Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
Chapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2ntly associated with the development of sepsis syndromes. Nearly 50% of patients with bacterial pneumonia develop severe sepsis, and around 5% develop septic shock, with consequent mortality rates as high as 50% (1 ]. Additionally, sepsis from any source, pulmonary or extrapulmo-nary, may result in Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2additional injury to the lung, known as the acute respiratory distress syndrome (ARDS), a syndrome characterized by an over-exuberant inflammatory resEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
ponse in the lung leading to increased alveolar-capillary permeability and predominantly non-hydrostatic pulmonary edema and hypoxemia. Although this Chapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2 loosely defined for decades. In 1994. the American-European Consensus Conference (AECC) on ARDS, comprised of members of the American Thoracic Society and the European Society of Intensive Care Medicine, published the first standardized definition of this syndrome, with the hopes that such a defini Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2tion would serve to better clarify the incidence, morbidity, and mortality associated with the syndrome, and provide homogeneous criteria which couldEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
be used to enroll patients in research protocols [3]. The committee established the following criteria, all of w hich were required to establish a diaChapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2 Antkowiak. MD • L. Mikulic. MD • B.T. Suratt, MD (S)Division of Pulmonary and Critical Care Medicine. University of Vermont College of Medicine. 89 Beaumont Avenue. Given E407. Burlington. VT 05405. USAe-mail: MaryEllen.Antkowiak@vtmednet.org: Lucas.Mikulic@vtmednet.org; Benjamin.Suratt@uvm.edu© Sp Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2ringer International Publishing AG 2017N.s. Ward. M.M. Levy (eds.). Sepsis, Respiratory Medicine, nni in inm/mo 2 ĨIO iQ,i7n a n143144M. Antkowiak elEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
al.3Bilateral infiltrates on chest radiography4Pulmonary artery wedge pressure (PAWP) < 18 mmHg or no clinical evidence of left atrial hypertensionTheChapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2hat it encompassed patients with a PaO;/FiO2 ratio of <300 [3].This definition served the clinical and research community well for more than 15 years, but throughout that period, some concerns regarding the AECC criteria were raised. The definition of acute onset was not clearly described. The clini Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2cal diagnosis of ARDS or AL1 did not always correlate well with histopathologic or autopsy findings. Chest radiograph interpretation could be highly vEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
ariable. PaOj/FiO: ratios and PAWP could be affected by the use of varying levels of PEEP, and PAWP assessment could also be affected by a variety of Chapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2 must occur within I week of a known insult or new or worsening respiratory symptoms. Although chest imaging is required to show the presence of bilateral infiltrates “not fully explained by effusions, lobar/lung collapse. or nodules,” PAWP measurements are no longer required. Instead, the new defin Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2ition states only that respiratory failure “not be fully explained by cardiac failure or fluid overload” to be considered ARDS. Furthermore, the BerliEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
n definition establishes three categories of severity based on PaO2/FiO2 ratio as measured on mechanical ventilation with a PEEP of 5 cmlFO. Severe ARChapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2as been removed from the definition entirely [4]. Retrospective analysis comparing both definitions with autopsy findings demonstrates that the Berlin criteria are more sensitive but less specific than the AECC criteria for the detection of the histopathological finding of diffuse alveolar damage [5 Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2].EpidemiologyPatients with sepsis syndromes have a markedly increased risk for the development of ARDS, with rates approaching 20%, as compared withEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
less than 1% in inpatients without evidence of sepsis 16]. Sepsis is indeed a leading risk factor for the development of ARDS. Historically, observatiChapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2de range in the incidence of ARDS, between 7.2 and 58.7/100.000 patients/year. and that pneumonia and sepsis accounted for 42.3 and 31.4% of cases of ARDS, respectively [8-11]. Additionally, the risk of ARDS is nearly three times higher in trauma patients who develop sepsis syndromes as compared wit Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2h trauma patients who do not (RR = 2.94: 95% CI. 1.51-5.74) [7]. As the severity of the sepsis syndrome increases, the risk of ARDS appears to increasEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
e as well.9 Sepsis and the Lung145In one series. 100% of patients with septic shock developed ARDS, yet only 15% of septic patients without shock met Chapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2betes has been found to be protective against the development of ARDS. Diabetic patients with sepsis are about half as likely to develop ARDS compared to nondiabetic patients with sepsis [12]. Conversely, chronic alcohol abuse appears to increase the risk of ARDS in septic patients. In one series, m Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2ore than 50% of septic patients with a history of alcohol abuse developed ARDS, while those without such history' developed ARDS in only 20% of casesEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
[13. 14].A variety of genetic polymorphisms may also predispose patients with sepsis to the development of ARDS. Certain variants of the genes encodinChapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2-phosphate receptor 3 appear to be strongly predictive ARDS risk in septic patients [16]. Furthermore, although our understanding of the interplay between genetics and ARDS risk is still limited, multistep genomic analyses of large databases of patients with sepsis from both pulmonary and extrapulmo Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2nary sources have identified a variety of single nucleotide polymorphisms (SNPs) that are associated with increased risk of the development of ARDS, wEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
hile still others have been identified as protective [17, IX].Regardless of etiology, patients with ARDS are at substantially increased risk for the dChapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2il-way protection or respiratory failure due to neuromuscular weakness). This additional injury, referred to as ventilator-induced lung injury (V1LI). has been found to occur in patients with ARDS at rales as high as 30-50% ị 19], While it has been proposed that patients w ith ARDS secondary' to a s Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2eptic etiology are at higher risk for VILI than patients with ARDS of a noil-septic etiology, at the lime of the International Consensus Conference onEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
Ventilator-Associated Lung Injury in ARDS, which convened in 1999. there was no definitive evidence of this phenomenon [19], and to date this associaChapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2tinct differences between ARDS from “direct” pulmonary sources (e.g.. pneumonia or toxic inhalation) and "indirect” extrapulmo-nary sources (e.g., sepsis of urinary origin or pancreatitis). Most observational studies suggest a higher incidence of ARDS in patients with pneumonia-related sepsis than i Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2n those with sepsis of an extrapulmonary source. One review' of the subject found that, although several published series demonstrate increased mortalEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
ity from ARDS due to pulmonary sepsis compared to extrapulmonary sepsis, others show no difference in such rates [20]. Studies aimed at identifying geChapter 9Sepsis and the LungMaryEIIen Antkowiak, Lucas Mikulic, and Benjamin T. SurattIntroductionInfections of the lung and pleural space are frequen Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2RDS in patients with pulmonary sepsis differ from those that may increase this risk in patients w ith extrapulmonary sepsis [IS], The pathophysiologic mechanisms, which are discussed in the following section, may differ. In pulmonary-related causes of ARDS, as might be expected.146M. Anikowiak et al Ebook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2.the inciting injury targets mostly the pulmonary epithelial cells; cxtrapulmonary causes of ARDS however may target the pulmonary vascular endotheliuEbook Sepsis - Definitions, pathophysiology and the challenge of bedside management: Part 2
m instead [201. Mouse models have also demonstrated a significantly greater inflammatory response in pulmonary as compared to extrapul monary ARDS [21Gọi ngay
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