasopressors, the mean PCT level was observed as 32.7 ng per ml and 9.6 ng per ml in patients with sepsis and without shock (Yunus et al, 2018). CRP and PCT levels are more commonly used to monitor response to treatment and provide guidance for antibiotic discontinuation, particularly in bacterial pneumonia (Adegboro et al, 2021;Gauger et al, 2020). In the study examining the knowledge and attitudes of physicians and nurses about sepsis management in Italy, it was determined that the mean score for early detection and management of sepsis was 49.6% in physicians and 42.3% in nurses (Nucera et al, 2018).…”

Treatment Advances in Sepsis and Septic Shock: Modulating Pro- and Anti-Inflammatory Mechanisms

“…After infection, the presence of pathogen-associated molecular patterns induces the expression of pro-inflammatory molecules and activation of the coagulation cascade and of the complement system [3,4]. C5a and its receptors, C5aR and C5aR2, have emerged as promising targets for sepsis therapy.…”

“…Patients with septic shock are characterized by persistent hypotension despite adequate volume resuscitation, the need for vasopressor therapy, and lactate >2 mmol/L [1,3]. The resulting metabolic dysfunction and inadequate tissue perfusion may ultimately lead to multiorgan failure and death [4,5].…”