TY  - CHAP
M1  - Book, Section
TI  - Chapter 46. Sepsis with Acute Organ Dysfunction
A1  - Ely, E. Wesley
A1  - Goyette, Richert E.
A2  - Hall, Jesse B.
A2  - Schmidt, Gregory A.
A2  - Wood, Lawrence D.H.
PY  - 2005
T2  - Principles of Critical Care, 3e
AB  - Sepsis  is  the  combination  of  a  known  or  suspected  infection  and  an  accompanying  systemic  inflammatory  response.Severe  sepsis  is  sepsis  with  acute  dysfunction  of  one  or  more  organ  systems;  septic  shock  is  a  subset  of  severe  sepsis.Severe  sepsis  is  common,  frequently  fatal,  and  expensive.  More  than  750,000  cases  occur  annually  in  the  United  States.Effective  management  of  patients  with  severe  sepsis  requires  early  identification,  cardiopulmonary  support,  antibiotics,  source  control,  and  general  supportive  care.The  prognosis  of  the  patient  with  severe  sepsis  is  related  to  the  number  of  dysfunctional  organs.Cardiopulmonary  support  consists  of  early  and  aggressive  fluid  resuscitation,  maintenance  of  mean  arterial  pressure  at  65  mm  Hg  or  higher,  and  measures  to  maximize  and  maintain  tissue  oxygenation;  judging  the  adequacy  of  tissue  oxygenation  is  informed  by  measurement  of  the  mixed  venous  oxygen  saturation,  and  supportive  therapy  is  most  effective  and  beneficial  when  provided  in  the  first  hours  of  presentation.Patients  should  receive  early  intravenous  empirical  antibiotics  directed  at  all  possible  sources  of  infection.  Appropriate  antibiotics  decrease  the  mortality  rate  by  10%  to  15%  in  patients  with  severe  sepsis.Source  control  can  be  surgical  or  nonsurgical  and  is  intended  to  remove  or  lessen  the  burden  from  the  primary  focus  of  infection.Despite  appropriate  antibiotics,  source  control,  and  organ  support,  the  mortality  rate  in  patients  with  severe  sepsis  remains  at  28%  to  50%.Specific  antisepsis  interventions  have  recently  been  introduced  that  target  multiple  pathophysiologic  aspects  of  the  sepsis  cascade  and  can  improve  outcomes.To  maximize  outcomes,  supportive  measures  must  be  introduced  to  ensure  proper  nutrition;  maintain  fluid,  glucose,  and  electrolyte  homeostasis;  promote  tissue  oxygenation;  and  prevent  complications.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2022/05/28
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=2290047
ER  -