BOOK
Sepsis, An Issue of Clinics in Chest Medicine, E-Book
Julie A. Bastarache | Eric J. Seeley
(2016)
Additional Information
Book Details
Abstract
This issue of Clinics in Chest Medicine focuses on Sepsis. Articles include: The changing epidemiology and definition of sepsis; risk stratification and prognosis in sepsis: what have we learned from biomarkers and microarrays?; Sepsis outside the ICU: development and implementation of sepsis alert systems; The use of ultrasound in caring for the septic patient; Sepsis resuscitation: Fluid choice and dose; Beyond the golden hours: caring for the septic patient after the initial resuscitation; Vasopressors during sepsis: selection and targets; Dysglycemia and glucose control during sepsis; Cardiac function and dysfunction in sepsis;Goal Directed Resuscitation in Septic Shock; and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Sepsis\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Sepsis\r | vii | ||
| The Changing Epidemiology and Definitions of Sepsis\r | vii | ||
| Therapeutic Targets in Sepsis: Past, Present, and Future\r | vii | ||
| Early Identification and Treatment of Pathogens in Sepsis: Molecular Diagnostics and Antibiotic Choice\r | vii | ||
| Risk Stratification and Prognosis in Sepsis: What Have We Learned from Microarrays?\r | vii | ||
| Development and Implementation of Sepsis Alert Systems\r | viii | ||
| Goal-Directed Resuscitation in Septic Shock: A Critical Analysis\r | viii | ||
| Sepsis Resuscitation: Fluid Choice and Dose\r | viii | ||
| Vasopressors During Sepsis: Selection and Targets\r | viii | ||
| Endothelial and Microcirculatory Function and Dysfunction in Sepsis\r | ix | ||
| Management of Acute Kidney Injury and Acid-Base Balance in the Septic Patient\r | ix | ||
| Cardiac Function and Dysfunction in Sepsis\r | ix | ||
| The Use of Ultrasound in Caring for Patients with Sepsis\r | ix | ||
| Dysglycemia and Glucose Control During Sepsis\r | x | ||
| Metabolism, Metabolomics, and Nutritional Support of Patients with Sepsis\r | x | ||
| Neuroanatomy and Physiology of Brain Dysfunction in Sepsis\r | x | ||
| Beyond the Golden Hours: Caring for Septic Patients After the Initial Resuscitation\r | x | ||
| Short-term Gains with Long-term Consequences: The Evolving Story of Sepsis Survivorship\r | xi | ||
| CME Accreditation Page | xii | ||
| PROGRAM OBJECTIVE | xii | ||
| TARGET AUDIENCE | xii | ||
| LEARNING OBJECTIVES | xii | ||
| ACCREDITATION | xii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | xii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | xiii | ||
| TO ENROLL | xiii | ||
| METHOD OF PARTICIPATION | xiii | ||
| CME INQUIRIES/SPECIAL NEEDS | xiii | ||
| Preface:\rSepsis | xv | ||
| The Changing Epidemiology and Definitions of Sepsis | 165 | ||
| Key points | 165 | ||
| INTRODUCTION | 165 | ||
| UNITED STATES TRENDS IN INCIDENCE AND MORTALITY FROM SEPSIS | 165 | ||
| GLOBAL EPIDEMIOLOGY OF SEPSIS | 170 | ||
| FACTORS ASSOCIATED WITH AN INCREASED INCIDENCE OF SEPSIS | 170 | ||
| CLINICAL CORRELATIONS AND THE FUTURE OF SEPSIS EPIDEMIOLOGY | 171 | ||
| SUMMARY | 177 | ||
| REFERENCES | 177 | ||
| Therapeutic Targets in Sepsis | 181 | ||
| Key points | 181 | ||
| INTRODUCTION | 181 | ||
| EVOLUTION OF SEPSIS THERAPY | 182 | ||
| Fluids | 182 | ||
| Antibiotics | 182 | ||
| Supporting Injured Organs | 182 | ||
| THE GOLDEN AGE OF CYTOKINES | 183 | ||
| HUMAN SEPSIS TRIALS: FROM OPTIMISM TO DISAPPOINTMENT | 183 | ||
| Blocking Lipopolysaccharide and Tumor Necrosis Factor | 183 | ||
| Why Did These Therapies Fail? | 183 | ||
| QUANTITATIVE RESUSCITATION REEXAMINED | 184 | ||
| FUTURE TARGETS | 184 | ||
| Healing the Injured Epithelium | 184 | ||
| Late Mediators of Septic Organ Injury | 185 | ||
| Large-Scale Screens of Compounds Safe for Human Use | 185 | ||
| OPTIMIZING TRIAL DESIGN | 186 | ||
| Reducing Heterogeneity | 186 | ||
| Innovative Trial Designs | 186 | ||
| SUMMARY | 187 | ||
| REFERENCES | 187 | ||
| Early Identification and Treatment of Pathogens in Sepsis | 191 | ||
| Key points | 191 | ||
| INTRODUCTION | 191 | ||
| MOLECULAR METHODS FOR DETECTION OF BACTEREMIA | 192 | ||
| NONAMPLIFIED, GROWTH-DEPENDENT METHODS | 192 | ||
| Pathogen-Specific Methods | 192 | ||
| Broad-Based Methods | 196 | ||
| AMPLIFIED METHODS: GROWTH REQUIRED | 197 | ||
| Pathogen-Specific Real-time Methods | 197 | ||
| Broad-based Technologies | 198 | ||
| BROAD-BASED TECHNOLOGIES DIRECTLY FROM WHOLE BLOOD | 198 | ||
| T2 Candida Magnetic Resonance Assay | 200 | ||
| IRIDICA BAC-BSI Assay | 201 | ||
| POTENTIAL ECONOMIC IMPACT OF RAPID MOLECULAR DIAGNOSTIC METHODS AND BENEFITS FOR ANTIMICROBIAL STEWARDSHIP PROGRAMS | 201 | ||
| SUMMARY | 204 | ||
| REFERENCES | 204 | ||
| Risk Stratification and Prognosis in Sepsis | 209 | ||
| Key points | 209 | ||
| INTRODUCTION | 209 | ||
| PROGNOSTICATION OF MORTALITY AT ADMISSION: GENE EXPRESSION AT THE ONSET OF SEPSIS | 210 | ||
| THE IMPORTANCE OF TIME IN STUDIES OF ACUTE CRITICAL ILLNESS | 212 | ||
| FINDINGS FROM LONGITUDINAL STUDIES: PREDICTING HOSPITAL-ACQUIRED SEPSIS | 212 | ||
| IMMUNE PARALYSIS IN SEPSIS: AN UPDATED VIEW | 212 | ||
| MARKERS OF ORGAN-SPECIFIC OUTCOMES IN PERIPHERAL BLOOD | 214 | ||
| UNSUPERVISED LEARNING OF SEPSIS SUBTYPES | 215 | ||
| CAVEATS IN GENE EXPRESSION PROFILING: CONSIDERATIONS FOR FUTURE STUDIES | 216 | ||
| WHAT IS LEARNED SO FAR AND FUTURE DIRECTIONS | 216 | ||
| SUMMARY | 217 | ||
| REFERENCES | 217 | ||
| Development and Implementation of Sepsis Alert Systems | 219 | ||
| Key points | 219 | ||
| INTRODUCTION | 219 | ||
| DEVELOPMENT AND IMPLEMENTATION OF SEPSIS ALERT SYSTEMS | 220 | ||
| BARRIERS TO DEVELOPMENT AND IMPLEMENTATION OF CLINICALLY USEFUL SEPSIS ALERT SYSTEMS | 220 | ||
| Clinical Diagnostic Cues Not Available in the Electronic Medical Record | 220 | ||
| Algorithm Alert Performance | 221 | ||
| Information Overload and Alert Fatigue | 221 | ||
| Variability in the Systems of Health Care Delivery | 221 | ||
| POTENTIAL SOLUTIONS TO DEVELOPMENT AND IMPLEMENTATION OF CLINICALLY USEFUL SEPSIS ALERT SYSTEMS | 224 | ||
| Improved Alert Performance: Mathematical Modeling and Machine Learning | 224 | ||
| Alert Delivery and Integration into Workflow | 224 | ||
| Reengineering the Hospital Environment | 226 | ||
| SUMMARY | 226 | ||
| REFERENCES | 227 | ||
| Goal-Directed Resuscitation in Septic Shock | 231 | ||
| Key points | 231 | ||
| A BRIEF HISTORY OF GOAL-DIRECTED RESUSCITATION | 231 | ||
| Early Identification, Intravenous Fluid Resuscitation, and Empiric Antibiotics | 232 | ||
| Early identification | 232 | ||
| Intravenous fluid resuscitation | 232 | ||
| Empiric antibiotics | 233 | ||
| Optimizing Preload | 234 | ||
| Vasopressor Support | 234 | ||
| Assessing Oxygen Delivery and the Use of Packed Red Blood Cells and Dobutamine | 235 | ||
| Moving Forward | 237 | ||
| REFERENCES | 237 | ||
| Sepsis Resuscitation | 241 | ||
| Key points | 241 | ||
| INTRODUCTION | 241 | ||
| PHYSIOLOGY OF FLUID RESUSCITATION IN SEPSIS | 241 | ||
| FLUID DOSE | 242 | ||
| Fluid Administration in Sepsis Resuscitation | 242 | ||
| Fluid Management in Sepsis After Resuscitation | 244 | ||
| FLUID CHOICE | 245 | ||
| Crystalloids | 245 | ||
| Hyperchloremic metabolic acidosis | 245 | ||
| Acute kidney injury | 245 | ||
| Isotonic crystalloids in sepsis | 245 | ||
| Colloids | 247 | ||
| Albumin | 247 | ||
| Semisynthetic colloids | 247 | ||
| SUMMARY | 249 | ||
| REFERENCES | 249 | ||
| Vasopressors During Sepsis | 251 | ||
| Key points | 251 | ||
| INTRODUCTION | 251 | ||
| HYPOTENSION, SHOCK, AND MEASUREMENT OF ARTERIAL PRESSURE | 251 | ||
| Recommendation for Clinical Practice | 252 | ||
| WHAT IS THE TARGET MEAN ARTERIAL PRESSURE FOR SEPTIC SHOCK? | 252 | ||
| Recommendation for Clinical Practice | 253 | ||
| COMPARISONS OF VASOPRESSORS FOR SEPTIC SHOCK | 253 | ||
| Recommendation for Clinical Practice | 254 | ||
| GOAL-DIRECTED THERAPIES | 254 | ||
| Recommendation for Clinical Practice | 257 | ||
| IMPROVED OUTCOMES OF SEPSIS AND SEPTIC SHOCK | 257 | ||
| Endothelial and Microcirculatory Function and Dysfunction in Sepsis | 263 | ||
| Key points | 263 | ||
| ANATOMY AND FUNCTION OF THE MICROVASCULATURE | 263 | ||
| THE NORMAL MICROVASCULAR RESPONSE TO INFECTION | 263 | ||
| Leukocyte Adhesion | 264 | ||
| Tissue Edema | 264 | ||
| Coagulation | 264 | ||
| EVIDENCE OF MICROVASCULAR DYSFUNCTION DURING SEPSIS | 264 | ||
| MEASURING SEPTIC MICROVASCULAR DYSFUNCTION IN HUMANS | 264 | ||
| PATHOGENESIS OF MICROVASCULAR DYSFUNCTION DURING SEPSIS | 266 | ||
| ENDOTHELIAL GLYCOCALYX AND THE SEPTIC MICROCIRCULATION | 267 | ||
| THERAPEUTIC TARGETING OF THE MICROCIRCULATION IN SEPSIS | 268 | ||
| NOVEL MICROCIRCULATION-PROTECTIVE THERAPIES | 270 | ||
| SUMMARY | 271 | ||
| REFERENCES | 271 | ||
| Management of Acute Kidney Injury and Acid-Base Balance in the Septic Patient | 277 | ||
| Key points | 277 | ||
| INTRODUCTION | 277 | ||
| Definitions | 277 | ||
| Epidemiology | 277 | ||
| Pathophysiology | 278 | ||
| Risk Factors | 279 | ||
| MANAGEMENT GOALS | 279 | ||
| “Euvolemia” | 279 | ||
| Mean Arterial Pressure Goals | 280 | ||
| Nephrotoxins | 281 | ||
| PHARMACOLOGIC STRATEGIES | 282 | ||
| NONPHARMACOLOGIC STRATEGIES | 282 | ||
| Renal Replacement Therapy | 282 | ||
| Indications | 282 | ||
| Timing (early vs late) | 282 | ||
| Modality (intermittent vs continuous) | 282 | ||
| Dose | 283 | ||
| Antibiotic dosing during renal replacement therapy | 283 | ||
| Acid-Base Balance | 283 | ||
| pH goal | 283 | ||
| Buffers | 283 | ||
| Avoidance of hyperchloremic solutions | 284 | ||
| FUTURE DIRECTIONS | 284 | ||
| SUMMARY | 284 | ||
| REFERENCES | 284 | ||
| Cardiac Function and Dysfunction in Sepsis | 289 | ||
| Key points | 289 | ||
| INTRODUCTION | 289 | ||
| PATHOPHYSIOLOGY | 289 | ||
| Functional Abnormalities | 289 | ||
| Genetics | 290 | ||
| Molecular | 290 | ||
| Metabolic | 290 | ||
| Structural Abnormalities | 290 | ||
| Necrosis and apoptosis | 292 | ||
| Myocardial infiltration | 292 | ||
| Hemodynamic Abnormalities | 292 | ||
| Contractile dysfunction | 292 | ||
| MECHANISMS OF CARDIAC DYSFUNCTION | 293 | ||
| Impact of Chronic Heart Disease on Acute Hemodynamics | 293 | ||
| Laboratory Studies | 293 | ||
| Imaging Studies | 295 | ||
| Management Goals and Treatment | 295 | ||
| SUMMARY | 296 | ||
| REFERENCES | 296 | ||
| The Use of Ultrasound in Caring for Patients with Sepsis | 299 | ||
| Key points | 299 | ||
| INTRODUCTION | 299 | ||
| KEYS TO LEARNING AND UNDERSTANDING CRITICAL CARE ULTRASOUND | 300 | ||
| Basic Critical Care Echocardiography | 300 | ||
| Advanced Critical Care Echocardiography | 300 | ||
| Main Views and Echocardiographic Parameters Useful for Hemodynamic Evaluation | 301 | ||
| DIFFERENT HEMODYNAMIC PROFILES DETECTED BY ECHOCARDIOGRAPHY | 302 | ||
| Hypovolemia or Fluid Responsiveness Status | 302 | ||
| Cardiac Failure, Also Called Septic Cardiomyopathy | 303 | ||
| Left ventricular systolic dysfunction | 303 | ||
| Left ventricular diastolic dysfunction | 303 | ||
| Right ventricular dysfunction | 304 | ||
| IN PRACTICE | 304 | ||
| SUMMARY | 305 | ||
| REFERENCES | 305 | ||
| Dysglycemia and Glucose Control During Sepsis | 309 | ||
| Key points | 309 | ||
| INTRODUCTION | 309 | ||
| DEFINITIONS, PREVALENCE, AND PATHOGENESIS | 309 | ||
| Stress Hyperglycemia | 309 | ||
| Mechanism of Stress-Induced Hyperglycemia | 310 | ||
| Harm Secondary to Hyperglycemia | 310 | ||
| Diabetes and the Impact of Chronic Hyperglycemia | 311 | ||
| Unrecognized Diabetes | 313 | ||
| Hypoglycemia | 313 | ||
| Glycemic Variability | 314 | ||
| GLUCOSE TARGETS | 314 | ||
| INTERPRETATION | 316 | ||
| SUMMARY | 316 | ||
| REFERENCES | 317 | ||
| Metabolism, Metabolomics, and Nutritional Support of Patients with Sepsis | 321 | ||
| Key points | 321 | ||
| INTRODUCTION | 321 | ||
| METABOLIC CHANGES IN SEPSIS | 322 | ||
| Mediators of Altered Metabolism in Sepsis | 322 | ||
| Altered endocrine physiology | 322 | ||
| Activation of the adrenergic nervous system | 322 | ||
| Metabolic effects of cytokine release | 322 | ||
| Mechanisms of Altered Cellular Metabolism in Sepsis | 323 | ||
| Macronutrients | 323 | ||
| Micronutrients | 324 | ||
| METABOLIC CHANGES AS BIOMARKERS IN SEPSIS | 324 | ||
| Lactate: the Prototypical Biomarker for Sepsis Diagnosis and Prognosis | 324 | ||
| Lactate as a biomarker in the diagnosis of sepsis | 324 | ||
| Lactate as a prognostic biomarker in sepsis | 324 | ||
| Broader Metabolic Profiling in Sepsis | 325 | ||
| NUTRITION IN PATIENTS WITH SEPSIS | 327 | ||
| Timing of Nutrition | 327 | ||
| Enteral Versus Parenteral Nutrition | 328 | ||
| Role of Macronutrient and Micronutrient Replacement | 328 | ||
| SUMMARY | 328 | ||
| REFERENCES | 329 | ||
| Neuroanatomy and Physiology of Brain Dysfunction in Sepsis | 333 | ||
| Key points | 333 | ||
| INTRODUCTION | 333 | ||
| CLINICAL PRESENTATION | 333 | ||
| Acute Brain Response During Sepsis | 333 | ||
| Neurophysiologic Tests and Neuroimaging Procedures | 334 | ||
| Short- and Long-term Outcomes | 335 | ||
| PATHOPHYSIOLOGY OF SEPSIS-ASSOCIATED ENCEPHALOPATHY | 335 | ||
| Neuroinflammation | 335 | ||
| Microglia | 336 | ||
| Astrocytes | 336 | ||
| Cellular metabolism | 338 | ||
| Ischemic Process | 338 | ||
| The gliovascular unit | 338 | ||
| Neurovascular coupling | 338 | ||
| Neuronal Dysfunction | 339 | ||
| FUNCTIONAL ANATOMY OF THE CENTRAL NERVOUS SYSTEM DURING SEPSIS | 339 | ||
| Brainstem | 339 | ||
| Hypothalamus and Pituitary Gland | 339 | ||
| Hippocampus, Frontal Cortex, and Amygdala | 340 | ||
| SUMMARY | 341 | ||
| ACKNOWLEDGMENTS | 341 | ||
| REFERENCES | 341 | ||
| Beyond the Golden Hours | 347 | ||
| Key points | 347 | ||
| INTRODUCTION | 347 | ||
| AGITATION AND DELIRIUM | 348 | ||
| Importance of Agitation and Delirium | 348 | ||
| Treatment of Pain, Agitation, and Delirium | 348 | ||
| Early mobilization and exercise | 349 | ||
| Spontaneous breathing trials and decreased sedation | 349 | ||
| Specific Medications for Sedation, Agitation, and Delirium | 349 | ||
| Dexmedetomidine | 349 | ||
| Propofol | 349 | ||
| Haloperidol and other delirium medication | 349 | ||
| Ramelteon and melatonin receptor agonists | 352 | ||
| MECHANICAL VENTILATION | 352 | ||
| Small Tidal Volumes, Low Plateau Pressures | 352 | ||
| Earliest Possible Extubation | 352 | ||
| Noninvasive Positive Pressure Ventilation | 352 | ||
| Selection of patients for noninvasive positive pressure | 352 | ||
| Current guidelines for noninvasive positive pressure ventilation in sepsis | 353 | ||
| HEMODYNAMIC MANAGEMENT: FLUIDS AND VASOPRESSORS | 353 | ||
| Fluid Choice | 353 | ||
| How Much Volume Resuscitation? | 354 | ||
| Intravascular Volume Assessment | 354 | ||
| BLOOD TRANSFUSION | 354 | ||
| Transfusion Threshold | 355 | ||
| Leukodepletion of Blood Products/Age of Blood | 355 | ||
| NUTRITION | 355 | ||
| Enteral Nutrition | 355 | ||
| Gastric Residuals | 356 | ||
| Parenteral Nutritional Support | 356 | ||
| VIRAL REACTIVATION | 356 | ||
| SUMMARY | 358 | ||
| REFERENCES | 358 | ||
| Short-term Gains with Long-term Consequences | 367 | ||
| Key points | 367 | ||
| LONG-TERM NEUROPSYCHOLOGICAL AND PHYSICAL IMPAIRMENTS | 368 | ||
| Cognitive Impairment | 368 | ||
| Psychological Morbidity | 369 | ||
| Physical Impairment and Functional Disability | 369 | ||
| Qualitative Experience of Sepsis Survivors | 370 | ||
| SEPSIS-INDUCED INFLAMMATION AND CARDIOVASCULAR RISK | 371 | ||
| SEPSIS-INDUCED IMMUNOSUPPRESSION | 371 | ||
| HEALTH CARE RESOURCE USE IN SEPSIS SURVIVORS | 371 | ||
| Post–Acute Care Use | 372 | ||
| Hospital-Based Acute Care Use | 372 | ||
| Emergency Department Visits | 372 | ||
| Hospital Readmissions | 372 | ||
| Risk factors | 372 | ||
| Readmission causes | 373 | ||
| Outcomes associated with hospital readmissions after sepsis | 373 | ||
| Hospital-level variation in hospital readmissions after sepsis | 373 | ||
| Long-term Health-related Quality of Life and Mortality | 374 | ||
| IMPROVING LONG-TERM OUTCOMES AFTER SEPSIS | 375 | ||
| SUMMARY | 376 | ||
| ACKNOWLEDGMENTS | 376 | ||
| REFERENCES | 376 | ||
| Index | 381 |