Septic Shock: Current Pathogenetic Concepts, Optimal Management, and Future Perspectives
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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Diagnostic Evaluation of the Septic Patient
Management of Septic Shock
General Supportive Measures
Monitoring of Shock
Prognosis and Staging for Sepsis
The Role of the Gastrointestinal Tract
The Role of the Liver
Apoptosis in Septic Shock
Genetic Predisposition to Sepsis and Septic Shock
Metabolic Derangements in Sepsis and Septic Shock
Microbiologic Considerations in Septic Shock
abdominal abscesses activation acute pancreatitis antibiotic antibiotic therapy apoptosis arterial associated bacteremia bacterial blood cardiac catheter caused central venous central venous catheters clinical clinician coagulation critically ill patients cytokines debridement decreased diagnostic disease drainage drotrecogin alfa endothelial cells endothelium endotoxin evaluation fluid function gram-negative hemodynamic host hypotension increased inflammation inflammatory mediators inflammatory response syndrome injury intensive care unit interleukin-6 intervention intravascular invasive ischemia levels macrophages management of septic microbial microorganisms microvascular mortality multiple organ dysfunction multiple organ failure myocardial necrotizing fasciitis necrotizing pancreatitis neutrophil normal nosocomial nutritional support outcome oxygen delivery pancreatic necrosis pathogenesis pathophysiology patients with sepsis percutaneous perforation perfusion plasma pneumonia postoperative potential pressure procalcitonin procedure prognosis protein pulmonary renal Respir Crit resuscitation risk role sepsis and septic sepsis syndrome septic patients septic shock serum severe sepsis soft tissue infections source control Surg surgery surgical systemic inflammatory response therapeutic toxic shock treatment Vancomycin vascular
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