Septic Shock : Symptoms, Management and Risk Factors [1 ed.] 9781622574995, 9781622574858

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Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova Science

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved. Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova

EMERGENCY AND INTENSIVE CARE MEDICINE

SEPTIC SHOCK

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

SYMPTOMS, MANAGEMENT AND RISK FACTORS

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Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova

EMERGENCY AND INTENSIVE CARE MEDICINE

SEPTIC SHOCK

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

SYMPTOMS, MANAGEMENT AND RISK FACTORS

MELVIN C. JOHNSTON AND

JEROME E. KNIGHT EDITORS

New York Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova

Copyright © 2012 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com

NOTICE TO THE READER

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers‘ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Additional color graphics may be available in the e-book version of this book.

Library of Congress Cataloging-in-Publication Data

LCCN: 2012942450 ISBN:  (eBook)

Published by Nova Science Publishers, Inc. † New York Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova

CONTENTS Preface Chapter 1

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Chapter 2

vii Pathophysiology of Cardiovascular Failure in Septic Shock Michael Eisenhut Sepsis and Septic Shock: Risk Factors, Symptoms and Management Kenji Okumura and Alan T. Lefor

Chapter 3

Septic Shock: Clinical Diagnosis and Risk Factors Diego Saa, Fernanda Galleguillos, Catherine Céspedes and Ramón Rodrigo

Chapter 4

Diagnosis and Management of Life-Threatening Infections and Septic Shock During Idiopathic Drug-Induced Agranulocytosis Emmanuel Andrès, Jacques Zimmer, Khalid Serraj and Frédéric Maloisel

Chapter 5

Sepsis: A Disease of the Microcirculation Farid Sadaka

Chapter 6

The Role of HMGB1 in Cardiac Dysfunction During Septic Shock Satoshi Hagiwara, Hideo Iwasaka and Takayuki Noguchi

Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova

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vi Chapter 7

Contents Pathophysiology of Sepsis and Septic Shock Jazmina Bongain

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Index

Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova

127 151

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

PREFACE Septic shock is a common and lethal condition that remains one of the leading causes of death in the hospital. Greater awareness, understanding of the condition and knowledge of effective management may decrease the mortality rate. In this book, the authors discuss the symptoms, management and risk factors of septic shock. Topics include the pathophysiology of cardiovascular failure in septic shock; life threatening infections and septic shock during idiopathic drug-induced agranulocytosis; the role of HMGB1 in cardiac dysfunction during septic shock; the epidemiological impact of sepsis and septic shock; and possible implications for the treatment of septic patients with interventions aimed at opening microcirculation. Chapter 1 - Recently there has been significant progress in the understanding of key pathophysiological processes in the pathogenesis of septic shock providing new targets for therapeutic approaches. Key processes involved are those leading to septic cardiomyopathy and those leading to changes in contractility of vascular smooth muscles regulating global organ perfusion and microcirculation. In septic shock up to 50% of patients manifest myocardial depression as manifested as left ventricular dilation or systolic dysfunction and septic cardiomyopathy implies a worse prognosis. Inflammatory mediators in circulation in sepsis such as tumor necrosis factor, interleukin-1 and interleukin-6 cause myocardial depression. These inflammatory mediators act through G-protein coupled receptors and nitric oxide which regulate the phosphorylation state of the myocardial and vascular smooth muscle ion channels, beta receptors mediating action of endogenous and exogenous vasoconstrictors and inotropes and contractile proteins through action of protein kinases and through activation of Poly(adenosine 5'diphosphate-ribose) polymerase (PARP). In addition to action on electro-

Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

viii

Melvin C. Johnston and Jerome E. Knight

physiology of myocardial and vascular smooth muscle myocytes sepsis may induce microvascular failure leading to myocardial cell dysfunction correlating with elevated cardiac troponin levels in septic patients, which relate to mortality. There is strong evidence that microcirculatory disorders occur in the course of septic shock with a decrease of density of perfused capillaries with sluggish or stop-flow perfusion patterns. Future research needs to explore modification of action of protein kinases to counteract inactivation of calcium channels directly and improve function of myocytes by reducing nitrosylation of key proteins with substances with effects similar to NG-methyl-L-arginine, a nonspecific NOS inhibitor. Chapter 2 - Septic shock is a common and lethal condition that remains one of the leading causes of death in the hospital. Greater awareness, understanding of the condition and knowledge of effective management may decrease the mortality rate. Current theories about the onset and progression of sepsis and SIRS focus on dysregulation of the inflammatory response, which can lead to multiple organ dysfunction syndrome (MODS). To prevent and manage MODS, which is a leading cause of mortality in these patients, it is essential to treat septic shock. Early goal-directed therapy, which has been shown to improve outcomes, has been applied to patients with severe sepsis or septic shock. Early awareness of septic shock is important to start early goaldirected therapy. Acknowledgement of the early clinical symptoms and risk factors of septic shock are critical for the prevention of MODS. This independent review of existing literature examines recent advances in severe sepsis and septic shock, especially regarding risk factors, diagnostic symptoms and initial management for adults. Recommendations are provided for therapies that have been shown to improve outcomes, including early goaldirected therapy, early and appropriate use of antimicrobial agents and source control. Chapter 3 - Septic shock is an important cause of mortality among critically ill patients. It arises out of a complex interaction between a susceptible host and a virulent pathogen. This interaction causes a massive release of different inflammatory mediators, reactive oxygen and nitrogen species and microbial antigens to bloodstream, and activation of different cell populations, e.g. leukocytes and endothelial cells. The result of such chaotic, uncontrolled and deregulated inflammatory cascade damages different organ tissues, which leads to multiple organ dysfunction syndrome and eventually, death. Once diagnosed the occurrence of septic shock, antibiotic and fluid therapies have been proven effective, while identification of this condition remains challenging. So, to increase survival rates and to improve clinical

Septic Shock : Symptoms, Management and Risk Factors, edited by Melvin C. Johnston, and Jerome E. Knight, Nova

Copyright © 2012. Nova Science Publishers, Incorporated. All rights reserved.

Preface

ix

outcomes in critically ill patients, clinical behavior should be focused in early and accurate identification of risk factors and diagnosis. Also novel biomarkers research and development of new diagnostic laboratory tools should be promoted. Altogether, these progresses may provide a better understanding of the pathophysiological mechanisms underlying this pathology, which could result in better and earlier target-specific therapeutical strategies to prevent its progression to multiple organ dysfunction syndrome and death. Chapter 4 - In this chapter, we report and discuss the diagnosis and management of life-threatening infections and septic shock during acute and severe neutropenia (neutrophil count of 65 years), septicemia or shock, metabolic disorders such as renal failure, and a neutrophil count below 0.1×109/L have been consensually accepted as poor prognostic factors. In this potentially life-threatening disorder, modern management with broad-spectrum antibiotics and hematopoietic growth factors (particularly G-CSF), is likely to improve the prognosis. Thus, with appropriate management, the mortality rate of idiosyncratic drug-induced agranulocytosis is currently around 5%. Chapter 5 - Regional tissue distress caused by microcirculatory dysfunction underlies the parthophysiology in sepsis. Despite correction of systemic oxygen delivery variables and macrocirculatory variables, regional hypoxia and oxygen extraction deficit persist. The microcirculation consists of the smallest blood vessels (