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Septicaemia and the prevention of multiorgan failure--the intensive care perspective
Abstract:
Septicaemia frequently presents without "classic" signs of infection--tachypnoea, hypotension and confusion are the commonest features. The mortality rate is 40 to 80% and in intensive care units, septicaemia accounts for 70% of all deaths. Despite the use of antimicrobial drugs to which the offending organism is sensitive, patients are still dying. Effects on distant organ systems are due to "Mediators". "Microvascular Failure" resulting in tissue hypoxia is the unifying hypothesis of multiple organ failure in septicaemia. Mortality is correlated with the number of organ system failures. Supportive management is aimed at prevention of organ failure--manipulation of the circulation being the central key. Intravascular volume expansion, vasoactive drugs, mechanical ventilation and invasive monitoring are the means. Antimicrobial therapy must be guided by 'best guess' approach with multiple agents until isolation of the offending organism can recommend specific therapy. Aggressive surgical drainage or excision, is particularly applicable in abdominal sepsis. Several adjunctive therapies aimed at mediators of sepsis, are as yet experimental.
Insights
Septicaemia, a severe infection, often lacks typical symptoms and has high mortality. Microvascular failure leading to tissue hypoxia is a key factor in organ failure and death, necessitating supportive circulatory management.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pathophysiology
Background:
- Septicaemia presents atypically, with tachypnoea, hypotension, and confusion as common signs.
- High mortality rates (40-80%) and significant ICU deaths (70%) highlight the severity of septicaemia.
- Despite sensitive antimicrobial drugs, patient mortality remains high due to mediator-induced organ system effects.
Purpose of the Study:
- To explore the unifying hypothesis of microvascular failure in septicaemia-induced multiple organ failure.
- To discuss the correlation between organ system failures and mortality in septicaemia.
- To outline current supportive management strategies focused on preventing organ failure.
Main Methods:
- Focus on supportive management, emphasizing circulatory manipulation.
- Utilizing intravascular volume expansion, vasoactive drugs, mechanical ventilation, and invasive monitoring.
- Employing a 'best guess' antimicrobial approach with multiple agents pending organism isolation.
Main Results:
- Microvascular failure causing tissue hypoxia is proposed as the unifying mechanism for multiple organ failure.
- Mortality is directly correlated with the number of organ systems failing.
- Aggressive surgical drainage or excision is crucial for abdominal sepsis.
Conclusions:
- Supportive management, particularly circulatory support, is central to preventing organ failure in septicaemia.
- Antimicrobial therapy requires a pragmatic 'best guess' strategy initially.
- Experimental adjunctive therapies targeting sepsis mediators show potential but require further investigation.