What do we mean by source control and what are we trying to accomplish with an open abdomen in severe complicated intra-abdominal sepsis?

Coccolini, Federico; Sartelli, Massimo; Kirkpatrick, Andrew W.

doi:10.1097/ta.0000000000004253

Cited by 5 publications

(6 citation statements)

References 17 publications

(24 reference statements)

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“…De ahí, que esta revisión trata de enfatizar la importancia refuerzan o corroboran los encontrados y publicados en otras áreas asistenciales, fundamentalmente en los ingresados en las unidades de cuidados intensivos [42][43][44][45], pacientes pediátricos [41] o valorados en emergencias extrahospitalarias [43]. Pero, más allá de los resultados de una variable individual, también cuando se valoran los resultados evolutivos dentro de los conseguidos por un paquete de medidas implementadas ("bundle de reconocimiento o inicial") tras la primera valoración del paciente en el SUH [66,67], las distintas intervenciones para el control del foco infeccioso se constituyen como una recomendación clara y necesaria junto con la estabilización hemodinámica (fluidoterapia y vasopresores) y la administración de la antibioterapia adecuada y precoz [1][2][3]11,[33][34][35][36][37][38][39][40][68][69][70].…”

Section: Discussionunclassified

Early source control of infection in patients seen in the emergency department: a systematic review

Julián-Jiménez,

Lorenzo Álvarez,

Gutiérrez Bueno

et al. 2024

Rev Esp Quimioter

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Introduction and objective. The term source (or focus) control encompasses all those physical measures that can be used to reduce the inoculum and modify those factors in the infectious medium that promote microbial growth or foreign antimicrobial defenses of the host. The main objective of this systematic review (SR) is to know and compare whether early detection and control of the focus (in less than 6 hours) in adult patients treated in the ED for severe infection or sepsis, compared to not controlling the focus or delayed focus control (more than 12 hours) is more effective and safer (improves clinical evolution, mortality, complications, hospital stay or need for ICU admission). Method. A systematic review is carried out following the PRISMA regulations in the databases of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2000 to December 31, 2023 without language restrictions and using a combination of MESH terms: “Source Control”, “Early” “Infection OR Bacterial Infection OR Sepsis”, “Emergencies OR Emergency OR Emergency Department” and “Adults”. Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively. Results. A total of 1,658 articles were identified, of which 2 that met the inclusion criteria and were classified as high quality were finally analyzed. The included studies represent a total of 2,404 patients with 678 cases in which an intervention was performed to control the focus (28.20%). In the first study, 28-day mortality was lower in patients who underwent an intervention to control the focus (12.3% vs. 22.5%; P <0.001), with an adjusted HR of 0.538 (95% CI: 0.389-0.744; P<0.001). In the second, it was demonstrated that the time elapsed from when the patient was evaluated for the first time and was hemodynamically stabilized, until the start of surgery was associated with his survival at 60 days with an OR of 0.31 (95% CI: 0.19-0.45; P <0.0001). In fact, for each hour of delay an adjusted OR of 0.29 (95% CI: 0.16-0.47; P<0.0001) is established. So if the intervention is performed before 2 hours at 60 days, 98% of the patients are still alive, if it is performed between 2-4 hours it is reduced to 78%, if it is between 4-6 hours it drops to 55%, but if it is done for more than 6 hours there will be no survivors at 60 days. Conclusions. This review shows that source control carried out after the evaluation of patients attending the ED reduces short-term mortality (30-60 days) and that it would be advisable to implement any required source control intervention as soon as possible, ideally early (within 6 hours).

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Section: Discussionunclassified

Early source control of infection in patients seen in the emergency department: a systematic review

Julián-Jiménez,

Lorenzo Álvarez,

Gutiérrez Bueno

et al. 2024

Rev Esp Quimioter

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“…We sincerely appreciate the commentary generated by Coccolini and colleagues regarding source control and the true intention of an open abdomen approach in the management of severe intra-abdominal sepsis described in our recent review 1,2 . The concept of source control is indeed nebulous, and the lack of a discrete definition complicates both clinical management and research endeavors.…”

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confidence: 94%

Author Reply: “What do we mean by source control and what are we trying to accomplish with an open abdomen in severe complicated intra-abdominal sepsis?”

Risinger,

Smith

2024

J Trauma Acute Care Surg

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Section: Introduction: a Global Perspectivementioning

confidence: 99%

“…Sepsis is recognised by the World Health Organization (WHO) as a global health priority across all countries and ages [ 26 ]. It is the most common cause of admission and death in the Intensive Care Unit (ICU) [ 91 ].…”

Section: Introduction: a Global Perspectivementioning

confidence: 99%

“…At the present time there is no magic bullet or pharmacological therapy for controlling the bioburden of propagating inflammation from intra-abdominal sepsis. Coccolini and colleagues (2023) [26] Sepsis is recognised by the World Health Organization (WHO) as a global health priority across all countries and ages [26]. It is the most common cause of admission and death in the Intensive Care Unit (ICU) [91].…”

Section: Introduction: a Global Perspectivementioning

confidence: 99%

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Revolution in sepsis: a symptoms-based to a systems-based approach?

Dobson,

Letson,

Morris

2024

J Biomed Sci

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Severe infection and sepsis are medical emergencies. High morbidity and mortality are linked to CNS dysfunction, excessive inflammation, immune compromise, coagulopathy and multiple organ dysfunction. Males appear to have a higher risk of mortality than females. Currently, there are few or no effective drug therapies to protect the brain, maintain the blood brain barrier, resolve excessive inflammation and reduce secondary injury in other vital organs. We propose a major reason for lack of progress is a consequence of the treat-as-you-go, single-nodal target approach, rather than a more integrated, systems-based approach. A new revolution is required to better understand how the body responds to an infection, identify new markers to detect its progression and discover new system-acting drugs to treat it. In this review, we present a brief history of sepsis followed by its pathophysiology from a systems’ perspective and future opportunities. We argue that targeting the body’s early immune-driven CNS-response may improve patient outcomes. If the barrage of PAMPs and DAMPs can be reduced early, we propose the multiple CNS-organ circuits (or axes) will be preserved and secondary injury will be reduced. We have been developing a systems-based, small-volume, fluid therapy comprising adenosine, lidocaine and magnesium (ALM) to treat sepsis and endotoxemia. Our early studies indicate that ALM therapy shifts the CNS from sympathetic to parasympathetic dominance, maintains cardiovascular-endothelial glycocalyx coupling, reduces inflammation, corrects coagulopathy, and maintains tissue O2 supply. Future research will investigate the potential translation to humans.

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What do we mean by source control and what are we trying to accomplish with an open abdomen in severe complicated intra-abdominal sepsis?

Cited by 5 publications

References 17 publications

Early source control of infection in patients seen in the emergency department: a systematic review

Early source control of infection in patients seen in the emergency department: a systematic review

Author Reply: “What do we mean by source control and what are we trying to accomplish with an open abdomen in severe complicated intra-abdominal sepsis?”

Revolution in sepsis: a symptoms-based to a systems-based approach?

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