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Book Details
Abstract
This issue of Critical Care Clinics, edited by Mervyn singer and Manu Shankar-Hari, includes: Sepsis 3.0 Definitions; Epidemiology and Outcomes; Pathophysiology of sepsis; Pathophysiology of Septic shock; Mechanism of organ dysfunction in sepsis; Endocrine and metabolic alterations in sepsis: challenges and treatments; The immune system in sepsis; Nutrition and Sepsis; Common sense approach to managing sepsis; Biomarkers for sepsis and their use; Personalizing sepsis care; Novel interventions - What’s new and the future; and Long term outcomes following Sepsis.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Sepsis | i | ||
| Copyright \r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Caring for Sepsis Patients: An Update | vii | ||
| Sepsis Definitions: A Work in Progress | vii | ||
| Epidemiology and Outcomes | vii | ||
| Immune Activation in Sepsis | vii | ||
| Pathophysiology of Septic Shock | viii | ||
| Mechanisms of Organ Dysfunction in Sepsis | viii | ||
| Endocrine and Metabolic Alterations in Sepsis and Implications for Treatment | viii | ||
| Management of Sepsis-Induced Immunosuppression | viii | ||
| Nutrition Therapy in Sepsis | ix | ||
| Common Sense Approach to Managing Sepsis | ix | ||
| Biomarkers in Sepsis | ix | ||
| Personalizing Sepsis Care | ix | ||
| Novel Interventions: What’s New and the Future | x | ||
| Improving Long-Term Outcomes After Sepsis | x | ||
| CRITICAL CARE CLINICS\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| April 2018 | xi | ||
| July 2018 | xi | ||
| October 2018 | xi | ||
| RECENT ISSUES | xi | ||
| October 2017 | xi | ||
| July 2017 | xi | ||
| April 2017 | xi | ||
| Preface:\rCaring for Sepsis Patients: An Update | xiii | ||
| REFERENCES | xiv | ||
| Sepsis Definitions | 1 | ||
| Key points | 1 | ||
| WHAT IS A DEFINITION, AND WHY IS IT IMPORTANT? | 1 | ||
| ANCIENT PERSPECTIVES | 2 | ||
| INFECTION AND THE GERM THEORY OF DISEASE | 3 | ||
| SEPSIS AS THE RESPONSE OF THE HOST | 4 | ||
| SEPSIS SYNDROME AND THE CONTEMPORARY CHALLENGE OF DEFINITION | 5 | ||
| THE AMERICAN COLLEGE OF CHEST PHYSICIANS/SOCIETY OF CRITICAL CARE MEDICINE SEPSIS DEFINITIONS CONFERENCE, 1991 | 6 | ||
| THE SECOND SEPSIS DEFINITIONS CONFERENCE, 2001 | 6 | ||
| SEPSIS-3 | 9 | ||
| ORGAN DYSFUNCTION AS THE SEPSIS PHENOTYPE | 10 | ||
| SUMMARY: SEPSIS DEFINITIONS ARE A WORK IN EVOLUTION | 11 | ||
| REFERENCES | 12 | ||
| Epidemiology and Outcomes | 15 | ||
| Key points | 15 | ||
| INTRODUCTION | 15 | ||
| INCIDENCE AND TEMPORAL TRENDS OF SEPSIS | 15 | ||
| REASONS FOR VARIABILITY IN REPORTED INCIDENCE OF SEPSIS | 16 | ||
| Case Definitions | 17 | ||
| Impact of Sepsis-3 Definition on Estimates of Sepsis Epidemiology | 17 | ||
| Policies | 17 | ||
| Access to Care | 18 | ||
| SHORT-TERM MORTALITY | 18 | ||
| ETIOLOGY AND SITE OF INFECTION | 19 | ||
| Etiology | 19 | ||
| Site of Infection | 20 | ||
| RISK FACTORS FOR SEPSIS AND MORTALITY | 21 | ||
| Demographics | 21 | ||
| Socioeconomic Status and Race | 21 | ||
| SPECIAL POPULATIONS | 22 | ||
| Maintenance Dialysis | 22 | ||
| Immunodeficiency | 22 | ||
| Maternal Sepsis | 22 | ||
| Postoperative Patients | 22 | ||
| Trauma Patients | 23 | ||
| COST OF SEPSIS | 23 | ||
| Length of Intensive Care Unit and Hospital Stay | 23 | ||
| Financial Cost | 23 | ||
| SUMMARY | 23 | ||
| REFERENCES | 24 | ||
| Immune Activation in Sepsis | 29 | ||
| Key points | 29 | ||
| INTRODUCTION | 29 | ||
| Overview of Innate and Adaptive Immune System Response to Pathogens | 30 | ||
| Complement and Coagulation Cascades in Sepsis | 30 | ||
| Danger Signals and Sepsis | 31 | ||
| Danger Signal Sensors | 31 | ||
| Transduction of Danger Signals by Pattern Recognition Receptors | 31 | ||
| Amplification | 31 | ||
| Host Response Patterns in Sepsis | 32 | ||
| Cytokines and Other Mediators in Sepsis | 32 | ||
| Compartmentalization of Host Responses | 32 | ||
| How Immune Responses Become Dysregulated Remains Unclear | 38 | ||
| REFERENCES | 38 | ||
| Pathophysiology of Septic Shock | 43 | ||
| Key points | 43 | ||
| INTRODUCTION | 43 | ||
| PERIPHERAL VASODILATION | 43 | ||
| Norepinephrine, Epinephrine, and Phenylephrine | 44 | ||
| Dopamine | 45 | ||
| Vasopressin | 45 | ||
| Methylene Blue | 45 | ||
| Angiotensin II | 46 | ||
| Inotropic Agents to Complement Vasopressors in Septic Shock | 46 | ||
| ENDOTHELIAL INJURY, VASCULAR LEAK, AND PERMEABILITY | 46 | ||
| Therapies That Limit Increased Endothelial Permeability Could Limit Fluid Requirements and the Risk of Fluid Overload | 47 | ||
| HYPOVOLEMIA AND VOLUME RESUSCITATION | 49 | ||
| How Much Fluid? How Does One Monitor Adequacy of Fluid Resuscitation? | 49 | ||
| What Type of Fluid? | 50 | ||
| MYOCARDIAL DYSFUNCTION DURING SEPTIC SHOCK: PATHOGENESIS AND THERAPY | 50 | ||
| Pathogenesis of Sepsis-Induced Cardiac Dysfunction | 50 | ||
| RATIONAL DIAGNOSIS OF ACUTE SEPTIC HEART FAILURE | 50 | ||
| Therapy for Acute Sepsis-Induced Heart Failure: Should We Reject Inotropic and Chronotropic Agents and Focus on Increasing ... | 52 | ||
| Therapies to Reduce Heart Rate Beyond Esmolol | 53 | ||
| DISCLOSURE | 54 | ||
| REFERENCES | 54 | ||
| Mechanisms of Organ Dysfunction in Sepsis | 63 | ||
| Key points | 63 | ||
| INTRODUCTION | 63 | ||
| MICROVASCULAR DYSFUNCTION | 64 | ||
| Mechanisms of Microvascular Dysfunction: Endothelial Injury and Loss of Autoregulation | 64 | ||
| Consequences of Altered Microvascular Flow | 66 | ||
| METABOLIC REPROGRAMING | 67 | ||
| Resistance and Tolerance | 67 | ||
| Metabolic Reprogramming as a Cell Survival Strategy | 68 | ||
| Metabolic Reprogramming: From Oxidative Phosphorylation to Aerobic Glycolysis | 70 | ||
| Respiratory Electron Transport Chain Inhibition | 70 | ||
| Cellular Regulation of Mitochondria: Mitophagy and Biogenesis | 70 | ||
| Regulation of the Cell Cycle | 72 | ||
| ORGAN CROSSTALK | 73 | ||
| Autonomic Nervous System | 74 | ||
| SUMMARY | 74 | ||
| REFERENCES | 74 | ||
| Endocrine and Metabolic Alterations in Sepsis and Implications for Treatment | 81 | ||
| Key points | 81 | ||
| INTRODUCTION | 81 | ||
| THE NEUROENDOCRINE RESPONSES TO SEPSIS | 83 | ||
| The Hypothalamic-Pituitary-Adrenal Axis | 83 | ||
| The Hypothalamic-Pituitary-Thyroid Axis | 85 | ||
| The Somatotropic Axis | 86 | ||
| The Male Gonadal Axis and Prolactin | 88 | ||
| Summary of the Neuroendocrine Responses to Sepsis | 88 | ||
| METABOLIC RESPONSES TO SEPSIS | 88 | ||
| Stress Hyperglycemia | 88 | ||
| Anorexia and Artificial Feeding | 90 | ||
| SUMMARY AND FUTURE DIRECTIONS | 91 | ||
| REFERENCES | 91 | ||
| Management of Sepsis-Induced Immunosuppression | 97 | ||
| Key points | 97 | ||
| INTRODUCTION: THE PROCESS OF SEPSIS-INDUCED IMMUNOSUPPRESSION | 97 | ||
| MANAGEMENT GOALS AND STRATEGIES | 98 | ||
| Is There Still Room for Anti-inflammatory Strategies in Sepsis? | 98 | ||
| Extracorporeal Therapies | 98 | ||
| Intravenous Immunoglobulin | 99 | ||
| Interferon Gamma | 99 | ||
| Granulocyte Macrophage Colony-Stimulating Factor | 100 | ||
| Interleukin 7 | 100 | ||
| Immune Checkpoint Inhibitors | 101 | ||
| PERSPECTIVES | 101 | ||
| Novel Design for Randomized Controlled Trial in Sepsis | 101 | ||
| Beyond Sepsis: Broadening the Area of Application | 102 | ||
| The Future | 102 | ||
| SUMMARY | 103 | ||
| REFERENCES | 103 | ||
| Nutrition Therapy in Sepsis | 107 | ||
| Key points | 107 | ||
| INTRODUCTION | 107 | ||
| MANAGEMENT GOALS FOR NUTRITION IN SEPSIS | 108 | ||
| Acute Catabolic Phase of Sepsis | 108 | ||
| Acute phase: adequate protein and moderated nonprotein calories | 108 | ||
| Chronic and Recovery Phase of Sepsis: Significantly Increased Protein and Calorie Needs | 116 | ||
| Chronic phase: postresuscitation increase in nutrition delivery | 116 | ||
| Recovery phase: continued increase in nutrition delivery needs: role of the Minnesota Starvation Study in intensive care un ... | 116 | ||
| Current Practice of Nutrition in Sepsis and Intensive Care Units Worldwide: Do We Already Hypocalorically Feed Our Patients ... | 117 | ||
| Intensive Care Unit/Hospital Discharge Nutrition Delivery to Optimize Recovery | 118 | ||
| Correction of Vitamin/Micronutrient Deficiencies and Specific Nutrient Delivery | 119 | ||
| Micronutrients and electrolytes | 119 | ||
| Thiamine | 119 | ||
| Vitamin C and antioxidants | 119 | ||
| Vitamin D | 119 | ||
| Glutamine | 120 | ||
| Lipids | 120 | ||
| SUMMARY | 121 | ||
| REFERENCES | 121 | ||
| Common Sense Approach to Managing Sepsis | 127 | ||
| Key points | 127 | ||
| THE SURVIVING SEPSIS CAMPAIGN GUIDELINES AND CARE BUNDLES | 128 | ||
| HOW SHOULD THE SURVIVING SEPSIS CAMPAIGN GUIDELINES BE USED? | 128 | ||
| HOW TO MANAGE THE PATIENT WITH SEPSIS? | 129 | ||
| IDENTIFICATION OF PATIENTS WITH SEPSIS | 129 | ||
| INITIAL RESUSCITATION AND ONGOING CIRCULATORY MANAGEMENT | 130 | ||
| Fluid Therapy | 130 | ||
| Vasopressors | 133 | ||
| Inotropes | 133 | ||
| Blood Transfusion | 134 | ||
| Hemodynamic Monitoring | 134 | ||
| ANTIMICROBIAL THERAPY | 134 | ||
| PERSPECTIVE | 135 | ||
| REFERENCES | 135 | ||
| Biomarkers in Sepsis | 139 | ||
| Key points | 139 | ||
| INTRODUCTION | 139 | ||
| TRADITIONAL (PROTEIN) BIOMARKERS | 141 | ||
| NEW BIOMARKERS DERIVED FROM OMICS RESEARCH | 143 | ||
| RNA Biomarkers | 144 | ||
| Proteomics and Metabolomics | 146 | ||
| FUTURE PERSPECTIVES | 148 | ||
| REFERENCES | 149 | ||
| Personalizing Sepsis Care | 153 | ||
| Key points | 153 | ||
| PROTOCOLS, GUIDELINES, AND PROCESS OF CARE | 153 | ||
| INDIVIDUALIZED PHYSIOLOGIC ENDPOINTS | 154 | ||
| SEPSIS — AN UMBRELLA SYNDROME | 155 | ||
| SEPSIS — A SERIES OF BIOLOGICAL PHENOTYPES WITH DIFFERING OUTCOMES | 156 | ||
| SEPSIS — OUTCOMES DIFFER BY INTERVENTION ACCORDING TO BIOLOGICAL PHENOTYPE | 157 | ||
| TRIAL DESIGN | 157 | ||
| REFERENCES | 158 | ||
| Novel Interventions | 161 | ||
| Key points | 161 | ||
| INTRODUCTION | 161 | ||
| PHARMACOLOGIC TREATMENT OPTIONS | 162 | ||
| Endothelial Cell Protection | 162 | ||
| Vasopressin | 162 | ||
| Interferon-beta | 162 | ||
| Thrombomodulin | 163 | ||
| Other experimental agents | 163 | ||
| Immunostimulation | 164 | ||
| Granulocyte-colony stimulating factor and granulocyte-macrophage colony stimulating factor | 164 | ||
| Interferon-gamma | 164 | ||
| Interleukin-7 and interleukin-15 | 164 | ||
| Programmed cell death 1 and programmed death ligand 1 | 165 | ||
| NONPHARMACOLOGIC EXPERIMENTAL TREATMENT OPTIONS | 166 | ||
| Blood Purification | 166 | ||
| CHALLENGES | 168 | ||
| SUMMARY | 169 | ||
| REFERENCES | 169 | ||
| Improving Long-Term Outcomes After Sepsis | 175 | ||
| Key points | 175 | ||
| INTRODUCTION | 175 | ||
| MANAGEMENT GOALS | 176 | ||
| In the Intensive Care Unit | 176 | ||
| In the Hospital | 177 | ||
| After Discharge | 178 | ||
| PHARMACOLOGIC STRATEGIES | 179 | ||
| Treatment of Sepsis | 179 | ||
| Stress Ulcer Prophylaxis | 179 | ||
| Pharmacologic Management of Pain and Agitation | 179 | ||
| Medications Associated with Intensive Care Unit–Acquired Weakness | 179 | ||
| Medication Reconciliation and Titration | 180 | ||
| NONPHARMACOLOGIC STRATEGIES | 180 | ||
| Intensive Care Unit Diaries | 180 | ||
| Early Activity and Mobility | 180 | ||
| Cognitive Therapy | 181 | ||
| Family Engagement | 181 | ||
| Intensive Care Unit Follow-up Clinics | 181 | ||
| SELF-MANAGEMENT STRATEGIES | 182 | ||
| Symptom Management | 182 | ||
| Exercise and Rehabilitation | 182 | ||
| Peer-to-Peer Support | 182 | ||
| EVALUATION, ADJUSTMENT, RECURRENCE | 182 | ||
| Evaluation | 182 | ||
| Adjustment | 182 | ||
| Recurrence | 183 | ||
| SUMMARY | 183 | ||
| REFERENCES | 183 |