Sepsis and the septic shock in oncological or other immunocompromised patients


Authors: M. Navrátil;  M. Tomíška;  Z. Kořístek;  J. Vorlíček;  J. Mayer
Authors‘ workplace: Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jiří Vorlíček, CSc.
Published in: Vnitř Lék 2010; 56(6): 557-569
Category: 65th Birthday - Petr Svacina, MD

Overview

Sepsis and the septic shock and the up to date knowledge about them represent a marked drifting for diagnostics and the treatment of this complications. Their application in patients with the oncological disease or the other immunocompromised patients represents further extension in the specific group of patients with several unique properties. In despite of the improving results in the oncological treatment there are only few reports in literature about this group of patients and this one is steadily growing due to the progressive improving of the supportive care in oncology. This group of patients with the febrile neutropenia and the sepsis (the most frequent complication) request the special focus of general practitioners and the internists because these ones are with these patients in contact as a first. They have to master the basal image about the specialties of this patient group. In our article we analyze this group of patients with focus on antibio­tics in febrilie neutropenia and sepsis and on the other supportive care in the immunocopromised patients.

Key words:
sepsis –  septic shock –  febrilie neutropenia –  immunocompromised patient


Sources

1. Antonelli M, Azoulay E, Bonten M et al. Year in review in Intensive Care Medicine, 2008: I. Brain injury and neurology, renal failure and endocrinology, metabolism and nutrition, sepsis, infections and pneumonia. Intensive Care Med 2009; 35: 30– 44.

2. Antonelli M, Azoulay E, Bonten M et al. Year in review in Intensive Care Medicine, 2007. II. Haemodynamics, pneumonia, infections and sepsis, invasive and non‑invasive mechanical ventilation, acute respiratory distress syndrome. Intensive Care Med 2008; 34: 405– 422.

3. Antonelli M, Azoulay E, Bonten M et al. Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control. Intensive Care Med 2010; 36: 196– 209.

4. Bagshaw SM, Bellomo R. Early diagnosis of acute kidney injury. Curr Opin Crit Care 2007; 13: 638– 644.

5. Bagshaw SM, Bellomo R. The influence of volume management on outcome. Curr Opin Crit Care 2007; 13: 541– 548.

6. Boyd JH, Walley KR. Is there a role for sodium bicarbonate in treating lactic acidosis from shock? Curr Opin Crit Care 2008; 14: 379– 383.

7. Camporota L, Wyncoll D. Practical aspects of treatment with drotrecogin alfa (activated). Crit Care 2007; 11 (Suppl 5): S7.

8. Canabal JM, Kramer DJ. Management of sepsis in patients with liver failure. Curr Opin Crit Care 2008; 14: 189– 197.

9. Casserly B, Read R, Levy MM. Hemodynamic monitoring in sepsis. Crit Care Clin 2009; 25: 803– 823.

10. Zanotti Cavazzoni SL, Dellinger RP. Hemodynamic optimization of sepsis‑induced tissue hypoperfusion. Crit Care 2006; 10 (Suppl 3): S2.

11. Cheng AC, Stephens DP, Currie BJ. Granulocyte‑ colony stimulating factor (G‑CSF) as an adjunct to antibio­tics in the treatment of pneumonia in adults. Cochrane Database Syst Rev 2007; 2: CD004400.

12. Christaki E, Opal SM. Is the mortality rate for septic shock really decreasing? Curr Opin Crit Care 2008; 14: 580– 586.

13. Cinel I, Opal SM. Molecular bio­logy of inflammation and sepsis: a primer. Crit Care Med 2009; 37: 291– 304.

14. Claessens YE, Dhainaut JF. Diagnosis and treatment of severe sepsis. Crit Care 2007; 11 (Suppl 5): S2.

15. Dellinger RP, Levy MM, Carlet JM et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008; 34: 17– 60.

16. Dellinger RP, Levy MM, Carlet JM et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36: 296– 327.

17. Doig GS, Heighes PT, Simpson F et al. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta‑analysis of randomised controlled trials. Intensive Care Med 2009; 35: 2018– 2027.

18. Downar J, Lapinsky SE. Pro/ con debate: should synthetic colloids be used in patients with septic shock? Crit Care 2009; 13: 203.

19. Fortin CF, McDonald PP, Fülöp T et al. Sepsis, leukocytes, and nitric oxide (NO): an intricate affair. Shock 2010; 33: 344– 352.

20. Frank AJ, Thompson BT. Pharmacological treatments for acute respiratory distress syndrome. Curr Opin Crit Care 2010; 16: 62– 68.

21. Funk D, Sebat F, Kumar A. A systems approach to the early recognition and rapid administration of best practice therapy in sepsis and septic shock. Curr Opin Crit Care 2009; 15: 301– 307.

22. Gao H, Evans TW, Finney SJ. Bench‑ to‑ bedside review: Sepsis, severe sepsis and septic shock –  does the nature of the infecting organism matter? Crit Care 2008; 12: 213.

23. Gottschlich B, Koch T. Nutritional support of intensive care patients. Anasthesiol Intensiv Med 2008; 49: 318.

24. Groeneveld AB, Molenaar N, Beishuizen B. Should we abandon corticosteroids during septic shock? No. Curr Opin Crit Care 2008; 14: 384– 389.

25. Hausfater P. Procalcitonin measurement in adult clinical practice. Rev Med Interne 2007; 28: 296– 305.

26. Heller AR, Ragaller M. Intestinal malfunction in the ICU. Anasthesiol Intensiv Med 2008; 49: 20.

27. Hollenberg SM. Inotrope and vasopressor therapy of septic shock. Crit Care Clin 2009; 25: 781– 802.

28. Hollenberg SM, Cinel I. Bench‑ to‑ bedside review: nitric oxide in critical illness –  update 2008. Critl Care 2009; 13: 218.

29. Holmes CL, Walley KR. Vasoactive drugs for vasodilatory shock in ICU. Curr Opin Crit Care 2009; 15: 398– 402.

30. Khan S, Trof RJ, Groeneveld AB. Transpulmonary dilution‑ derived extravascular lung water as a measure of lung edema. Curr Opin Crit Care 2007; 13: 303– 307.

31. Klastersky J. Empirical treatment of sepsis in neutropenic patients. Hosp Med 2001; 62: 101– 103.

32. Klastersky J, Paesmans M. Risk‑adapted strategy for the management of febrile neutropenia in cancer patients. Support Care Cancer 2007; 15: 477– 482.

33. Kollef MH, Micek ST. Using protocols to improve patient outcomes in the intensive care unit: focus on mechanical ventilation and sepsis. Semin Respir Crit Care Med 2010; 31: 19– 30.

34. Lange M, Ertmer C, Westphal M. Vasopressin vs. terlipressin in the treatment of cardiovascular failure in sepsis. Intensive Care Med 2008; 34: 821– 832.

35. Laterre PF. Clinical trials in severe sepsis with drotrecogin alfa (activated). Crit Care 2007; 11 (Suppl 5): S5.

36. Leaver SK, Finney SJ, Burke‑ Gaffney A et al. Sepsis since the discovery of Toll‑like receptors: disease concepts and therapeutic opportunities. Crit Care Med 2007; 35: 1404– 1410.

37. Levi M. Disseminated intravascular coagulation. Crit Care Med 2007; 35: 2191– 2195.

38. Levi M, Opal SM. Coagulation abnormalities in critically ill patients. Crit Care 2006; 10: 222.

39. Levi M, van der Poll T. Recombinant human activated protein C: current insights into its mechanism of action. Crit Care 2007; 11 (Suppl 5): S3.

40. Levi M, van der Poll T. Inflammation and coagulation. Crit Care Med 2010; 38 (Suppl 2): S26– S34.

41. Levy B. Bench‑ to‑ bedside review: Is there a place for epinephrine in septic shock? Crit Care 2005; 9: 561– 565.

42. Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care 2006; 12: 315– 321.

43. Lortholary O, Lefort A, Tod M et al. Pharmacodynamics and pharmacokinetics of antibacterial drugs in the management of febrile neutropenia. Lancet Infect Dis 2008; 8: 612– 620.

44. Lundy DJ, Trzeciak S. Microcirculatory dysfunction in sepsis. Crit Care Clin 2009; 25: 721– 731.

45. Magder S. Bench‑ to‑ bedside review: ventilatory abnormalities in sepsis. Crit Care 2009; 13: 202.

46. Marik PE, Pastores SM, Annane D et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med 2008; 36: 1937– 1949.

47. Marik PE, Zaloga GP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature. Intensive Care Med 2008; 34: 1980– 1990.

48. Marshall JC, Reinhart K. International Sepsis Forum. Biomarkers of sepsis. Crit Care Med 2009; 37: 2290– 2298.

49. Mendes AV, Sapolnik R, Mendonça N. New guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients. J Pediatr 2007; 83 (Suppl 2): S54– S63.

50. Napolitano LM, Kurek S, Luchette FA et al. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Crit Care Med 2009; 37: 3124– 3157.

51. Nobre V, Sarasin FP, Pugin J. Prompt antibio­tic administration and goal‑ directed hemodynamic support in patients with severe sepses and septic shock. Curr Opin Crit Care 2007; 13: 586– 591.

52. Opal SM, LaRosa SP. Year in review 2008: Critical Care –  sepsis. Critical Care 2009; 13: 224.

53. Ragaller M, Fritzsche K, Sengebusch K et al. Treatment of sepsis –  what is indispensable? Anasthesiol Intensiv Med 2009; 50: 654.

54. Roche AM, James MF. Colloids and crystalloids: does it matter to the kidney? Curr Opin Crit Care 2009; 15: 520– 524.

55. Rodloff AC, Goldstein EJ, Torres A. Two decades of imipenem therapy. J Antimicrob Chemother 2006; 58: 916– 929.

56. Rodríguez‑ Baño J. Selection of empiric therapy in patients with catheter‑related infections. Clin Microbio­l Infect 2002; 8: 275– 281.

57. Ronco C, Tetta C. Extracorporal blood purification: more than diffusion and convection. Does this help? Curr Opin Crit Care 2007; 13: 662– 667.

58. Rudiger A, Singer M. Mechanisms of sepsis‑induced cardiac dysfunction. Crit Care Med 2007; 35: 1599– 1608.

59. Sandrock CE, Albertson TE. Controversies in the treatment of sepsis. Semin Respir Crit Care Med 2010; 31: 66– 78.

60. Sevransky J. Clinical assessment of hemodynamically unstable patients. Curr Opin Crit Care 2009; 15: 234– 238.

61. Sevransky JE, Nour S, Susla GM et al. Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature. Crit Care 2007; 11: R67.

62. Sharma AC. Sepsis‑induced myocardial dysfunction. Shock 2007; 28: 265– 269.

63. Siami S, Annane D, Sharshar T. The encephalopathy in sepsis. Crit Care Clin 2008; 24: 67– 82.

64. Singer P, Shapiro H, Theilla M et al. Anti‑inflammatory properties of omega‑ 3 fatty acids in critical illness: novel mechanisms and an integrative perspective. Intensive Care Med 2008; 34: 1580– 1592.

65. Singh S, Evans TW. Organ dysfunction during sepsis. Intensive Care Med 2006; 32: 349– 360.

66. Stevens RD, Dowdy DW, Michaels RK et al. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 2007; 33: 1876– 1891.

67. Sutherland AM, Walley KR. Bench‑ to‑ bedside review: Association of genetic variation with sepsis. Crit Care 2009; 13: 210.

68. Thirumala R, Ramaswamy M, Chawla S. Diagnosis and management of infectious complications in critically Ill patients with cancer. Crit Care Clin 2010; 26: 59– 91.

69. van Haren FM, Sleigh JW, Pickkers P et al. Gastrointestinal perfusion in septic shock. Anaesth Intensive Care 2007; 35: 679– 694.

70. Vriesendorp TM, DeVries JH, Hoekstra JB. Hypoglycemia and strict glycemic control in critically ill patients. Curr Opin Crit Care 2008; 14: 397– 402.

71. Westphal M, Van Aken H, Rehberg S et al. All colloids are not the same. Anasthesiol Intensiv Med 2009; 50: 378– 381.

72. Wiedermann CJ. Clinical review: molecular mechanisms underlying the role of antithrombin in sepsis. Crit Care 2006; 10: 209.

73. Zarychanski R, Ariano RE, Paunovic B et al. Historical perspectives in critical care medicine: blood transfusion, intravenous fluids, inotropes/ vasopressors, and antibio­tics. Crit Care Clin 2009; 25: 201– 220.

74. Zimmerman JJ. A history of adjunctive glucocorticoid treatment for pediatric sepsis: moving beyond steroid pulp fiction toward evidence‑based medicine. Pediatr Crit Care Med 2007; 8: 530– 539.

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Diabetology Endocrinology Internal medicine

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