Sepsis: Back on Track
DOI:
https://doi.org/10.24950/rspmi.364Keywords:
Sepsis/diagnosis, Sepsis/therapyAbstract
Sepsis prevalence is increasing worldwide, but its management is challenging because it has no specific diagnostic criteria or surrogate markers, Definitions have been changing and Sepsis 3 is part of this confusion: because instead of 1 has proposed 2 different criteria (qSOFA and SOFA), depending on place where the patient is evaluated, with different descriptors for the same parameter. S3 ignored the SIRS’ concept and has centered their criteria in the recognition of the most severe patients with higher mortality, instead of focusing early recognition.
The Surviving Sepsis Campaign 2021 Recommendations, rescan good clinical sense, refuse qSOFA, recognized the importance of SIRS, early recognition and clinical-centered evaluation and treatment strategies. It is the territory of choice of Internists either in outpatient clinic or emergency
departments and wards This text intends to review the components of the RSSC 2021 that benefit from the intervention of the Internists and General and General Partitioners based on interventions that effectively save lives in sepsis.
Downloads
References
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021 1;49:e1063-143. doi: 10.1097/CCM.0000000000005337.
Vincent JL, Singer M, Einav S, Moreno R, Wendon J, Teboul JL, et al.. Equilibrating SSC guidelines with individualized care. Crit Care. 2021;25:397. doi: 10.1186/s13054-021-03813-0.
Vincent JL, Marshall JC. Surviving sepsis: a guide to the guidelines. Crit Care. 2008;12:162. doi:10.1186/cc6924.
Abraham E, Matthay MA, Dinarello CA, Vincent JL, Cohen J, Opal SM et al. Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: time for a reevaluation in Crit Care Med. 2000 Jan;28(1):232-5. doi:10.1097/00003246-200001000-00039
Carneiro AH, Póvoa P, Andrade Gomes J - Novidades na Sépsis com Implicações na Prática Clínica in Medicina Interna. Rev Soc Port Med Interna. 2016; 23: 44-52.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801-10. doi:10.1001.Jama.2016.0287
Gomes JA. Sepse: os critérios do Sr. Machado. Rev Bras Ter Intensiva; 2017;29:261-63. doi:10.5935/0103-507X.20170037
Carneiro AH, Gomes JA, Póvoa P, Cara Sépsis-3, Lamentamos Dizer-lho, Mas Não Gostamos de Si. Rev Soc Port Med Interna. 2016; 23: 56-60.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med;31:1250-6. doi:10.1097/01.CCM.0000050454.01978.3B.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fain AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644-55. doi: 10.1378/chest.101.6.1644
Carneiro AH, Manual do Curso de Sépsis e Infeção Grave da Reanima 2021. Lisboa: REanima;2021.
Vincent JL, Ince C, Bakker J. Clinical review - Circulatory shock - an update - a tribute to Professor Max Harry Weil. Crit Care.2012;16: 239. doi:10.1186/cc11510
Vincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Crit Care. 2021;27:298-302. doi: 10.1097/MCC.0000000000000824
Marshall JC, Deutschman CS. The multiple organ dysfunction syndrome: syndrome, metaphor, and unsolved clinical challenge. Crit Care Med. 2021;49:1402-13. doi: 10.1097/CCM.0000000000005139.
Cecconi M, Hernandez G, Dunser M, Antonelli M, Baker T, Bakker J, et al. Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force. Intensive Care Med. 2019;45:21-32. doi: 10.1007/s00134-018-5415-2.
Klouwenberg PM, Cremer OL, Vught LA, Ong DS, Frencken JF, Schultz MJ, et al. Likelihood of infection in patients with presumed sepsis at the time of ICU admission: a cohort study. Care. 2015;19:319. doi: 10.1186/s13054-015-1035-1
Vincent JL. Fluid management in the critically ill. Kidney Int. 2019;96:52-7. doi: 10.1016/j.kint.2018.11.047.
Levy MM, Dellinger RP, Townsend SR, Zwirble WTL, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med. 2010; 3: 222–31. doi: 10.1007/s00134-009-1738-3
Liu V, Morehouse JW, Soule J, Whippy A, Escobar GJ. Fluid Volume, Lactate Values, and Mortality in Sepsis Patients with Intermediate Lactate Values. Ann Am Thorac Soc. 2013;10:466-73. doi: 10.1513/AnnalsATS.201304-099OC
Koopmans NK, Stolmeijer R, Sijtsma BC, A van Beest P, Boerma EC, Veeger NJ, et al. Non-invasive assessment of fluid responsiveness to guide fluid therapy in patients with sepsis in the emergency department: a prospective cohort study Emerg Med J. 2021;38:416-22. doi: 10.1136/emermed-2020-209771.
Vincent JL, Cecconi M, Backer DD. The fluid challenge. Crit Care. 2020; 24:703. doi: 10.1186/s13054-020-03443-y
Berlin DA, Bakker J. Starling curves and central venous pressure. Crit Care. 2015;19:55. doi: 10.1186/s13054-015-0776-1
Li Y, Li H, Zhang D. Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis. Crit Care. 202; 2: 488. 10.1186/s13054-020-03204-x
Bai X, Yu W, Ji W, Lin Z, Tan S, Duan K, et al. Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care. 2014;18:532. doi: 10.1186/s13054-014-0532-y.
Russell JA, Gordon AC, Williams MD, Boyd JH, Walley KR, Kissoon N. Vasopressor Therapy in the Intensive Care Unit. Semin Respir Crit Care Med. 2021;42:59-77. doi: 10.1055/s-0040-1710320.
Gamper G, Havel C, Arrich J, Losert H, Pace NL, Müllner M, Herkner H. Vasopressors for hypotensive shock. Cochrane Database Syst Rev. 2016;2:CD003709. doi: 10.1002/14651858.CD003709.pub4.
Yang WS, Kang HD, Jung SK, Lee YJ, Oh SH, Kim YJ, et al. A mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis-3). Clin Respir J. 2020;14:857-63. doi: 10.1111/crj.13218.
Ranzani OT, Monteiro MB, Ferreira EM, Santos SR, Machado FR, Noritomi DT. Reclassifying the spectrum of septic patients using lactate: severe sepsis, cryptic shock, vasoplegic shock and dysoxic shock. Rev Bras Ter Intensiva. 2013;25:270-8. doi: 10.5935/0103-507X.20130047.
Gavelli F, Castello LM, Avanzi GC. Management of sepsis and septic shock in the emergency department. Intern Emerg Med. 2021;16:1649-61. doi: 10.1007/s11739-021-02735-7.
Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44:925-8. doi: 10.1007/s00134-018-5085-0.
Santacruz CA, Pereira AJ, Celis E, Vincent JL. Which Multicenter Randomized Controlled Trials in Critical Care Medicine Have Shown Reduced Mortality? A Systematic Review. Crit Care Med. 2019;47:1680-91. doi: 10.1097/CCM.0000000000004000.
Prescott HC, Iwashyna TJ. Improving Sepsis Treatment by Embracing Diagnostic Uncertainty. Ann Am Thorac Soc. 2019;16:426-9. doi: 10.1513/AnnalsATS.201809-646PS.
Kollef MH, Shorr AF, Bassetti M. Timing of antibiotic therapy in the ICU. Crit Care. 2021; 25: 360. doi:10.1186/s13054-021-03787-z
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2022 Medicina Interna
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
