Critical care clinics
-
Critical care clinics · Apr 2000
ReviewScoring systems for assessing organ dysfunction and survival.
Sepsis is an ongoing disease process carrying a high risk of organ failure and death. Scoring systems to determine disease severity and risk of mortality may be useful in patient management and clinical trial enrollment, although the role of either type of score in the determination of admission or discharge criteria or in decisions relating to the continuation or withholding of treatment remains controversial. General scoring systems have been developed to quantify the severity of illness and the risk of mortality in ICU patients. ⋯ Organ function scores, however, can be assessed repeatedly and used to define a patient's progress. This approach can thus be used to evaluate individual patient care, to identify patients for enrollment in clinical trials or epidemiologic analyses, and to assess morbidity measures in clinical trials of new interventions. Organ dysfunction scores are just that, descriptors of organ dysfunction, and although high values correlate well with mortality, prognostication is not their prime aim; organ dysfunction scores and outcome prediction scores should rather be viewed as complementary systems in the description of ICU populations.
-
Critical care clinics · Apr 2000
ReviewSevere sepsis and septic shock. Definitions, epidemiology, and clinical manifestations.
Severe sepsis and septic shock are frequently encountered conditions in today's hospital environment. The incidence appears to be increasing despite our growing armamentarium of antibiotics and our enhanced knowledge of the pathophysiologic processes at play. ⋯ A high index of suspicion and prompt institution of appropriate antimicrobial treatment is mandatory for a successful outcome. It is hoped that adoption of uniform definitions will aid in research and in effective communication concerning sepsis and its adverse sequelae.
-
Over the last decade, it has become clear that myocardial depression, like vascular dysfunction, is typical of human septic shock. Human septic myocardial depression is characterized by reversible biventricular dilatation, decreased ejection fraction, and decreased response to fluid resuscitation and catecholamine stimulation (in the presence of overall hyperdynamic circulation). A circulating myocardial depressant substance, not myocardial hypoperfusion, is responsible for this phenomenon. ⋯ For the moment, the therapeutic approach to the patient with cardiac dysfunction in distributive or septic shock must be primarily aimed at reestablishing adequate organ perfusion and oxygen delivery by vigorous fluid resuscitation and vasopressor or inotropic support. In the long term, however, only continued research regarding the cellular mechanisms of organ dysfunction, including septic myocardial depression, will lead to successful therapeutic strategies. These strategies will likely involve direct manipulation of intracellular signaling processes that lead to organ dysfunction as manifested by septic myocardial dysfunction and septic shock.
-
Critical care clinics · Apr 2000
ReviewPathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock.
Organ system dysfunction is a common adverse sequelae of severe sepsis and septic shock and has been reported to be the most common cause of death in the noncoronary intensive care unit. The pathophysiology of the development of multiple organ system dysfunction is likely multifactoral and may take several different pathways. ⋯ The presence of organ dysfunction has great clinical impact on the underlying disease process, can prolong the hospital stay, increase the cost of care, and has been associated with an increase in mortality rate. At present, there is no recognized specific treatment for established organ failure, this primary attention has been directed toward prevention.