الفهرس 
Pathophysiology of sepsisOnly 14 pages are availabe for public view
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Abstract
Sepsis is a syndrome clinically defined as the body’s
systemic inflammatory response to infection. Severe sepsis and
septic shock are the end results of the body’s maladaptive and
inappropriate response to pathogenic microbes, resulting in organ
dysfunction, tissue hypoperfusion and dysoxia, and ultimately
death.
Mortality rates with severe sepsis and septic shock range
from 25%to over 75%, with higher rates of death in patients with
multi–organ dysfunction and prolonged hypoperfusion.
The severity of disease appears to be increasing, the most
common manifestations of severe organ dysfunction were acute
respiratory distress syndrome, acute renal failure, and
disseminated intravascular coagulation.
In patients with severe sepsis and septic shock, acute renal
failure (ARF) is an independent factor for mortality. One of the
most important recommendations is volume expansion that could
also prevent ARF.
Fluid resuscitation is one of the cornerstones of
management of sepsis. Though there is a consensus on the need
for adequate fluid therapy, the timing, type, and quantity of fluid
resuscitation remain controversial. Furthermore, the optimal
Summary
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monitoring technique to guide fluid therapy continues to be
debated.
Early goal directed therapy, targeting a specific central
venous pressure (CVP) and mixed central venous oxygen
saturation (ScVO2), improved mortality by 16%. In response, the
surviving sepsis guidelines recommend early aggressive fluid
resuscitation during the “golden” hours.
The optimal fluid choice for volume resuscitation in severe
sepsis and septic shock remains unclear. Though crystalloids are
the least costly of all fluid options, the volume of fluid needed
poses risks to patients.Dextrans and gelatins have limited data
supporting their use in severe sepsis and septic shock.
Tetrastarches are the most promising of the synthetic colloid
solutions used in the critically ill patients.
The most recent update to the Surviving Sepsis campaign
recommends against the use of synthetic colloids for fluid
resuscitation, thus, their use in severe sepsis and septic shock
should be avoided at this time.Early aggressive therapy with one
type of fluid clearly favors crystalloids and albumin.