Severe Sepsis and Septic Shock: Review of the Literature and Emergency Department Management Guidelines

Nguyen, H. Bryant; Rivers, Emanuel P.; Abrahamian, Fredrick M.; Moran, Gregory J.; Abraham, Edward; Trzeciak, Stephen; Huang, David T.; Osborn, Tiffany M.; Stevens, Dennis L.; Talan, David A.

doi:10.1016/j.annemergmed.2006.02.015

Cited by 276 publications

(256 citation statements)

References 263 publications

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“…It has been suggested that blockage of the main receptors that mediate recognition of bacteria and their products may be a suitable strategy for treating sepsis shock syndrome, which, at present, has a high mortality rate (up to 70% in septic patients) (30,31). Accordingly, strategies targeting or using several innate immune receptors, such as activated protein C, TLR2, or CD14, are being currently tested in animal models of septic shock and also in clinical trials (32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

CD6 binds to pathogen-associated molecular patterns and protects from LPS-induced septic shock

Sarrias

Farnós

Mota

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

100

118

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CD6 is a lymphocyte receptor that belongs to the scavenger receptor cysteine-rich superfamily. Because some members of the scavenger receptor cysteine-rich superfamily act as pattern recognition receptors for microbial components, we studied whether CD6 shares this function. We produced a recombinant form of the ectodomain of CD6 (rsCD6), which was indistinguishable (in apparent molecular mass, antibody reactivity, and cell binding properties) from a circulating form of CD6 affinity-purified from human serum. rsCD6 bound to and aggregated several Gram-positive and -negative bacterial strains through the recognition of lipoteichoic acid and LPS, respectively. The K d of the LPS-rsCD6 interaction was 2.69 ؎ 0.32 ؋ 10 ؊8 M, which is similar to that reported for the LPS-CD14 interaction. Further experiments showed that membrane CD6 also retains the LPS-binding ability, and it results in activation of the MAPK signaling cascade. In vivo experiments demonstrated that i.p. administration of rsCD6 before lethal LPS challenge significantly improved mice survival, and this was concomitant with reduced serum levels of the proinflammatory cytokines TNF-␣, IL6, and IL-1␤. In conclusion, our results illustrate the unprecedented bacterial binding properties of rsCD6 and support its therapeutic potential for the intervention of septic shock syndrome or other inflammatory diseases of infectious origin.bacterial cell component ͉ innate immunity ͉ lymphocyte surface receptor

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Section: Discussionmentioning

confidence: 99%

CD6 binds to pathogen-associated molecular patterns and protects from LPS-induced septic shock

Sarrias

Farnós

Mota

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

100

118

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“…Several studies demonstrate improved patient outcomes when initial interventions are administered within the first six hours of care. Further emphasizing the importance of timely and organized intervention, care administered during the first hour, often termed the "golden hour" is associated with improved patient outcomes [4] .…”

Section: Review Of the Literaturementioning

confidence: 99%

Early recognition and rapid intervention of sepsis: Implementation of a focused educational initiative emphasizing early goal-directed therapy in the emergency department

Moser

2014

JNEP

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Introduction: Prompt recognition of Systemic Inflammatory Response Syndrome (SIRS)/sepsis and early initiation of goal-directed therapy in the emergency department is vital for improved patient outcomes. The aim of this educational initiative was to implement an educational program detailing the imperative steps within the "golden hour" of early recognition and intervention of SIRS/sepsis in the emergency department and analyze the effectiveness of the intervention.Methodology: This performance improvement project was the program evaluation of a mandatory educational initiative, incorporating a retrospective, repeated measures, test-retest, time series design for registered nurses working in the emergency department who were specifically trained in the emergency department triage (n = 38), at an emergency department between January 2008-March 2008. Conclusions/Significance:Results of the statistical analysis showed a positive change between pre-test (t1) and initial post-test (t2) scores, (t1 and t2) p = .000, (95% CI -5.072, -3.402), indicating understanding of the educational material provided and between (t1) and one-month post-test (t3) scores, (t1 and t3) p = .0001, (95% CI -5.345, -3.780), showing retention of the educational material. The educational initiative implemented in the emergency department was beneficial in educating the nurses and resulted in practice change at the facility. As a result, the educational initiative was implemented as a house-wide annual nursing competency. The initiative was instrumental in the development of a house-wide interprofessional, collaborative sepsis task force.

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“…In patients with sepsis, heparin can applied for deep venous thrombosis prophylaxis and stress ulcer prophylaxis [28].…”

Section: Treatmentmentioning

confidence: 99%

Sepsis and Septic Shock: Current Treatment Strategies and New Approaches

et al. 2017

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Sepsis is a complex condition characterized by the simultaneous activation of inflammation and coagulation in response to microbial insult. These events manifest as systemic inflammatory response syndrome or sepsis symptoms through the release of proinflammatory cytokines, procoagulants, and adhesion molecules from immune cells and/or damaged endothelium. Today, sepsis is a severe multisystem disease with difficult treatments for its manifestations and high mortality rates. In the last two decades in particular, many studies have been conducted on sepsis that cause shock, multiorgan dysfunction, and organ failure by especially leading to hemodynamic changes. In sepsis, increasing antibiotic resistance and medicine-resistant hemodynamic changes have resulted in further research on new treatment modalities in addition to classical treatments. In the last decade, the sepsis physiopathology has been elucidated. Various therapeutic agents have been used in addition to antibiotherapy, but no satisfactory results have been obtained. This review summarizes the sepsis pathophysiology, current treatment protocols, and new approaches.

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Severe Sepsis and Septic Shock: Review of the Literature and Emergency Department Management Guidelines

Cited by 276 publications

References 263 publications

CD6 binds to pathogen-associated molecular patterns and protects from LPS-induced septic shock

CD6 binds to pathogen-associated molecular patterns and protects from LPS-induced septic shock

Early recognition and rapid intervention of sepsis: Implementation of a focused educational initiative emphasizing early goal-directed therapy in the emergency department

Sepsis and Septic Shock: Current Treatment Strategies and New Approaches

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