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    Critical care anesthesiology
    Critical care anesthesiology
    Critical care anesthesiology
    Ebook91 pages1 hour

    Critical care anesthesiology

    By Claudia Meazzini

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    About this ebook

    This book is dedicated to the management of the critically ill patient, in particular, the one affected by infectious diseases. The book, thanks to its structure, can be useful both to health professionals already operating within health facilities, and to those who have to take the anesthesiology exam for the health professions. The book also contains brief reviews on bacteremia, innate immunity, hemostasis, the coagulation cascade, activation of the complement system and the mechanism of the inflammatory response.
    LanguageEnglish
    PublisherClaudia Meazzini
    Release dateSep 15, 2020
    ISBN9788835894971
    Critical care anesthesiology

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      Book preview

      Critical care anesthesiology - Claudia Meazzini

      www.claudiameazzini.altervista.org

      Contents

      Contents

      Introduction

      Sepsis

      Definition

      Septic shock

      Symptomatology

      Pathophysiology

      Sepsis and Multiple Organ Dysfunction Syndrome

      The inflammatory types

      The stages of sepsis

      The management of circulatory shock

      The SOFA score and the MODS

      The main pathogenetic mechanisms of MODS

      The diagnosis of sepsis

      The inflammatory markers

      The proteins of the acute phase

      The SeptiFast

      The 2017 guidelines - The management of septic patient

      The initial resuscitation

      Screening for sepsis

      Diagnosis

      Antibiotic therapy

      Focus control

      Fluid therapy

      Mechanical ventilation

      Sedation, analgesia or neuromuscular block

      Glycemic control

      Renal replacement therapies

      Bicarbonate therapy

      Venous thromboembolism prophylaxis

      Nutrition

      Posture

      Objectives of care

      Introduction

      This book is dedicated to the management of the critically ill patient, in particular, the one affected by infectious diseases. The book, thanks to its structure, can be useful both to health professionals already operating within health facilities, and to those who have to take the anesthesiology exam for the health professions. The book also contains brief reviews on bacteremia, innate immunity, hemostasis, the coagulation cascade, activation of the complement system and the mechanism of the inflammatory response. 

      Sepsis

      Definition

      Sepsis is a syndrome characterized by a marked systemic inflammatory response (SIRS), performed by the body, to counteract the passage of potentially pathogenic microorganisms from the sepsigenic focus to the circulatory stream (remember that, physiologically, the blood is aseptic, i.e. it is free of pathogenic microorganisms). The mortality of the patient with sepsis is about 10%. The presence of bacteria in the blood is not always associated with sepsis, in fact, when the phlogistic component is missing, there is a simple bacteremia. Bacteremia is highlighted through a positive blood culture and can usually present as:

      transient and asymptomatic. An example of very frequent transient bacteremia occurs when we brush our teeth vigorously, in fact through this normal movement we are able to involuntarily create small lesions in the periodontal tissues, through which bacteria enter the mouth. Once the pathogenic microorganisms have overcome the micro-lesion created, they enter the bloodstream, and are then spontaneously eliminated by the body;

      intermittent: it is characterized by a periodic release of bacteria into the bloodstream. Examples of intermittent bacteremia are extravascular abscesses or infections of the body cavities;

      continuous and persistent: this is usually an intravascular infection. Typical examples of continuous and persistent bacteremia are: infective endocarditis, suppurative thrombophlebitis or aneurysms.

      When bacteremia is no longer localized but spreads throughout the body, it determines systemic (for example sepsis or septic shock) and very serious metastatic consequences (for example endocarditis in patients with valvulopathies).

      Septic shock

      Septic shock is a subset of sepsis, characterized by circulatory and metabolic alterations so severe as to significantly increase the patient's risk of mortality (mortality is greater than 40%). Typical alterations that occur in the patient with septic shock, despite adequate intravenous fluid therapy, are persistent hypotension which requires the use of vasopressor drugs to obtain a MAP greater than or equal to 65 mmHg and a quantity of serum lactate greater than 2 mmol/L or 18 mg/dL.

      When there is a suspicion of infection, the QSOFA must be performed; if the QSOFA has obtained a value greater than or equal to 2, the evidence of organ dysfunction must be evaluated, in addition, the SOFA score must be performed. If the SOFA score is also greater than or equal to 2, there is a diagnosis of sepsis. If vasopressor therapy is required to maintain MAP above 65 mmHg despite adequate fluid therapy, lactates should be evaluated. If lactates are less than 2 mmol/L, sepsis is confirmed otherwise the diagnosis is septic shock.

      If the patient with a suspected infection is found to have a QSOFA of less than 2, the suspected sepsis should be re-evaluated, otherwise the medical condition monitored and re-evaluated for possible sepsis if clinically indicated, whereas if it is still suspected it is necessary to evaluate if there is evidence of organ dysfunction. If the SOFA is less than 2 and sepsis is clinically indicated, the patient's medical condition is periodically monitored and reassess.

      Supplementary worksheet n.1: bacteremia

      Bacteremia is the presence of live bacteria capable of reproducing within the bloodstream. It is detected through the execution of a blood culture and is mainly manifested when certain predisposing conditions are present: tissue infections, presence of catheters or devices (venous, arterial, urinary, intracardiac, ostomy, etc.) in the person's body, during the postoperative of some surgical interventions, in the course of assistance

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