classiﬁ cation of, 79–80 deﬁ nition of, 74, 78–80, 79 differentiated from intraabdominal

(1)

151

Index

A

Abdominal compartment syndrome (ACS)

classiﬁ cation of, 79–80 deﬁ nition of, 74, 78–80, 79 differentiated from intraabdominal

hypertension, 78–79 hypercarbia in, 82 hypoxemia in, 82

intraabdominal hypertension in, 78–80

organ dysfunction in, 78–79 prevention of, 84

primary, 79, 80

primary/secondary, 79–80 secondary, 79, 80

sequential organ failure association (SOFA) score in, 79, 80 tertiary, 80

Abdominal perfusion pressure (APP) assessment of, 75, 81

intraabdominal hypertension-related decrease in, 83

receiver operating characteristics (ROC) curves for, 85–86 as resuscitation endpoint, 86

Abdominal wall components separation, 85

Acidosis

lactic, 126–135 hypoxic, 126, 128 prognostic values of, 132 relationship to hyperlactatemia,

127–128 treatment of, 132

metabolic

as hemodynamic instability indicator, 100

intraabdominal pressure-related, 83

Acinetobacter, antibiotic resistance in, 43

Acinetobacter baumanii, antibiotic resistance in, 34

ACS. See Abdominal compartment syndrome (ACS)

Adenosine triphosphate (ATP), 104–105, 127

Adenovirus infections, transmission of, 39

Adrenal insufﬁ ciency, 25, 26 Age factors, in sepsis, 21 Albuterol, 51

Alloimmunization reactions, red blood cell transfusion-related, 5 American College of Chest Physicians/

Society of Critical Care Medicine (ACCP/SCCM), 12, 20

American Psychiatric Association (APA), 145

Aminoglycosides, bacterial resistance to, 43

Aminopenicillins, bacterial resistance to, 35

Anemia, in septic patients, 1–10 causes of, 1–2

red blood cell transfusion therapy for, 1–10

Angiotensin-converting enzyme

inhibitors, 5

(2)

Antibiotic control strategies, 40–42 antibiotic combinations, 41–42 antibiotic restriction, 40–41, 42 antibiotic rotation, 41

Antibiotics. See also names of speciﬁ c antibiotics

bacterial resistance to. See Antimicrobial resistance

Anticholinergic drugs, as delirium cause, 138, 140

Anticoagulant/antithrombotic compounds, in the blood, 107–111, 112–113 Antiendotoxin therapy, 27

Anti-inﬂ ammatory mediators, in sepsis, 55 Antimicrobial resistance, in the ICU. See also names of speciﬁ c antibiotics causes of, 33–36

control of, 36–43

antibiotic control strategies for, 40–42 containment strategies for, 36–37 isolation strategies for, 37–40 resistance surveillance strategies for,

42–43

as multiresistance, 43 risk of, 34–35 transmission of, 34, 36

Antipsychotic drugs, as delirium cause, 138, 139, 140

Antithrombin, 114 Antithrombin III, 107

as sepsis treatment, 113

APC (autoprothrombin III-A), 107–108, 109–112

Apoptosis, in myocardial depression, 55 Apoptosis inhibition therapy, 27 APP. See Abdominal perfusion pressure

(APP)

Arachidonic acid metabolites, 55 as myocardial depressants, 63 Argentina, sepsis epidemiology in, 18 Arousal level, assessment of, 142 Atelectasis, alveolar, 82

Autoprothrombin III-A (APC), 107–108, 109–112

B

Bacteremia

epidemiological studies of, 15–16 in ICU versus non-ICU patients, 16

incidence of in Europe, 15–16 in Mexico, 20

mortality rate in, in Mexico, 20–21 nosocomial

in Europe, 16

in Latin America, 19, 20 Bacterial nucleic acid, 66

“Barcelona Declaration,” 21 Benzodiazepines, as delirium cause,

146 Beta-lactamases, extended-spectrum (EEBL), 35, 41, 43

Beta-lactams, 41, 42

Bicarbonate, contraindication as lactic acidosis treatment, 132 Bilirubin, in sepsis, 13

Blood cultures, for bacteremia diagnosis, 15, 20–21

Blood ﬂ ow

arterial, in intraabdominal hypertension, 82, 83, 84 coronary sinus, 62–63 myocardial, 62–63

Blood loss, as anemia cause, 1 Body temperature, in systemic

inﬂ ammatory response syndrome (SIRS), 12

Bolivia, sepsis epidemiology in, 18 Brazil, sepsis epidemiology in, 18, 19,

20 British Intensive Care National Audit and Research Centre, 17

C

Calpains, 49–50 L-Canavanine, 67

Carbapenems, bacterial resistance to, 34–35, 43

Cardiac index

in hyperresuscitation, 97 in resuscitation, 94

during early resuscitation, 100 in sepsis, 13, 56

in septic shock, 60, 61 Cardiac output

in intraabdominal hypertension, 81 in septic shock, 56

in tissue hypoxia, 126–127

(3)

Cardiovascular failure. See also Heart failure

sepsis-related, 134, 137–138 Cardiovascular stress, 56 Caspase inhibitors, 27

Catheterization, pulmonary arterial (PAC), 56, 60, 94, 97, 99, 101 Cefotaxime, bacterial resistance to, 42 Cefoxitin, bacterial resistance to, 42 Ceftazidime, bacterial resistance to, 34,

35, 42

Ceftriaxone, bacterial resistance to, 42 Celiac artery blood ﬂ ow, 83

Centers for Disease Control and Prevention (CDC), 13, 37 Central nervous system dysfunction,

sepsis-related, 134, 137–138 Central venous oxygen saturation, 97–98 Central venous pressure (CVP)

correlation with left ventricular end- diastolic volume, 56

effect of red blood cell transfusions on, 6

in hypotension, 93

in intraabdominal hypertension, 81, 84 in resuscitation, 100

in septic shock, monitoring of, 94 Cephalosporins, bacterial resistance to,

33, 35

Cerebral perfusion pressure (CPP), 75 in intraabdominal hypertension, 84 Chemokines, 104–105

as delirium cause, 138 Chile, sepsis epidemiology in, 18 Cineangiography, radionuclide, 56 Ciproﬂ oxacin, bacterial resistance to, 34,

35, 42 Citrate synthetase, 50

Clostridium difﬁ cile, transmission of, 39 Clothing, protective, 37, 38, 39

Coagulation

disorders of, 103–120 as delirium cause, 138 phases of

ampliﬁ cation phase, 104–105 initiation phase, 103–104 propagation of, 106

relationship to inﬂ ammatory system, 112–113

as sepsis-related hypercoagulation, 112–113

Coagulation cascade, 103, 104

Cognitive impairment, delirium-related, 140 Colombia, sepsis epidemiology in, 18,

19, 20

Coma, delirium-related, 136–137, 141 Confusion Assessment Method (CAM),

142–143

Confusion Assessment Method for the ICU(CAM-ICU), 142–144 Consciousness, assessment of, 142 Containment strategies, for antimicrobial

resistance control, 36–37 Corticosteroids, 25–26, 53

Coupled plasma ﬁ ltration adsorption (CPFA), 27

C-reactive protein, 13 Creutzfeldt-Jakob disease, 5 Crystalloid infusions, during early

resuscitation, 100

Cuba, sepsis epidemiology in, 18, 19 CUB-Réa Network, 17

Cytokine antagonists, 67 Cytokines

as delirium cause, 138

in diaphragmatic dysfunction, 50–51 as septic myocardial depression cause,

55, 63–65

D

Delirium, in septic patients, 136–150 deﬁ nition of, 138

diagnosis and assessment of, 142–144 healthcare costs of, 141–142

historical perspectives on, 136–137 mechanical ventilation-related, 139,

140, 141 assessment of, 143 pathogenesis of, 137–138 prevalence of, 141 prevention of, 145

prognostic signiﬁ cance of, 140–141 as “ICU psychosis,” 136

risk factors for, 139–140, 146 subtypes of, 139

as “ICU syndrome,” 136

treatment of, 145–146

underdiagnosis of, 142

(4)

Dementia, delirium-related, 140 Diagnostic and Statistical Manual of

Mental Disorders-IV (DSM-IV), 138, 142

Diaphragm, mechanical ventilation- related dysfunction of, 47–54 calpains in, 49–50

clinical implications of, 51–53 cytokines in, 50–51

diagnosis of, 47–48

diaphragmatic structural changes in, 48–49, 51, 52, 53

in elderly patients, 52 myosin heavy chains in, 50 oxidative stress in, 49–51, 52

positive end expiratory pressure in, 51 proteolysis in, 48–49

Dichloroacetate, 128, 132

Digoxin, as myocardial depression treatment, 66

Dimer D, 113, 114

Diphtheria, transmission of, 39

Disseminated intravascular coagulation, 112, 113

Dobutamine

hemodynamic effects of, 123 as myocardial depression treatment,

66 as septic shock treatment, 123 use in resuscitation, 93, 94, 122

in early resuscitation, 100 Dobutamine challenge, 61 Dopamine, 123

comparison with noradrenaline, 93 dosage of, 93

use in resuscitation, 93 in early resuscitation, 100 Drotrecogin alpha (activated), 26, 30,

114 E

Ecuador, sepsis epidemiology in, 18 Edema

intraabdominal hypertension-related, 81–82

plasma volume expansion-related, 92 Elderly patients, delirium risk factors in,

139–140

Embolism, pulmonary, intraabdominal hypertension-related, 81–82

Encephalopathy deﬁ nition of, 138 septic, 136–137

Endorphins, as myocardial depressants, 63

Endothelial cell protein C receptors (EPCRs), 107, 108, 109

Endothelium, in hypercoagulation, 112–113 Endotoxemia, treatment of, 28

Endotoxin inhibition of, 27

pyruvate dehydrogenase-inhibiting effects of, 128

tissue factor-factor VII complex- activating effects of, 112 Enteric infections, transmission of, 39 Enterobacter spp., cephalosporin

resistance in, 33

Enterococcus faecium, vancomycin resistance in, 33, 35 EPCRs (endothelial cell protein C

receptors), 107, 108, 109 Epidemiology, of sepsis, 11–24

global perspective on, 13–17 in Latin America, 17–21 Epidermal growth factor, 109

Epinephrine, as myocardial depression treatment, 66

EPISSEPSIS Study Group, 17 Erythropoiesis, 1–2, 3

Escherichia coli, aminoglycoside resistance in, 43

Escherichia coli infections antibiotic control of, 41 transmission of, 39

European Society of Intensive Care Medicine (ESICM), 11 External negative abdominal pressure

(NEXAP), 85

F

Factor V, 106 inhibition of, 107

Factor V Leiden polymorphism, 107 Factor Va, inhibition of, 112 Factor VII, 103, 104, 106 Factor VIII, 106 Factor VIIIa, 106 Factor IX, 106

Factor IXa, inhibition of, 107

(5)

Factor X, 104, 106 Factor Xa, 104, 106

inhibition of, 107 Ferritin, 1

Fever, as delirium cause, 139, 140 Fibrinogen, 105

Fibrinogen degradable products, 112 Fibrinolysis, inhibition of, 108 Fibrinolytic system, 111–112 Fifth Toronto Sepsis Roundtable, 12 Fludrocortisone, 25–26

Folic acid deﬁ ciency, 2 Free radicals, 55

Furunculosis, transmission of, 39

G

Gentamicin, bacterial resistance to, 35, 42 German measles, transmission of, 39 Glasgow Coma Scale, 84

Gloves, protective, 37, 38, 39 Glucose control, 29

Glycolysis, as hyperlactatemia cause, 126, 127, 129, 130

H

Hageman factor fragments, 111 Haloperidol

anti-inﬂ ammatory properties of, 146 as delirium treatment, 138, 145 Handwashing, hygienic, 37, 38, 39 Heart failure, treatment of, 122 Heart rate

in sepsis, 13 in septic shock, 61

in systemic inﬂ ammatory response syndrome (SIRS), 12

Hemodilution, as anemia cause, 1, 3 Hemodynamic resuscitation, in septic

patients, 29–30, 92–102 abdominal perfusion pressure in, 75 central venous pressure in, 93 early, 98, 99–100

goal-directed, 98, 99–100

“golden” hours of, 99

hemodynamic management in, 94–100 initial, 94–100

as hyperresuscitation, 97, 98–99 late, 97–98, 99, 100–101 oxygen debt in, 94–100 preventive, 98–99

Hemodynamics

of intraabdominal hypertension, 81–82 of sepsis, 13

in tissue hypoxia, 126–127 Hemodynamic support, 28–29

for critically ill septic patients, 28–29 Hemoﬁ ltration, as myocardial depression

treatment, 67 Hemoglobin levels

in ICU patients, 1 in septic patients, 2–3

Hemolytic reactions, red blood cell transfusion-related, 5 Hemoperfusion therapy, 27 Hemophilus inﬂ uenzae infections,

transmission of, 39 Hemorrhage, protein C-related, 114 Hepatic artery, blood ﬂ ow in, 84 Hepatitis, red blood cell transfusion-

related transmission of, 5 Hepatitis A, transmission of, 39 Hepatitis B, red blood cell transfusion-

related transmission of, 5 Hepatitis C, red blood cell transfusion-

related transmission of, 5 Herpes simplex virus, transmission of, 39 High-density lipoprotein, endotoxin-

inhibiting effects of, 27 High-mobility group B-1 protein

(HMGB1), 27 Hippocrates, 134

Histamine, as myocardial depressant, 63 Human immunodeﬁ ciency virus (HIV)

infection, red blood cell transfusion-related, 5 Hydrocortisone, 25–26 Hypercarbia, 82

Hypercoagulable states, 107 Hyperglycemia, 29 Hyperlactatemia, 126, 127

anaerobic metabolism associated with, 128

glycolysis-induced, 126, 127, 129, 130 inﬂ ammatory processes-related,

131–132, 133 prognostic value of, 132 relationship to

hypoxia, 128

lactate acidosis, 127–128

tissue hypoxia, 128

(6)

Hypertension

idiopathic intracranial, 84 intraabdominal, 74–91

abdominal compartment syndrome- related, 79

acute, 80

cardiovascular assessment in, 81–82 chronic, 80

classiﬁ cation of, 80 deﬁ nition of, 75, 77–78 differentiated from acute

compartment syndrome, 78–79 gastrointestinal assessment in, 83 hepatic assessment in, 83–84 hyperacute, 80

neurologic assessment in, 84 organ function assessment in, 80–84 pulmonary assessment in, 82 renal assessment in, 82–83 subacute, 80

treatment of, 84–85

red blood cell transfusion-related, 5 Hyperventilation, in systemic

inﬂ ammatory response syndrome (SIRS), 12

Hypoperfusion, 121 myocardial, 62–63 Hypotension, 92, 121

central venous pressure (CVP) in, 93 refractory, 55

vasodilatory, 124 as resuscitation goal, 95 treatment of, 94 Hypovolemia, 82 Hypoxemia, 82 Hypoxia

complications of, 126 cytopathic, 128, 131 detection of, 126

as lactic acidosis cause, 126, 128 relationship to hyperlactatemia, 128

I

IAP. See Intraabdominal pressure (IAP) ICP. See Intracranial pressure

“ICU psychosis,” 136

“ICU syndrome,” 136

Imipenem, bacterial resistance to, 33, 34, 42

Immunocompromised patients. See also Human immunodeﬁ ciency virus (HIV) infection

protective isolation of, 39 Immunomodulation, red blood cell

transfusion-related, 5 Immunomodulatory therapies, 25–28

apoptosis inhibition, 27 corticosteroids, 25–26, 30

drotrecogin alpha (activated), 26, 30, 114

hemoperfusion strategies, 27 high-mobility group B-1 protein

(HMGB1) inhibition, 27 new antiendotoxin strategies, 27 poly (ADP) ribose polymerase/

synthetase (PARP/PARS), 28 Immunonutrition, 29

Impetigo, transmission of, 39 Infection, as delirium cause, 139, 140 Inﬂ ammation, in sepsis, 13

Inﬂ ammatory mediators as delirium cause, 138 in sepsis, 55

Inﬂ ammatory processes, as sepsis-related hypoperfusion cause, 121

Inﬂ uenza, transmission of, 39 Insulin therapy, 29

Intercellular adhesion molecule (ICAM), 28

Interferon- γ, 55 Interleukin-1, 28

as delirium cause, 138

tissue factor-factor VII complex activating property of, 112 Interleukin-1 receptor antagonist, 55–56 Interleukin-1 β, 55

as myocardial depressant, 64–65, 66, 67

Interleukin-1 β antagonists, as myocardial depression treatment, 67

Interleukin-10, 55–56

International Sepsis Deﬁ nition Conference, 12 International Sepsis Forum, 11 Intestines, lactate production in, 130 Intraabdominal pressure (IAP), 74–75

deﬁ nition of, 74

diurnal and nocturnal variations in, 85

(7)

in intraabdominal hypertension, 75, 77–78

measurement of, 75, 81, 85–87 instrumentation for, 75, 76–77 normal values for, 74

receiver operating characteristics (ROC) curves for, 85–86 therapeutic decrease in, 85 Intracranial pressure (ICP), 75

in intraabdominal hypertension, 84 normal, 78

Intrathoracic pressure

intraabdominal hypertension-related increase in, 82

intraabdominal pressure-related increase in, 81

Iron, serum levels of, 1 Ischemia, intestinal, 83

Isolation strategies, for antimicrobial resistance control, 37–40

K Klebsiella

aminoglycoside resistance in, 43 antibiotic control of, 41

L

β-Lactamases, extended-spectrum (EEBL), 35, 41, 43 β-Lactams, 41, 42

Lactate. See also Acidosis, lactic;

Hyperlactatemia clearance of, 126, 129–130 metabolism of, 127 production of, 126

in inﬂ ammatory processes, 131 regional, 130–131

in septic shock, 97 Laparoscopy, 84

Latin America, sepsis epidemiology in, 17–21

L-canavanine, 67 Lectins, C-type, 110

Left ventricular dysfunction, 56, 57–58

Left ventricular ejection fraction (LVEF), 57–58

effect of myocardial depressant substances on, 63

Left ventricular end-diastolic volume index (LVEDVI), 57–58, 61 effect of myocardial depressant

substances on, 63

Left ventricular end-diastolic volume (LVEDV), 56

Lipopolysaccharide binding protein (LBP), 27

Liver, lactate metabolism in, 130, 132 Liver failure, intraabdominal

hypertension-related, 83 Lung, lactate production in, 130 Lung injury, red blood cell transfusion-

related, 5 Lysozyme c, 65, 67

M

Mean arterial pressure (MAP), 75 effect of red blood cell transfusions on,

6 in intraabdominal hypertension, 81 in renal failure, 83

in resuscitation, 86, 93, 100 in septic shock, 96

norepinephrine treatment of, 94 Measles, transmission of, 39 Mechanical ventilated patients,

haloperidol use in, 146 Mechanical ventilation

beneﬁ ts of, 47

as delirium cause, 139, 140, 141 assessment of, 143

as diaphragmatic dysfunction cause, 47–54

calpains in, 49–50

clinical implications of, 51–53 cytokines in, 50–51

diagnosis of, 47–48

diaphragmatic structural changes in, 48–49, 51, 52, 53

in elderly patients, 52 myosin heavy chains in, 50 oxidative stress in, 49–51, 52 positive end expiratory pressure in,

51 proteolysis in, 48–49 during resuscitation, 94

sequential organ failure assessment

score as indication for, 82

(8)

Mechanical ventilation (cont.) weaning from, 47

intraabdominal hypertension-related prolongation of, 82

Memory impairment, delirium-related, 140 Methicillin resistance

in coagulase-negative Staphylococcus, 33

in Staphylococcus aureus, 33

Methylene blue, as myocardial depression treatment, 67

Mexico, sepsis epidemiology in, 18, 19, 20–21

Microplasma infections, transmission of, 39

Milrinone, as myocardial depression treatment, 66

Mitogen-activated protein kinase (MAPK), 109, 111

Mixed-venous oxygen saturation, in tissue hypoxia, 126–127

Mortality rate

in bacteremia, in Mexico, 20–21 delirium-related, 141

effect of norepinephrine on, 122 in sepsis, 2, 55

in Latin America, 18, 19, 20 in septicemia

in Latin America, 18, 20 in the United States, 13 in septic shock, 25

in Brazil, 20 in severe sepsis, 15

in systemic inﬂ ammatory response syndrome (SIRS), in Latin America, 20

Multiple organ failure, 92

abdominal compartment syndrome- related, 78–79

intraabdominal hypertension-related, 84

as mortality cause, 121 Mupirocin, 40

Myocardial depression, in sepsis and septic shock, 55–73, 92 clinical manifestations of, 56–62

historical perspective on, 56

left ventricular function in, 57–58, 61

right ventricular function in, 57, 59–60

deﬁ nition of, 55 etiology of, 62–66

at cellular level, 65–66

myocardial depressant substances in, 63–65

myocardial hypoperfusion in, 62–63

at organ level, 62–65 pathogenesis of, 55

Myocardial hypoperfusion, 62–63 Myosin heavy chains, 50

N

Na/K ATPase, 129, 132

Narcotics, as delirium cause, 138, 140, 146

National Center for Health Statistics, 13 National Hospital Discharge Survey

(NHDS), 13, 15

Neisseria meningitidis infections, transmission of, 39 Neuroleptic agents, as delirium

treatment, 145–146 Neurotransmitters, in delirium, 138 Nitric oxide

in myocardial depression, 55, 65–66 as vasodilatation cause, 92, 121 Nitric oxide inhibitors, 67 Nitric oxide scavengers, 67 Nitric oxide synthase, 121

constitutive, 66 inducible, 66

inhibitor of, 67

in myocardial depression, 66 Nitric oxide synthase inhibitors, 28, 67 Norepinephrine (noradrenaline), 122

comparison with dopamine, 93 as septic shock treatment, 94 use in initial hemodynamic

resuscitation, 94

Novel therapies, in critically ill septic patients, 25–32

general management strategies glucose control, 29

hemodynamic support, 28–29

nutritional support, 29

(9)

immunomodulatory therapies, 25–28 apoptosis inhibition, 27

corticosteroids, 25–26, 30 drotrecogin alpha (activated), 26,

30, 114

hemoperfusion strategies, 27 high-mobility group B-1 protein

(HMGB1) inhibition, 27 new antiendotoxin strategies, 27 poly (ADP) ribose polymerase/

synthetase (PARP/PARS), 28 Nuclear factor- κB, 28, 108, 110 Nucleic acid, bacterial, 66

Nutritional support, for critically ill septic patients, 29

O Oliguria

as hemodynamic instability indicator, 100

intraabdominal hypertension-related, 82

renal failure-related, 82 Osler, William, 134 Oxidative stress, 49–51, 52

Oxygen-carrying capacity, of tissue, effect of red blood cell transfusions on, 3, 4–5, 6–7 Oxygen consumption

in hyperresuscitation, 97 in shock, 95, 96

in tissue hypoxia, 126–127 Oxygen debt, in hemodynamic

resuscitation, 94–101 Oxygen delivery, in tissue hypoxia,

126–127

P

Partial pressure of oxygen in alveolar gas (PaO

2

), in sepsis, 13

Parvovirus B19 infections, transmission of, 39

red blood cell transfusion-related, 5 Pascal’s law, 75

Pediculosis, transmission of, 39 Peritoneal dialysis, abdominal wall

complications of, 81 Peritonitis, treatment of, 28

Phlebotomy, as anemia cause, 1 Phrenitis, 134

PIRO classiﬁ cation scheme, for sepsis, 12–13, 30

Plasma volume expanders, 92–93 Plasmin, 109, 111, 112

Plasminogen activation inhibitor (PAI-1), 112

Platelet activating factor, 55 as myocardial depressant, 63, 67 Pleural pressure, intraabdominal

hypertension-related increase in, 82

Poly (ADP) ribose polymerase/synthetase (PARP/PARS), 28

Positive end-expiratory pressure (PEEP), 51

in late resuscitation, 100 Procalcitonin, 13

Procoagulant compounds, in sepsis, 112–113

Prokinetic drugs, 85

Protective clothing, 37, 38, 39 Protein C

activated, 26, 107

as septic shock treatment, 114 as sepsis marker, 113

Protein C-thrombomodulin, inhibition of, 112

Protein C-thrombomodulin complex- protein C endothelial receptor, 110 Protein kinase C, 109

Protein S, 107 inhibition of, 112

Proteus mirabilis, aminoglycoside resistance in, 43

Prothrombin, 106 Prowess Trial, 114 P-selectin, 105

Pseudomonas aeruginosa, antibiotic resistance in, 33, 34–35, 43 Pulmonary arterial catheterization (PAC),

94, 97, 99, 101

Pulmonary capillary wedge pressure (PCWP), 56

Pulmonary vascular resistance (PVR), 59 effect of red blood cell transfusions

on, 4

(10)

Pyruvate, 127, 128, 129

Pyruvate dehydrogenase, 126, 128 inhibition of, 128

treatment of, 128, 132

Q

Quinolones, 35

R

Ramsay Scale, 142

Red blood cells, half life of, 1 Red blood cell transfusions, in septic

patients, 1–10

central venous pressure in, 6 complications of, 2, 4–6 during early resuscitation, 100 effect on oxygen-carrying capacity, 3,

4–5, 6–7

effect on pulmonary vascular resistance, 4

hemoglobin levels in, 2, 3–4, 6, 7 mean arterial pressure in, 6 mixed venous saturation in, 6, 7 as nosocomial infection risk factor, 3 Renal artery, blood ﬂ ow in, 82, 83 Renal dialysis, in septic patients,

29–30

Renal dysfunction, deﬁ nition of, 82 Renal failure

deﬁ nition of, 82

intraabdominal hypertension-related, 82–83

sepsis-related, 134, 137–138 Renal ﬁ ltration gradient (FG), 82–83 Renal perfusion pressure (RPP), 82, 83 Respiratory failure, sepsis-related, 134 Resuscitation. See Hemodynamic

resuscitation

Richmond Agitation-Sedation Scale (RASS), 142

Right ventricular dysfunction, in sepsis, 59–60

Right ventricular ejection fraction (RVEF), 59, 60, 61

S

Scabies, transmission of, 39 Sedation-Agitation Scale (SAS), 142 Sedation scales, 142

Sepsis

age factors in, 21

annual number of cases, 141 deﬁ nition of, 11–13, 55 duration of, 21

epidemiology of, in Latin America, 17–21

frequency of, 2 hemodynamics of, 13

ICD-9-CM coding for, 13, 15, 20 incidence of, 2

in Brazil, 20

inﬂ ammatory variables in, 13 mortality rate in, 2, 121

in Latin America, 18, 19, 20 organ dysfunction in, 13 pathophysiology of, 55–56

PIRO “staging” system of, 12–13, 30 severe, 12

economic cost of, 15 incidence of, 15, 55 mortality rate in, 15, 20 tissue perfusion in, 13 Sepsis syndrome, 11–12, 14–15

deﬁ nition of, 14 incidence of, 14–15 Septicemia, 11–12

mortality rate in, 13 in Latin America, 18, 20 rates of, 13

Sequential organ failure assessment (SOFA) score, in intraabdominal hypertension, 81, 82, 83, 84 in cardiovascular failure, 81 in gastrointestinal failure, 83 in hepatic failure, 83 in neurologic failure, 84 in renal failure, 82 in respiratory failure, 82 Serotonin, 104–105 Shigella, transmission of, 39 Shock, septic, 12

cardiogenic, 61

cardiovascular prognostic factors in, 60–61

clinical presentations of, 56 cold, 56

distributive, 61

duration of, 21

(11)

hemodynamic collapse proﬁ les in, 61 hemodynamic resuscitation in,

92–102

“golden” hours of, 99

“metabolic” aspects of, 95–97 oxygen debt in, 94–101 hyperdynamic state in, 56, 57 mortality rate in, 25

in Brazil, 20

myocardial depression associated with, 55–73, 92

clinical manifestations of, 56–62 deﬁ nition of, 55

etiology of, 62–66 pathogenesis of, 55 treatment of, 66–67 prevalence of, 15

in ICU patients, 25 vasopressin levels in, 123, 124 warm, 56

Society of Clinical Care Medicine (SCCM), 6, 7, 11, 142 Standard precautions, for bacterial

infection control, 37–40 Staphylococcus, coagulase-negative,

methicillin resistance in, 33 Staphylococcus aureus, methicillin-

resistant (MRSA), 33

Stenotrophomonas maltophila, antibiotic resistance in, 34–35, 43

Superior mesenteric artery blood ﬂ ow, 83 Surviving Sepsis Campaign, 11, 142, 145 Systemic inﬂ ammatory response

syndrome (SIRS), 11–12, 55, 56, 60, 92

diagnostic criteria for, 12, 14 incidence of, 14

mortality rate in, in Latin America, 20 as sepsis component, 14

Systemic vascular resistance (SVR), in septic shock, 60, 61

T

Tachypnea, in sepsis, 13

Thrombin, 104–105, 106, 107, 110 α-Thrombin, 111–112

Thrombin-activatable ﬁ brinolysis inhibitor (TAFI), 108, 109, 110

Thrombomodulin, 107, 108–111, 109–111

Thrombosis sepsis-related, 112

venous, intraabdominal hypertension- related, 81–82

Thromboxane A2, 104–105 Tissue factor, 103–104, 104, 112

inhibition of, 108

Tissue factor pathway inhibitor (TFPI), 107, 113

Tissue perfusion, in sepsis, 13 evaluation of, 94

Tissue plasminogen activator (tPA), 111–112

Tonometry, gastric, 98

Toronto Sepsis Roundtable, Fifth, 12 Transforming growth factor (TGF),

55–56 Troponins I and T, 63

Tuberculosis, transmission of, 39 Tumor necrosis factor, 28

Tumor necrosis factor-

_α

, 27, 55, 108 as delirium cause, 138

hemodynamic effects of, 64

as myocardial depressant, 64–64, 65, 66, 67

tissue factor-factor VII complex activating effects of, 112 Tumor necrosis factor-

_α

monoclonal

antibodies, 64, 67

U

University of Iowa Hospital and Clinics, 14

Urokinase, 111, 112

V

Vancomycin, bacterial resistance to, 33, 35, 42

Varicella, transmission of, 39 Vasoactive drugs. See also

Vasoconstrictors; Vasopressors;

names of speciﬁ c drugs use in resuscitation, 92–93

Vasoconstriction, noradrenaline-mediated, 122

Vasoconstrictors, 92–93 dosage of, 92

guidelines for infusion of, 93

indication for use of, 92

(12)

Vasodilatation, as sepsis-related hypoperfusion cause, 121 Vasopressors, 121–125