الفهرس 
SEPSIS AND SEPTIC SHOCKOnly 14 pages are availabe for public view
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Abstract
Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is a critical reduction in tissue perfusion; acute failure of multiple organs, including the lungs, kidneys, and liver. Common causes include many different species of gram-positive and gram-negative bacteria. Immunocompromised patients may have uncommon bacterial or fungal species as a cause. Signs include fever, hypotension, oliguria, and confusion. Diagnosis is primarily clinical combined with culture results. Early recognition and treatment is critical. Treatment is aggressive fluid resuscitation, antibiotics, surgical excision of infected or necrotic tissue and drainage of pus, and supportive care.
Sepsis is a potentially lethal syndrome. When the septic response is triggered by an infection, inflammation can be found throughout the entire vascular tree of the body. Inflammatory molecules pour into the circulation and spread through the body, injuring the endothelium that lines the blood vessels. The damaged vascular endothelial cells reduce perfusion into adjacent tissues, and organs or portions of organs become hypoxic.
In sepsis, volume loss is a critical problem. To resuscitate a septic patient requires administration of liters of fluids. Sometimes, however, even copious fluid resuscitation cannot shore up the patient’s dropping blood pressure; at this point, septic shock has set in.
In its early stages, sepsis may resemble a variety of other disorders, so it can be difficult to diagnose. Rapid diagnosis is essential, however, because sepsis is a worsening disorder with a mortality rate that steadily increases the longer treatment is delayed.
The mortality and morbidity of severe sepsis can be improved by effective clinical interventions applied in a timely and systematic manner. Like heart attacks and strokes, sepsis treatment is time-dependent and must be initiated upon recognition of the disease.
Among the most frequently used agents are dopamine and norepinephrine. Both dopamine and norepinephrine affect the alpha-adrenergic and beta- adrenergic receptors, though to varying degrees. The effects of alpha-adrenergic receptors lead to increased vascular tone. However, it could decrease the cardiac output as well as the regional flow of blood, particularly in cutaneous, renal, and splanchnic bed.
The underlying infection must be treated, because sepsis is difficult to stop unless the infection is controlled. When the microbe causing the infection is unknown, broad-spectrum antibiotics are started. Giving antibiotics should not be delayed by long searches for the infection.
Source control should be accomplished within the first 12 hours when the patient is able to tolerate it. Any infected or potentially infected sites should be drained, cleaned, or removed, because persisting pockets of microbes will continue to trigger the septic reaction. All indwelling devices are examined and, if infected, must be removed. Surgical advice or participation is often needed because abscesses must be drained and infected tissues should be debrided or resected.
Protective and supportive measures for a critically ill patient should be set in place. These provisions include ensuring adequate nutrition, treating hyperglycemia, and instituting prophylaxis against deep venous thromboses and stress ulcers.
Sepsis is a major concern of the critical care health system. More than half of patients with severe sepsis need ICU care. And, although 2% to 3% of all hospitalized patients have severe sepsis, those patients account for 20% of hospital ICU admissions.
In spite of intensive research, sepsis remains potentially fatal. Severe sepsis and septic shock are the tenth leading cause of death in the United States, officially accounting for 9.3% of all deaths each year.
This prospective comparative observational study was performed to evaluate the efficacy and safety of norepinephrine infusion versus dopamine infusion as the initial vasopressor in septic shock patients who were managed with a specific treatment protocol after approval of Ethical committee of critical care department on fifty patients in general ICU divided into two groups of twenty five patients each.
The main findings in this study are:
1. Norepinephrine infusion is more preferred than dopamine infusion in patients with septic shock in improving tissue perfusion as regarding MAP, HR, UOP.
2. Dopamine is associated with more arrhythmic events.