Clinical Management of Shock - The Science and Art of Physiological Restoration最新文献

{"title":"Introductory Chapter: Shock is a Physiological State of War","authors":"S. Stawicki, T. Papadimos, M. Swaroop","doi":"10.5772/intechopen.88686","DOIUrl":"https://doi.org/10.5772/intechopen.88686","url":null,"abstract":"Among specialists in critical care medicine, emergency medicine, infectious diseases, and trauma surgery, shock elicits a sense of impending immediacy and sets off a cascade of clinical interventions designed to support systemic circulation. This includes urgent focus on ensuring end-organ perfusion, definitive treatment of the underlying cause (from anaphylaxis to sepsis), and providing subsequent physiological restoration. Despite the apparent heterogeneity of “shock” as a clinico-pathological entity, there are some common threads that permeate all forms and manifestations of shock, with apparent increase in observed commonalities in the more advanced (and often irreversible) stages of the systemic syndrome [1–7]. Let us take a closer look at septic shock as an excellent example of the above concepts. More than 19 million people annually develop sepsis, which is defined as a “life-threatening acute organ dysfunction secondary to infection [8].” Approximately 14 million survive to hospital discharge, 50% recover, 33% die in the following year, and about 15% experience continuing problems and ailments [8]. Patients who survive hospitalization develop, on average, one to two new functional problems (such as challenges with simple tasks like dressing or other daily functions one may otherwise take for granted); a significant increase in cognitive difficulties; as well as various behavioral sequelae such as anxiety, depression, and post-traumatic stress disorder (PTSD) [8]. Survival of sepsis, septic shock, and other forms of shock (e.g., hemorrhagic, anaphylactic, cardiogenic, neurogenic) has improved in recent years [9–13]. Yet our understanding of the war-like ravages the state of shock creates remains limited, especially in the context of the cumulative impact of the initial physiologic insult, its duration and severity and the subsequent recovery. This book aims to highlight commonly encountered forms of shock by focusing on contemporary diagnostic and treatment approaches. For the purposes of this introductory chapter, the authors will focus on one of the best understood models of shock—the septic shock. References to other types of shock will also be made when appropriate.","PeriodicalId":319103,"journal":{"name":"Clinical Management of Shock - The Science and Art of Physiological Restoration","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125973367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitation Endpoints in Traumatic Shock: A Focused Review with Emphasis on Point-of-Care Approaches","authors":"K. Kelley, Kyle Dammann, Alex Alers, T. Zanders, C. Bendas, S. Stawicki","doi":"10.5772/intechopen.90686","DOIUrl":"https://doi.org/10.5772/intechopen.90686","url":null,"abstract":"Trauma resuscitation is a blend of art and science, with the traumatologist at the helm of a large, multidisciplinary team, making split-second decisions and overseeing various parallel processes. Despite tremendous progress over the past few decades, the “art” component continues to play a large part in the overall trauma resuscitation process, with the “science” part slowly but steadily increasing its footprint as a determinant of processes and decisions. Thus, it becomes critical for all clinicians to be able to recognize the evidence-based factors which can be most valuable in guiding trauma resuscitations. This chapter serves as an overview of the current clinical findings, resuscitative endpoints, imaging techniques, and physiologic indices that are most helpful in order to promptly recognize and treat traumatic shock as well as projecting forward to look at novel techniques and biomarkers. Though a single universal marker that accurately and consistently identifies traumatic shock has yet to be discovered, certain factors discussed, such as lactate and base deficit, have been proven to be much more reliable than others.","PeriodicalId":319103,"journal":{"name":"Clinical Management of Shock - The Science and Art of Physiological Restoration","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133021810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Biomarkers of Sepsis with Clinical Relevance","authors":"D. M. Cunha, G. Silva, M. Hamasaki","doi":"10.5772/INTECHOPEN.82156","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82156","url":null,"abstract":"A 2016 task force convened by multiple societies proposed a new definition of sepsis, termed Sepsis 3. The new clinical diagnosis of sepsis is based on variation points in the Sequential (Sepsis-related) Organ Assessment Score (SOFA) and excluded Systemic Inflammatory Response Syndrome (SIRS) as a criterion for defining the diagnosis. Although the new definitions have provided improvements in understanding the disease, the main concern generated by Sepsis 3 is the reduced sensitivity to detect cases that might have an unfavorable course, mainly in early conditions. By limiting the diagnosis to organic dysfunction, the new concept tends to select a more severely ill population. In this way, biomarkers to diagnose sepsis may allow early intervention, which can reduce the risk of death. Although lactate is currently the most commonly used biomarker to identify sepsis, other biomarkers may help to enhance lactate’s effectiveness and may be used as a tool for staging the disease, prognosis, and response to intervention. The objective of this chapter is to present possible new biomarkers that are clinically relevant.","PeriodicalId":319103,"journal":{"name":"Clinical Management of Shock - The Science and Art of Physiological Restoration","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127989733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burn Shock and Resuscitation: Many Priorities, One Goal","authors":"John Sojka, A. Krakowski, S. Stawicki","doi":"10.5772/INTECHOPEN.85646","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85646","url":null,"abstract":"Burn injuries come in a wide variety of presentations, depending on the size and depth of the thermal insult, concurrent traumatic or inhalation injury, as well as the associated physiological response of the burn victim. To minimize patient morbidity and reduce mortality, prompt recognition and tailored treatment strategies are critically important. As the percentage of total body surface area (TBSA) burned increases so do the body’s physiologic response and the associated complexity of management. Understanding the pathophysiology of burn injury allows the practitioner to optimize and individualize burn patient management—a component of care critical to limiting wound progression and improving outcomes. Burn patient care starts with an accurate and thorough burn patient evaluation conducted in person by an experienced provider. For burns >10–15% TBSA, prompt initiation of fluid resuscitation greatly impacts clinical outcomes. Several formulae have been published to guide crystalloid and/or colloid fluid resuscitation in the setting of burn shock. Other important considerations include ambient temperature control, early enteral nutritional support, vitamin and mineral supplementation, assessment for inhalation injury, glycemic control, early recognition of potential complications of large volume resuscitation, potential need for cardiovascular support, and early wound excision and coverage. Burn patients often require multidisciplinary teams to manage the physical, social, and psychological effects associated with their injury. Dedicated burn centers are the ideal places for meeting the complex needs of each burn patient.","PeriodicalId":319103,"journal":{"name":"Clinical Management of Shock - The Science and Art of Physiological Restoration","volume":"94 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128866095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urosepsis: Flow is Life","authors":"Nissar Shaikh, Umm-e-Amara, Jazib Hassan, Zeeshan Qazi, Arshad H. Chanda, Zia Mahemood, M. Zubair, AR Raju Vegensa, A. Tharayil, A. Ganaw, R. Matthias, Muna Al Musalmani","doi":"10.5772/INTECHOPEN.82262","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82262","url":null,"abstract":"Urosepsis is one of the important etiological factors for community as well as hospital-acquired infections. Accordingly, urosepsis is divided into community-acquired and hospital-acquired urosepsis. Obstruction to the flow of urine is a common risk factor for community-acquired urosepsis, whereas the indwelling urinary catheter is the risk for the hospital-acquired urosepsis. E. coli remained the most common bacteria-causing urosepsis. If not treated early and appropriately, urosepsis can complicate into septic shock and multiple organ dysfunction. The cornerstone for the improved outcome of these patients is initial resuscitation and proper antibiotic therapy and restoring the flow of urine or removing the infected urinary catheter. Community-acquired urosepsis can be prevented by removing the obstruction to flow of urine permanently. The hospital-acquired urosepsis can be prevented by strictly following catheter-associated urinary tract infection prevention bundle and removing the catheter as early as possible.","PeriodicalId":319103,"journal":{"name":"Clinical Management of Shock - The Science and Art of Physiological Restoration","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121701036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}