الفهرس 
Definition &DiagnosisOnly 14 pages are availabe for public view
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Abstract
Understanding sepsis has advanced tremendously in the past 15 years. During that time, important advances in the pathophysiology of sepsis have led directly to new effective therapies. Severe sepsis is an infection-induced inflammatory syndrome that ultimately leads to organ dysfunction. The incidence of sepsis and number of sepsis-related deaths appear to be increasing. We are aiming to be updated in our management of septic shock respecting all new guidelines in fighting sepsis. Our primary goals are resuscitation during the first 6 hrs after recognition, blood cultures before antibiotic therapy, administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis for 7–10 days guided by clinical response.
Regarding fluid administration, either crystalloid or colloid can be used aiming to restore mean circulating filling pressure. Norepinephrine and dopamine centrally administered are the initial vasopressors of choice. Norepinephrine is preferred over dopamine as a vasopressor to maintain an initial target of mean arterial pressure >65 mm Hg .Epinephrine, phenylephrine, or vasopressin should not be administered as the initial vasopressor in septic shock. Dobutamine is the best as an inotrope.
Steroid therapy may be given only after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy of a dose ≤ 300mg/dl of hydrocortisone. Recombinant activated protein C may be used in patients with severe sepsis and high risk for death (APACHE II ≥ 25 or multiple organ failure) if there are no contraindications.Genetically engineered variants have been designed with greater anti-apoptotic activity and reduced anticoagulant activity relative to wild-type rAPC. In the absence of tissue hypoperfusion, coronary artery disease or acute hemorrhage, target a hemoglobin of 7–9 g/dL.
Lung protective strategy should be considered as a low tidal volume 6 ml/kg, limitation of inspiratory plateau pressure ≤ 30 cm H2O and a minimal amount of positive end-expiratory pressure in acute lung injury. Permissive hypercapnia in conjunction with limiting tidal volume and minute ventilation has been demonstrated to be safe. Sedation and analgesia may be intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening but neuromuscular blockers should be avoided. Institution of tight glycemic control targeting a blood glucose <150 mg/dL after initial stabilization seems to improve outcome using Leuven protocol.
Primary prevention of sepsis has never been attempted. Statins are currently used for hyperlipidaemia control and considered useful for protection from cardiovascular events. In addition, there is increasing evidence for the potential use of statins in preventing and treating sepsis. There is an association between statins use and a lower incidence of sepsis and sepsis-related mortality.
Statins have anti-inflammatory and immunomodulatory properties, independent of their lipid-lowering abilities. They may interfere with the first step in the activation of the inflammatory cascade. In addition, statins significantly decrease inflammatory mediators in acute phase response such as C-reactive protein, cytokines, and others. They also improve endothelial dysfunction, blunt apoptosis, affect NO availability. Statins are well tolerated by most patients. The most common adverse effects are gastrointestinal disturbances and headache which are usually mild and transient. Hepatic and skeletal muscle toxicity are concerns, although they are fortunately quite rare.