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Septic Shock

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Abstract

This chapter is concerned with the diagnosis and immediate treatment of patients with septic shock. Most clinicians will have a mental image of this condition and would expect to have little difficulty in recognizing it from the end of the bed, but despite this there is no universally accepted definition. Indeed, when clinical investigators attempt to arrive at a consensus there are wide variations in terms. Thus, a necessary preface to this chapter is a brief discussion of the controversy surrounding the nomenclature of these syndromes.

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References

  1. Vincent J-L. Sepsis and septic shock: update on definitions. In Reinhart K, Eyrich K, Sprung C (Eds). Sepsis. Current perspectives in pathophysiology and therapy. Berlin: Springer-Verlag, 1994:3.

    Google Scholar 

  2. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644, 1992.

    Article  PubMed  CAS  Google Scholar 

  3. Bone RC, Fisher CJ Jr, Clemmer TP, et al. Sepsis syndrome: a valid clinical entity. Crit Care Med 17:389, 1989.

    Article  PubMed  CAS  Google Scholar 

  4. Bone RC. Definitions and therapy of sepsis. In Reinhart K, Eyrich K, Sprung C (Eds). Sepsis. Current perspectives in pathophysiology and therapy. Berlin: Springer-Verlag, 1994: 228.

    Google Scholar 

  5. Forgacs IC, Eykyn SJ, Bradley RD. Serious infection in the intensive therapy unit: a 15 year study of bacteremia. Quarterly J Med 60:773, 1986.

    CAS  Google Scholar 

  6. Rangel-Frausto M. The epidemiology of bacterial sepsis. Infect Dis Clinics N Am 13:299, 1999.

    Article  CAS  Google Scholar 

  7. Ispahani P, Pearson NJ, Greenwood D. An analysis of community and hospital-acquired bacteremia in a large teaching hospital in the United Kingdom. Quarterly J Med 63:427, 1987.

    CAS  Google Scholar 

  8. Brun BC, Doyon F, Carlet J, et al. Incidence, risk factors and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. J Am Med Assoc 274:968, 1995.

    Article  Google Scholar 

  9. Pittet D, Wenzl RP. Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 155:1177, 1995.

    Article  PubMed  CAS  Google Scholar 

  10. Crowe M, Ispahani P, Humphreys H, et al. Bacteremia in the adult intensive care unit of a teaching hospital in Nottinhgam, UK, 1985–1996. Eur J Clin Microbiol Infect Dis 17:377, 1998.

    PubMed  CAS  Google Scholar 

  11. Wolff M, Brun-Buisson C, Lode H, et al. The changing epidemiology of severe infections in the ICU. Clin Microbiol Infect 3 (Suppl 1):S36, 1997.

    Article  Google Scholar 

  12. Roberts FJ, Geere IW, Coldman A. A three-year study of positive blood cultures, with emphasis on prognosis. Rev Infect Dis 13:34, 1991.

    Article  PubMed  CAS  Google Scholar 

  13. Cohen J, Abraham E. Microbiologic findings and correlations with serum Tumor Necrosis Factor-α in patients with severe sepsis and septic shock. J Infect Dis 180:116, 1999.

    Article  PubMed  CAS  Google Scholar 

  14. Abraham E, Glauser M-P, Butler T, et al. p55 Tumor Necrosis Factor Receptor Fusion Protein in the Treatment of Patients with Severe Sepsis and Septic Shock. A randomized controlled multicenter trial. J Am Med Assoc 277:1531, 1997.

    Article  CAS  Google Scholar 

  15. Hanberger H, Garcia RJ, Gobernado M, et al. Antibiotic susceptibility among aerobic Gram-negative bacilli in intensive care units in 5 European countries. J Am Med Assoc 281:67, 1999.

    Article  CAS  Google Scholar 

  16. Opal SM, Cohen J. Are there fundamental differences of clincal relevance between Gram positive and Gram negative bacterial sepsis? Crit Care Med 27:1608, 1999.

    Article  PubMed  CAS  Google Scholar 

  17. Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 68:344, 1980.

    Article  PubMed  CAS  Google Scholar 

  18. Circiumaru B, Baidock G, Cohen J. A prospective study of fever in the intensive care unit. Intensive Care Med 25:668, 1999.

    Article  PubMed  CAS  Google Scholar 

  19. O’Grady NP, Barie PS, Bartlett JG. et al. Practice guidelines for evaluating new fever in critically ill adult patients. Critical Care Med 26:1041, 1998.

    Google Scholar 

  20. Llewelyn M, Cohen J. Diagnosis of infection in sepsis. Intensive Care Med 27 (suppl 1): S10, 2001.

    Article  PubMed  Google Scholar 

  21. Carlet J. Rapid diagnostic methods in the detection of sepsis. Infect Dis Clinics N Am 13:483, 1999.

    Article  CAS  Google Scholar 

  22. Povoa P, Almeida E, Moreira P, et al. C-reactive protein as an indicator of sepsis. Intensive Care Med 24:1052, 1998.

    Article  PubMed  CAS  Google Scholar 

  23. de Werra I, Jaccard C, Corradin SB, et al. Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations: comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Critical Care Med 25:607, 1997.

    Article  Google Scholar 

  24. Oberhoffer M, Karzai W, Meier-Hellmann A, et al. Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-α and interleulin-6 in patients with sepsis. Critical Care Med 27:1814, 1999.

    Article  CAS  Google Scholar 

  25. Ugarte H, Silva E, Mercan D, et al. Procalcitonin used as a marker of infection in the intensive care unit. Critical Care Med 27:498, 1999.

    Article  CAS  Google Scholar 

  26. Danner RL, Elin RJ, Hosseini JM, et al. Endo-toxemia in human septic shock. Chest 99:169, 1991.

    Article  PubMed  CAS  Google Scholar 

  27. Guidet B, Barakett V, Vassal T, et al. Endotoxemia and bacteremia in patients with sepsis syndrome in the intensive care unit. Chest 106:1194, 1994.

    Article  PubMed  CAS  Google Scholar 

  28. Bates DW, Parsonnet J, Ketchum PA, et al. Limulus Amebocyte Lysate assay for detection of endotoxin in patients with sepsis syndrome. Clin Infect Dis 27:582, 1998.

    Article  PubMed  CAS  Google Scholar 

  29. Casey LC, Balk RA, Bone RC. Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 119:771, 1993.

    Article  PubMed  CAS  Google Scholar 

  30. Fink PC, Grunert JH. Endotoxemia in intensive care patients: a longitudinal study with the limulus amebocyte lysate test. Klinische Wochenschrift 62:986, 1984.

    Article  PubMed  CAS  Google Scholar 

  31. Cohen J. The detection and interpretation of endotoxemia. Intensive Care Med 26 (suppl 1):S51,2000.

    Article  PubMed  Google Scholar 

  32. Hurley JC. Reappraisal with meta-analysis of bacteremia, endotoxemia, and mortality in Gram-negative sepsis. J Clin Microbiol 33:1278, 1995.

    PubMed  CAS  Google Scholar 

  33. Brandtzaeg P, Kerrulf P, Gaustad P, et al. Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease. J Infect Dis 159:195, 1989.

    Article  PubMed  CAS  Google Scholar 

  34. Edwards JD. Management of septic shock. Br Med J 306:1661, 1993.

    Article  CAS  Google Scholar 

  35. Dellinger RP. Current therapy for sepsis. Infect Dis Clinics N Am 13:495, 1999.

    Article  CAS  Google Scholar 

  36. Wheeler AP, Bernard GR. Treating patients with severe sepsis. New Engl J Med 340:207, 1999.

    Article  PubMed  CAS  Google Scholar 

  37. Byl B, Clevenbergh P, Jacobs F, et al. Impact of infectious disaeases specialists and microbiologic data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis 29:60, 1999.

    Article  PubMed  CAS  Google Scholar 

  38. Bochud P-Y, Glauser M-P, Calandra T. Antibiotics in sepsis Intensive Care Med 27 (suppl 1):S33, 2001.

    Article  Google Scholar 

  39. Dofferhoff AS, Potthoff H, Bom VJ, et al. The release of endotoxin, TNF and IL-6 during the antibiotic treatment of experimental Gram-negative sepsis. J Endotoxin Res 2:37, 1995.

    Google Scholar 

  40. Jackson JJ, Kropp H. ß-lactam antibiotic-induced release of free endotoxin: in vitro comparison of penicillin-binding protein (PBP) 2-specific imipenem and PBP 3-specifk ceftazidime. J Infect Dis 165:1033, 1992.

    Article  PubMed  CAS  Google Scholar 

  41. Prins JM, van Deventer SJ, Kuijper EJ, et al. Clinical relevance of antibiotic-induced endotoxin release. Antimicrob Agents Chemo 38: 1211, 1994.

    Article  CAS  Google Scholar 

  42. Lehner PJ, Davies KA, Walport MJ, et al. Meningococcal septicaemia in a C6-deficient patient and effects of plasma transfusion on lipopolysaccharide release. Lancet 340:1379, 1992.

    Article  PubMed  CAS  Google Scholar 

  43. Prins JM, van Agtmael M, Kuijper EJ, et al. Antibiotic-induced endotoxin release in patients with Gram-negative urosepsis: a double-blind study comparing imipenem and ceftazidime. J Infect Dis 172:886, 1995.

    Article  PubMed  CAS  Google Scholar 

  44. Maury E, Barakett V, Blanchard H, et al. Circulating endotoxin during initial antibiotic treatment of severe Gram-negative bacteremic infections. J Infect Dis 178:270, 1998.

    Article  PubMed  CAS  Google Scholar 

  45. Levi M, ten Cate H. Disseminated intravascular coagulation. New Engl J Med 341:586, 1999.

    Article  PubMed  CAS  Google Scholar 

  46. Eisele B, Lamy M, Thijs LG, et al. Antithrombin III in patients with severe sepsis. A randomized, placebo-controlled, double-blind multicenter trial plus a meta-analysis on all randomized, placebo-controlled, double-blind trials with antithrombin III in severe sepsis. Intensive Care Med 24:663, 1998.

    Article  PubMed  CAS  Google Scholar 

  47. Roback MG, Stack AM, Thompson C, et al. Activated protein C concentrate for the treatment of meningococcal endotoxin shock in rabbits. Shock 9:138, 1998.

    Article  PubMed  CAS  Google Scholar 

  48. Bernard GR, Vincent JL, Laterre G-F, et al. Efficacy safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699, 2001.

    Article  PubMed  CAS  Google Scholar 

  49. Hinshaw LB, Peduzzi P, Young E, et al. Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. New Engl J Med 317:659, 1987.

    Article  Google Scholar 

  50. Bone RC, Fisher CJ Jr, Clemmer TP, et al. A controlled clinical trial of high-dose methylpred-nisolone in the treatment of severe sepsis and septic shock. New Engl J Med 317:653, 1987.

    Article  PubMed  CAS  Google Scholar 

  51. Cronin L, Cook DJ, Carlet J, et al. Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med 23:1430, 1995.

    Article  PubMed  CAS  Google Scholar 

  52. Bollaert P-E, Charpentier C, Levy B, et al. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 26:645, 1998.

    Article  PubMed  CAS  Google Scholar 

  53. Annane D. Effects of the combination of hydrocortisone and fludrocortisone on mortality in septic shock. Crit Care Med 26:A46, 2001.

    Google Scholar 

  54. Cohen J. Adjunctive therapy in sepsis: a critical analysis of the clinical trial programme. Brit Med Bull 55:212, 1999.

    Article  PubMed  CAS  Google Scholar 

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Cohen, J. (2001). Septic Shock. In: Rello, J., Valles, J., Kollef, M.H. (eds) Critical Care Infectious Diseases Textbook. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1679-8_23

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  • DOI: https://doi.org/10.1007/978-1-4615-1679-8_23

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5674-5

  • Online ISBN: 978-1-4615-1679-8

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