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  • Image not available. The spectrum of microorganisms associated with sepsis has changed from predominantly gram-negative bacteria in the late 1970s and 1980s to gram-positive bacteria as the major pathogens since the 1990s.
  • Image not available. Candidemia is a major cause of morbidity and mortality. Candida albicans remains the most common pathogen (45.6%); however, non–C. albicans Candida species collectively is more frequently isolated (54.4%).
  • Image not available. Sepsis presents a complex pathophysiology, characterized by the activation of multiple overlapping and interacting cascades leading to systemic inflammation, a procoagulant state, and decreased fibrinolysis.
  • Image not available.Mortality rates with sepsis are higher for patients with preexisting disease, intensive care unit care, and multiple organ failure.
  • Image not available. Prompt initiation of broad-spectrum, parenteral antibiotic therapy is required due to the high incidence of complications and mortality with sepsis.
  • Image not available. A significant volume of fluid leaks from the vasculature occurs with sepsis, and initial fluid resuscitation with large volumes of fluid is required. There is no clinical outcome difference between colloid and crystalloid fluid resuscitation.
  • Image not available.Norepinephrine is generally preferred over dopamine as the vasopressor to correct hypotension in septic shock. Low-dose dopamine does not maintain or improve renal function.
  • Image not available. Early goal-directed therapy of sepsis, consisting of hemodynamic monitoring with a central venous catheter, volume resuscitation, inotropic therapy, and red blood cell transfusions, demonstrated a significant clinical outcome benefit with a 16% absolute reduction in 28-day mortality.
  • Image not available. A blood glucose level less than150 mg/dL is recommended for the majority of critically ill patients to reduce morbidity and mortality without the detrimental effects associated with hypoglycemia.
  • Image not available. IV hydrocortisone is recommended for adult patients with septic shock whose blood pressure is unresponsive to fluids and vasopressors.
  • Image not available. Drotrecogin (recombinant human activated protein C), which has both antiinflammatory and anticoagulant properties, was associated with a 6.1% reduction in 28-day all-cause mortality in comparison to placebo and should be used in patients at high risk of death.

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On completion of the chapter, the reader will be able to:

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  • 1. Define the following terms: systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, and acute respiratory distress syndrome (ARDS).
  • 2. Describe the typical clinical presentation, including signs, symptoms, vital signs, hemodynamic measures, and laboratory tests, for each condition above.
  • 3. Describe the microbiologic causes of sepsis.
  • 4. Describe the mechanism of sepsis, including components involving inflammatory cytokines and other mediators, the role of various cells, and the coagulation system.
  • 5. Describe the priorities for treatment of sepsis.
  • 6. Given a description of a patient with sepsis, select the most appropriate treatments.
  • 7. Determine appropriate fluid resuscitation for sepsis with colloids or crystalloids.
  • 8. Recommend an appropriate antibiotic regimen for treatment of sepsis based on patient characteristics and site of primary infection.
  • 9. Determine the role of vasoactive agents in supporting the physiologic function of a patient with sepsis, and be able to select the appropriate agent given details of a patient’s condition.
  • 10. Describe the appropriate role of low-dose and high-dose corticosteroids in patients with ...

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