Sepsis And Organ Dysfunction

An experienced physician knows how to recognize a patient suffering from sepsis, but cannot accurately determine whether the patient will survive. Cardinal elements of the treatment for sepsis include specific antibiotic and vasoactive drugs, enteral and parenteral nutrition, artificial respiration, and optimization of the oxygen transport to tissues. Nonetheless, with a certain frequency, these techniques are insufficient to ensure the recovery of a critically ill patient, especially when it is necessary to overcome functional alterations subsequent to organ and vital-system overload. The key elements in the progression of the sepsis-MODS syndrome are tied to numerous factors. These include: the severity and location of the lesion; the patient's age; the remaining functional reserve; the presence of mediatory which may be stimulatory, inhibitory or both.

Sepsis is a syndrome or sometimes it is a clinical condition evoked by uncontrolled endotoxin-reactions. These pathophysiological alterations can disturb the organism's homeostasis leading ultimately to a condition of severe organ dysfunction which in itself means a bad prognosis for patient survival. In the last decades researchers and clinicians have been involved in process directed to a better understanding of the basic mechanisms of sepsis and MODS. The best goal will be the achievement of preventive measures and optimization of management in patients suffering severe infections and critical conditions. This objective represents a true challenge at the dawn of the XXI century.

Sepsis evolution and organ dysfunction are still an enigmatic topic. Severe infection causes an important aggression of the whole body, and the so-called inflammation mediators play an important role in this evolution. It is however certain that the immune system is a key factor in sepsis progression. The volume focuses on some primary aspects such as the research of the rationale of the immune system activation during sepsis, on the molecular strategies available for ARDS treatment and on techniques of emofiltration and absorption of endotoxins through apheresis in the septic patient.

There have been tremendous advances in understanding the cellular mechanisms involved in sepsis and contributing to the development of multiple organ dysfunction and mortality in this setting. The chapters in this book provide up-to-date insights into important pathways that are initiated by sepsis.

Sepsis represents a life threatening condition to ICU patients. The evolution of sepsis to severe sepsis or septic shock may occur in an unpredictable way. In the coming millennium the prevention and management of sepsis and organ dysfunction will present a real challenge for researchers and clinicians.

Even if in the last years more information on sepsis and new treatments has become available, mortality rate is however high. In fact, the complexity of the several biohumoral factors involved in this process is difficult to understand. Another major problem is the consequent organ failure, which grows in a sequential way and in relation with the lesion gravity and the functional reserves of the patient. The volume presents the most recent results of research in this field.

Severe sepsis is among the most common causes of death in the United States and the most common cause of death in the Intensive Care Units worldwide, and its recognition and treatment remain the most important challenges of critical care medicine. Severe sepsis and septic shock have a profound effect on kidney function and the function of other organs through complex mechanisms, which involve the immune response, multiple pro and anti-inflammatory pathways, intracellular dysfunction and hemodynamic instability. Their optimal management requires complex knowledge of general medicine, immunology, nephrology, extra-corporeal technology, fluid resuscitation and critical care endocrinology. In order to deliver optimal patient care, nephrologists and intensive care medicine specialists need to understand and be highly knowledgeable in the epidemiology of sepsis, the mechanisms of injury which determine outcome and the fundamental aspects of new insights into fluid resuscitation, acid-base physiology and glucose control. They also need to have a clear appreciation of new technical developments in the monitoring of critically ill patients and in the delivery of advanced extra-corporeal blood purification therapies.Experts from the fields of intensive care medicine, nephrology, endocrinology, acid-base physiology, extra-corporeal blood purification technology and immunology have contributed to the present book, providing a cutting edge view of developments in each field which contribute to the care of patients with severe sepsis, acute renal failure and multiple organ failure. The resulting mix of fundamental knowledge and recent developments from clinical trials and laboratory research constitute a valuable tool for all professionals involved in the care of the critically ill patient.