Septic Shock: Current Pathogenetic Concepts, Optimal Management, and Future Perspectives

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Nova Publishers, 2005 - Medical - 115 pages
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Sepsis is one of the most frequent complications in the surgical patient and one of the leading causes of mortality in intensive care units. During the past two decades, a great deal has been learned about surgical bacteriology, antibiotic prophylaxis, supportive management, and the host response to microbial invasion. Sepsis can be caused by infection with gram-negative bacteria, gram-positive bacteria, fungi (and particularly Candida), or viruses. Sepsis may also occur in the absence of detectable bacterial invasion, and in these cases, microbial toxins, particularly gram-negative bacterial endotoxin (lipopolysaccharide, LPS), and endogenous cytokine production have been implicated as initiators and mediators. Although activation of the immune system during microbial invasion is generally protective, septic shock develops in a significant number of patients as a consequence of a poorly regulated immune response to the offending organism. Sepsis can be presented with a spectrum of severity. Septic shock represents the most severe form of host response to infection. The aim of this monograph is to summarise the currently available data regarding epidemiology, pathogenesis, and optimal management of septic shock, with a particular emphasis on the role of source control in sepsis. Emerging therapies for septic shock are also discussed.
 

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Contents

Introduction
Epidemiology
5
Pathophysiology of Septic Shock
9
The Role of Macrophages
10
Cytokines in Sepsis
13
Other Inflammatory Mediators
14
Coagulation Disorders in Sepsis
16
Complement Activation
17
Diagnostic Evaluation of the Septic Patient
27
Management of Septic Shock
31
Pulmonary Dysfunction
32
Cardiovascular Dysfunction
33
Renal Dysfunction
35
General Supportive Measures
36
Monitoring of Shock
65
Prognosis and Staging for Sepsis
69

The Role of the Gastrointestinal Tract
18
The Role of the Liver
20
Apoptosis in Septic Shock
21
Genetic Predisposition to Sepsis and Septic Shock
22
Metabolic Derangements in Sepsis and Septic Shock
23
Microbiologic Considerations in Septic Shock
24
Prevention
73
Conclusions and Practical Recommendations
75
References
77
Index
103
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Page 102 - Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:1368-1377.
Page 101 - Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100: 1619-1624.

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