PMID- 27940455
DCOM- 20180801
LR  - 20180801
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 117
IP  - suppl 3
DP  - 2016 Dec
TI  - Sepsis for the anaesthetist.
PG  - iii44-iii51
AB  - Sepsis is as a dysregulated systemic response to infection. Morbidity and
      mortality of the syndrome are very high worldwide. Recent definitions have
      redefined criteria for sepsis. The new definition (Sepsis-3) classifies sepsis as
      infection with organ dysfunction (the old 'severe sepsis'). Septic patients are
      at risk for secondary injuries, thus aggressive source control, resuscitation,
      and antibiotic therapy are the mainstays of management. Central to sepsis
      physiology is vasodilated shock. Many patients respond to i.v. fluid therapy.
      Pathophysiology also includes energy failure, or a cellular inability to oxidize 
      fuel, and immune incompetence, often manifest by susceptibility to
      superinfections. Sepsis treatment is optimized by timely resuscitation and
      control of infection. Early recognition and resuscitation are associated with
      improved outcomes, although no single resuscitation end point is as good as
      overall patient assessment. Dynamic resuscitation metrics might be useful to
      avoid overinfusion of fluid therapies. Antibiotics should treat likely pathogens,
      with broader coverage for sicker patients (e.g. those with septic shock).
      Avoidance of iatrogenic injury, such as ventilator-induced lung injury from large
      tidal volumes, helps to prevent subsequent tissue damage and worsened systemic
      response. Single-agent therapies to block the systemic response have not
      fulfilled promise in sepsis, probably because part of the complex syndrome is
      adaptive. However, early aggressive care based on bundles is associated with
      improved outcomes. Research opportunities include understanding the role of
      neurological, endocrine, immune, and metabolic pathophysiology in the syndrome.
CI  - (c) The Author 2016. Published by Oxford University Press on behalf of the
      British Journal of Anaesthesia. All rights reserved. For Permissions, please
FAU - Nunnally, M E
AU  - Nunnally ME
AD  - Department of Anesthesiology, NYU Medical Center, 550 1st Avenue, Tisch Room 530,
      New York, NY 10016, USA
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
SB  - IM
MH  - Anesthesia
MH  - *Anesthesiologists
MH  - Cardiopulmonary Resuscitation/*methods
MH  - Critical Care
MH  - Humans
MH  - Sepsis/diagnosis/*therapy
MH  - Shock, Septic/diagnosis/*therapy
OT  - resuscitation
OT  - sepsis
OT  - shock
EDAT- 2016/12/13 06:00
MHDA- 2018/08/02 06:00
CRDT- 2016/12/13 06:00
PHST- 2016/12/13 06:00 [entrez]
PHST- 2016/12/13 06:00 [pubmed]
PHST- 2018/08/02 06:00 [medline]
AID - aew333 [pii]
AID - 10.1093/bja/aew333 [doi]
PST - ppublish
SO  - Br J Anaesth. 2016 Dec;117(suppl 3):iii44-iii51. doi: 10.1093/bja/aew333.