Sepsis (eBook)

Contents 6
Contributors 8
1 Sepsis: Introduction and Epidemiology 10
The Epidemiology of Sepsis 10
Incidence and Occurrence of Sepsis 11
Outcome from Sepsis 12
Predictors of Outcome 12
Changes in Microbiology Over Time 13
The Economics of Sepsis 13
Conclusion 13
References 13
2 Mechanisms of Innate Immunity in Sepsis 14
The Innate Immune Response in Sepsis 14
Triggering of Innate Immune Responses 15
Toll-Like Receptors 15
TLR Signaling 16
Regulation of TLR Signaling 18
Endotoxin Tolerance 18
Clinical Directions 19
References 19
3 Metabolic and Endocrine Changes in Sepsis and the Catabolic State 20
Sepsis and the Catabolic State 20
Metabolic-Nutritional Responses to Sepsis and Critical Illness 20
The Insulin-Glucose Axis in Sepsis and Critical Illness 21
Endocrine Responses to Sepsis and Critical Illness 21
Implications for Clinical Practice 24
4 Hematological and Coagulation Changes in Sepsis 26
Introduction 26
Hematological Changes in Sepsis 26
Coagulation Changes in Sepsis 28
Disseminated Intravascular Coagulation 28
Other Coagulation Changes in Sepsis 32
Conclusion 32
References 33
5 The Genetics of Sepsis and Inflammation 35
What Are Genetic Polymorphisms and How Can They Be Used to Investigate the Genetics of Sepsis? 35
Genetic Association Studies in Sepsis 37
Combinations of Polymorphisms 39
Clinical Uses for Polymorphisms 39
The Future 39
6 Cardiac, Circulatory, and Microvascular Changes in Sepsis and Multiorgan Dysfunction Syndrome 41
Cardiovascular Effects of Sepsis 41
Cardiovascular Support in Sepsis 44
Microcirculation and Cellular Considerations in Sepsis 45
Summary 47
References 47
7 Specific Bacterial Infections in the Immunocompetent Patient 49
Meningococcal Disease 49
b-Hemolytic Streptococci 51
Toxic Shock Syndrome 52
Surgical Infections 54
8 Infection in the Immunocompromised Patient 56
Increased Susceptibility to Infection 56
Management of Granulocytopenic Sepsis 58
Humoral Immunodeficiency 60
CMV Infection in Transplant Recipients 60
Pneumocystis Jiroveci Pneumonia 62
Diagnosis 63
9 Severe Infections in the Returning Traveler 65
Severe and Complicated Malaria 65
SARS as an Example of an Emerging Contagious Disease with High Morbidity and Mortality 67
Viral Hemorrhagic Fever 69
Summary 71
10 Antibiotic Prescribing Including Antibiotic Resistance 72
Important Antibiotics and their Use in the Critical Care Setting 72
Principles of Choice of Antimicrobial Agent 74
Principles for Prescribing Antimicrobial Agents 74
Antibiotic Resistance 76
Current Therapeutic Problems in ITU 77
Summary 78
11 Infection Control in the Intensive Care Unit 79
General Principles 79
Means of Transmission of Infection 79
Patient Isolation 80
Universal Precautions 80
Specific Problems 81
Conclusions 85
12 Randomized Controlled Trials in Sepsis 87
Management of the Proinflammatory Response 87
Management of the Metabolic Response 89
Management of the Procoagulant Response 90
Standard Resuscitation 92
Conclusions 94
13 Guidelines, Protocols, and the Surviving Sepsis Guidelines: A Critical Appraisal 96
What is the Purpose of Guidelines? 96
Why do Guidelines Fail? 96
Conclusion 100
14 Practical Approaches to the Patient with Severe Sepsis: Illustrative Case Histories 102
Illustrative Cases 103
Practical Tips and Avoiding Pitfalls 106
Conclusions 107
References 107
Index 108