Yıl: 2017 Cilt: 49 Sayı: 1 Sayfa Aralığı: 53 - 58 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Sepsis and Septic Shock: Current Treatment Strategies and New Approaches

Öz:
Sepsis, mikrobiyal maruziyet sonrasında enflamasyon ve koagülasyonun birlikte aktive olmasıyla karakterize komleks bir sendromdur. Bu olaylar, immün hücreler veya hasar görmüş endotel hücrelerinden salınan proinflamatuvar sitokinler, prokoagülanlar ve adezyon molekülleri yoluyla sistemik enflamatuvar yanıt sendromu veya sepsis bulguları ile ortaya çıkar. Sepsis, günümüzde halen yüksek mortalite ile seyreden tedavisi güç bir klinik tablodur. Birçok sistemi tutan, özellikle hemodinamik değişikliklere yol açarak şok, organ fonksiyon bozukluğu ve organ yetmezliğine giden sepsis hakkında özellikle son yirmi yılda pek çok çalışma yapılmıştır. Sepsiste özellikle artan antibiyotik direnci ve septik şok fazındaki tedaviye dirençli hemodinamik değişiklikler, klasik tedavilere ek olarak yeni tedavi teknikleri geliştirme çabalarına neden olmuştur. Fizyopatolojisi daha iyi anlaşıldıkça, antibiyotik tedavisine ilave olarak birçok ajan denenmiş ama hala yeterli sonuçlar elde edilememiştir. Bu derlemede sepsis patofizyolojisi, mevcut tedavileri ve yeni yaklaşımları özetlenmiştir
Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Sepsis ve Septik Şok: Mevcut Tedavi Stratejileri ve Yeni Yaklaşımlar

Öz:
Sepsis is a complex condition characterized by the simultaneous activation of inflammation and coagulation in response to microbial insult. These events manifest as systemic inflammatory response syndrome or sepsis symptoms through the release of proinflammatory cytokines, procoagulants, and adhesion molecules from immune cells and/or damaged endothelium. Today, sepsis is a severe multisystem disease with difficult treatments for its manifestations and high mortality rates. In the last two decades in particular, many studies have been conducted on sepsis that cause shock, multiorgan dysfunction, and organ failure by especially leading to hemodynamic changes. In sepsis, increasing antibiotic resistance and medicine-resistant hemodynamic changes have resulted in further research on new treatment modalities in addition to classical treatments. In the last decade, the sepsis physiopathology has been elucidated. Various therapeutic agents have been used in addition to antibiotherapy, but no satisfactory results have been obtained. This review summarizes the sepsis pathophysiology, current treatment protocols, and new approaches
Anahtar Kelime:

Konular: Genel ve Dahili Tıp
Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık
  • 1. Bone RC, Grodzin CJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest 1997; 112: 235-43. [CrossRef]
  • 2. Cohen J. The immunopathogenesis of sepsis. Nature 2002; 420: 885-91. [CrossRef]
  • 3. Marx G, Schuerholz T, Reinhart K. New approaches to intensive care for sepsis. Chirurg 2005; 76: 845-55. [CrossRef]
  • 4. Pittet D, Li N, Woolson RF, Wenzel RP. Microbiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based model. Clin Infect Dis 1997; 24: 1068-78. [CrossRef]
  • 5. Uzun O, Akalin HE, Hayran M, Unal S. Factors influencing prognosis in bacteremia due to gram-negative organisms: evaluation of 448 episodes in a Turkish university hospital. Clin Infect Dis 1992; 15: 866-73. [CrossRef]
  • 6. Zarakolu P, Akova M. Antimicrobial treatment in sepsis. Yoğun Bakım Dergisi 2005; 5: 103-8.
  • 7. Rivers EP, McIntyre L, Morro DC, Rivers KK. Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity. CMAJ 2005; 173: 1054-65. [CrossRef]
  • 8. Sriskandan S, Cohen J. The pathogenesis of septic shock. J Infect 1995; 30: 201-6. [CrossRef]
  • 9. Mermutluoglu C, Deveci O, Dayan S, Aslan E, Bozkurt F, Tekin R. Antifungal susceptibility and risk factors in patients with candidemia. Eurasian J Med 2016;48:199-203. [CrossRef]
  • 10. Mertens K. Zinc in inflammation and sepsis. Applied Biology 2014, University of Aberdeen. Available From: URL: http://ethos.bl.uk/OrderDetails. do?uin=uk.bl.ethos.600115
  • 11. Bone RC. The pathogenesis of sepsis. Ann Intern Med 1991; 115: 457-69.[CrossRef]
  • 12. Rittirsch D, Flierl MA, Ward PA. Harmful molecular mechanisms in sepsis. Nat Rev Immunol 2008; 8: 776-87. [CrossRef]
  • 13. Schouten M, Wiersinga WJ, Levi M, van der Poll T. Inflammation, endothelium, and coagulation in sepsis. J Leukoc Biol 2008; 83: 536-45. [CrossRef]
  • 14. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 136: 1644-55. [CrossRef]
  • 15. Sahin S. Sepsiste Suprafizyolojik Doz Steroid Tedavisinin Yeri, in Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı 2009, Erciyes Üniversitesi Tıp Fakültesi.
  • 16. Tas G. Deneysel Rat Sepsis Modelinde Fenofibrat Tedavisinin Rolü, in Askeri Tıp Fakültesi İç Hastalıkları Bilim Dalı Başkanlığı 2010, T.C. Genelkurmay Başkanlığı Gülhane Askeri Tıp Akademisi. 17. Russell JA. Management of sepsis. N Engl J Med 2006; 355: 1699-713. [CrossRef]
  • 18. Medzhitov R, Janeway C Jr. Innate immunity. N Engl J Med 2000; 343: 338-44. [CrossRef]
  • 19. Cheng B, Hoeft AH, Book M, Shu Q, Pastores SM. Sepsis: pathogenesis, biomarkers, and treatment. Biomed Res Int 2015; 2015: 846935. [CrossRef]
  • 20. Wang H, Bloom O, Zhang M, et al. HMG-1 as a late mediator of endotoxin lethality in mice. Science 1999; 285: 248-51. [CrossRef]
  • 21. Yuzbasioglu Y, Duymaz H, Tanrikulu CS, et al. Role of procalcitonin in evaluation of the severity of acute cholecystitis. Eurasian J Med 2016; 48: 162-6. [CrossRef]
  • 22. Reinhart KB, Brunkhorst FM. Pathophysiology of sepsis and multiple organ dysfunction in Critical Care. AE Fink MP, Vincent JL, Kochanek PM, Editor 2005, Elsevier-Saunders: Philadelphia. p. 1249-58.
  • 23. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med 2003; 348: 138-50. [CrossRef]
  • 24. Bone RC. Gram-negative sepsis. Background, clinical features, and intervention. Chest 1991; 100: 802-8. [CrossRef]
  • 25. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004; 32: 858-73. [CrossRef]
  • 26. Cronin L, Cook DJ, Carlet J, et al. Corticosteroid treatment for sepsis: a critical appraisal and metaanalysis of the literature. Crit Care Med 1995; 23: 1430-9. [CrossRef]
  • 27. Besirbellioglu BA. Hayatı tehdit eden enfeksiyonların tedavisi: Sepsis. In: EKMUD Bilimsel Platformu 2006, Bilkent Otel ve Konferans Merkezi: Ankara.
  • 28. Nguyen HB, Rivers FM. Abrahamian, et al. Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Ann Emerg Med 2006; 48: 28-54. [CrossRef]
  • 29. Hadley JS, Hinds CJ. Anabolic strategies in critical illness. Curr Opin Pharmacol 2002; 2: 700-7. [CrossRef]
  • 30. Chioléro RL, Berger MM. Improving nutritional support in critically Ill septic patients: glutamine alone or in combination? Nutrition 2002; 18: 723-4. [CrossRef]
  • 31. Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med 2003; 31: 359-66. [CrossRef]
  • 32. Pildal J, Gøtzsche PC. Polyclonal immunoglobulin for treatment of bacterial sepsis: a systematic review. Clin Infect Dis 2004; 39: 38-46. [CrossRef]
  • 33. Avontuur JA, Tutein Nolthenius RP, van Bodegom JW, Bruining HA. Prolonged inhibition of nitric oxide synthesis in severe septic shock: a clinical study. Crit Care Med 1998; 26: 660-7. [CrossRef]
  • 34. Alonso de Vega JM, Diaz J, Serrano E, Carbonell LF. Oxidative stress in critically ill patients with systemic inflammatory response syndrome. Crit Care Med 2002; 30: 1782-6. [CrossRef]
  • 35. López A, Lorente JA, Steingrub J, et al. Multiplecenter, randomized, placebo-controlled, doubleblind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 2004; 32: 21-30. [CrossRef]
  • 36. Polderman KH, Girbes AR. Drug intervention trials in sepsis: divergent results. Lancet 2004; 363: 1721-3. [CrossRef]
  • 37. Reinhart K, Meier-Hellmann A, Beale R, et al. Open randomized phase II trial of an extracorporeal endotoxin adsorber in suspected Gram-negative sepsis. Crit Care Med 2004; 32: 1662-8. [CrossRef]
  • 38. Yang ZJ, Bosco G, Montante A, Ou XI, Camporesi EM. Hyperbaric O2 reduces intestinal ischemiareperfusion-induced TNF-alpha production and lung neutrophil sequestration. Eur J Appl Physiol 2001; 85: 96-103. [CrossRef]
  • 39. Wiel E, Lebuffe G, Robin E, et al. Pretreatment with peroxysome proliferator-activated receptor alpha agonist fenofibrate protects endothelium in rabbit Escherichia coli endotoxin-induced shock. Intensive Care Med 2005; 31: 1269-79. [CrossRef]
  • 40. Zangrillo A, Putzu A, Monaco F, et al. Levosimendan reduces mortality in patients with severe sepsis and septic shock: A meta-analysis of randomized trials. J Crit Care 2015; 30: 908-13. [CrossRef]
  • 41. Gordon AC, Perkins GD, Singer M, et al. Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis. N Engl J Med 2016; 375: 1638-48. [CrossRef]
  • 42. Ayaz G, Halici Z, Albayrak A, Karakus E, Cadirci E. Evaluation of 5-HT7 receptor trafficking on ın vivo and ın vitro model of lipopolysaccharide (LPS)- ınduced ınflammatory cell ınjury in rats and LPStreated A549 cells. Biochem Genet 2017; 55: 34-47. [CrossRef]
  • 43. Ozogul B, Halici Z, Cadirci E, et al. Comparative study on effects of nebulized and oral salbutamol on a cecal ligation and puncture-induced sepsis model in rats. Drug Res (Stuttg) 2015; 65: 192-8.
  • 44. Akpinar E, Halici Z, Cadirci E, et al. What is the role of renin inhibition during rat septic conditions: preventive effect of aliskiren on sepsis-induced lung injury. Naunyn Schmiedebergs Arch Pharmacol 2014; 387: 969-78. [CrossRef]
  • 45. Polat B, Cadirci E, Halici Z, et al. The protective effect of amiodarone in lung tissue of cecal ligation and puncture-induced septic rats: a perspective from inflammatory cytokine release and oxidative stress. Naunyn Schmiedebergs Arch Pharmacol 2013; 386: 635-43. [CrossRef]
  • 46. Albayrak A, Halici Z, Polat B, et al. Protective effects of lithium: a new look at an old drug with potential antioxidative and anti-inflammatory effects in an animal model of sepsis. Int Immunopharmacol 2013; 16: 35-40. [CrossRef]
  • 47. Coskun AK, Yigiter M, Oral A, et al. The effects of montelukast on antioxidant enzymes and proinflammatory cytokines on the heart, liver, lungs, and kidneys in a rat model of cecal ligation and puncture-induced sepsis. ScientificWorldJournal 2011; 11: 1341-56. [CrossRef]
  • 48. Cadirci E, Altunkaynak BZ, Halici Z, et al. Alpha-lipoic acid as a potential target for the treatment of lung injury caused by cecal ligation and puncture-induced sepsis model in rats. Shock 2010; 33: 479-84.
  • 49. Cadirci E, Halici Z, Odabasoglu F, et al. Sildenafil treatment attenuates lung and kidney injury due to overproduction of oxidant activity in a rat model of sepsis: a biochemical and histopathological study. Clin Exp Immunol 2011; 166: 374-84. [CrossRef]
  • 50. Celik MG, Saracoglu A, Saracoglu T, et al. Effects of propofol and midazolam on the ınflammation of lungs after ıntravenous endotoxin administration in rats. Eurasian J Med 2015; 47: 109-14. [CrossRef]
APA POLAT G, UGAN R, CADIRCI E, HALICI Z (2017). Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. , 53 - 58.
Chicago POLAT Gizem,UGAN Rustem Anil,CADIRCI ELIF,HALICI Zekai Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. (2017): 53 - 58.
MLA POLAT Gizem,UGAN Rustem Anil,CADIRCI ELIF,HALICI Zekai Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. , 2017, ss.53 - 58.
AMA POLAT G,UGAN R,CADIRCI E,HALICI Z Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. . 2017; 53 - 58.
Vancouver POLAT G,UGAN R,CADIRCI E,HALICI Z Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. . 2017; 53 - 58.
IEEE POLAT G,UGAN R,CADIRCI E,HALICI Z "Sepsis and Septic Shock: Current Treatment Strategies and New Approaches." , ss.53 - 58, 2017.
ISNAD POLAT, Gizem vd. "Sepsis and Septic Shock: Current Treatment Strategies and New Approaches". (2017), 53-58.
APA POLAT G, UGAN R, CADIRCI E, HALICI Z (2017). Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. Eurasian Journal of Medicine, 49(1), 53 - 58.
Chicago POLAT Gizem,UGAN Rustem Anil,CADIRCI ELIF,HALICI Zekai Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. Eurasian Journal of Medicine 49, no.1 (2017): 53 - 58.
MLA POLAT Gizem,UGAN Rustem Anil,CADIRCI ELIF,HALICI Zekai Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. Eurasian Journal of Medicine, vol.49, no.1, 2017, ss.53 - 58.
AMA POLAT G,UGAN R,CADIRCI E,HALICI Z Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. Eurasian Journal of Medicine. 2017; 49(1): 53 - 58.
Vancouver POLAT G,UGAN R,CADIRCI E,HALICI Z Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. Eurasian Journal of Medicine. 2017; 49(1): 53 - 58.
IEEE POLAT G,UGAN R,CADIRCI E,HALICI Z "Sepsis and Septic Shock: Current Treatment Strategies and New Approaches." Eurasian Journal of Medicine, 49, ss.53 - 58, 2017.
ISNAD POLAT, Gizem vd. "Sepsis and Septic Shock: Current Treatment Strategies and New Approaches". Eurasian Journal of Medicine 49/1 (2017), 53-58.