The Sepsis Codex

1st Edition - November 30, 2022
Editors: Marcio Borges, Jorge Hidalgo, Javier Perez-Fernandez
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 8 8 2 7 1 - 2
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 8 8 2 8 0 - 4

Offering a global, multidisciplinary perspective on this life-threatening medical emergency, The Sepsis Codex provides a concise yet comprehensive look at a complex topic. Nearly… Read more

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Offering a global, multidisciplinary perspective on this life-threatening medical emergency, The Sepsis Codex provides a concise yet comprehensive look at a complex topic. Nearly 20% of global deaths are attributed to sepsis annually, nearly half of which are in children under the age of five, with low-resource settings being disproportionately affected. A “one size fits all” approach is not sufficient to meet individual patients’ needs, instead requiring a therapeutic approach that considers different ages, predisposing factors, genetic traits, and more. This cutting-edge resource brings you up to date with recent medical advances in this challenging area.

Cover image
Title page
Table of Contents
Copyright
Dedication
List of Contributors
Preface
Acknowledgments
Part I. Introduction
Chapter 1. Sepsis: Past, Present, and Future—Lessons Learned from COVID-19
Conclusions
Chapter 2. Sepsis Definitions: A Historical Perspective
What Is Sepsis?
Sepsis Through the Years
Future Directions
Conclusions
Chapter 3. The Epidemiology of Sepsis
Introduction
Limitations and Challenges
Conclusions
Part II. Basic Concepts
Chapter 4. Pathophysiology of Sepsis
Introduction
Immunology
Endothelium
Shock and Organ Failure
The Neuroendocrine Response
Metabolic Response to Sepsis
Conclusion
Chapter 5. Sepsis and Microcirculation
Introduction
Macrocirculation
Microcirculation in Sepsis
Clinical Assessment
Skin Mottling
Peripheral Perfusion Index
Biochemical Markers
Plasma Lactate
Handheld Vital Microscopy
Chapter 6. Genetics and Sepsis
Genetics and Sepsis
Sepsis Response
Genetic Variability
Human Genome
Finding the Genes
Key Genes
Personalized and Precision Medicine
Part III. Diagnosis and Monitoring
Chapter 7. Screening and early detection of sepsis
Introduction
Limitations for sepsis detection
Early detection
Diagnosis
Bundle of the early detection
Experience and impact of the early sepsis detection
Other possibilities for early sepsis detection/screening
Summary
Chapter 8. Diagnosis and Monitoring of Sepsis
Introduction
Sepsis Definitions and Controversies
SIRS and Surrounding Controversies
Organ Dysfunction/Failure Criteria
Severity Scores: A Critical Assessment
Chapter 9. Sepsis: Molecular Diagnostics and Biomarkers
Introduction
Biomarkers as Clinical Tools
Established Biomarkers
Emerging Molecular Approaches
Nondiagnostic Utility of Biomarkers
Summary
Chapter 10. Hemodynamic Monitoring: Current Practice and New Perspectives
Introduction
Current Practice Based on International Experts' Recommendations
Improvement of Available Minimally or Noninvasive Technologies
New Noninvasive Hemodynamic Monitoring Technologies
Clinical Application of Technologies Assessing Microcirculation Currently Used for Research Purpose
Automation/Artificial Intelligence/Machine Learning
Conclusion
Chapter 11. Point of Care Ultrasound in the Management of Sepsis
Objectives
Introduction
Case Presentation
Is POCUS Helpful in Managing This Patient?
Role of POCUS in the Diagnosis of Sepsis
Preload Sensitivity and Volume Responsiveness
Inferior Vena Cava Assessment
Tips and Tricks
Variations in the Left Ventricular Outflow Tract Velocity Time Interval
Passive Leg Raise Test
Tips and Tricks for Performing an Accurate PLR Test
Left Ventricle Systolic Dysfunction
Left Ventricle Diastolic Dysfunction
How to Assess?
Tips and Tricks
Right Ventricle Dysfunction in Sepsis
POCUS-Guided Management in Septic Shock
Key Points
Chapter 12. New Approaches and Understanding of Sepsis
Introduction
Monitoring Clinical Signs
Diagnosis
Monitoring with Biomarkers and Practical Application of Monitoring Systems in the Different Phases of Sepsis
Infectious Monitoring
Monitoring According with Organ Dysfunction
Treatment
Long-Term Outcome and Mortality
Chapter 13. Sepsis Quality Indicators in the Emergency Department
Introduction
Infection Prevention Indicators
Timing Indicators
Diagnostic Indicators
Perspectives
Part IV. Treatment
Chapter 14. Sepsis Treatment: Fluids
Introduction
Background: the Four D's of Fluid Therapy
Basics of the Fluid Treatment in Sepsis: the ROSE Principle and Four Phases of Fluid Resuscitation
Fluids and Their Difference: Choosing the Right Drug
Chapter 15. Vasopressor Therapy in Septic Shock
Introduction
Understanding the Relevant Pathophysiology of Septic Shock
Noradrenaline
Adrenaline
Phenylephrine
Dopamine
NonCatecholamines
Vasopressin Analogs
Selepressin
Angiotensin II
Methylene Blue
Side Effects of Vasopressor Therapy
Principles of Vasopressor Therapy
Clinical Monitoring of Vasopressor Therapy
Weaning of Vasopressor Therapy
Vasopressor Sparing Strategies
Directions of Future Research
Conclusion
Key Points
Chapter 16. Mechanical Ventilation in Sepsis
Chapter 17. Extracorporeal Membrane Oxygenation for the Support of Patients with Refractory Septic Shock
Introduction
Hemodynamics of Septic Shock
Why Might ECMO be Effective in Patients With Refractory Septic Shock?
Indications
When Initiating ECMO
Predictor Risk Factor for ECMO in Septic Shock Patients
In Conclusion
Chapter 18. Antimicrobials in the Management of Sepsis
Timeliness of Therapy
Antimicrobial Stewardship
Choice of Antimicrobial Therapy
Antimicrobial Selection
Route of Administration
Antifungal Agents
Chapter 19. Kidney Support in Sepsis
Introduction
Fluid Management in AKI
RRT Principles
Renal Replacement Therapy
Intermittent Renal Replacement Therapy
Continuous Renal Replacement Therapy
Renal Dosage Adjustment for Antimicrobials
Chapter 20. Hematological Support in Sepsis
Introduction
The Endothelium
The White Blood Cells in Sepsis
The Red Blood Cells in Sepsis
The Platelets in Sepsis
Platelets Involvement
Coagulation Factors in Sepsis
General Approach of Sepsis-Induced Coagulopathy
Chapter 21. Specific Treatment of Focus Control in Sepsis
Introduction
Educational Goals of the Chapter
Epidemiology and Short-Term Outcome of Patients with Drainable Source of Sepsis
Focus Control into the Context of the General Principles of Sepsis Management
Usefulness of Ancillary Test for General Assessment in Patients with Potentially Focus Control of Sepsis
Organ System-Specific Focus Control of Sepsis
Chapter 22. Sepsis Adjunctive Therapies
Introduction
Glycemic Control
VTE Prophylaxis
Nutrition
Stress Ulcer Prophylaxis
Long-Term Outcomes
Palliative Care
Music Therapy
Sleep Therapy
Chapter 23. Glycemic Control and Stress Ulcer Prophylaxis
Glycemic Control
Stress Ulcer Prophylaxis
Chapter 24. Nutrition in Sepsis
Introduction
Pathophysiology of Sepsis and Its Impact on Metabolism
Nutrition in Sepsis
Enteral and Parenteral Feeding
Screening for Nutritional Risk in Septic Patients
Conclusions
Part V. Special Settings
Chapter 25. Fever in Intensive Care Units
Introduction
Definitions for Fever
Measurement of Fever
Pathogenesis of Fever
Significance of Fever
Fever Patterns
Causes of Fever in the ICU
A Treatment Approach for Critically Ill Febrile Patients
Initial Investigations
Diagnostic Evaluation
Infectious Causes of Fever
Noninfectious Causes of Fever in the ICU
Treatment of Fever in the ICU
Chapter 26. Sepsis—In the Era of Antimicrobial Resistance
Introduction
Epidemiology of AMR Sepsis
Antibiotic Resistance—Genetics
Treatment
Key Points
Chapter 27. Factors Underlying Racial and Gender Disparities in Sepsis Management
Introduction
Racial Disparities
Gender Disparities
Potential Target for Interventions to Reduce Disparities
Conclusion
Chapter 28. Sepsis in Special Populations
Sepsis and Obesity
Sepsis and Cancer
Sepsis and Solid Organ Transplant Recipients
Burns and Sepsis
Chapter 29. Comprehensive Management of Sepsis in Pediatrics
Epidemiology
Definition
Identifying Sepsis, Clinical Presentation, and Complementary Diagnostic Tests
Initial Clinical Assessment
Additional Diagnostic Tests for Sepsis
Etiology and Treatment With Antimicrobials
Controlling the Source of Infection
Hemodynamic Therapy
Initial Resuscitation and Fluid-Refractory Shock (See Table 29.6)
Catecholamine-Resistant Shock
Persistent Catecholamine-Resistant Shock and Refractory Shock
Other Therapeutic Measures
Chapter 30. Maternal Sepsis
Introduction
Physiological Changes During Pregnancy and Risk Factors
Diagnosis
Treatment
Perspectives
Part VI. Special Considerations
Chapter 31. Role of Preventive Measures in Sepsis
Introduction
Challenges
Etiology and Risk Factors
Preventive Measures
Conclusions
Chapter 32. Value of the Protocolization and Sepsis Performance Improvement Program in Early Identification
Introduction
Uniformity and Protocolization
Early Warning Digital Systems and Artificial Intelligence
High-Fidelity Simulation
Chapter 33. Long-Term Sequelae of Sepsis
Introduction
Long-Term Derangements in Sepsis Survivors
Part VII. Future Outlook
Chapter 34. New Diagnostic and Therapeutic Perspectives
Introduction
The Role of Translational Research
New Molecules for Adjuvant Treatment of Sepsis
Nanotechnology
Future Directions
Chapter 35. Artificial Intelligence in Sepsis
Introduction
A High-Level Overview of Artificial Intelligence Techniques in Healthcare
Machine Learning for Sepsis
Challenges with AI for Sepsis
Conclusions
Index

Marcio Borges

Affiliations and expertise

Associate Professor of Infectious Disease Balearic Islands University; Coordinator, Multidisciplinary Sepsis Unit, Critical Care Medicine, Son Llatzer University Hospital, Palma de Mallorca, Spain

Jorge Hidalgo

Dr. Jorge Hidalgo is a Professor of Critical Care and the Head of the Division of Critical Care at Karl Heusner Memorial Hospital in Belize, Central America. He is the President Elect of the World Federation of Societies of Critical Care and Intensive Care Medicine. He has won several awards with the highest recognition and the Director of the very prestigious ACP Review Course hosted by the Paraguay Society of Internal Medicine. Due to his outstanding contribution to the Society of Critical Care Medicine he received the Presidential Citation Award. And Global Safar Award, becoming the First Latin American Intensivist to get this Nomination. He is involved in numerous congresses and a well-recognized international speaker.

Affiliations and expertise

Professor and Head, Division of Critical care, Karl Heusner Memorial Hospital, Belize, Central America

Javier Perez-Fernandez

Dr. Javier Perez-Fernandez serves as Medical Director of the Critical Care Services at Baptist Hospital of Miami. He is a Clinical Associate Professor of Medicine at Florida International University, Herbert Wertheim College of Medicine and Professor Pulmonary and Critical Care Medicine at Larkin University, Miami-Dade Florida. He is the Secretary-General of the World Federation of Intensive Care. Dr. Perez-Fernandez manages a large group of critical care physicians, South Florida Critical Care Services, overseeing the operations of seven ICUs with over 350 beds. He has been a regional and national recognized leader during the COVID-19 pandemic with multiple TV and media appearances and consulting services for several national and international organizations. He has been directly involved in the development of Rapid Response Teams, technology implementation and “open ICU” models. He has lectured worldwide and author of many original publications with the Society of Critical Care Medicine.

Affiliations and expertise

Medical Director, Critical Care Services Baptist Hospital of Miami, Florida, USA