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Sepsis and infection are the major enemies of the intensive care patient in whom immunological defenses are severely impaired. This major problem is thefocus of attention in this book, based on the presentation of the First International Congress on the Immune Consequences of Trauma, Shock, and Sepsis, which is one of the first attempts to exchange ideas on the state-of-the-art in this area of immunology. Both basic and clinical research, including new centres of attention, are described. The growing role of immunology in medicine opens new avenues to the under- standing of trauma and sepsis and will allow the design of novel therapeutic approaches.
This book presents a unique overview of all aspects of host defense alterations under stressful conditions. It is based on the most important contributions given at the "2nd International Congress on the Immune Consequences of Trauma, Shock, and Sepsis-Mechanisms and Therapeutic Approaches," which was held in Munich under the auspices of the most distinguished scientific societies involved in this field (Society of Critical Care Medicine, European Society of Intensive Care Medicine, Societe Internationale de Chirurgie, Surgical Infection Society, Surgical Infection Society Europe, European Society for Surgical Research, International Society for Burn Injury, American Association for the Surgery of Trauma, and National Institutes of Health). Since the first conference of this kind in 1988, new information from basic studies and clinical trials has provided exciting and novel insights into the immune dysfunctions accom panying trauma, shock, and sepsis. The volume is divided into 18 parts presenting the structural background of trauma-induced alterations of immune and imflammatory mechanisms as well as the currently discussed therapeutic interventions designed to restore or maintain normal host defenses following major injury. Introducing the general theme of the book is a summary of the essential keystones of trauma and sepsis-related immune deficits. Discussions of the progress in trauma care brought through better understanding of the cell biology of injury and of the major clinical factors that influence host defense integrity in operative medicine provide a setting for understanding the wide array of detailed information that is presented thereafter.
This book is designed to offer the reader first-rate guidance on shock management in the real world. Comprehensive, evidence-based, and up-to-date instruction is provided on optimal care of patients with different types of shock – septic, hemorrhagic, cardiogenic, anaphylactic, and obstructive – at all stages from initial response through to ICU admission. As well as management, the coverage encompasses pathophysiology, clinical presentation, diagnosis, and emerging trends. A further key feature is the use of a scenario-based approach to present a series of cases based on real-life experiences. Here, a narrative style and Q&A form are employed to vividly convey scenarios that may be encountered in clinical practice and to elucidate decision making in complex circumstances. When readers experience difficulty in answering the questions, the earlier sections can be consulted to identify the correct response. This book will be of great value for all health care professionals. In particular, it will be very helpful for novice or inexperienced practitioners in emergency medicine, critical care medicine, and traumatology.
This practically oriented book provides an up-to-date overview of all significant aspects of the pathogenesis of sepsis and its management, including within the intensive care unit. Readers will find information on the involvement of the coagulation and endocrine systems during sepsis and on the use of biomarkers to diagnose sepsis and allow early intervention. International clinical practice guidelines for the management of sepsis are presented, and individual chapters focus on aspects such as fluid resuscitation, vasopressor therapy, response to multiorgan failure, antimicrobial therapy, and adjunctive immunotherapy. The closing section looks forward to the coming decade, discussing novel trial designs, sepsis in low- and middle-income countries, and emerging management approaches. The book is internatio nal in scope, with contributions from leading experts worldwide. It will be of value to residents and professionals/practitioners in the fields of infectious diseases and internal medicine, as well as to GPs and medical students.
This book is open access under a CC BY 4.0 license. It constitutes a unique source of knowledge and guidance for all healthcare workers who care for patients with sepsis and septic shock in resource-limited settings. More than eighty percent of the worldwide deaths related to sepsis occur in resource-limited settings in low and middle-income countries. Current international sepsis guidelines cannot be implemented without adaptations towards these settings, mainly because of the difference in local resources and a different spectrum of infectious diseases causing sepsis. This prompted members of the Global Intensive Care working group of the European Society of Intensive Care Medicine (ESICM) and the Mahidol-Oxford Tropical Medicine Research Unit (MORU, Bangkok, Thailand) - among which the Editors – to develop with an international group of experts a comprehensive set of recommendations for the management of sepsis in resource-limited settings. Recommendations are based on both current scientific evidence and clinical experience of clinicians working in resource-limited settings. The book includes an overview chapter outlining the current challenges and future directions of sepsis management as well as general recommendations on the structure and organization of intensive care services in resource-limited settings. Specific recommendations on the recognition and management of patients with sepsis and septic shock in these settings are grouped into seven chapters. The book provides evidence-based practical guidance for doctors in low and middle income countries treating patients with sepsis, and highlights areas for further research and discussion.
The first edition of this publication was aimed at defining the current concepts of trauma induced coagulopathy by critically analyzing the most up-to-date studies from a clinical and basic science perspective. It served as a reference source for any clinician interested in reviewing the pathophysiology, diagnosis, and management of the coagulopathic trauma patient, and the data that supports it. By meticulously describing the methodology of most traditional as well as state of the art coagulation assays the reader is provided with a full understanding of the tests that are used to study trauma induced coagulopathy. With the growing interest in understanding and managing coagulation in trauma, this second edition has been expanded to 46 chapters from its original 35 to incorporate the massive global efforts in understanding, diagnosing, and treating trauma induced coagulopathy. The evolving use of blood products as well as recently introduced hemostatic medications is reviewed in detail. The text provides therapeutic strategies to treat specific coagulation abnormalities following severe injury, which goes beyond the first edition that largely was based on describing the mechanisms causing coagulation abnormalities. Trauma Induced Coagulopathy 2nd Edition is a valuable reference to clinicians that are faced with specific clinical challenges when managing coagulopathy.
Sepsis is a very complex clinical condition that can be considered the central point of the infectious process: the arrival point in the evolution of a localized septic outbreak that has caused a systemic inflammatory reaction. In the clinical setting two important questions regarding the transition from local inflammation, with beneficial effect, to systemic inflammatory disease, with deleterious results, remain unanswered. First, why does the transition from local to systemic disease only occur in some subjects? Second, how long does this transition take? This book attempts to answer these questions. Chapters cover such topics as surgical infections, microbiota therapy in sepsis, cytokines for host immune response, and the role of serum amyloid A in the acute phase of sepsis.
The world's most renowned researchers in fluid management explain what you should know when providing infusion fluids to surgical patients.
The use of intravenous human antibodies in the treatment of primary immunodeficiencies is well recognized. However, it is now evident that they also have therapeutic potential for a wide range of other clinical disorders. This book describes the use of human antibodies in the management of secondary (virus-induced) immunodeficiencies, neonatal and perinatal infections, and autoimmunity. Insight into their mechanism of action is also provided.