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Early ICU Management of Polytrauma Patients Who Develop Sepsis

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Textbook of Polytrauma Management

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Abstract

Polytrauma patients are at high risk to develop late infections and a substantial portion of these will result in a dysregulated immune response that causes sepsis (with attributable organ dysfunctions) that prolongs ICU stays and can induce multiple organ failure which worsens short- and long-term outcomes. Early recognition of sepsis before it progresses into septic shock is imperative to improving outcomes. Unfortunately, the diagnosis of sepsis after polytrauma is especially challenging and the recent evolution in the definitions of sepsis from the Sepsis-2 to Sepsis-3 criteria adds to the confusion. However, over the past 15 years, performance improvement programs that insure optimal implementation of the Surviving Sepsis Campaign evidence-based guidelines have been consistently shown to reduce in hospital mortality. This chapter will discuss the evolving definitions of sepsis, provide a historic perspective on evidence-based sepsis care, and focus on the current guideline as they pertain to polytrauma patients. Key interventions discussed include (a) sepsis screening, (b) vascular access and monitoring, (c) administer broad-spectrum antimicrobial agent(s), (d) initial fluid resuscitation, (e) addition of vasopressor agents, (f) addition of inotropic agents, (g) use of steroids, (h) blood transfusions, (i) ongoing fluid resuscitation, and (j) source control.

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Authors and Affiliations

  1. Sepsis Critical Illness Research Center, University of Florida, Gainesville, FL, USA

    Frederick A. Moore

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  1. Frederick A. Moore
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Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

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Moore, F.A. (2022). Early ICU Management of Polytrauma Patients Who Develop Sepsis. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_34

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