Sepsis - Knowledge

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higher in women. During the same time frame, the in-hospital case fatality rate was reduced from 28% to 18%. However, according to the nationwide inpatient sample from the United States, the incidence of severe sepsis increased from 200 per 10,000 population in 2003 to 300 cases in 2007 for population aged more than 18 years. The incidence rate is particularly high among infants, with an incidence of 500 cases per 100,000 population. Mortality related to sepsis increases with age, from less than 10% in the age group of 3 to 5 years to 60% by sixth decade of life. The increase in the average age of the population, alongside the presence of more people with chronic diseases or on

2692: 1472:(CHEST) raised concerns that qSOFA and SOFA criteria may lead to delayed diagnosis of serious infection, leading to delayed treatment. Although SIRS criteria can be too sensitive and not specific enough in identifying sepsis, SOFA also has its limitations and is not intended to replace the SIRS definition. qSOFA has also been found to be poorly sensitive though decently specific for the risk of death with SIRS possibly better for screening. NOTE - Surviving Sepsis Campaign 2021 Guidelines recommends "against using qSOFA compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock". 9464: 1468:). The three criteria for the qSOFA score include a respiratory rate greater than or equal to 22 breaths per minute, systolic blood pressure 100 mmHg or less and altered mental status. Sepsis is suspected when 2 of the qSOFA criteria are met. The SOFA score was intended to be used in the intensive care unit (ICU) where it is administered upon admission to the ICU and then repeated every 48 hours, whereas the qSOFA could be used outside the ICU. Some advantages of the qSOFA score are that it can be administered quickly and does not require labs. However, the 2433:(EGDT) is an approach to the management of severe sepsis during the initial 6 hours after diagnosis. It is a step-wise approach, with the physiologic goal of optimizing cardiac preload, afterload, and contractility. It includes giving early antibiotics. EGDT also involves monitoring of hemodynamic parameters and specific interventions to achieve key resuscitation targets which include maintaining a central venous pressure between 8–12 mmHg, a mean arterial pressure of between 65 and 90 mmHg, a central venous oxygen saturation (ScvO 2818:

as of the date of their article over 150 clinical trials of sepsis had been conducted in humans, almost all of them supported by promising data in mice and that all of them had failed. The authors called for abandoning the use of mouse models in sepsis research; others rejected that but called for more caution in interpreting the results of mouse studies, and more careful design of preclinical studies. One approach is to rely more on studying biopsies and clinical data from people who have had sepsis, to try to identify

2647:(ICU) and the tenth-most-common cause of death overall (the first being heart disease). Children under 12 months of age and elderly people have the highest incidence of severe sepsis. Among people from the U.S. who had multiple sepsis hospital admissions in 2010, those who were discharged to a skilled nursing facility or long-term care following the initial hospitalization were more likely to be readmitted than those discharged to another form of care. A study of 18 U.S. states found that, amongst people with 1906:

intravenous fluids if there is evidence of either low blood pressure or other evidence for inadequate blood supply to organs (as evidenced by a raised level of lactate); blood cultures also should be obtained within this time period. After six hours the blood pressure should be adequate, close monitoring of blood pressure and blood supply to organs should be in place, and the lactate should be measured again if initially it was raised. A related bundle, the "

55: 1219: 591: 1392: 2333:(PEEP) is recommended for moderate to severe ARDS in sepsis as it opens more lung units for oxygen exchange. Predicted body weight is calculated based on sex and height, and tools for this are available. Recruitment maneuvers may be necessary for severe ARDS by briefly raising the transpulmonary pressure. It is recommended that the head of the bed be raised if possible to improve ventilation. However, 2234:

hypotensive shock because it reduces blood flow to the abdominal organs and increases lactate levels. Vasopressin can be used in septic shock because studies have shown that there is a relative deficiency of vasopressin when shock continues for 24 to 48 hours. However, vasopressin reduces blood flow to the heart, finger/toes, and abdominal organs, resulting in a lack of oxygen supply to these tissues.

1809:(SuPAR) is a nonspecific marker of inflammation and does not accurately diagnose sepsis. This same review concluded, however, that SuPAR has prognostic value, as higher SuPAR levels are associated with an increased rate of death in those with sepsis. Serial measurement of lactate levels (approximately every 4 to 6 hours) may guide treatment and is associated with lower mortality in sepsis. 583:, approximately 0.2 to 3 people per 1000 are affected by sepsis yearly, resulting in about a million cases per year in the United States. Rates of disease have been increasing. Some data indicate that sepsis is more common among males than females, however, other data show a greater prevalence of the disease among women. Descriptions of sepsis date back to the time of 2875: 1990:) are recommended. The choice of antibiotics is important in determining the survival of the person. Some recommend they be given within one hour of making the diagnosis, stating that for every hour of delay in the administration of antibiotics, there is an associated 6% rise in mortality. Others did not find a benefit with early administration. 2860:" was established in 2002 to educate people about sepsis and to improve outcomes with sepsis. The Campaign has published an evidence-based review of management strategies for severe sepsis, with the aim to publish a complete set of guidelines in subsequent years. The guidelines were updated in 2016 and again in 2021. 2614:

and Mortality in Emergency Department Sepsis. APACHE II factors in the person's age, underlying condition, and various physiologic variables to yield estimates of the risk of dying of severe sepsis. Of the individual covariates, the severity of the underlying disease most strongly influences the risk

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to bring it down to 7.8–10 mmol/L (140–180 mg/dL) is recommended with lower levels potentially worsening outcomes. Glucose levels taken from capillary blood should be interpreted with care because such measurements may not be accurate. If a person has an arterial catheter, arterial blood is

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Two sets of blood cultures (aerobic and anaerobic) are recommended without delaying the initiation of antibiotics. Cultures from other sites such as respiratory secretions, urine, wounds, cerebrospinal fluid, and catheter insertion sites (in-situ more than 48 hours) are recommended if infections from

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also decreases, causing a narrowing/decreasing of pulse pressure. A pulse pressure of over 70 mmHg in patients with sepsis is correlated with an increased chance of survival. A widened pulse pressure is also correlated with an increased chance that someone with sepsis will benefit from and respond to

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Serpa Neto A, Veelo DP, Peireira VG, de Assunção MS, Manetta JA, Espósito DC, Schultz MJ (February 2014). "Fluid resuscitation with hydroxyethyl starches in patients with sepsis is associated with an increased incidence of acute kidney injury and use of renal replacement therapy: a systematic review

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and heart rate. In some people, the required dose of vasopressor needed to increase the mean arterial pressure can become exceedingly high that it becomes toxic. In order to reduce the required dose of vasopressor, epinephrine may be added. Epinephrine is not often used as a first-line treatment for

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is sufficient to achieve peak plasma concentration for a clinical response without kidney toxicity. Meanwhile, for antibiotics with low volume distribution (vancomycin, teicoplanin, colistin), a loading dose is required to achieve an adequate therapeutic level to fight infections. Frequent infusions

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Previously, SIRS criteria had been used to define sepsis. If the SIRS criteria are negative, it is very unlikely the person has sepsis; if it is positive, there is just a moderate probability that the person has sepsis. According to SIRS, there were different levels of sepsis: sepsis, severe sepsis,

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Controversy occurred in the scientific community over the use of mouse models in research into sepsis in 2013 when scientists published a review of the mouse immune system compared to the human immune system and showed that on a systems level, the two worked very differently; the authors noted that

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gene 4 (TLR 4). Genetic mapping work, performed over a period of five years, showed that TLR4 was the sole candidate locus within the Lps critical region; this strongly implied that a mutation within TLR4 must account for the lipopolysaccharide resistance phenotype. The defect in the TLR4 gene that

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In the original trial, early goal-directed therapy was found to reduce mortality from 46.5% to 30.5% in those with sepsis, and the Surviving Sepsis Campaign has been recommending its use. However, three more recent large randomized control trials (ProCESS, ARISE, and ProMISe), did not demonstrate a

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only if both intravenous fluids and vasopressors are not able to adequately treat septic shock. The 2021 Surviving Sepsis Campaign recommends IV corticosteroids for adults with septic shock who have an ongoing requirement for vasopressor therapy. A 2019 Cochrane review found low-quality evidence of

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or community-acquired infection, and which organ systems are thought to be infected. Antibiotic regimens should be reassessed daily and narrowed if appropriate. Treatment duration is typically 7–10 days with the type of antibiotic used directed by the results of cultures. If the culture result

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Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. (June 2008). "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

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Sepsis occurs in 1–2% of all hospitalizations and accounts for as much as 25% of ICU bed utilization. Due to it rarely being reported as a primary diagnosis (often being a complication of cancer or other illness), the incidence, mortality, and morbidity rates of sepsis are likely underestimated. A

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Sepsis was the most expensive condition treated in United States' hospital stays in 2013, at an aggregate cost of $ 23.6 billion for nearly 1.3 million hospitalizations. Costs for sepsis hospital stays more than quadrupled since 1997 with an 11.5 percent annual increase. By payer, it was the most

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levels are recommended to confirm the diagnosis. The method of stopping glucocorticoid drugs is variable, and it is unclear whether they should be slowly decreased or simply abruptly stopped. However, the 2016 Surviving Sepsis Campaign recommended to taper steroids when vasopressors are no longer

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reaches 8–12 mmHg. Once these goals are met, the central venous oxygen saturation (ScvO2), i.e., the oxygen saturation of venous blood as it returns to the heart as measured at the vena cava, is optimized. If the ScvO2 is less than 70%, blood may be given to reach a hemoglobin of 10 g/dL and

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of the test to be 77% and the specificity to be 79%. The authors suggested that procalcitonin may serve as a helpful diagnostic marker for sepsis, but cautioned that its level alone does not definitively make the diagnosis. More current literature recommends utilizing the PCT to direct antibiotic

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Sepsis will prove fatal in approximately 24.4% of people, and septic shock will prove fatal in 34.7% of people within 30 days (32.2% and 38.5% after 90 days). Lactate is a useful method of determining prognosis, with those who have a level greater than 4 mmol/L having a mortality of 40% and

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can also be used in hypotensive septic shock to increase cardiac output and correct blood flow to the tissues. Dobutamine is not used as often as epinephrine due to its associated side effects, which include reducing blood flow to the gut. Additionally, dobutamine increases the cardiac output by

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From 1979 to 2000, data from the United States National Hospital Discharge Survey showed that the incidence of sepsis increased fourfold, to 240 cases per 100,000 population, with a higher incidence in men when compared to women. However, the global prevalence of sepsis has been estimated to be

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of death. Septic shock is also a strong predictor of short- and long-term mortality. Case-fatality rates are similar for culture-positive and culture-negative severe sepsis. The Mortality in Emergency Department Sepsis (MEDS) score is simpler and useful in the emergency department environment.

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10 to 80% risk of death; These mortality rates (they are for a range of conditions along a spectrum: sepsis, severe sepsis, and septic shock) may be lower if treated aggressively and early, depending on the organism and disease, the patient's previous health, and the abilities of the treatment

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can be difficult to diagnose as newborns may be asymptomatic. If a newborn shows signs and symptoms suggestive of sepsis, antibiotics are immediately started and are either changed to target a specific organism identified by diagnostic testing or discontinued after an infectious cause for the

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Early recognition and focused management may improve the outcomes in sepsis. Current professional recommendations include a number of actions ("bundles") to be followed as soon as possible after diagnosis. Within the first three hours, someone with sepsis should have received antibiotics and,

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Norepinephrine is often used as a first-line treatment for hypotensive septic shock because evidence shows that there is a relative deficiency of vasopressin when shock continues for 24 to 48 hours. Norepinephrine raises blood pressure through a vasoconstriction effect, with little effect on

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transfusion usually does not correct the underlying clotting abnormalities before a planned surgical procedure. However, platelet transfusion is suggested for platelet counts below (10 × 10/L) without any risk of bleeding, or (20 × 10/L) with high risk of bleeding, or (50 × 10/L) with active

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symptoms has been ruled out. Despite early intervention, death occurs in 13% of children who develop septic shock, with the risk partly based on other health problems. For those without multiple organ system failures or who require only one inotropic agent, mortality is low.

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People in sepsis may have micronutrient deficiencies, including low levels of vitamin C. Reviews mention that an intake of 3.0 g/day, which requires intravenous administration, may needed to maintain normal plasma concentrations in people with sepsis or severe burn injury.

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Disease severity partly determines the outcome. The risk of death from sepsis is as high as 30%, while for severe sepsis it is as high as 50%, and septic shock 80%. Sepsis affected about 49 million people in 2017, with 11 million deaths (1 in 5 deaths worldwide). In the

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The most common sites of infection resulting in severe sepsis are the lungs, the abdomen, and the urinary tract. Typically, 50% of all sepsis cases start as an infection in the lungs. In one-third to one-half of cases, the source of infection is unclear.

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Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJ, Perry JJ (February 2018). "Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis".

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score), where it was thought to confer a survival benefit. However, subsequent studies showed that it increased adverse events—bleeding risk in particular—and did not decrease mortality. It was removed from sale in 2011. Another medication known as

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90-day mortality benefit of early goal-directed therapy when compared to standard therapy in severe sepsis. It is likely that some parts of EGDT are more important than others. Following these trials the use of EGDT is still considered reasonable.

469:(qSOFA), replaced the SIRS system of diagnosis. qSOFA criteria for sepsis include at least two of the following three: increased breathing rate, change in the level of consciousness, and low blood pressure. Sepsis guidelines recommend obtaining 2618:

Some people may experience severe long-term cognitive decline following an episode of severe sepsis, but the absence of baseline neuropsychological data in most people with sepsis makes the incidence of this difficult to quantify or to study.

2726:(ICD) version 9, which was in use in the US until 2013, used the term septicemia with numerous modifiers for different diagnoses, such as "Streptococcal septicemia". All those diagnoses have been converted to sepsis, again with modifiers, in 2172:, or acute bleeding. In a 2014 trial, blood transfusions to keep target hemoglobin above 70 or 90 g/L did not make any difference to survival rates; meanwhile, those with a lower threshold of transfusion received fewer transfusions in total. 2395:

cases remains controversial. When appropriately used, paralytics may aid successful mechanical ventilation, however, evidence has also suggested that mechanical ventilation in severe sepsis does not improve oxygen consumption and delivery.

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Roberts JA, Abdul-Aziz MH, Davis JS, Dulhunty JM, Cotta MO, Myburgh J, et al. (September 2016). "Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis. A Meta-analysis of Individual Patient Data from Randomized Trials".

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General anesthesia is recommended for people with sepsis who require surgical procedures to remove the infective source. Usually, inhalational and intravenous anesthetics are used. Requirements for anesthetics may be reduced in sepsis.

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Sepsis is caused by a combination of factors related to the particular invading pathogen(s) and to the status of the immune system of the host. The early phase of sepsis characterized by excessive inflammation (sometimes resulting in a

2984:. Marik's own initial research, published in 2017, showed a dramatic evidence of benefit, leading to the protocol becoming popular among intensive care physicians, especially after the protocol received attention on social media and 8901: 1269:. If other sources of infection are suspected, cultures of these sources, such as urine, cerebrospinal fluid, wounds, or respiratory secretions, also should be obtained, as long as this does not delay the use of antibiotics. 8666:

Poltorak A, Smirnova I, He X, Liu MY, Van Huffel C, McNally O, et al. (September 1998). "Genetic and physical mapping of the Lps locus: identification of the toll-4 receptor as a candidate gene in the critical region".

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Several medical conditions increase a person's susceptibility to infection and developing sepsis. Common sepsis risk factors include age (especially the very young and old); conditions that weaken the immune system such as

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Gu WJ, Wang F, Tang L, Liu JC (February 2015). "Single-dose etomidate does not increase mortality in patients with sepsis: a systematic review and meta-analysis of randomized controlled trials and observational studies".

4594:"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" 2437:) greater than 70% and a urine output of greater than 0.5 mL/kg/hour. The goal is to optimize oxygen delivery to tissues and achieve a balance between systemic oxygen delivery and demand. An appropriate decrease in serum 7227:

Rusconi AM, Bossi I, Lampard JG, Szava-Kovats M, Bellone A, Lang E (September 2015). "Early goal-directed therapy vs usual care in the treatment of severe sepsis and septic shock: a systematic review and meta-analysis".

2349:(CPAP), T piece, or inspiratory pressure augmentation can be helpful in reducing the duration of ventilation. Minimizing intermittent or continuous sedation is helpful in reducing the duration of mechanical ventilation. 1889:, but neonatal sepsis also may be due to infection with fungi, viruses, or parasites. Criteria with regard to hemodynamic compromise or respiratory failure are not useful because they present too late for intervention. 1241:, measuring serum lactate, and obtaining appropriate cultures before starting antibiotics, so long as this does not delay their use by more than 45 minutes. To identify the causative organism(s), at least two sets of 5111: 9592: 9565: 9546: 2723: 2554:(UGIB) such as on mechanical ventilation for more than 48 hours, coagulation disorders, liver disease, and renal replacement therapy. Achieving partial or full enteral feeding (delivery of nutrients through a 1993:

Several factors determine the most appropriate choice for the initial antibiotic regimen. These factors include local patterns of bacterial sensitivity to antibiotics, whether the infection is thought to be a

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Carpenter CR, Keim SM, Upadhye S, Nguyen HB (October 2009). "Risk stratification of the potentially septic patient in the emergency department: the Mortality in the Emergency Department Sepsis (MEDS) score".

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has recommended 30 mL/kg of fluid to be given in adults in the first three hours followed by fluid titration according to blood pressure, urine output, respiratory rate, and oxygen saturation with a target

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is unclear. However, the exact way of determining corticosteroid insufficiency remains problematic. It should be suspected in those poorly responding to resuscitation with fluids and vasopressors. Neither

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We hope this editorial will clarify that the qSOFA is meant to be used to raise suspicion of sepsis and prompt further action—it is not a replacement for SIRS and is not part of the definition of sepsis.

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Leentjens J, Kox M, van der Hoeven JG, Netea MG, Pickkers P (June 2013). "Immunotherapy for the adjunctive treatment of sepsis: from immunosuppression to immunostimulation. Time for a paradigm change?".

1914:; this requires the administration of antibiotics within an hour of recognition, blood cultures, lactate, and hemoglobin determination, urine output monitoring, high-flow oxygen, and intravenous fluids. 5384:

We believe that adopting a more restrictive definition that requires further progression along the sepsis pathway may delay intervention in this highly time-dependent condition, with additional risk to

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is negative, antibiotics should be de-escalated according to the person's clinical response or stopped altogether if an infection is not present to decrease the chances that the person is infected with

2205:, plasma filtration, and coupled plasma filtration adsorption) to remove inflammatory mediators and bacterial toxins from the blood also does not demonstrate any survival benefit for septic shock. 2469:

Treating fever in sepsis, including people in septic shock, has not been associated with any improvement in mortality over a period of 28 days. Treatment of fever still occurs for other reasons.

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microbial response to a sudden decline of host survival chances. Under this scenario, the microbe species provoking sepsis benefit from monopolizing the future cadaver, utilizing its biomass as

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Within twelve hours, it is essential to diagnose or exclude any source of infection that would require emergent source control, such as a necrotizing soft tissue infection, an infection causing

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symptoms including agitation, confusion, coma; causes may include ischemia, bleeding, formation of blood clots in small blood vessels, microabscesses, multifocal necrotizing leukoencephalopathy

593: 6124:"Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis" 882:. Either of these phases may prove fatal. On the other hand, systemic inflammatory response syndrome (SIRS) occurs in people without the presence of infection, for example, in those with 2558:) is chosen as the best approach to provide nutrition for a person who is contraindicated for oral intake or unable to tolerate orally in the first seven days of sepsis when compared to 2185:

bleeding, before a planned surgery or an invasive procedure. IV immunoglobulin is not recommended because its beneficial effects are uncertain. Monoclonal and polyclonal preparations of

2148:, and need for blood transfusion. Various colloid solutions (such as modified gelatin) carry no advantage over crystalloid. Albumin also appears to be of no benefit over crystalloids. 8893: 7355:

Kutko MC, Calarco MP, Flaherty MB, Helmrich RF, Ushay HM, Pon S, Greenwald BM (July 2003). "Mortality rates in pediatric septic shock with and without multiple organ system failure".

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that may lead to organ failure. Fever is the most common presenting symptom in sepsis, but fever may be absent in some people such as the elderly or those who are immunocompromised.

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from the wider medical community. Subsequent independent research failed to replicate Marik's positive results, indicating the possibility that they had been compromised by bias. A

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Early diagnosis is necessary to properly manage sepsis, as the initiation of rapid therapy is key to reducing deaths from severe sepsis. Some hospitals use alerts generated from

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Lyle NH, Pena OM, Boyd JH, Hancock RE (September 2014). "Barriers to the effective treatment of sepsis: antimicrobial agents, sepsis definitions, and host-directed therapies".

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Ni YN, Liu YM, Wang YW, Liang BM, Liang ZA (September 2019). "Can corticosteroids reduce the mortality of patients with severe sepsis? A systematic review and meta-analysis".

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Belsky JB, Wira CR, Jacob V, Sather JE, Lee PJ (December 2018). "A review of micronutrients in sepsis: the role of thiamine, L-carnitine, vitamin C, selenium and vitamin D".

1116:(yellowish discoloration of the skin). In kidneys, inadequate oxygenation results in tubular epithelial cell injury (of the cells lining the kidney tubules), and thus causes 2719:

process. Though severe systemic toxicity had already been observed, it was only in the 19th century that the specific term – sepsis – was used for this condition.

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Biomarkers can help diagnosis because they can point to the presence or severity of sepsis, although their exact role in the management of sepsis remains undefined. A 2013

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Poltorak A, He X, Smirnova I, Liu MY, Van Huffel C, Du X, et al. (December 1998). "Defective LPS signaling in C3H/HeJ and C57BL/10ScCr mice: mutations in Tlr4 gene".

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Lee YR, Vo K, Varughese JT (March 2022). "Benefits of combination therapy of hydrocortisone, ascorbic acid and thiamine in sepsis and septic shock: A systematic review".

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Shear MJ (1944). "Chemical treatment of tumors, IX: Reactions of mice with primary subcutaneous tumors to injection of a hemorrhage-producing bacterial polysaccharide".

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Goldstein B, Giroir B, Randolph A (January 2005). "International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics".

2280: 2805:. These mice were also found to be hyper susceptible to infection by gram-negative bacteria. These observations were finally linked in 1998 by the discovery of the 1272:

Within six hours, if blood pressure remains low despite initial fluid resuscitation of 30 mL/kg, or if initial lactate is ≥ four mmol/L (36 mg/dL),

6021:"Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" 8205: 2866:

is a charitable organization based in the United States that was created to raise sepsis awareness among both the general public and healthcare professionals.

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Consensus definitions, however, continue to evolve, with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience.

6165:"Hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin in patients with sepsis: systematic review with meta-analysis and trial sequential analysis" 2225:(noradrenaline) is recommended as the initial choice. Delaying initiation of vasopressor therapy during septic shock is associated with increased mortality. 8525:

Lüderitz O, Galanos C, Lehmann V, Nurminen M, Rietschel ET, Rosenfelder G, et al. (July 1973). "Lipid A: chemical structure and biological activity".

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Khilnani P, Singhi S, Lodha R, Santhanam I, Sachdev A, Chugh K, Jaishree M, Ranjit S, Ramachandran B, Ali U, Udani S, Uttam R, Deopujari S (January 2010).

1013:. Invariably, the association of a PAMP and a PRR will cause a series of intracellular signalling cascades. Consequentially, transcription factors such as 1921:, the management of sepsis also involves surgical drainage of infected fluid collections and appropriate support for organ dysfunction. This may include 7883:"Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis" 2643:

found approximately 651 hospital stays per 100,000 population with a sepsis diagnosis in 2010. It is the second-leading cause of death in non-coronary

2092:(MIC), thus providing a better clinical response. Giving beta-lactam antibiotics continuously may be better than giving them intermittently. Access to 6250:"Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality" 9701: 5805: 2794:

character of enteric endotoxins was elucidated in 1944 by Shear. The molecular character of this material was determined by Luderitz et al. in 1973.

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through various mechanisms as described below. Increased permeability of the lung vessels causes leaking of fluids into alveoli, which results in

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Chan CM, Mitchell AL, Shorr AF (November 2012). "Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*".

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Cherfan AJ, Arabi YM, Al-Dorzi HM, Kenny LP (May 2012). "Advantages and disadvantages of etomidate use for intubation of patients with sepsis".

4218:"A widened pulse pressure: a potential valuable prognostic indicator of mortality in patients with sepsis. J Community Hosp Intern Med Perspect" 433:

Sepsis is caused by many organisms including bacteria, viruses and fungi. Common locations for the primary infection include the lungs, brain,

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Desale M, Thinkhamrop J, Lumbiganon P, Qazi S, Anderson J (October 2016). "Ending preventable maternal and newborn deaths due to infection".

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and an increased risk of death. The small amount of evidence there is, however, has not found a change in the risk of death with etomidate.

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The terms "septicemia", also spelled "septicaemia", and "blood poisoning" referred to the microorganisms or their toxins in the blood. The

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are recommended for those who are septic and unable to tolerate enteral feeding. However, these agents may precipitate prolongation of the

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Munford RS (2011). "Ch. 271: Severe Sepsis and Septic Shock". In Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J (eds.).

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hypotension with blood pressure < 5th percentile for age or systolic blood pressure < 2 standard deviations below normal for age, or

9979: 9116: 5886: 2020: 2072:) for less ill people. Prolonged antibiotic prophylaxis is not recommended in people who has SIRS without any infectious origin such as 9039: 8193: 8189: 8111: 3061: 2113:(MAP) of 65 mmHg. In children an initial amount of 20 mL/kg is reasonable in shock. In cases of severe sepsis and septic shock where a 1175:

The low blood pressure seen in those with sepsis is the result of various processes, including excessive production of chemicals that

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is defined as sepsis with sepsis-induced organ dysfunction or tissue hypoperfusion (manifesting as hypotension, elevated lactate, or

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Sepsis causes millions of deaths globally each year and is the most common cause of death in people who have been hospitalized. The

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than norepinephrine and also has an immunosuppressive effect. Dopamine is not proven to have protective properties on the kidneys.

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Antonopoulou A, Giamarellos-Bourboulis EJ (January 2011). "Immunomodulation in sepsis: state of the art and future perspective".

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accounts for approximately 5% of severe sepsis and septic shock cases; the most common cause of fungal sepsis is an infection by

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is helpful when looking for the possible location of the infection. Other potential causes of similar signs and symptoms include

458: 285: 1033:, the host systemic immune system is activated. Immune cells not only recognise pathogen-associated molecular patterns but also 2198: 2140:

can be used if a large amount of crystalloid is required for resuscitation. Crystalloid solutions shows little difference with

1736: 669: 117: 7789:"The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials" 5766:

Machowicz R, Janka G, Wiktor-Jedrzejczak W (June 2017). "Similar but not the same: Differential diagnosis of HLH and sepsis".

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is important to ensure adequate drug therapeutic level while at the same time preventing the drug from reaching toxic level.

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for sepsis is broad and has to examine (to exclude) the non-infectious conditions that may cause the systemic signs of SIRS:

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and one through each vascular access device (such as an IV catheter) that has been in place more than 48 hours. Bacteria are

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were the primary cause of sepsis before the introduction of antibiotics in the 1950s. After the introduction of antibiotics,

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Septicemia... has been used... in a variety of ways... We therefore suggest that this term be eliminated from current usage.

3693:"Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis: A Systematic Review and Meta-analysis" 9055: 8123: 5252: 4585: 3858:"Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study" 1469: 793:

became the predominant cause of sepsis from the 1960s to the 1980s. After the 1980s, gram-positive bacteria, most commonly

5936:"The Impact of Timing of Antibiotics on Outcomes in Severe Sepsis and Septic Shock: A Systematic Review and Meta-Analysis" 1140:, direct damage of the brain cells and disturbances of neurotransmissions causes altered mental status. Cytokines such as 9902: 9887: 9827: 2773: 2392: 2384: 2346: 2127: 1495: 1481: 1169: 1105: 1097: 1086: 1034: 762: 185: 5259:) (June 1992). "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis". 4584:

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. (The ACCP/SCCM Consensus Conference Committee.

1160:, leading to endothelial damage. The damaged endothelial surface inhibits anticoagulant properties as well as increases 8138: 4516: 4043: 2535: 1854: 8179: 2683:, and also the increase in the number of invasive procedures being performed, has led to an increased rate of sepsis. 10389: 10300: 9997: 9112: 8363: 8081: 5670:"Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review" 5256: 4589: 4376: 4293: 3121: 3108:) (2011). "Ch. 146: Septic Shock". In Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD (eds.). 3065: 2238:

is typically not recommended. Although dopamine is useful to increase the stroke volume of the heart, it causes more

2635:

sepsis affects approximately 3 in 1,000 people, and severe sepsis contributes to more than 200,000 deaths per year.

10793: 9687: 5890: 4010: 3777:"Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes--United States, 1999-2014" 2898:, and then transmitted through soil or water to establish mutualistic relations with new individuals. The bacteria 2330: 2089: 1277: 997:(PRRs) of the innate immune system, which may be membrane-bound or cytosolic. There are four families of PRRs: the 951: 5204:"Point-of-care lactate testing for sepsis at presentation to health care: a systematic review of patient outcomes" 4503:

Ely EW, Goyette RE (2005). "Ch. 46: Sepsis with Acute Organ Dysfunction". In Hall JB, Schmidt GA, Wood LD (eds.).

3352:"Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality" 10143: 10002: 9935: 8976:"The diagnostic and prognostic value of systems biology research in major traumatic and thermal injury: a review" 4030:

Felner K, Smith RL (2012). "Ch. 138: Sepsis". In McKean S, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS (eds.).

2551: 1192: 765:. After three months in hospital, the patient recovered within a month and is since then fully well (as of 2023). 17: 9495: 6804: 1041:

are not recruited to the specific site of infection, but instead they are recruited all over the body. Then, an

10274: 8436: 1730: 1702: 690:

Oxidative stress is observed in septic shock, with circulating levels of copper and vitamin C being decreased.

2707:

The term "σήψις" (sepsis) was introduced by Hippocrates in the fourth century BC, and it meant the process of

10803: 9781: 9764: 7838:

Berger MM, Oudemans-van Straaten HM (March 2015). "Vitamin C supplementation in the critically ill patient".

6800: 6122:

Zarychanski R, Abou-Setta AM, Turgeon AF, Houston BL, McIntyre L, Marshall JC, Fergusson DA (February 2013).

2088:

of beta-lactam antibiotics without exceeding total daily dose would help to keep the antibiotics level above

1343: 994: 7041:"Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008" 3548:"Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012" 2369:

has a minimal effect on the cardiovascular system, it is often not recommended as a medication to help with

10798: 10788: 10670: 10382: 9758: 9080: 9043: 2890:

may not always be an accidental side effect of the deteriorating host immune system. Rather it is often an

2527: 2357:

can reduce the level of proinflammatory cytokines, altering leukocyte adhesion and proliferation, inducing

700:, which is the difference between the systolic and diastolic blood pressures. If sepsis becomes severe and 548: 5828: 1440:). Severe sepsis is an infectious disease state associated with multiple organ dysfunction syndrome (MODS) 10184: 10118: 9243: 7200:

Dell'Anna AM, Taccone FS (October 2015). "Early-goal directed therapy for septic shock: is it the end?".

2989: 2430: 2380: 2342: 2222: 2093: 1995: 1798: 1647:

the ratio of the arterial partial-pressure of oxygen to the fraction of oxygen in the gases inspired (PaO

836: 6514:

Hamzaoui O, Scheeren TW, Teboul JL (August 2017). "Norepinephrine in septic shock: when and how much?".

2999:

Overall, the evidence for any role for vitamin C in the treatment of sepsis remains unclear as of 2021.

9776: 9721: 9324:

Rubin R (July 2019). "Wide Interest in a Vitamin C Drug Cocktail for Sepsis Despite Lagging Evidence".

6564:"The spectrum of cardiovascular effects of dobutamine - from healthy subjects to septic shock patients" 4957:

Nimah M, Brilli RJ (July 2003). "Coagulation dysfunction in sepsis and multiple organ system failure".

2186: 604: 540:

may be placed for access to the bloodstream and to guide treatment. Other helpful measurements include

346:

In 2017 there were 48.9 million cases and 11 million sepsis-related deaths worldwide (according to WHO)

10707: 6163:

Haase N, Perner A, Hennings LI, Siegemund M, Lauridsen B, Wetterslev M, Wetterslev J (February 2013).

1797:

level as a method to distinguish sepsis from non-infectious causes of SIRS. The same review found the

10695: 10532: 10478: 10305: 10101: 10096: 10047: 9470: 9463: 9140:"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016" 9107: 6648:"Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis" 6297:

Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, et al. (October 2014).

3304:"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016" 3196:

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. (February 2016).

3008: 2857: 2772:

released during infection caused the fever and shock that were commonplace during severe infections.

2519: 2105: 1967: 1551: 1266: 1018: 9187:"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021" 9185:

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. (November 2021).

8393: 5067: 1280:

should be measured. Lactate should be re-measured if the initial lactate was elevated. Evidence for

797:, are thought to cause more than 50% of cases of sepsis. Other commonly implicated bacteria include 563:

unless other conditions prevent such interventions. Some people might benefit from tight control of

10732: 10727: 10490: 9607: 5668:

Backes Y, van der Sluijs KF, Mackie DP, Tacke F, Koch A, Tenhunen JJ, Schultz MJ (September 2012).

5164: 4068:

Gauer RL (July 2013). "Early recognition and management of sepsis in adults: the first six hours".

2900: 2691: 2648: 2628: 2354: 2334: 2004: 2000: 1772: 1706: 1212: 693: 307: 1580:

Cardiovascular dysfunction (after fluid resuscitation with at least 40 mL/kg of crystalloid)

10199: 10042: 10027: 9710: 7603:"Human recombinant protein C for severe sepsis and septic shock in adult and paediatric patients" 2566:

are not recommended as immune supplements for a person with sepsis or septic shock. The usage of

2118: 2114: 2015: 1710: 1273: 1238: 918:, allow colonization, immune evasion, and establishment of disease in the host. Sepsis caused by 710: 533: 441:. Risk factors include being very young or old, a weakened immune system from conditions such as 177: 6999:

De Waele JJ (2009). "Source Control in the ICU". In Vincent JL, Malbrain MM, De Laet IE (eds.).

4113:

Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. (February 2019).

2594:. The usage of prokinetic agents should be reassessed daily and stopped if no longer indicated. 2416:. It is one of the oldest procedures for control of infections, giving rise to the Latin phrase 1941:, and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition—preferably by 962:. This forced receptor interaction induces the production of pro-inflammatory chemical signals ( 10629: 10279: 10081: 9504: 8388: 8102:"Trends in Septicemia Hospitalizations and Readmissions in Selected HCUP States, 2005 and 2010" 7449:"Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey" 6019:

de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, et al. (November 2015).

5062: 3856:

Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. (January 2020).

2918: 2787: 2680: 2587: 2539: 2531: 2388: 2326: 2214: 2157: 2110: 2009: 1930: 1818: 1755: 1377: 1137: 1129: 1121: 1014: 811: 799: 790: 786: 525: 9647: 9559: 9102: 7400:"Antipyretic Therapy in Critically Ill Septic Patients: A Systematic Review and Meta-Analysis" 5847:"Surviving the first hours in sepsis: getting the basics right (an intensivist's perspective)" 4273: 3639:

Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y, et al. (December 2019).

3450:"Pathological alteration and therapeutic implications of sepsis-induced immune cell apoptosis" 2962:. Evidently, not all cases of sepsis arise through such adaptive microbial strategy switches. 1971: 1288: 10742: 10581: 10284: 10205: 9555: 8073: 7970:"Acute respiratory distress syndrome, sepsis, and cognitive decline: a review and case study" 7398:

Drewry AM, Ablordeppey EA, Murray ET, Stoll CR, Izadi SR, Dalton CM, et al. (May 2017).

7039:

Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. (January 2008).

5103: 4508: 4368: 4035: 3113: 2985: 2959: 2924: 2543: 2409: 2374: 2272: 1846: 1667: 1637: 653: 486: 299: 8617:

O'Brien AD, Rosenstreich DL, Scher I, Campbell GH, MacDermott RP, Formal SB (January 1980).

8347: 6073:

Lewis SR, Pritchard MW, Evans DJ, Butler AR, Alderson P, Smith AF, Roberts I (August 2018).

3546:

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. (February 2013).

2651:

in 2011, sepsis was the second most common principal reason for readmission within 30 days.

2408:

and reduce conditions favorable to microorganism growth or host defense impairment, such as

10808: 10586: 10136: 9956: 9278: 9138:

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. (March 2017).

8928: 8711: 8619:"Genetic control of susceptibility to Salmonella typhimurium in mice: role of the LPS gene" 8355: 8026: 7447:

Niven DJ, Laupland KB, Tabah A, Vesin A, Rello J, Koulenti D, et al. (December 2013).

6465: 4532:

Shukla P, Rao GM, Pandey G, Sharma S, Mittapelly N, Shegokar R, Mishra PR (November 2014).

3302:

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. (March 2017).

2996:

of trials in 2021 found that the claimed benefits of the protocol could not be confirmed.

2559: 2189:

do not lower the rate of death in newborns and adults with sepsis. Evidence for the use of

2176:

is not recommended in the treatment of anemia with septic shock because it may precipitate

2133: 2019:, the addition of an antibiotic specific to the gram-negative organism is recommended. For 1979: 1950: 1946: 1195:. In those with severe sepsis and septic shock, this sequence of events leads to a type of 1145: 1132:, increased permeability of the mucosa alters the microflora, causing mucosal bleeding and 1090: 959: 895: 742: 552: 8538: 7271:

Shane AL, Stoll BJ (January 2014). "Neonatal sepsis: progress towards improved outcomes".

5202:

Morris E, McCartney D, Lasserson D, Van den Bruel A, Fisher R, Hayward G (December 2017).

8: 10737: 10665: 10591: 10522: 10179: 10086: 10007: 9897: 9892: 9882: 9835: 9752: 9736: 9596: 8915:

Seok J, Warren HS, Cuenca AG, Mindrinos MN, Baker HV, Xu W, et al. (February 2013).

8570:"High Susceptibility of Strain A Mice to Endotoxin and Endotoxin-Red Blood Cell Mixtures" 6611:

Patel GP, Balk RA (January 2012). "Systemic steroids in severe sepsis and septic shock".

2912: 2883: 2644: 2591: 2418: 2193:-enriched polyclonal preparations of IVIG is inconsistent. On the other hand, the use of 2181: 2165: 2145: 2141: 1678: 1641: 1383: 1117: 1010: 998: 770: 726: 661: 513: 9282: 8932: 8715: 8030: 7815: 7650:

Fink MP, Warren HS (October 2014). "Strategies to improve drug development for sepsis".

6469: 5165:"Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis" 2840:

costly condition billed to Medicare and the uninsured, the second-most costly billed to

2801:

was immune to the endotoxin-induced shock. The genetic locus for this effect was dubbed

2194: 2117:

is used to measure blood pressures dynamically, fluids should be administered until the

466: 289: 10555: 10228: 10059: 9992: 9909: 9870: 9845: 9770: 9601: 9436: 9411: 9392: 9349: 9216: 9167: 9002: 8975: 8951: 8916: 8869: 8844: 8820: 8795: 8776: 8648: 8542: 8414: 8328: 8303:

Geroulanos S, Douka ET (December 2006). "Historical perspective of the word "sepsis"".

8245: 8220: 8050: 7994: 7969: 7909: 7882: 7863: 7769: 7721: 7694: 7675: 7627: 7602: 7575: 7550: 7526: 7499: 7475: 7448: 7424: 7399: 7380: 7368: 7332: 7307: 7253: 7174: 7149: 7130: 7065: 7040: 6976: 6950:"Current understanding in source control management in septic shock patients: a review" 6949: 6930: 6886: 6843: 6769: 6720: 6672: 6647: 6588: 6563: 6539: 6488: 6453: 6426: 6399: 6375: 6350: 6328: 6274: 6249: 6189: 6164: 6099: 6074: 6045: 6020: 5960: 5935: 5743: 5718: 5694: 5669: 5609: 5582: 5563: 5551: 5520: 5508: 5477: 5425: 5398: 5329: 5304: 5228: 5203: 5053:

Marik PE (June 2014). "Early management of severe sepsis: concepts and controversies".

5023: 4996: 4934: 4907: 4883: 4858: 4758: 4733: 4709: 4684: 4660: 4635: 4558: 4533: 4467: 4442: 4418: 4393: 4340: 4315: 4242: 4217: 4190: 4163: 4144: 4002: 3990: 3944: 3919: 3892: 3857: 3717: 3692: 3665: 3640: 3618: 3589:"Trends in Epidemiology and Microbiology of Severe Sepsis and Septic Shock in Children" 3474: 3449: 3376: 3351: 3222: 3197: 2810:

led to the endotoxin resistant phenotype was discovered to be due to a mutation in the

2806: 2791: 2780:

at the beginning of the 20th century to denote the pyrogenic principle associated with

2563: 2523: 2405: 2337:

are not recommended to treat ARDS because it may reduce survival rates and precipitate

2259:

in sepsis is controversial. Studies do not give a clear picture as to whether and when

2073: 1834: 1826: 1822: 1696: 1596: 1369: 1254: 1200: 1021:, will up-regulate the expression of pro-inflammatory and anti-inflammatory cytokines. 927: 649: 545: 505: 498: 317: 124: 8594: 8569: 8268:

Rubin LG, Schaffner W (July 2014). "Clinical practice. Care of the asplenic patient".

5495:

Abraham E, Singer M (October 2007). "Mechanisms of sepsis-induced organ dysfunction".

5180: 4970: 4874: 3920:"Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes" 3873: 3198:"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)" 10722: 10717: 10331: 10077: 9877: 9855: 9840: 9731: 9658: 9618: 9441: 9396: 9384: 9353: 9341: 9306: 9220: 9208: 9159: 9084: 9047: 9007: 8956: 8874: 8825: 8780: 8768: 8727: 8684: 8640: 8599: 8550: 8466: 8406: 8359: 8320: 8285: 8250: 8197: 8160: 8115: 8077: 8042: 7999: 7950: 7914: 7855: 7820: 7761: 7726: 7667: 7632: 7580: 7531: 7480: 7429: 7372: 7337: 7288: 7257: 7245: 7209: 7179: 7122: 7070: 7012: 6981: 6922: 6878: 6835: 6831: 6761: 6712: 6677: 6646:

Volbeda M, Wetterslev J, Gluud C, Zijlstra JG, van der Horst IC, Keus F (July 2015).

6628: 6593: 6531: 6493: 6454:"Vasopressors for the Treatment of Septic Shock: Systematic Review and Meta-Analysis" 6431: 6400:"Early versus delayed administration of norepinephrine in patients with septic shock" 6380: 6320: 6279: 6230: 6194: 6145: 6104: 6050: 6001: 5965: 5899: 5868: 5820: 5783: 5779: 5748: 5699: 5614: 5555: 5512: 5469: 5430: 5375: 5334: 5278: 5233: 5184: 5080: 5028: 4974: 4939: 4888: 4834: 4799: 4763: 4714: 4665: 4613: 4593: 4563: 4534:"Therapeutic interventions in sepsis: current and anticipated pharmacological agents" 4512: 4472: 4423: 4372: 4345: 4289: 4247: 4195: 4136: 4077: 4039: 3994: 3970:

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. (April 2003).

3949: 3897: 3833: 3798: 3757: 3740:

Long B, Koyfman A (November 2017). "Controversies in Corticosteroid use for Sepsis".

3722: 3670: 3622: 3610: 3569: 3479: 3425: 3381: 3325: 3227: 3163: 3117: 3012: 2993: 2891: 2660: 2491: 1656: 1316: 1196: 1082: 1042: 1006: 982: 939: 879: 778: 705: 537: 517: 446: 427: 407: 280: 245: 112: 9171: 8652: 8418: 8332: 7867: 7773: 7679: 7384: 6934: 6724: 6332: 5524: 4331: 4148: 4006: 3708: 1237:

Within the first three hours of suspected sepsis, diagnostic studies should include

355:

is a potentially life-threatening condition that arises when the body's response to

10648: 10570: 10189: 9860: 9431: 9423: 9376: 9333: 9296: 9286: 9198: 9151: 8997: 8987: 8946: 8936: 8864: 8856: 8815: 8807: 8758: 8719: 8676: 8630: 8589: 8581: 8534: 8507: 8398: 8312: 8277: 8240: 8232: 8150: 8054: 8034: 7989: 7981: 7946: 7942: 7904: 7894: 7847: 7810: 7800: 7753: 7716: 7706: 7659: 7622: 7618: 7614: 7570: 7566: 7562: 7521: 7511: 7470: 7460: 7419: 7411: 7364: 7327: 7319: 7280: 7237: 7169: 7161: 7134: 7112: 7060: 7052: 7004: 6971: 6961: 6914: 6870: 6847: 6827: 6773: 6753: 6704: 6667: 6659: 6620: 6583: 6575: 6543: 6523: 6483: 6473: 6421: 6411: 6370: 6366: 6362: 6310: 6269: 6261: 6222: 6184: 6176: 6135: 6094: 6090: 6086: 6040: 6032: 5993: 5955: 5947: 5858: 5775: 5738: 5730: 5689: 5681: 5645: 5604: 5594: 5567: 5547: 5504: 5481: 5461: 5420: 5410: 5365: 5324: 5316: 5270: 5223: 5215: 5176: 5072: 5018: 5008: 4966: 4929: 4919: 4878: 4870: 4826: 4791: 4753: 4745: 4704: 4696: 4655: 4647: 4605: 4553: 4545: 4462: 4454: 4413: 4405: 4335: 4327: 4277: 4237: 4229: 4185: 4175: 4126: 3986: 3939: 3931: 3887: 3877: 3869: 3825: 3788: 3753: 3749: 3712: 3704: 3660: 3656: 3652: 3600: 3559: 3469: 3461: 3415: 3371: 3363: 3315: 3217: 3209: 3153: 2954: 2906: 2607:

those with a level of less than 2 mmol/L having a mortality of less than 15%.

2567: 2477: 2338: 2318: 2239: 2190: 1850: 1620: 1528: 1487: 1421: 1413: 1405: 1363: 1300: 1250: 1184: 1161: 1124:(ATP), can cause myocardial depression, reducing cardiac contractility and causing 990: 907: 827: 805: 633: 616:

In addition to symptoms related to the actual cause, people with sepsis may have a

438: 395: 382:. There may also be symptoms related to a specific infection, such as a cough with 379: 375: 265: 167: 147: 75: 8723: 8379:

Marshall JC (March 2008). "Sepsis: rethinking the approach to clinical research".

8180:"Conditions with the Largest Number of Adult Hospital Readmissions by Payer, 2011" 7968:

Jackson JC, Hopkins RO, Miller RR, Gordon SM, Wheeler AP, Ely EW (November 2009).

6890: 5885: 5320: 4997:"Iatrogenic salt water drowning and the hazards of a high central venous pressure" 4749: 4100: 3829: 1120:(AKI). Meanwhile, in the heart, impaired calcium transport, and low production of 10783: 10215: 10113: 9987: 9612: 9511: 9485: 9412:"Vitamin C for sepsis intervention: from redox biochemistry to clinical medicine" 9291: 9266: 9203: 9186: 9155: 9030:"National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013" 8860: 8585: 7985: 7851: 7415: 7165: 6874: 6757: 6527: 6478: 6036: 5951: 5261: 3691:

Fang F, Zhang Y, Tang J, Lunsford LD, Li T, Tang R, et al. (February 2019).

3564: 3547: 3158: 3141: 2968:'s "Marik protocol", also known as the "HAT" protocol, proposed a combination of 2863: 2782: 2526:

is not recommended for a person with lactic acidosis secondary to hypoperfusion.

2483: 2457: 2276: 2130:(ARDS) and sufficient tissue blood fluid, more fluids should be given carefully. 2045: 1942: 1922: 1886: 1866: 1606: 1576:

More specific definitions of end-organ dysfunction exist for SIRS in pediatrics.

1555: 1523:

Liver: disruption of protein synthetic function manifests acutely as progressive

1499: 1133: 1101: 1089:

ensues because tissues are unable to use oxygen efficiently due to inhibition of

955: 680: 580: 572: 529: 478: 10712: 9265:

Rózsa L, Apari P, Sulyok M, Tappe D, Bodó I, Hardi R, Müller V (November 2017).

9070: 9029: 8101: 7101:"Early goal-directed therapy in the treatment of severe sepsis and septic shock" 7008: 6351:"Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock" 5370: 5353: 2724:

International Statistical Classification of Diseases and Related Health Problems

2480:

does not reduce mortality in those with SIRS or sepsis and may even be harmful.

1037:

from damaged tissues. An uncontrolled immune response is then activated because

532:

may be needed to support the function of the lungs and kidneys, respectively. A

10675: 10455: 10414: 10326: 10169: 9946: 9623: 9427: 8921:

Proceedings of the National Academy of Sciences of the United States of America

8471: 7899: 7805: 7788: 7284: 7096: 6708: 6624: 6579: 6226: 6075:"Colloids versus crystalloids for fluid resuscitation in critically ill people" 5997: 5650: 5633: 4795: 4363:

Bloch KC (2009). "Ch. 4: Infectious Diseases". In McPhee SJ, Hammer GD (eds.).

4131: 4114: 2981: 2969: 2571: 2538:

devices are recommended for any person with sepsis at moderate to high risk of

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Sepsis and Non-infectious Systemic Inflammation: From Biology to Critical Care

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Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases

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Al-Khalisy H, Nikiforov I, Jhajj M, Kodali N, Cheriyath P (11 December 2015).

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Bone RC, Balk RA, et al. (The ACCP/SCCM Consensus Conference Committee.

4609: 2965: 2942: 2708: 2632: 2547: 2507: 2230: 2202: 1794: 1561: 1281: 1246: 1242: 1222: 1149: 1125: 1046: 1002: 986: 947: 935: 919: 794: 782: 750: 645: 509: 494: 470: 434: 363: 321: 221: 190: 9578: 9574: 8941: 8917:"Genomic responses in mouse models poorly mimic human inflammatory diseases" 7881:

Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D (May 2020).

7601:

Martí-Carvajal AJ, Solà I, Gluud C, Lathyris D, Cardona AF (December 2012).

6966: 5100:"Synergy Between Nurses And Automation Could Be Key To Finding Sepsis Early" 4394:"Gram-positive and gram-negative bacterial toxins in sepsis: a brief review" 4233: 4180: 3605: 3588: 1053:, which is known as "compensatory anti-inflammatory response syndrome". The 10700: 10550: 10439: 10434: 10429: 10363: 10264: 10131: 10123: 10069: 9971: 9961: 9865: 9822: 9445: 9388: 9345: 9337: 9310: 9212: 9163: 9088: 9051: 9011: 8960: 8878: 8829: 8772: 8688: 8680: 8603: 8511: 8410: 8324: 8289: 8254: 8201: 8164: 8119: 8046: 8003: 7954: 7918: 7859: 7824: 7765: 7730: 7671: 7636: 7584: 7535: 7484: 7433: 7376: 7341: 7292: 7249: 7213: 7183: 7126: 7099:, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. (November 2001). 7074: 6985: 6926: 6882: 6839: 6765: 6716: 6681: 6632: 6597: 6535: 6497: 6435: 6384: 6324: 6283: 6234: 6198: 6149: 6108: 6054: 6005: 5969: 5872: 5824: 5787: 5752: 5703: 5618: 5559: 5516: 5473: 5434: 5379: 5338: 5237: 5188: 5084: 5032: 4978: 4943: 4892: 4838: 4803: 4767: 4718: 4669: 4567: 4476: 4427: 4349: 4251: 4199: 4140: 4081: 3998: 3953: 3901: 3837: 3802: 3793: 3776: 3761: 3726: 3674: 3614: 3573: 3483: 3429: 3385: 3367: 3329: 3231: 3213: 3167: 3053: 2668: 2579: 2555: 2362: 2314: 2288: 2284: 2069: 2049: 1938: 1750:≥ 2 times the upper limit of normal for age or 2-fold increase in baseline 1600: 1524: 1444: 1180: 1176: 970: 891: 857: 754: 684: 556: 520:

is not enough to maintain blood pressure, then the use of medications that

461:(SIRS) criteria in the setting of presumed infection. In 2016, a shortened 450: 423: 325: 303: 250: 200: 31: 9679: 8731: 8644: 8554: 8281: 7551:"N-acetylcysteine for sepsis and systemic inflammatory response in adults" 6918: 6315: 6299:"Lower versus higher hemoglobin threshold for transfusion in septic shock" 6298: 6140: 6123: 5934:

Sterling SA, Miller WR, Pryor J, Puskarich MA, Jones AE (September 2015).

5282: 5219: 5076: 4617: 4316:"Sepsis and Septic Shock: Current Treatment Strategies and New Approaches" 3972:"2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference" 3420: 3403: 969:

There are a number of microbial factors that may cause the typical septic

696:

falls during the early stages of sepsis, causing a widening/increasing of

10687: 10596: 10509: 10473: 10463: 10405: 10346: 10269: 9850: 9642: 8811: 8155: 7117: 7100: 5863: 5846: 4443:"Invasive candidiasis as a cause of sepsis in the critically ill patient" 4095: 2948: 2936: 2823: 2741:

are present in the blood at abnormal levels and are the causative issue,

2631:

worldwide of sepsis is estimated to be 18 million cases per year. In the

2583: 2575: 2438: 2422:, and remains important despite the emergence of more modern treatments. 2218: 2201:

is also not useful. Meanwhile, the blood purification technique (such as

2065: 2053: 2031: 1842: 1802:

therapy for improved antibiotic stewardship and better patient outcomes.

1675: 1586: 1449: 1395:

Sepsis Steps. Training tool for teaching the progression of sepsis stages

1292: 1284:

lactate measurement over usual methods of measurement, however, is poor.

1188: 1157: 1153: 1066: 851: 746: 738: 701: 676: 657: 629: 621: 584: 564: 521: 490: 482: 473:

before starting antibiotics; however, the diagnosis does not require the

415: 411: 399: 371: 229: 142: 137: 8546: 8402: 8139:"The epidemiology of sepsis in the United States from 1979 through 2000" 7711: 5909: 4651: 3971: 3882: 2283:. Treatment with corticosteroids might be most beneficial in those with 10657: 10624: 10606: 10504: 10353: 10336: 10248: 10164: 10108: 9914: 9653: 9301: 8038: 7695:"Blood glucose control in patients with severe sepsis and septic shock" 5734: 4700: 4458: 4409: 2930: 2895: 2887: 2819: 2734: 2640: 2494:) was originally introduced for severe sepsis (as identified by a high 2370: 2263:

should be used. The 2016 Surviving Sepsis Campaign recommends low dose

2243: 2177: 2161: 2057: 2036: 2027: 2003:

organisms. In case of people having a high risk of being infected with

1975: 1918: 1907: 1874: 1870: 1857:(HLH) may have similar symptoms and are on the differential diagnosis. 1751: 1747: 1461: 1409: 1353: 1265:

in only about 30% of cases. Another possible method of detection is by

1262: 1165: 1058: 922:

bacteria is thought to be largely due to a response by the host to the

911: 887: 841: 817: 474: 462: 457:. Previously, a sepsis diagnosis required the presence of at least two 54: 10374: 9538: 9517: 8845:"Physiologically relevant human tissue models for infectious diseases" 6265: 4830: 4549: 3935: 2733:

The current terms are dependent on the microorganism that is present:

10514: 10499: 10341: 10223: 10159: 8437:"Understand How ICD-10 Expands Sepsis Coding – AAPC Knowledge Center" 6788: 6398:

Bai X, Yu W, Ji W, Lin Z, Tan S, Duan K, et al. (October 2014).

6180: 5465: 5201: 4164:"Pediatric Sepsis Guidelines: Summary for resource-limited countries" 2973: 2811: 2777: 2765: 2611: 2495: 2487: 2366: 2358: 2292: 2287:

and early severe ARDS, whereas its role in others such as those with

2169: 2041: 1983: 1878: 1793:

concluded moderate-quality evidence exists to support the use of the

1766: 1565: 1536: 1532: 1417: 1304: 1226: 1141: 1109: 1062: 1054: 1038: 978: 963: 931: 625: 575:

is controversial, with some reviews finding benefit, and others not.

383: 356: 332: 8616: 7663: 7516: 7465: 2878:

Phenotypic strategy switches of microbes capable of provoking sepsis

2144:

in terms of risk of death. Starches also carry an increased risk of

1218: 10758: 10634: 10468: 10243: 10194: 10174: 10032: 9951: 9726: 9667: 8225:

European Journal of Clinical Microbiology & Infectious Diseases

6349:

Alejandria MM, Lansang MA, Dans LF, Mantaring JB (September 2013).

6121: 5599: 4285: 3818:

Best Practice & Research. Clinical Obstetrics & Gynaecology

3195: 2977: 2841: 2761: 2750: 2738: 2712: 2664: 2500: 2301: 2256: 2235: 2123: 2061: 1897: 1720: 1569: 1543: 1437: 1308: 1113: 1057:(cell death) of lymphocytes further worsens the immunosuppression. 943: 915: 822: 652:(which may be accompanied by a faster breathing rate that leads to 641: 419: 152: 6211: 4816: 4734:"Recognition of Staphylococcus aureus by the innate immune system" 4115:"ESPEN guideline on clinical nutrition in the intensive care unit" 10358: 10238: 2746: 2742: 2610:

There are a number of prognostic stratification systems, such as

2511: 2413: 2361:(cell death) of the lymphocytes, possibly with a toxic effect on 2137: 1312: 1230: 1030: 923: 846: 774: 734: 568: 387: 9468:

Knowledge's health care articles can be viewed offline with the

6452:

Avni T, Lador A, Lev S, Leibovici L, Paul M, Grossman A (2015).

5765: 5162: 1348:<36 °C (96.8 °F) or >38 °C (100.4 °F) 938:

bacteria may result from an immunological response to cell wall

426:

is low blood pressure due to sepsis that does not improve after

213:

May be rapid (less than three hours) or prolonged (several days)

9569: 9550: 9499: 9235: 8219:

Koh GC, Peacock SJ, van der Poll T, Wiersinga WJ (April 2012).

8218: 7600: 7500:"Clinical review: fever in septic ICU patients--friend or foe?" 7226: 5667: 4780: 3815: 3638: 2769: 2754: 2727: 2700: 2656: 2387:, as a growing body of evidence points to reduced durations of 2213:

If the person has been sufficiently fluid resuscitated but the

1790: 1547: 1404:

SIRS is the presence of two or more of the following: abnormal

1391: 1382:<4x10/L (<4000/mm), >12x10/L (>12,000/mm), or ≥10% 1296: 1078: 758: 442: 362:

This initial stage of sepsis is followed by suppression of the

255: 240: 157: 8524: 7880: 6645: 6348: 5982: 4215: 1966:

these sites are suspected. In severe sepsis and septic shock,

1949:—is important during prolonged illness. Medication to prevent 1568:

that depress myocyte function, cellular damage, manifest as a

9184: 7497: 7308:"Neonatal infectious diseases: evaluation of neonatal sepsis" 7305: 6296: 4636:"Recognition of lipopolysaccharide pattern by TLR4 complexes" 2874: 2798: 2404:

Source control refers to physical interventions to control a

1806: 1465: 1164:, which may lead to intravascular clotting, the formation of 832: 729:

of a German hospital (2015) with a severe sepsis caused by a

637: 617: 403: 367: 132: 7397: 7354: 6947: 6162: 5933: 5163:

Wacker C, Prkno A, Brunkhorst FM, Schlattmann P (May 2013).

4161: 3641:"Corticosteroids for treating sepsis in children and adults" 3110:

Tintinalli's Emergency Medicine: A Comprehensive Study Guide

2882:

Some authors suggest that initiating sepsis by the normally

2760:

By the end of the 19th century, it was widely believed that

2383:

are not suggested for use in sepsis cases in the absence of

1762:

Liver dysfunction (only applicable to infants > 1 month)

1727:

or 50% drop from maximum in chronically thrombocytopenic, or

1456:

In 2016 a new consensus was reached to replace screening by

1215:

to bring attention to potential cases as early as possible.

1108:(ARDS). Impaired utilization of oxygen in the liver impairs 10233: 9919: 7837: 4112: 3855: 2672: 2077: 1934: 1830: 977:(PAMPs). Examples of PAMPs include lipopolysaccharides and 883: 733:

of incidental negative events after a prior surgery of the

454: 270: 260: 195: 162: 84: 10311:

European Society of Paediatric and Neonatal Intensive Care

7967: 7931: 7094: 6613:

American Journal of Respiratory and Critical Care Medicine

6018: 5986:

American Journal of Respiratory and Critical Care Medicine

4784:

American Journal of Respiratory and Critical Care Medicine

8914: 7548: 6948:

Lagunes L, Encina B, Ramirez-Estrada S (September 2016).

6817: 6742: 6072: 5450: 5399:"qSOFA does not replace SIRS in the definition of sepsis" 5107: 4908:"Organ dysfunction as a new standard for defining sepsis" 4863:

Cardiovascular & Hematological Disorders Drug Targets

3545: 2716: 2136:

is recommended as the fluid of choice for resuscitation.

1400:

and septic shock. The definition of SIRS is shown below:

1299:(free air on an abdominal X-ray or CT scan), an abnormal 1074: 950:

also may cause sepsis. Superantigens simultaneously bind

93: 9137: 8177: 7306:

Camacho-Gonzalez A, Spearman PW, Stoll BJ (April 2013).

3774: 3301: 2715:

used the term "blood rot" for diseases linked to severe

1531:

and disruption of metabolic functions leads to impaired

1430:

is defined as SIRS in response to an infectious process.

898:. However, sepsis also causes similar response to SIRS. 398:

may have no symptoms of a specific infection, and their

7446: 7150:"Lactate as a hemodynamic marker in the critically ill" 7038: 5537: 4314:

Polat G, Ugan RA, Cadirci E, Halici Z (February 2017).

3969: 2550:

are useful in a person with risk factors of developing

2060:, is chosen for people with severe sepsis, followed by 8221:"The impact of diabetes on the pathogenesis of sepsis" 8136: 7549:

Szakmany T, Hauser B, Radermacher P (September 2012).

6786: 6513: 6247: 5250: 4583: 4313: 2126:

are added until the ScvO2 is optimized. In those with

1705:

with drop in GCS of 3 or more points in a person with

9942:

Critical illness–related corticosteroid insufficiency

9264: 9071:"Costs for Hospital Stays in the United States, 2011" 8793: 8701: 8665: 8348:"Ch. 1: Definition of Sepsis and Non-infectious SIRS" 8137:

Martin GS, Mannino DM, Eaton S, Moss M (April 2003).

7743: 6451: 4859:"Sepsis pathophysiology and anesthetic consideration" 4531: 3775:

Epstein L, Dantes R, Magill S, Fiore A (April 2016).

3690: 2281:

critical illness–related corticosteroid insufficiency

1807:

soluble urokinase-type plasminogen activator receptor

1535:

metabolism, resulting in elevated unconjugated serum

1460:(SIRS) with the sequential organ failure assessment ( 96: 90: 81: 9528: 8973: 8095: 8093: 7498:

Launey Y, Nesseler N, Mallédant Y, Seguin P (2011).

7199: 6248:

Patel A, Laffan MA, Waheed U, Brett SJ (July 2014).

2391:, ICU and hospital stays. However, paralytic use in 757:

via the machine on the left became necessary due to

87: 9068: 8747:"[Mouse Models of Sepsis and Septic Shock]" 8339: 8016: 7787:Liang B, Su J, Shao H, Chen H, Xie B (March 2023). 7692: 6561: 3586: 3349: 2980:as a treatment for preventing sepsis for people in 2797:It was discovered in 1965 that a strain of C3H/HeJ 1917:Apart from the timely administration of fluids and 1684:

supplemental oxygen requirement of greater than FiO

1452:, despite the administration of intravenous fluids. 78: 8794:Lewis AJ, Seymour CW, Rosengart MR (August 2016). 5887:Scottish Intercollegiate Guidelines Network (SIGN) 5354:"New Sepsis Criteria: A Change We Should Not Make" 2856:A large international collaboration entitled the " 1572:leak (although not necessarily ischemic in nature) 839:. The most common causes for parasitic sepsis are 551:. People with sepsis need preventive measures for 8090: 7001:Yearbook of Intensive Care and Emergency Medicine 6860: 6344: 6342: 5396: 5048: 5046: 5044: 5042: 4271: 3401: 2373:in this situation due to concerns it may lead to 1662:arterial partial-pressure of carbon dioxide (PaCO 1609:: serum lactate 2 times the upper limit of normal 648:. Signs of established sepsis include confusion, 10775: 9069:Pfuntner A, Wier LM, Steiner C (December 2013). 8178:Hines AL, Barrett ML, et al. (April 2014). 7693:Hirasawa H, Oda S, Nakamura M (September 2009). 5580: 4810: 4731: 4579: 4577: 4440: 4385: 4274:"Ch. 75: Sepsis, Severe Sepsis and Septic Shock" 3587:Sehgal M, Ladd HJ, Totapally B (December 2020). 3139: 3135: 3133: 2317:of 6 mL/kg of predicted body weight (PBW) and a 2048:is chosen. If fungal infection is suspected, an 1233:, and yellow cap for blood samples from children 9227: 8302: 8296: 7786: 7147: 7034: 7032: 7030: 7028: 7003:. Springer Berlin Heidelberg. pp. 93–101. 6738: 6736: 6734: 6509: 6507: 6115: 4498: 4496: 4494: 4492: 4490: 4488: 4486: 4025: 4023: 3965: 3963: 3191: 3189: 3187: 3185: 3183: 3181: 3179: 3177: 402:may be low or normal instead of constituting a 191:temporary, transient, or permanent organ damage 9366: 8967: 8695: 8267: 8099: 7925: 6694: 6339: 5806:"Neonatal sepsis: a continuing disease burden" 5716: 5039: 4267: 4265: 4263: 4261: 4063: 4061: 4059: 4057: 4055: 3443: 3441: 3439: 2425: 989:of the gram-positive bacterial cell wall, and 10390: 9695: 9062: 9023: 9021: 8908: 8659: 8518: 8372: 7874: 7686: 6903: 5759: 5663: 5661: 5494: 5158: 5156: 5154: 4899: 4774: 4685:"Anti-endotoxin vaccines: back to the future" 4574: 4211: 4209: 3913: 3911: 3130: 2958:spp. are all capable of such a high level of 1636:Respiratory dysfunction (in the absence of a 1512:pediatric acute respiratory distress syndrome 359:causes injury to its own tissues and organs. 62:Skin blotching and inflammation due to sepsis 8567: 8561: 8061: 7961: 7542: 7348: 7025: 6731: 6557: 6555: 6553: 6504: 5927: 5799: 5797: 5531: 5488: 5444: 5397:Vincent JL, Martin GS, Levy MM (July 2016). 5298: 5296: 5294: 5292: 4990: 4988: 4856: 4725: 4483: 4434: 4391: 4032:Principles and Practice of Hospital Medicine 4020: 3960: 3350:Jawad I, Lukšić I, Rafnsson SB (June 2012). 3297: 3295: 3293: 3291: 3289: 3287: 3285: 3283: 3281: 3279: 3277: 3275: 3273: 3271: 3269: 3267: 3265: 3263: 3261: 3174: 3142:"Sepsis: current dogma and new perspectives" 2711:of organic matter. In the eleventh century, 1257:are necessary. At least one should be drawn 1085:are more apoptosis resistant. Subsequently, 973:. An invading pathogen is recognized by its 9709: 9233: 9095: 8885: 8610: 8130: 7607:The Cochrane Database of Systematic Reviews 7555:The Cochrane Database of Systematic Reviews 7299: 7220: 7195: 7193: 6811: 6639: 6447: 6445: 6355:The Cochrane Database of Systematic Reviews 6079:The Cochrane Database of Systematic Reviews 6012: 5976: 5838: 5717:Mayr FB, Yende S, Angus DC (January 2014). 5390: 5345: 5244: 4956: 4258: 4052: 4029: 3781:MMWR. Morbidity and Mortality Weekly Report 3739: 3686: 3684: 3645:The Cochrane Database of Systematic Reviews 3541: 3539: 3537: 3535: 3533: 3531: 3529: 3527: 3525: 3523: 3521: 3519: 3517: 3515: 3513: 3436: 3345: 3343: 3341: 3339: 3259: 3257: 3255: 3253: 3251: 3249: 3247: 3245: 3243: 3241: 1319:may indicate the presence of an infection. 1289:inflammation of the abdominal cavity lining 878:) may be followed by a prolonged period of 10397: 10383: 9702: 9688: 9258: 9040:Agency for Healthcare Research and Quality 9027: 9018: 8842: 8836: 8787: 8489: 8261: 8194:United States National Library of Medicine 8190:Agency for Healthcare Research and Quality 8171: 8112:United States National Library of Medicine 8070:Harrison's Principles of Internal Medicine 8019:Annals of the New York Academy of Sciences 7780: 7649: 7596: 7594: 7491: 7391: 7270: 7141: 6697:The American Journal of Emergency Medicine 6397: 6068: 6066: 6064: 5658: 5195: 5151: 4525: 4502: 4206: 3908: 3634: 3632: 3511: 3509: 3507: 3505: 3503: 3501: 3499: 3497: 3495: 3493: 3397: 3395: 3099: 3097: 3095: 3093: 3091: 3089: 3087: 3085: 3083: 3062:Centers for Disease Control and Prevention 3048: 3046: 3044: 3042: 3040: 3038: 3036: 3034: 3032: 3030: 2764:produced substances that could injure the 2156:The Surviving Sepsis Campaign recommended 1626:core to peripheral temperature difference 880:decreased functioning of the immune system 737:. After an emergency surgery, he received 640:. Early signs include a rapid heart rate, 53: 9435: 9300: 9290: 9202: 9001: 8991: 8950: 8940: 8868: 8819: 8762: 8634: 8593: 8392: 8244: 8154: 8010: 7993: 7908: 7898: 7814: 7804: 7720: 7710: 7626: 7574: 7525: 7515: 7474: 7464: 7440: 7423: 7331: 7264: 7173: 7116: 7064: 6975: 6965: 6797:National Heart, Lung, and Blood Institute 6671: 6610: 6604: 6587: 6550: 6487: 6477: 6425: 6415: 6374: 6314: 6290: 6273: 6241: 6205: 6188: 6156: 6139: 6098: 6044: 5959: 5862: 5851:The Journal of Antimicrobial Chemotherapy 5803: 5794: 5742: 5693: 5649: 5608: 5598: 5424: 5414: 5369: 5328: 5302: 5289: 5227: 5066: 5022: 5012: 4985: 4950: 4933: 4923: 4905: 4882: 4757: 4708: 4676: 4659: 4557: 4466: 4417: 4339: 4241: 4189: 4179: 4155: 4130: 3943: 3891: 3881: 3792: 3716: 3664: 3604: 3563: 3473: 3447: 3419: 3375: 3319: 3221: 3157: 3015:and severe acute sepsis after a dog bite) 2730:, such as "Sepsis due to streptococcus". 1812: 1775:(ALT) ≥ 2 times the upper limit of normal 1295:, or an intestinal infarction. A pierced 769:Infections leading to sepsis are usually 504:Sepsis requires immediate treatment with 463:sequential organ failure assessment score 394:. The very young, old, and people with a 9489:) is being considered for deletion. See 8974:Hazeldine J, Hampson P, Lord JM (2016). 8499:Journal of the National Cancer Institute 8430: 8428: 8378: 8350:. In Cavaillon JM, Christophe A (eds.). 8212: 8100:Sutton JP, Friedman B (September 2013). 7643: 7190: 6998: 6854: 6442: 5710: 5631: 4627: 4309: 4307: 4305: 3733: 3681: 3402:Angus DC, van der Poll T (August 2013). 3336: 3238: 3106:American College of Emergency Physicians 2873: 2690: 2329:due to sepsis-induced severe ARDS. High 1896: 1475: 1390: 1217: 720: 589: 10404: 9505:SIRS, Sepsis, and Septic Shock Criteria 9076:Healthcare Cost and Utilization Project 9035:Healthcare Cost and Utilization Project 8744: 8434: 8345: 8185:Healthcare Cost and Utilization Project 8107:Healthcare Cost and Utilization Project 8067: 7591: 7090: 7088: 7086: 7084: 6780: 6568:Revista Brasileira de Terapia Intensiva 6061: 5879: 5844: 5768:Critical Reviews in Oncology/Hematology 5351: 5208:The British Journal of General Practice 4852: 4850: 4848: 4633: 4441:Delaloye J, Calandra T (January 2014). 4356: 4016:from the original on 24 September 2015. 3924:Expert Review of Anti-Infective Therapy 3629: 3490: 3392: 3140:Deutschman CS, Tracey KJ (April 2014). 3080: 3027: 2844:, and the fourth-most costly billed to 2534:(UFH), and mechanical prophylaxis with 2515:recommended for blood glucose testing. 2325:O is recommended for those who require 1974:with broad coverage, or broad-spectrum 1688:0.5 to maintain oxygen saturation ≥ 92% 1458:systemic inflammatory response syndrome 1329:Systemic inflammatory response syndrome 1049:1 (TH1) is shifted to TH2, mediated by 459:systemic inflammatory response syndrome 286:Systemic inflammatory response syndrome 14: 10776: 9058:from the original on 6 September 2017. 8891: 8568:Heppner G, Weiss DW (September 1965). 8454: 8126:from the original on 6 September 2017. 6897: 6688: 6562:Dubin A, Lattanzio B, Gatti L (2017). 6213:and meta-analysis of the literature". 5097: 3917: 2829: 2247:abnormally increasing the heart rate. 2199:disseminated intravascular coagulation 1853:. Hyperinflammatory syndromes such as 1737:Disseminated intravascular coagulation 1045:state ensues when the proinflammatory 975:pathogen-associated molecular patterns 27:Life-threatening response to infection 10378: 9683: 9409: 9323: 9317: 9246:from the original on 8 September 2015 9028:Torio CM, Moore BJ (1 January 2006). 8669:Blood Cells, Molecules & Diseases 8495: 8467:The Merck Manual—Home Health Handbook 8425: 7148:Fuller BM, Dellinger RP (June 2012). 6807:from the original on 3 December 2019. 5114:from the original on 27 February 2018 5052: 4994: 4857:Yuki K, Murakami N (6 January 2016). 4732:Fournier B, Philpott DJ (July 2005). 4682: 4640:Experimental & Molecular Medicine 4362: 4302: 4088: 4067: 3851: 3849: 3847: 2099: 611: 512:. Ongoing care often continues in an 261:Chronic Obstructive Pulmonary Disease 10190:Recombinant activated protein C 9524:. U.S. National Library of Medicine. 8843:Mills M, Estes MK (September 2016). 7081: 5253:American College of Chest Physicians 4845: 4586:American College of Chest Physicians 4222:J Community Hosp Intern Med Perspect 3448:Cao C, Yu M, Chai Y (October 2019). 3068:from the original on 4 December 2014 2271:During critical illness, a state of 1873:in the first month of life, such as 1805:A 2012 systematic review found that 1470:American College of Chest Physicians 1035:damage-associated molecular patterns 993:. These PAMPs are recognized by the 901: 366:. Common signs and symptoms include 196:extra corporeal membrane oxygenation 9903:Multiple organ dysfunction syndrome 9888:Acute respiratory distress syndrome 9828:Multiple organ dysfunction syndrome 9416:Molecular and Cellular Biochemistry 8539:10.1093/infdis/128.Supplement_1.S17 8270:The New England Journal of Medicine 8143:The New England Journal of Medicine 7105:The New England Journal of Medicine 6303:The New England Journal of Medicine 5305:"Sepsis: recognition and treatment" 5091: 3408:The New England Journal of Medicine 3103: 2522:may be used if indicated. However, 2347:continuous positive airway pressure 2164:levels below 70 g/L if there is no 2128:acute respiratory distress syndrome 1496:acute respiratory distress syndrome 1482:Multiple organ dysfunction syndrome 1448:is severe sepsis plus persistently 1106:acute respiratory distress syndrome 1098:multiple organ dysfunction syndrome 763:multiple organ dysfunction syndrome 186:Multiple organ dysfunction syndrome 24: 9267:"The evolutionary logic of sepsis" 8904:from the original on 9 April 2017. 8527:The Journal of Infectious Diseases 8208:from the original on 4 March 2016. 7369:10.1097/01.PCC.0000074266.10576.9B 7312:Pediatric Clinics of North America 5898:. Guideline 139. Edinburgh: SIGN. 5804:Satar M, Ozlü F (September 2012). 5552:10.1097/01.PCC.0000149131.72248.E6 5509:10.1097/01.CCM.0000282072.56245.91 4272:Munford RS, Suffredini AF (2014). 3991:10.1097/01.CCM.0000050454.01978.3B 3844: 2536:intermittent pneumatic compression 2268:benefit, as did two 2019 reviews. 2217:is not greater than 65 mmHg, 1860: 1855:hemophagocytic lymphohistiocytosis 1527:due to an inability to synthesize 868: 749:via automated injection employing 158:absent or near absent urine output 25: 10820: 10301:Society of Critical Care Medicine 9998:Ventilator-associated lung injury 9493:to help reach a consensus. › 9456: 9271:Infection, Genetics and Evolution 9119:from the original on 4 March 2014 9113:Society of Critical Care Medicine 8796:"Current Murine Models of Sepsis" 8477:from the original on 28 July 2017 7935:The Journal of Emergency Medicine 7699:World Journal of Gastroenterology 5813:The Turkish Journal of Pediatrics 5634:"PCT testing in sepsis protocols" 5257:Society of Critical Care Medicine 5139:. WVUH Laboratories. 7 April 2012 4875:10.2174/1871529x15666150108114810 4634:Park BS, Lee JO (December 2013). 4590:Society of Critical Care Medicine 3742:The Journal of Emergency Medicine 2399: 2187:intravenous immunoglobulin (IVIG) 2151: 1183:, a deficiency of chemicals that 9817: 9462: 9403: 9360: 9178: 9131: 8738: 7831: 7737: 7357:Pediatric Critical Care Medicine 7154:Current Opinion in Critical Care 6954:Annals of Translational Medicine 6832:10.1002/j.1875-9114.2012.01027.x 6516:Current Opinion in Critical Care 5780:10.1016/j.critrevonc.2017.03.023 5581:Pierrakos C, Vincent JL (2010). 5540:Pediatric Critical Care Medicine 4320:The Eurasian Journal of Medicine 3404:"Severe sepsis and septic shock" 2331:positive end expiratory pressure 2279:may occur. This has been termed 2090:minimum inhibitory concentration 1372:<32 mmHg (4.3 kPa) 1278:central venous oxygen saturation 1193:ATP-sensitive potassium channels 952:major histocompatibility complex 683:and is part of the criteria for 74: 10003:Ventilator-associated pneumonia 9936:Critical illness polyneuropathy 7230:Internal and Emergency Medicine 6992: 6941: 6787:NHLBI–NIH ARDS Network (2014). 6391: 5719:"Epidemiology of severe sepsis" 5638:Frontiers in Analytical Science 5625: 5574: 5169:The Lancet. Infectious Diseases 5126: 4906:Fujishima S (1 November 2016). 4538:British Journal of Pharmacology 4392:Ramachandran G (January 2014). 4332:10.5152/eurasianjmed.2017.17062 4106: 3809: 3768: 3709:10.1001/jamainternmed.2018.5849 3580: 2699:, carrying a spray can marked " 2622: 2552:upper gastrointestinal bleeding 2542:. Stress ulcer prevention with 2335:β2 adrenergic receptor agonists 2208: 1910:", is in widespread use in the 1592:two of the following criteria: 1464:) and the abbreviated version ( 1307:(with focal opacification), or 1081:all undergo apoptosis, whereas 1024: 410:or blood flow. The presence of 9410:Li YR, Zhu H (December 2021). 8745:Korneev KV (18 October 2019). 7947:10.1016/j.jemermed.2009.03.016 7840:Curr Opin Clin Nutr Metab Care 7652:Nature Reviews. Drug Discovery 7619:10.1002/14651858.CD004388.pub6 7567:10.1002/14651858.CD006616.pub2 6367:10.1002/14651858.CD001090.pub2 6091:10.1002/14651858.CD000567.pub7 5892:Care of Deteriorating Patients 4284:(8th ed.). Philadelphia: 3754:10.1016/j.jemermed.2017.05.024 3657:10.1002/14651858.CD002243.pub4 3054:"Sepsis Questions and Answers" 1960: 1901:Intravenous fluids being given 1731:international normalized ratio 1655:) < 300 (the definition of 1560:Heart: systolic and diastolic 1510:< 300), different ratio in 1322: 13: 1: 9782:Geriatric intensive-care unit 9765:Pediatric intensive care unit 9478: 8892:Engber D (13 February 2013). 8724:10.1126/science.282.5396.2085 6801:National Institutes of Health 5583:"Sepsis biomarkers: a review" 5321:10.7861/clinmedicine.12-3-276 5303:Soong J, Soni N (June 2012). 5181:10.1016/S1473-3099(12)70323-7 5098:Harris R (22 February 2018). 4971:10.1016/s0749-0704(03)00008-3 4912:Inflammation and Regeneration 4750:10.1128/CMR.18.3.521-540.2005 4738:Clinical Microbiology Reviews 4103:. Retrieved 29 November 2014. 3874:10.1016/S0140-6736(19)32989-7 3830:10.1016/j.bpobgyn.2016.05.008 3020: 2681:immunosuppressive medications 2308: 1892: 1784: 1096:Inflammatory responses cause 995:pattern recognition receptors 422:may suggest poor blood flow. 10185:Neuromuscular-blocking drugs 10128:Nutritional supplementation 9759:Neonatal intensive care unit 9292:10.1016/j.meegid.2017.09.006 9204:10.1097/CCM.0000000000005337 9156:10.1097/CCM.0000000000002255 9081:National Library of Medicine 9044:National Library of Medicine 8861:10.1016/j.drudis.2016.06.020 8586:10.1128/JB.90.3.696-703.1965 8381:Journal of Leukocyte Biology 7986:10.1097/SMJ.0b013e3181b6a592 7852:10.1097/MCO.0000000000000148 7416:10.1097/CCM.0000000000002285 7166:10.1097/MCC.0b013e3283532b8a 6875:10.1097/CCM.0b013e31825fec26 6758:10.1097/CCM.0b013e31817603ba 6528:10.1097/mcc.0000000000000418 6479:10.1371/journal.pone.0129305 6037:10.1161/cir.0000000000000266 5952:10.1097/CCM.0000000000001142 3565:10.1097/CCM.0b013e31827e83af 3159:10.1016/j.immuni.2014.04.001 2886:(or neutral) members of the 2851: 2834: 2601: 2528:Low-molecular-weight heparin 2503:also has not shown benefit. 2080:unless sepsis is suspected. 1937:dysfunction, transfusion of 1525:disruption of blood clotting 1206: 1168:in small blood vessels, and 1029:Upon detection of microbial 201:blood filtration or dialysis 7: 10285:Water-electrolyte imbalance 10119:Early goal-directed therapy 8072:(18th ed.). New York: 7009:10.1007/978-3-540-92276-6_9 5454:Annals of Internal Medicine 5371:10.1016/j.chest.2016.02.653 4505:Principles of Critical Care 3011:(Bacteria that can lead to 3002: 2990:science by press conference 2869: 2586:and consequently provoke a 2518:Intermittent or continuous 2452: 2431:Early goal directed therapy 2426:Early goal directed therapy 2343:spontaneous breathing trial 2250: 2094:therapeutic drug monitoring 981:in gram-negative bacteria, 837:hospital-acquired infection 670:disorders in blood-clotting 465:(SOFA score), known as the 10: 10825: 10137:Total parenteral nutrition 10070:Life-supporting treatments 9777:Critical illness insurance 9428:10.1007/s11010-021-04240-z 9079:. Statistical Brief #168. 9038:. Statistical Brief #204. 8435:Stewart C (8 April 2011). 8188:. Statistical Brief #172. 8110:. Statistical Brief #161. 7900:10.1186/s13054-020-02950-2 7806:10.1186/s13054-023-04392-y 7746:Nutrition Research Reviews 7285:10.1016/j.jinf.2013.09.011 6709:10.1016/j.ajem.2018.11.040 6625:10.1164/rccm.201011-1897CI 6580:10.5935/0103-507x.20170068 6227:10.1016/j.jcrc.2013.09.031 5998:10.1164/rccm.201601-0024oc 5651:10.3389/frans.2023.1229003 5134:"Blood Culture Collection" 4796:10.1164/rccm.201301-0036CP 4507:(3rd ed.). New York: 4367:(6th ed.). New York: 4365:Pathophysiology of Disease 4276:. In Bennett JE, Dolin R, 4132:10.1016/j.clnu.2018.08.037 3112:(7th ed.). New York: 2988:, leading to criticism of 2686: 1968:broad-spectrum antibiotics 1865:In common clinical usage, 1479: 1293:infection of the bile duct 1158:cells lining blood vessels 890:, or the initial state in 660:due to decreased systemic 516:. If an adequate trial of 29: 10751: 10696:Hypersegmented neutrophil 10686: 10656: 10647: 10617: 10603:Hemoglobin precipitation 10569: 10543: 10533:Hereditary stomatocytosis 10479:Hereditary elliptocytosis 10448: 10422: 10413: 10319: 10306:Surviving Sepsis Campaign 10293: 10257: 10214: 10152: 10102:Ventricular assist device 10097:Intra-aortic balloon pump 10068: 10048:Pulmonary artery catheter 10020: 9970: 9928: 9797: 9790: 9745: 9717: 9633: 9532: 9381:10.1177/02601060211018371 9108:Surviving Sepsis Campaign 8993:10.1186/s41038-016-0059-3 8764:10.1134/S0026893319050108 8636:10.4049/jimmunol.124.1.20 8317:10.1007/s00134-006-0392-2 8237:10.1007/s10096-011-1337-4 7758:10.1017/S0954422418000124 7324:10.1016/j.pcl.2012.12.003 7242:10.1007/s11739-015-1248-y 7057:10.1007/s00134-007-0934-2 6664:10.1007/s00134-015-3899-6 6417:10.1186/s13054-014-0532-y 6031:(18 Suppl 2): S526–S542. 5686:10.1007/s00134-012-2613-1 5416:10.1186/s13054-016-1389-z 5014:10.1186/s13613-014-0021-0 4925:10.1186/s41232-016-0029-y 4683:Cross AS (January 2014). 4070:American Family Physician 3466:10.1038/s41419-019-2015-1 3321:10.1007/s00134-017-4683-6 3009:Capnocytophaga canimorsus 2858:Surviving Sepsis Campaign 2520:renal replacement therapy 2441:may be equivalent to ScvO 2275:and tissue resistance to 2106:Surviving Sepsis Campaign 1552:electrolyte abnormalities 1267:polymerase chain reaction 1213:electronic health records 704:compromise advances, the 679:seen in sepsis can cause 342: 331: 313: 295: 279: 228: 224:triggered by an infection 217: 209: 176: 123: 111: 66: 61: 52: 47: 10728:Critical green inclusion 10519:Sickle cell/drepanocyte 10491:Hereditary spherocytosis 9510:17 February 2015 at the 9491:templates for discussion 8751:Molekuliarnaia Biologiia 7974:Southern Medical Journal 7273:The Journal of Infection 6215:Journal of Critical Care 5845:Daniels R (April 2011). 5632:Valencia L (July 2023). 5275:10.1378/chest.101.6.1644 5001:Annals of Intensive Care 4610:10.1378/chest.101.6.1644 4286:Elsevier Health Sciences 4096:MedlinePlus Encyclopedia 3454:Cell Death & Disease 3356:Journal of Global Health 2901:Streptococcus pneumoniae 2464: 2355:Inhalational anesthetics 2298:ACTH stimulation testing 2001:multiple drug resistance 1773:alanine aminotransferase 1717:Hematologic dysfunction 1225:bottles: orange cap for 716: 694:Diastolic blood pressure 376:increased breathing rate 148:increased breathing rate 10794:Intensive care medicine 10460:Membrane abnormalities 10200:Stress ulcer prevention 10144:Therapeutic hypothermia 10043:Central venous catheter 9711:Intensive care medicine 8942:10.1073/pnas.1222878110 8574:Journal of Bacteriology 8305:Intensive Care Medicine 7202:Minerva Anestesiologica 7045:Intensive Care Medicine 6967:10.21037/atm.2016.09.02 6652:Intensive Care Medicine 5674:Intensive Care Medicine 5352:Simpson SQ (May 2016). 4234:10.3402/jchimp.v5.29426 4181:10.4103/0972-5229.63029 3918:Martin GS (June 2012). 3606:10.1542/hpeds.2020-0174 3308:Intensive Care Medicine 2119:central venous pressure 2115:central venous catheter 2040:infection, addition of 2016:Acinetobacter baumannii 2005:multiple drug resistant 1945:, but if necessary, by 1711:intellectual disability 1693:Neurologic dysfunction 1612:oliguria (urine output 1490:include the following: 1274:central venous pressure 1239:white blood cell counts 1185:constrict blood vessels 534:central venous catheter 406:. Severe sepsis causes 10630:Red cell agglutination 10275:Level of consciousness 10082:mechanical ventilation 9980:Methicillin-resistant 9338:10.1001/jama.2019.7936 9191:Critical Care Medicine 9144:Critical Care Medicine 8681:10.1006/bcmd.1998.0201 7404:Critical Care Medicine 6863:Critical Care Medicine 6746:Critical Care Medicine 5940:Critical Care Medicine 5857:(Suppl 2): ii11–ii23. 5497:Critical Care Medicine 4995:Marik PE (June 2014). 4168:Indian J Crit Care Med 3979:Critical Care Medicine 3794:10.15585/mmwr.mm6513a2 3697:JAMA Internal Medicine 3552:Critical Care Medicine 3368:10.7189/jogh.01.010404 3214:10.1001/jama.2016.0287 2919:Pseudomonas aeruginosa 2879: 2788:gram-negative bacteria 2768:host and that soluble 2709:decay or decomposition 2704: 2588:ventricular arrhythmia 2540:venous thromboembolism 2532:unfractionated heparin 2445:and easier to obtain. 2389:mechanical ventilation 2339:abnormal heart rhythms 2321:less than 30 cm H 2240:abnormal heart rhythms 2215:mean arterial pressure 2158:packed red blood cells 2111:mean arterial pressure 2021:methicillin-resistant 2010:Pseudomonas aeruginosa 1931:mechanical ventilation 1902: 1871:blood stream infection 1869:refers to a bacterial 1819:differential diagnosis 1813:Differential diagnosis 1756:chronic kidney disease 1438:decreased urine output 1396: 1234: 1170:multiple organ failure 1138:central nervous system 1130:gastrointestinal tract 1122:adenosine triphosphate 1087:multiple organ failure 1015:nuclear factor-kappa B 812:Pseudomonas aeruginosa 800:Streptococcus pyogenes 791:gram-negative bacteria 787:Gram-positive bacteria 766: 677:drop in blood pressure 608: 526:Mechanical ventilation 396:weakened immune system 338:location and its staff 9982:Staphylococcus aureus 9471:Medical Knowledge app 8623:Journal of Immunology 8533:: Suppl:17–Suppl:29. 8356:John Wiley & Sons 8282:10.1056/NEJMcp1314291 6919:10.1378/chest.14-1012 6316:10.1056/NEJMoa1406617 6141:10.1001/jama.2013.430 5220:10.3399/bjgp17X693665 5104:All Things Considered 5077:10.1378/chest.13-2104 4959:Critical Care Clinics 4038:. pp. 1099–109. 3421:10.1056/NEJMra1208623 2986:National Public Radio 2960:phenotypic plasticity 2925:Staphylococcus aureus 2877: 2694: 2560:intravenous nutrition 2544:proton-pump inhibitor 2375:poor adrenal function 2273:adrenal insufficiency 2083:Once-daily dosing of 2023:Staphylococcus aureus 1900: 1847:adrenal insufficiency 1703:altered mental status 1638:cyanotic heart defect 1488:end-organ dysfunction 1476:End-organ dysfunction 1394: 1221: 1142:tumor necrosis factor 724: 654:respiratory alkalosis 602: 487:adrenal insufficiency 308:pneumonia vaccination 300:influenza vaccination 10804:Causes of amputation 10733:Alder–Reilly anomaly 10587:Basophilic stippling 9957:Stress hyperglycemia 9798:Organ system failure 9732:Medical specialities 9369:Nutrition and Health 8849:Drug Discovery Today 8812:10.1089/sur.2016.021 8512:10.1093/jnci/4.5.461 8156:10.1056/NEJMoa022139 8076:. pp. 2223–31. 7279:(Suppl 1): S24–S32. 7118:10.1056/NEJMoa010307 6221:(1): 185.e1–185.e7. 5834:on 19 December 2014. 3116:. pp. 1003–14. 3104:Jui J, et al. ( 3064:(CDC). 22 May 2014. 2134:Crystalloid solution 2034:is recommended. For 1951:deep vein thrombosis 1947:parenteral nutrition 1670:) over baseline PaCO 1263:present in the blood 1191:, and activation of 1177:dilate blood vessels 1091:cytochrome c oxidase 1011:RIG-I-like receptors 971:inflammatory cascade 960:antigen presentation 896:chemical pneumonitis 753:(background right). 743:parenteral nutrition 622:low body temperature 553:deep vein thrombosis 522:raise blood pressure 475:blood to be infected 372:increased heart rate 138:increased heart rate 10799:Medical emergencies 10789:Infectious diseases 10708:Pelger–Huët anomaly 10666:Reactive lymphocyte 10592:Pappenheimer bodies 10523:Sickle cell disease 10320:Related specialties 10280:Acid–base imbalance 10216:ICU scoring systems 10087:Tracheal intubation 9898:Respiratory failure 9893:Acute liver failure 9883:Acute renal failure 9753:Intensive care unit 9737:Respiratory therapy 9283:2017InfGE..55..135R 9197:(11): e1063–e1143. 8933:2013PNAS..110.3507S 8800:Surgical Infections 8716:1998Sci...282.2085P 8710:(5396): 2085–2088. 8403:10.1189/jlb.0607380 8346:Vincent JL (2008). 8031:2014NYASA1323..101L 7712:10.3748/wjg.15.4132 6470:2015PLoSO..1029305A 4652:10.1038/emm.2013.97 4509:McGraw-Hill Medical 4288:. pp. 914–34. 3593:Hospital Pediatrics 2952:spp. and the fungi 2830:Society and culture 2695:Personification of 2665:absence of a spleen 2645:intensive care unit 2629:number of new cases 2592:torsades de pointes 2564:omega-3 fatty acids 2419:Ubi pus, ibi evacua 2365:function. Although 2182:Fresh frozen plasma 2166:myocardial ischemia 2146:acute kidney injury 2142:hydroxyethyl starch 1972:β-lactam antibiotic 1743:Kidney dysfunction 1707:developmental delay 1679:respiratory failure 1666:) > 65 torr (20 1642:respiratory disease 1640:or a known chronic 1331: 1255:anaerobic organisms 1245:using bottles with 1118:acute kidney injury 1112:transport, causing 1019:activator protein-1 999:toll-like receptors 934:. Sepsis caused by 727:intensive care unit 662:vascular resistance 642:decreased urination 524:becomes necessary. 514:intensive care unit 408:poor organ function 10556:Hypochromic anemia 10229:Glasgow Coma Scale 10180:Intravenous fluids 10060:Screening cultures 10028:Arterial blood gas 9993:Refeeding syndrome 9910:Neonatal infection 9871:Vasodilatory shock 9846:Distributive shock 9771:Coronary care unit 9634:External resources 8980:Burns & Trauma 8039:10.1111/nyas.12444 5864:10.1093/jac/dkq515 5735:10.4161/viru.27372 5214:(665): e859–e870. 4701:10.4161/viru.25965 4459:10.4161/viru.26187 4410:10.4161/viru.27024 4119:Clinical Nutrition 3868:(10219): 200–211. 2880: 2826:for intervention. 2807:toll-like receptor 2792:lipopolysaccharide 2705: 2524:sodium bicarbonate 2406:focus of infection 2100:Intravenous fluids 2074:acute pancreatitis 2007:organisms such as 1957:also may be used. 1903: 1835:pulmonary embolism 1827:acute pancreatitis 1823:alcohol withdrawal 1769:≥ 4 mg/dL, or 1697:Glasgow Coma Score 1597:metabolic acidosis 1450:low blood pressure 1397: 1327: 1235: 1201:distributive shock 1083:regulatory T cells 1007:NOD-like receptors 958:in the absence of 928:lipopolysaccharide 767: 658:low blood pressure 650:metabolic acidosis 612:Signs and symptoms 609: 546:superior vena cava 506:intravenous fluids 499:pulmonary embolism 412:low blood pressure 318:Intravenous fluids 143:low blood pressure 118:Infectious disease 10771: 10770: 10767: 10766: 10723:Toxic vacuolation 10718:Toxic granulation 10649:White blood cells 10643: 10642: 10582:Howell–Jolly body 10372: 10371: 10332:Internal medicine 10078:Airway management 10016: 10015: 9856:Obstructive shock 9841:Cardiogenic shock 9677: 9676: 9422:(12): 4449–4460. 9234:Sepsis Alliance. 8149:(16): 1546–1554. 8025:(2014): 101–114. 7980:(11): 1150–1157. 7705:(33): 4132–4136. 7208:(10): 1138–1143. 7111:(19): 1368–1377. 7018:978-3-540-92275-9 6869:(11): 2945–2953. 6309:(15): 1381–1391. 6266:10.1136/bmj.g4561 5915:on 11 August 2014 5905:978-1-909103-26-9 5503:(10): 2408–2416. 5309:Clinical Medicine 4831:10.2217/imt.10.82 4790:(12): 1287–1293. 4550:10.1111/bph.12829 4544:(22): 5011–5031. 3936:10.1586/eri.12.50 3599:(12): 1021–1030. 2994:systematic review 2846:private insurance 2568:prokinetic agents 2492:drotrecogin alpha 2221:are recommended. 1657:acute lung injury 1389: 1388: 1317:purpura fulminans 1197:circulatory shock 1043:immunosuppression 991:CpG bacterial DNA 983:muramyl dipeptide 940:lipoteichoic acid 908:virulence factors 902:Microbial factors 706:systolic pressure 630:a fast heart rate 600: 549:oxygen saturation 538:arterial catheter 518:fluid replacement 428:fluid replacement 388:painful urination 350: 349: 281:Diagnostic method 42:Medical condition 30:For the fly, see 16:(Redirected from 10816: 10738:Jordans' anomaly 10654: 10653: 10571:Inclusion bodies 10420: 10419: 10399: 10392: 10385: 10376: 10375: 10093:Cardiac devices 9947:Decubitus ulcers 9861:Neurogenic shock 9795: 9794: 9704: 9697: 9690: 9681: 9680: 9530: 9529: 9525: 9466: 9450: 9449: 9439: 9407: 9401: 9400: 9364: 9358: 9357: 9321: 9315: 9314: 9304: 9294: 9262: 9256: 9255: 9253: 9251: 9231: 9225: 9224: 9206: 9182: 9176: 9175: 9135: 9129: 9128: 9126: 9124: 9099: 9093: 9092: 9066: 9060: 9059: 9025: 9016: 9015: 9005: 8995: 8971: 8965: 8964: 8954: 8944: 8927:(9): 3507–3512. 8912: 8906: 8905: 8889: 8883: 8882: 8872: 8855:(9): 1540–1552. 8840: 8834: 8833: 8823: 8791: 8785: 8784: 8766: 8742: 8736: 8735: 8699: 8693: 8692: 8663: 8657: 8656: 8638: 8614: 8608: 8607: 8597: 8565: 8559: 8558: 8522: 8516: 8515: 8493: 8487: 8486: 8484: 8482: 8458: 8452: 8451: 8449: 8447: 8432: 8423: 8422: 8396: 8376: 8370: 8369: 8343: 8337: 8336: 8300: 8294: 8293: 8265: 8259: 8258: 8248: 8216: 8210: 8209: 8175: 8169: 8168: 8158: 8134: 8128: 8127: 8097: 8088: 8087: 8065: 8059: 8058: 8014: 8008: 8007: 7997: 7965: 7959: 7958: 7929: 7923: 7922: 7912: 7902: 7878: 7872: 7871: 7835: 7829: 7828: 7818: 7808: 7784: 7778: 7777: 7741: 7735: 7734: 7724: 7714: 7690: 7684: 7683: 7647: 7641: 7640: 7630: 7613:(12): CD004388. 7598: 7589: 7588: 7578: 7546: 7540: 7539: 7529: 7519: 7495: 7489: 7488: 7478: 7468: 7444: 7438: 7437: 7427: 7395: 7389: 7388: 7352: 7346: 7345: 7335: 7303: 7297: 7296: 7268: 7262: 7261: 7224: 7218: 7217: 7197: 7188: 7187: 7177: 7145: 7139: 7138: 7120: 7092: 7079: 7078: 7068: 7036: 7023: 7022: 6996: 6990: 6989: 6979: 6969: 6945: 6939: 6938: 6901: 6895: 6894: 6858: 6852: 6851: 6815: 6809: 6808: 6784: 6778: 6777: 6752:(6): 1937–1949. 6740: 6729: 6728: 6703:(9): 1657–1664. 6692: 6686: 6685: 6675: 6658:(7): 1220–1234. 6643: 6637: 6636: 6608: 6602: 6601: 6591: 6559: 6548: 6547: 6511: 6502: 6501: 6491: 6481: 6449: 6440: 6439: 6429: 6419: 6395: 6389: 6388: 6378: 6346: 6337: 6336: 6318: 6294: 6288: 6287: 6277: 6245: 6239: 6238: 6209: 6203: 6202: 6192: 6181:10.1136/bmj.f839 6160: 6154: 6153: 6143: 6119: 6113: 6112: 6102: 6070: 6059: 6058: 6048: 6016: 6010: 6009: 5980: 5974: 5973: 5963: 5946:(9): 1907–1915. 5931: 5925: 5924: 5922: 5920: 5914: 5908:. 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Archived from 5810: 5801: 5792: 5791: 5763: 5757: 5756: 5746: 5714: 5708: 5707: 5697: 5680:(9): 1418–1428. 5665: 5656: 5655: 5653: 5629: 5623: 5622: 5612: 5602: 5578: 5572: 5571: 5535: 5529: 5528: 5492: 5486: 5485: 5466:10.7326/M17-2820 5448: 5442: 5441: 5428: 5418: 5394: 5388: 5387: 5373: 5364:(5): 1117–1118. 5349: 5343: 5342: 5332: 5300: 5287: 5286: 5248: 5242: 5241: 5231: 5199: 5193: 5192: 5160: 5149: 5148: 5146: 5144: 5138: 5130: 5124: 5123: 5121: 5119: 5095: 5089: 5088: 5070: 5061:(6): 1407–1418. 5050: 5037: 5036: 5026: 5016: 4992: 4983: 4982: 4954: 4948: 4947: 4937: 4927: 4903: 4897: 4896: 4886: 4854: 4843: 4842: 4814: 4808: 4807: 4778: 4772: 4771: 4761: 4729: 4723: 4722: 4712: 4680: 4674: 4673: 4663: 4631: 4625: 4624: 4604:(6): 1644–1655. 4581: 4572: 4571: 4561: 4529: 4523: 4522: 4500: 4481: 4480: 4470: 4438: 4432: 4431: 4421: 4389: 4383: 4382: 4360: 4354: 4353: 4343: 4311: 4300: 4299: 4269: 4256: 4255: 4245: 4213: 4204: 4203: 4193: 4183: 4159: 4153: 4152: 4134: 4110: 4104: 4092: 4086: 4085: 4065: 4050: 4049: 4027: 4018: 4017: 4015: 3985:(4): 1250–1256. 3976: 3967: 3958: 3957: 3947: 3915: 3906: 3905: 3895: 3885: 3853: 3842: 3841: 3813: 3807: 3806: 3796: 3772: 3766: 3765: 3737: 3731: 3730: 3720: 3688: 3679: 3678: 3668: 3651:(12): CD002243. 3636: 3627: 3626: 3608: 3584: 3578: 3577: 3567: 3543: 3488: 3487: 3477: 3445: 3434: 3433: 3423: 3399: 3390: 3389: 3379: 3347: 3334: 3333: 3323: 3299: 3236: 3235: 3225: 3193: 3172: 3171: 3161: 3137: 3128: 3127: 3101: 3078: 3077: 3075: 3073: 3050: 3013:pupura fulminans 2907:Escherichia coli 2776:coined the term 2508:high blood sugar 2478:N-acetylcysteine 2381:Paralytic agents 2319:plateau pressure 2160:transfusion for 1980:fluoroquinolones 1970:(usually two, a 1851:neurogenic shock 1726: 1629: 1621:capillary refill 1615: 1614:< 0.5 mL/kg/h 1566:chemical signals 1564:, likely due to 1544:low urine output 1529:clotting factors 1422:white blood cell 1414:respiratory rate 1406:body temperature 1364:Respiratory rate 1332: 1326: 1303:consistent with 1259:through the skin 1229:, green cap for 1162:antifibrinolysis 956:T-cell receptors 845:(which leads to 806:Escherichia coli 761:malfunction and 646:high blood sugar 601: 491:low blood volume 467:quick SOFA score 439:abdominal organs 420:low urine output 400:body temperature 392:kidney infection 266:multiple myeloma 237:Young or old age 153:low urine output 103: 102: 99: 98: 95: 92: 89: 86: 83: 80: 57: 45: 44: 21: 10824: 10823: 10819: 10818: 10817: 10815: 10814: 10813: 10774: 10773: 10772: 10763: 10747: 10682: 10639: 10613: 10565: 10539: 10444: 10415:Red blood cells 10409: 10403: 10373: 10368: 10315: 10289: 10253: 10210: 10170:Antithrombotics 10148: 10132:Enteral feeding 10114:Kidney dialysis 10064: 10012: 9988:Oxygen toxicity 9966: 9924: 9786: 9741: 9713: 9708: 9678: 9673: 9672: 9629: 9628: 9541: 9516: 9512:Wayback Machine 9494: 9475: 9467: 9459: 9454: 9453: 9408: 9404: 9365: 9361: 9322: 9318: 9263: 9259: 9249: 9247: 9232: 9228: 9183: 9179: 9136: 9132: 9122: 9120: 9101: 9100: 9096: 9067: 9063: 9026: 9019: 8972: 8968: 8913: 8909: 8890: 8886: 8841: 8837: 8792: 8788: 8743: 8739: 8700: 8696: 8664: 8660: 8615: 8611: 8566: 8562: 8523: 8519: 8494: 8490: 8480: 8478: 8472:Merck & Co. 8460: 8459: 8455: 8445: 8443: 8433: 8426: 8394:10.1.1.492.7774 8377: 8373: 8366: 8344: 8340: 8301: 8297: 8266: 8262: 8217: 8213: 8176: 8172: 8135: 8131: 8098: 8091: 8084: 8066: 8062: 8015: 8011: 7966: 7962: 7930: 7926: 7879: 7875: 7836: 7832: 7785: 7781: 7742: 7738: 7691: 7687: 7664:10.1038/nrd4368 7658:(10): 741–758. 7648: 7644: 7599: 7592: 7561:(9): CD006616. 7547: 7543: 7517:10.1186/cc10097 7496: 7492: 7466:10.1186/cc13153 7445: 7441: 7396: 7392: 7353: 7349: 7304: 7300: 7269: 7265: 7225: 7221: 7198: 7191: 7146: 7142: 7093: 7082: 7037: 7026: 7019: 6997: 6993: 6946: 6942: 6902: 6898: 6859: 6855: 6820:Pharmacotherapy 6816: 6812: 6785: 6781: 6741: 6732: 6693: 6689: 6644: 6640: 6609: 6605: 6560: 6551: 6512: 6505: 6464:(8): e0129305. 6450: 6443: 6396: 6392: 6361:(9): CD001090. 6347: 6340: 6295: 6291: 6246: 6242: 6210: 6206: 6161: 6157: 6120: 6116: 6085:(8): CD000567. 6071: 6062: 6017: 6013: 5981: 5977: 5932: 5928: 5918: 5916: 5912: 5906: 5895: 5884: 5880: 5843: 5839: 5831: 5808: 5802: 5795: 5764: 5760: 5715: 5711: 5666: 5659: 5630: 5626: 5579: 5575: 5536: 5532: 5493: 5489: 5449: 5445: 5395: 5391: 5350: 5346: 5301: 5290: 5249: 5245: 5200: 5196: 5161: 5152: 5142: 5140: 5136: 5132: 5131: 5127: 5117: 5115: 5096: 5092: 5068:10.1.1.661.7518 5051: 5040: 4993: 4986: 4955: 4951: 4904: 4900: 4855: 4846: 4815: 4811: 4779: 4775: 4730: 4726: 4681: 4677: 4632: 4628: 4592:) (June 1992). 4582: 4575: 4530: 4526: 4519: 4501: 4484: 4439: 4435: 4390: 4386: 4379: 4361: 4357: 4312: 4303: 4296: 4270: 4259: 4214: 4207: 4160: 4156: 4111: 4107: 4093: 4089: 4066: 4053: 4046: 4028: 4021: 4013: 3974: 3968: 3961: 3916: 3909: 3854: 3845: 3814: 3810: 3787:(13): 342–345. 3773: 3769: 3738: 3734: 3689: 3682: 3637: 3630: 3585: 3581: 3544: 3491: 3446: 3437: 3400: 3393: 3348: 3337: 3300: 3239: 3194: 3175: 3138: 3131: 3124: 3102: 3081: 3071: 3069: 3052: 3051: 3028: 3023: 3016: 3005: 2872: 2864:Sepsis Alliance 2854: 2837: 2832: 2783:Vibrio cholerae 2689: 2625: 2604: 2476:concluded that 2474:Cochrane review 2467: 2458:Neonatal sepsis 2455: 2444: 2436: 2428: 2410:drainage of pus 2402: 2324: 2311: 2277:corticosteroids 2261:glucocorticoids 2253: 2211: 2154: 2102: 2046:fluoroquinolone 1988:aminoglycosides 1963: 1943:enteral feeding 1895: 1887:gastroenteritis 1867:neonatal sepsis 1863: 1861:Neonatal sepsis 1815: 1787: 1754:in people with 1724: 1687: 1673: 1665: 1654: 1650: 1627: 1613: 1607:lactic acidosis 1589:requirement, or 1556:volume overload 1548:no urine output 1507: 1503: 1484: 1478: 1325: 1209: 1156:factors in the 1134:paralytic ileus 1102:pulmonary edema 1071:dendritic cells 1027: 1005:receptors, the 904: 871: 869:Pathophysiology 719: 681:lightheadedness 626:rapid breathing 614: 603:Video summary ( 590: 581:developed world 573:corticosteroids 561:pressure ulcers 479:Medical imaging 275: 222:Immune response 205: 172: 107: 77: 73: 43: 38: 28: 23: 22: 18:Blood poisoning 15: 12: 11: 5: 10822: 10812: 10811: 10806: 10801: 10796: 10791: 10786: 10769: 10768: 10765: 10764: 10762: 10761: 10755: 10753: 10749: 10748: 10746: 10745: 10740: 10735: 10730: 10725: 10720: 10715: 10710: 10705: 10704: 10703: 10692: 10690: 10684: 10683: 10681: 10680: 10679: 10678: 10676:Russell bodies 10668: 10662: 10660: 10651: 10645: 10644: 10641: 10640: 10638: 10637: 10632: 10627: 10621: 10619: 10615: 10614: 10612: 10611: 10610: 10609: 10601: 10600: 10599: 10594: 10589: 10584: 10578:Developmental 10575: 10573: 10567: 10566: 10564: 10563: 10558: 10553: 10547: 10545: 10541: 10540: 10538: 10537: 10536: 10535: 10527: 10526: 10525: 10517: 10512: 10507: 10502: 10497: 10496: 10495: 10494: 10493: 10483: 10482: 10481: 10471: 10466: 10458: 10456:Poikilocytosis 10452: 10450: 10446: 10445: 10443: 10442: 10437: 10432: 10426: 10424: 10417: 10411: 10410: 10402: 10401: 10394: 10387: 10379: 10370: 10369: 10367: 10366: 10361: 10356: 10351: 10350: 10349: 10344: 10339: 10329: 10327:Anesthesiology 10323: 10321: 10317: 10316: 10314: 10313: 10308: 10303: 10297: 10295: 10291: 10290: 10288: 10287: 10282: 10277: 10272: 10267: 10261: 10259: 10255: 10254: 10252: 10251: 10246: 10241: 10236: 10231: 10226: 10224:APACHE II 10220: 10218: 10212: 10211: 10209: 10208: 10203: 10197: 10192: 10187: 10182: 10177: 10172: 10167: 10162: 10156: 10154: 10150: 10149: 10147: 10146: 10141: 10140: 10139: 10134: 10126: 10121: 10116: 10111: 10106: 10105: 10104: 10099: 10091: 10090: 10089: 10074: 10072: 10066: 10065: 10063: 10062: 10057: 10055:Blood cultures 10052: 10051: 10050: 10045: 10040: 10030: 10024: 10022: 10018: 10017: 10014: 10013: 10011: 10010: 10005: 10000: 9995: 9990: 9985: 9976: 9974: 9968: 9967: 9965: 9964: 9959: 9954: 9949: 9944: 9939: 9932: 9930: 9926: 9925: 9923: 9922: 9917: 9912: 9906: 9905: 9900: 9895: 9890: 9885: 9880: 9874: 9873: 9868: 9863: 9858: 9853: 9848: 9843: 9838: 9831: 9830: 9825: 9820: 9815: 9810: 9805: 9804:Shock sequence 9801: 9799: 9792: 9788: 9787: 9785: 9784: 9779: 9774: 9768: 9762: 9756: 9749: 9747: 9743: 9742: 9740: 9739: 9734: 9729: 9724: 9722:Health science 9718: 9715: 9714: 9707: 9706: 9699: 9692: 9684: 9675: 9674: 9671: 9670: 9661: 9650: 9638: 9637: 9635: 9631: 9630: 9627: 9626: 9615: 9604: 9589: 9562: 9542: 9537: 9536: 9534: 9533:Classification 9527: 9526: 9514: 9502: 9461: 9460: 9458: 9457:External links 9455: 9452: 9451: 9402: 9359: 9332:(4): 291–293. 9316: 9257: 9226: 9177: 9150:(3): 486–552. 9130: 9094: 9061: 9017: 8966: 8907: 8894:"Septic Shock" 8884: 8835: 8806:(4): 385–393. 8786: 8757:(5): 799–814. 8737: 8694: 8675:(3): 340–355. 8658: 8609: 8580:(3): 696–703. 8560: 8517: 8488: 8453: 8424: 8387:(3): 471–482. 8371: 8364: 8338: 8295: 8276:(4): 349–356. 8260: 8231:(4): 379–388. 8211: 8170: 8129: 8089: 8082: 8060: 8009: 7960: 7941:(3): 319–327. 7924: 7873: 7846:(2): 193–201. 7830: 7779: 7736: 7685: 7642: 7590: 7541: 7490: 7439: 7410:(5): 806–813. 7390: 7363:(3): 333–337. 7347: 7318:(2): 367–389. 7298: 7263: 7236:(6): 731–743. 7219: 7189: 7160:(3): 267–272. 7140: 7080: 7024: 7017: 6991: 6940: 6913:(2): 335–346. 6896: 6853: 6826:(5): 475–482. 6810: 6779: 6730: 6687: 6638: 6619:(2): 133–139. 6603: 6574:(4): 490–498. 6549: 6522:(4): 342–347. 6503: 6441: 6390: 6338: 6289: 6240: 6204: 6155: 6134:(7): 678–688. 6114: 6060: 6011: 5992:(6): 681–691. 5975: 5926: 5904: 5878: 5837: 5819:(5): 449–457. 5793: 5758: 5709: 5657: 5624: 5600:10.1186/cc8872 5573: 5530: 5487: 5460:(4): 266–275. 5443: 5389: 5344: 5315:(3): 276–280. 5288: 5269:(6): 1644–55. 5243: 5194: 5175:(5): 426–435. 5150: 5125: 5090: 5038: 4984: 4965:(3): 441–458. 4949: 4898: 4844: 4825:(1): 117–128. 4809: 4773: 4744:(3): 521–540. 4724: 4695:(1): 219–225. 4675: 4626: 4573: 4524: 4518:978-0071416405 4517: 4482: 4453:(1): 161–169. 4433: 4404:(1): 213–218. 4384: 4377: 4355: 4301: 4294: 4257: 4205: 4154: 4105: 4087: 4051: 4045:978-0071603898 4044: 4019: 3959: 3930:(6): 701–706. 3907: 3843: 3808: 3767: 3748:(5): 653–661. 3732: 3703:(2): 213–223. 3680: 3628: 3579: 3558:(2): 580–637. 3489: 3435: 3414:(9): 840–851. 3391: 3335: 3314:(3): 304–377. 3237: 3208:(8): 801–810. 3173: 3152:(4): 463–475. 3129: 3122: 3079: 3025: 3024: 3022: 3019: 3018: 3017: 3004: 3001: 2982:intensive care 2970:hydrocortisone 2871: 2868: 2853: 2850: 2836: 2833: 2831: 2828: 2688: 2685: 2624: 2621: 2603: 2600: 2572:metoclopramide 2506:In those with 2466: 2463: 2454: 2451: 2442: 2434: 2427: 2424: 2401: 2400:Source control 2398: 2322: 2310: 2307: 2265:hydrocortisone 2252: 2249: 2223:Norepinephrine 2210: 2207: 2178:blood clotting 2174:Erythropoietin 2153: 2152:Blood products 2150: 2101: 2098: 2085:aminoglycoside 1978:combined with 1962: 1959: 1955:gastric ulcers 1939:blood products 1927:kidney failure 1912:United Kingdom 1894: 1891: 1883:pyelonephritis 1862: 1859: 1839:thyrotoxicosis 1814: 1811: 1786: 1783: 1779: 1778: 1777: 1776: 1770: 1760: 1759: 1758: 1741: 1740: 1739: 1734: 1728: 1725:< 80,000/mm 1715: 1714: 1713: 1700: 1699:(GCS) ≤ 11, or 1691: 1690: 1689: 1685: 1682: 1671: 1663: 1660: 1652: 1648: 1634: 1633: 1632: 1631: 1630: 1624: 1623:> 5 seconds 1617: 1610: 1604: 1590: 1584: 1574: 1573: 1558: 1540: 1521: 1518:encephalopathy 1514: 1505: 1501: 1480:Main article: 1477: 1474: 1454: 1453: 1441: 1431: 1425: 1387: 1386: 1380: 1374: 1373: 1368:>20/min or 1366: 1360: 1359: 1356: 1350: 1349: 1346: 1340: 1339: 1336: 1324: 1321: 1297:internal organ 1243:blood cultures 1208: 1205: 1154:procoagulation 1051:interleukin 10 1026: 1023: 966:) by T-cells. 930:, also called 903: 900: 876:cytokine storm 870: 867: 751:infusion pumps 731:chain reaction 725:Patient of an 718: 715: 698:pulse pressure 666:cardiac output 613: 610: 542:cardiac output 510:antimicrobials 471:blood cultures 348: 347: 344: 340: 339: 335: 329: 328: 322:antimicrobials 315: 311: 310: 297: 293: 292: 283: 277: 276: 274: 273: 268: 263: 258: 253: 248: 243: 238: 234: 232: 226: 225: 219: 215: 214: 211: 207: 206: 204: 203: 198: 193: 188: 182: 180: 174: 173: 171: 170: 165: 160: 155: 150: 145: 140: 135: 129: 127: 121: 120: 115: 109: 108: 106: 105: 70: 68: 64: 63: 59: 58: 50: 49: 41: 26: 9: 6: 4: 3: 2: 10821: 10810: 10807: 10805: 10802: 10800: 10797: 10795: 10792: 10790: 10787: 10785: 10782: 10781: 10779: 10760: 10757: 10756: 10754: 10750: 10744: 10741: 10739: 10736: 10734: 10731: 10729: 10726: 10724: 10721: 10719: 10716: 10714: 10711: 10709: 10706: 10702: 10699: 10698: 10697: 10694: 10693: 10691: 10689: 10685: 10677: 10674: 10673: 10672: 10669: 10667: 10664: 10663: 10661: 10659: 10655: 10652: 10650: 10646: 10636: 10633: 10631: 10628: 10626: 10623: 10622: 10620: 10616: 10608: 10605: 10604: 10602: 10598: 10595: 10593: 10590: 10588: 10585: 10583: 10580: 10579: 10577: 10576: 10574: 10572: 10568: 10562: 10561:Polychromasia 10559: 10557: 10554: 10552: 10549: 10548: 10546: 10542: 10534: 10531: 10530: 10528: 10524: 10521: 10520: 10518: 10516: 10513: 10511: 10508: 10506: 10503: 10501: 10498: 10492: 10489: 10488: 10487: 10484: 10480: 10477: 10476: 10475: 10472: 10470: 10467: 10465: 10462: 10461: 10459: 10457: 10454: 10453: 10451: 10447: 10441: 10438: 10436: 10433: 10431: 10428: 10427: 10425: 10421: 10418: 10416: 10412: 10407: 10400: 10395: 10393: 10388: 10386: 10381: 10380: 10377: 10365: 10362: 10360: 10357: 10355: 10352: 10348: 10345: 10343: 10340: 10338: 10335: 10334: 10333: 10330: 10328: 10325: 10324: 10322: 10318: 10312: 10309: 10307: 10304: 10302: 10299: 10298: 10296: 10294:Organisations 10292: 10286: 10283: 10281: 10278: 10276: 10273: 10271: 10268: 10266: 10263: 10262: 10260: 10256: 10250: 10247: 10245: 10244:SAPS III 10242: 10240: 10237: 10235: 10232: 10230: 10227: 10225: 10222: 10221: 10219: 10217: 10213: 10207: 10204: 10201: 10198: 10196: 10193: 10191: 10188: 10186: 10183: 10181: 10178: 10176: 10173: 10171: 10168: 10166: 10163: 10161: 10158: 10157: 10155: 10151: 10145: 10142: 10138: 10135: 10133: 10130: 10129: 10127: 10125: 10122: 10120: 10117: 10115: 10112: 10110: 10107: 10103: 10100: 10098: 10095: 10094: 10092: 10088: 10085: 10084: 10083: 10079: 10076: 10075: 10073: 10071: 10067: 10061: 10058: 10056: 10053: 10049: 10046: 10044: 10041: 10039: 10038:Arterial line 10036: 10035: 10034: 10031: 10029: 10026: 10025: 10023: 10019: 10009: 10006: 10004: 10001: 9999: 9996: 9994: 9991: 9989: 9986: 9984: 9983: 9978: 9977: 9975: 9973: 9969: 9963: 9960: 9958: 9955: 9953: 9950: 9948: 9945: 9943: 9940: 9937: 9934: 9933: 9931: 9929:Complications 9927: 9921: 9918: 9916: 9913: 9911: 9908: 9907: 9904: 9901: 9899: 9896: 9894: 9891: 9889: 9886: 9884: 9881: 9879: 9878:Organ failure 9876: 9875: 9872: 9869: 9867: 9864: 9862: 9859: 9857: 9854: 9852: 9849: 9847: 9844: 9842: 9839: 9837: 9833: 9832: 9829: 9826: 9824: 9821: 9819: 9818:Severe sepsis 9816: 9814: 9811: 9809: 9806: 9803: 9802: 9800: 9796: 9793: 9789: 9783: 9780: 9778: 9775: 9772: 9769: 9766: 9763: 9760: 9757: 9754: 9751: 9750: 9748: 9746:General terms 9744: 9738: 9735: 9733: 9730: 9728: 9725: 9723: 9720: 9719: 9716: 9712: 9705: 9700: 9698: 9693: 9691: 9686: 9685: 9682: 9669: 9665: 9662: 9660: 9656: 9655: 9651: 9649: 9645: 9644: 9640: 9639: 9636: 9632: 9625: 9621: 9620: 9616: 9614: 9610: 9609: 9605: 9603: 9599: 9598: 9594: 9590: 9588: 9584: 9580: 9576: 9572: 9571: 9567: 9563: 9561: 9557: 9553: 9552: 9548: 9544: 9543: 9540: 9535: 9531: 9523: 9519: 9515: 9513: 9509: 9506: 9503: 9501: 9497: 9492: 9488: 9487: 9482: 9477: 9476: 9473: 9472: 9465: 9447: 9443: 9438: 9433: 9429: 9425: 9421: 9417: 9413: 9406: 9398: 9394: 9390: 9386: 9382: 9378: 9374: 9370: 9363: 9355: 9351: 9347: 9343: 9339: 9335: 9331: 9327: 9320: 9312: 9308: 9303: 9298: 9293: 9288: 9284: 9280: 9276: 9272: 9268: 9261: 9245: 9241: 9237: 9230: 9222: 9218: 9214: 9210: 9205: 9200: 9196: 9192: 9188: 9181: 9173: 9169: 9165: 9161: 9157: 9153: 9149: 9145: 9141: 9134: 9118: 9114: 9110: 9109: 9104: 9098: 9090: 9086: 9082: 9078: 9077: 9072: 9065: 9057: 9053: 9049: 9045: 9041: 9037: 9036: 9031: 9024: 9022: 9013: 9009: 9004: 8999: 8994: 8989: 8985: 8981: 8977: 8970: 8962: 8958: 8953: 8948: 8943: 8938: 8934: 8930: 8926: 8922: 8918: 8911: 8903: 8899: 8895: 8888: 8880: 8876: 8871: 8866: 8862: 8858: 8854: 8850: 8846: 8839: 8831: 8827: 8822: 8817: 8813: 8809: 8805: 8801: 8797: 8790: 8782: 8778: 8774: 8770: 8765: 8760: 8756: 8752: 8748: 8741: 8733: 8729: 8725: 8721: 8717: 8713: 8709: 8705: 8698: 8690: 8686: 8682: 8678: 8674: 8670: 8662: 8654: 8650: 8646: 8642: 8637: 8632: 8628: 8624: 8620: 8613: 8605: 8601: 8596: 8591: 8587: 8583: 8579: 8575: 8571: 8564: 8556: 8552: 8548: 8544: 8540: 8536: 8532: 8528: 8521: 8513: 8509: 8506:(5): 461–76. 8505: 8501: 8500: 8492: 8476: 8473: 8469: 8468: 8463: 8457: 8442: 8438: 8431: 8429: 8420: 8416: 8412: 8408: 8404: 8400: 8395: 8390: 8386: 8382: 8375: 8367: 8365:9783527319350 8361: 8358:. p. 3. 8357: 8353: 8349: 8342: 8334: 8330: 8326: 8322: 8318: 8314: 8310: 8306: 8299: 8291: 8287: 8283: 8279: 8275: 8271: 8264: 8256: 8252: 8247: 8242: 8238: 8234: 8230: 8226: 8222: 8215: 8207: 8203: 8199: 8195: 8191: 8187: 8186: 8181: 8174: 8166: 8162: 8157: 8152: 8148: 8144: 8140: 8133: 8125: 8121: 8117: 8113: 8109: 8108: 8103: 8096: 8094: 8085: 8083:9780071748896 8079: 8075: 8071: 8064: 8056: 8052: 8048: 8044: 8040: 8036: 8032: 8028: 8024: 8020: 8013: 8005: 8001: 7996: 7991: 7987: 7983: 7979: 7975: 7971: 7964: 7956: 7952: 7948: 7944: 7940: 7936: 7928: 7920: 7916: 7911: 7906: 7901: 7896: 7892: 7888: 7887:Critical Care 7884: 7877: 7869: 7865: 7861: 7857: 7853: 7849: 7845: 7841: 7834: 7826: 7822: 7817: 7812: 7807: 7802: 7798: 7794: 7790: 7783: 7775: 7771: 7767: 7763: 7759: 7755: 7752:(2): 281–90. 7751: 7747: 7740: 7732: 7728: 7723: 7718: 7713: 7708: 7704: 7700: 7696: 7689: 7681: 7677: 7673: 7669: 7665: 7661: 7657: 7653: 7646: 7638: 7634: 7629: 7624: 7620: 7616: 7612: 7608: 7604: 7597: 7595: 7586: 7582: 7577: 7572: 7568: 7564: 7560: 7556: 7552: 7545: 7537: 7533: 7528: 7523: 7518: 7513: 7509: 7505: 7504:Critical Care 7501: 7494: 7486: 7482: 7477: 7472: 7467: 7462: 7458: 7454: 7453:Critical Care 7450: 7443: 7435: 7431: 7426: 7421: 7417: 7413: 7409: 7405: 7401: 7394: 7386: 7382: 7378: 7374: 7370: 7366: 7362: 7358: 7351: 7343: 7339: 7334: 7329: 7325: 7321: 7317: 7313: 7309: 7302: 7294: 7290: 7286: 7282: 7278: 7274: 7267: 7259: 7255: 7251: 7247: 7243: 7239: 7235: 7231: 7223: 7215: 7211: 7207: 7203: 7196: 7194: 7185: 7181: 7176: 7171: 7167: 7163: 7159: 7155: 7151: 7144: 7136: 7132: 7128: 7124: 7119: 7114: 7110: 7106: 7102: 7098: 7091: 7089: 7087: 7085: 7076: 7072: 7067: 7062: 7058: 7054: 7050: 7046: 7042: 7035: 7033: 7031: 7029: 7020: 7014: 7010: 7006: 7002: 6995: 6987: 6983: 6978: 6973: 6968: 6963: 6959: 6955: 6951: 6944: 6936: 6932: 6928: 6924: 6920: 6916: 6912: 6908: 6900: 6892: 6888: 6884: 6880: 6876: 6872: 6868: 6864: 6857: 6849: 6845: 6841: 6837: 6833: 6829: 6825: 6821: 6814: 6806: 6802: 6798: 6794: 6790: 6783: 6775: 6771: 6767: 6763: 6759: 6755: 6751: 6747: 6739: 6737: 6735: 6726: 6722: 6718: 6714: 6710: 6706: 6702: 6698: 6691: 6683: 6679: 6674: 6669: 6665: 6661: 6657: 6653: 6649: 6642: 6634: 6630: 6626: 6622: 6618: 6614: 6607: 6599: 6595: 6590: 6585: 6581: 6577: 6573: 6569: 6565: 6558: 6556: 6554: 6545: 6541: 6537: 6533: 6529: 6525: 6521: 6517: 6510: 6508: 6499: 6495: 6490: 6485: 6480: 6475: 6471: 6467: 6463: 6459: 6455: 6448: 6446: 6437: 6433: 6428: 6423: 6418: 6413: 6409: 6405: 6404:Critical Care 6401: 6394: 6386: 6382: 6377: 6372: 6368: 6364: 6360: 6356: 6352: 6345: 6343: 6334: 6330: 6326: 6322: 6317: 6312: 6308: 6304: 6300: 6293: 6285: 6281: 6276: 6271: 6267: 6263: 6259: 6255: 6251: 6244: 6236: 6232: 6228: 6224: 6220: 6216: 6208: 6200: 6196: 6191: 6186: 6182: 6178: 6174: 6170: 6166: 6159: 6151: 6147: 6142: 6137: 6133: 6129: 6125: 6118: 6110: 6106: 6101: 6096: 6092: 6088: 6084: 6080: 6076: 6069: 6067: 6065: 6056: 6052: 6047: 6042: 6038: 6034: 6030: 6026: 6022: 6015: 6007: 6003: 5999: 5995: 5991: 5987: 5979: 5971: 5967: 5962: 5957: 5953: 5949: 5945: 5941: 5937: 5930: 5911: 5907: 5901: 5894: 5893: 5888: 5882: 5874: 5870: 5865: 5860: 5856: 5852: 5848: 5841: 5830: 5826: 5822: 5818: 5814: 5807: 5800: 5798: 5789: 5785: 5781: 5777: 5773: 5769: 5762: 5754: 5750: 5745: 5740: 5736: 5732: 5728: 5724: 5720: 5713: 5705: 5701: 5696: 5691: 5687: 5683: 5679: 5675: 5671: 5664: 5662: 5652: 5647: 5643: 5639: 5635: 5628: 5620: 5616: 5611: 5606: 5601: 5596: 5592: 5588: 5587:Critical Care 5584: 5577: 5569: 5565: 5561: 5557: 5553: 5549: 5545: 5541: 5534: 5526: 5522: 5518: 5514: 5510: 5506: 5502: 5498: 5491: 5483: 5479: 5475: 5471: 5467: 5463: 5459: 5455: 5447: 5440: 5436: 5432: 5427: 5422: 5417: 5412: 5408: 5404: 5403:Critical Care 5400: 5393: 5386: 5381: 5377: 5372: 5367: 5363: 5359: 5355: 5348: 5340: 5336: 5331: 5326: 5322: 5318: 5314: 5310: 5306: 5299: 5297: 5295: 5293: 5284: 5280: 5276: 5272: 5268: 5264: 5263: 5258: 5254: 5247: 5239: 5235: 5230: 5225: 5221: 5217: 5213: 5209: 5205: 5198: 5190: 5186: 5182: 5178: 5174: 5170: 5166: 5159: 5157: 5155: 5135: 5129: 5113: 5109: 5105: 5101: 5094: 5086: 5082: 5078: 5074: 5069: 5064: 5060: 5056: 5049: 5047: 5045: 5043: 5034: 5030: 5025: 5020: 5015: 5010: 5006: 5002: 4998: 4991: 4989: 4980: 4976: 4972: 4968: 4964: 4960: 4953: 4945: 4941: 4936: 4931: 4926: 4921: 4917: 4913: 4909: 4902: 4894: 4890: 4885: 4880: 4876: 4872: 4868: 4864: 4860: 4853: 4851: 4849: 4840: 4836: 4832: 4828: 4824: 4820: 4819:Immunotherapy 4813: 4805: 4801: 4797: 4793: 4789: 4785: 4777: 4769: 4765: 4760: 4755: 4751: 4747: 4743: 4739: 4735: 4728: 4720: 4716: 4711: 4706: 4702: 4698: 4694: 4690: 4686: 4679: 4671: 4667: 4662: 4657: 4653: 4649: 4645: 4641: 4637: 4630: 4623: 4619: 4615: 4611: 4607: 4603: 4599: 4595: 4591: 4587: 4580: 4578: 4569: 4565: 4560: 4555: 4551: 4547: 4543: 4539: 4535: 4528: 4520: 4514: 4510: 4506: 4499: 4497: 4495: 4493: 4491: 4489: 4487: 4478: 4474: 4469: 4464: 4460: 4456: 4452: 4448: 4444: 4437: 4429: 4425: 4420: 4415: 4411: 4407: 4403: 4399: 4395: 4388: 4380: 4378:9780071621670 4374: 4370: 4366: 4359: 4351: 4347: 4342: 4337: 4333: 4329: 4325: 4321: 4317: 4310: 4308: 4306: 4297: 4295:9780323263733 4291: 4287: 4283: 4279: 4275: 4268: 4266: 4264: 4262: 4253: 4249: 4244: 4239: 4235: 4231: 4227: 4223: 4219: 4212: 4210: 4201: 4197: 4192: 4187: 4182: 4177: 4173: 4169: 4165: 4158: 4150: 4146: 4142: 4138: 4133: 4128: 4124: 4120: 4116: 4109: 4102: 4098: 4097: 4091: 4083: 4079: 4075: 4071: 4064: 4062: 4060: 4058: 4056: 4047: 4041: 4037: 4033: 4026: 4024: 4012: 4008: 4004: 4000: 3996: 3992: 3988: 3984: 3980: 3973: 3966: 3964: 3955: 3951: 3946: 3941: 3937: 3933: 3929: 3925: 3921: 3914: 3912: 3903: 3899: 3894: 3889: 3884: 3879: 3875: 3871: 3867: 3863: 3859: 3852: 3850: 3848: 3839: 3835: 3831: 3827: 3823: 3819: 3812: 3804: 3800: 3795: 3790: 3786: 3782: 3778: 3771: 3763: 3759: 3755: 3751: 3747: 3743: 3736: 3728: 3724: 3719: 3714: 3710: 3706: 3702: 3698: 3694: 3687: 3685: 3676: 3672: 3667: 3662: 3658: 3654: 3650: 3646: 3642: 3635: 3633: 3624: 3620: 3616: 3612: 3607: 3602: 3598: 3594: 3590: 3583: 3575: 3571: 3566: 3561: 3557: 3553: 3549: 3542: 3540: 3538: 3536: 3534: 3532: 3530: 3528: 3526: 3524: 3522: 3520: 3518: 3516: 3514: 3512: 3510: 3508: 3506: 3504: 3502: 3500: 3498: 3496: 3494: 3485: 3481: 3476: 3471: 3467: 3463: 3459: 3455: 3451: 3444: 3442: 3440: 3431: 3427: 3422: 3417: 3413: 3409: 3405: 3398: 3396: 3387: 3383: 3378: 3373: 3369: 3365: 3362:(1): 010404. 3361: 3357: 3353: 3346: 3344: 3342: 3340: 3331: 3327: 3322: 3317: 3313: 3309: 3305: 3298: 3296: 3294: 3292: 3290: 3288: 3286: 3284: 3282: 3280: 3278: 3276: 3274: 3272: 3270: 3268: 3266: 3264: 3262: 3260: 3258: 3256: 3254: 3252: 3250: 3248: 3246: 3244: 3242: 3233: 3229: 3224: 3219: 3215: 3211: 3207: 3203: 3199: 3192: 3190: 3188: 3186: 3184: 3182: 3180: 3178: 3169: 3165: 3160: 3155: 3151: 3147: 3143: 3136: 3134: 3125: 3123:9780071484800 3119: 3115: 3111: 3107: 3100: 3098: 3096: 3094: 3092: 3090: 3088: 3086: 3084: 3067: 3063: 3059: 3055: 3049: 3047: 3045: 3043: 3041: 3039: 3037: 3035: 3033: 3031: 3026: 3014: 3010: 3007: 3006: 3000: 2997: 2995: 2991: 2987: 2983: 2979: 2975: 2971: 2967: 2966:Paul E. Marik 2963: 2961: 2957: 2956: 2951: 2950: 2945: 2944: 2943:Lactobacillus 2939: 2938: 2933: 2932: 2927: 2926: 2921: 2920: 2915: 2914: 2909: 2908: 2903: 2902: 2897: 2893: 2889: 2885: 2876: 2867: 2865: 2861: 2859: 2849: 2847: 2843: 2827: 2825: 2821: 2815: 2813: 2808: 2804: 2800: 2795: 2793: 2789: 2785: 2784: 2779: 2775: 2771: 2767: 2763: 2758: 2756: 2752: 2748: 2744: 2740: 2736: 2731: 2729: 2725: 2720: 2718: 2714: 2710: 2702: 2698: 2693: 2684: 2682: 2676: 2674: 2670: 2666: 2662: 2658: 2652: 2650: 2646: 2642: 2636: 2634: 2633:United States 2630: 2620: 2616: 2613: 2608: 2599: 2595: 2593: 2589: 2585: 2581: 2577: 2573: 2569: 2565: 2561: 2557: 2553: 2549: 2548:H2 antagonist 2545: 2541: 2537: 2533: 2529: 2525: 2521: 2516: 2513: 2509: 2504: 2502: 2497: 2493: 2489: 2485: 2481: 2479: 2475: 2470: 2462: 2459: 2450: 2446: 2440: 2432: 2423: 2421: 2420: 2415: 2411: 2407: 2397: 2394: 2390: 2386: 2382: 2378: 2376: 2372: 2368: 2364: 2363:mitochondrial 2360: 2356: 2350: 2348: 2344: 2340: 2336: 2332: 2328: 2320: 2316: 2306: 2303: 2299: 2294: 2290: 2286: 2282: 2278: 2274: 2269: 2266: 2262: 2258: 2248: 2245: 2241: 2237: 2232: 2231:stroke volume 2226: 2224: 2220: 2216: 2206: 2204: 2203:hemoperfusion 2200: 2196: 2192: 2188: 2183: 2179: 2175: 2171: 2167: 2163: 2159: 2149: 2147: 2143: 2139: 2135: 2131: 2129: 2125: 2120: 2116: 2112: 2107: 2097: 2095: 2091: 2086: 2081: 2079: 2075: 2071: 2067: 2063: 2059: 2055: 2051: 2047: 2043: 2039: 2038: 2033: 2029: 2025: 2024: 2018: 2017: 2012: 2011: 2006: 2002: 1997: 1991: 1989: 1985: 1981: 1977: 1973: 1969: 1958: 1956: 1952: 1948: 1944: 1940: 1936: 1932: 1928: 1924: 1920: 1915: 1913: 1909: 1899: 1890: 1888: 1884: 1880: 1876: 1872: 1868: 1858: 1856: 1852: 1848: 1844: 1840: 1836: 1832: 1828: 1824: 1820: 1810: 1808: 1803: 1800: 1796: 1795:procalcitonin 1792: 1782: 1774: 1771: 1768: 1764: 1763: 1761: 1757: 1753: 1749: 1745: 1744: 1742: 1738: 1735: 1732: 1729: 1722: 1719: 1718: 1716: 1712: 1708: 1704: 1701: 1698: 1695: 1694: 1692: 1683: 1680: 1677: 1674:(evidence of 1669: 1661: 1658: 1646: 1645: 1643: 1639: 1635: 1625: 1622: 1618: 1611: 1608: 1605: 1602: 1598: 1594: 1593: 1591: 1588: 1585: 1582: 1581: 1579: 1578: 1577: 1571: 1567: 1563: 1562:heart failure 1559: 1557: 1553: 1549: 1545: 1541: 1538: 1534: 1530: 1526: 1522: 1519: 1515: 1513: 1509: 1497: 1493: 1492: 1491: 1489: 1483: 1473: 1471: 1467: 1463: 1459: 1451: 1447: 1446: 1442: 1439: 1435: 1434:Severe sepsis 1432: 1429: 1426: 1423: 1419: 1415: 1411: 1407: 1403: 1402: 1401: 1393: 1385: 1381: 1379: 1376: 1375: 1371: 1367: 1365: 1362: 1361: 1357: 1355: 1352: 1351: 1347: 1345: 1342: 1341: 1337: 1334: 1333: 1330: 1320: 1318: 1314: 1310: 1306: 1302: 1298: 1294: 1290: 1285: 1283: 1282:point of care 1279: 1275: 1270: 1268: 1264: 1260: 1256: 1252: 1248: 1244: 1240: 1232: 1228: 1224: 1223:Blood culture 1220: 1216: 1214: 1204: 1202: 1198: 1194: 1190: 1186: 1182: 1178: 1173: 1171: 1167: 1163: 1159: 1155: 1152:may activate 1151: 1150:interleukin 6 1147: 1146:interleukin 1 1143: 1139: 1135: 1131: 1127: 1126:heart failure 1123: 1119: 1115: 1111: 1107: 1103: 1099: 1094: 1092: 1088: 1084: 1080: 1076: 1072: 1068: 1064: 1060: 1056: 1052: 1048: 1047:T helper cell 1044: 1040: 1036: 1032: 1022: 1020: 1016: 1012: 1008: 1004: 1003:C-type lectin 1000: 996: 992: 988: 987:peptidoglycan 984: 980: 976: 972: 967: 965: 961: 957: 953: 949: 948:superantigens 945: 941: 937: 936:gram-positive 933: 929: 926:component of 925: 921: 920:gram-negative 917: 913: 909: 899: 897: 893: 889: 885: 881: 877: 866: 862: 860: 859: 854: 853: 848: 844: 843: 838: 835:, a frequent 834: 830: 829: 824: 823:Fungal sepsis 820: 819: 814: 813: 808: 807: 802: 801: 796: 795:staphylococci 792: 788: 784: 780: 776: 772: 764: 760: 756: 752: 748: 744: 740: 736: 732: 728: 723: 714: 712: 707: 703: 699: 695: 691: 688: 686: 682: 678: 673: 671: 667: 663: 659: 655: 651: 647: 643: 639: 635: 631: 627: 623: 619: 606: 588: 586: 582: 576: 574: 571:. The use of 570: 566: 562: 558: 557:stress ulcers 554: 550: 547: 543: 539: 535: 531: 527: 523: 519: 515: 511: 507: 502: 500: 496: 495:heart failure 492: 488: 484: 480: 476: 472: 468: 464: 460: 456: 452: 448: 444: 440: 436: 435:urinary tract 431: 429: 425: 421: 417: 414:, high blood 413: 409: 405: 401: 397: 393: 389: 385: 381: 377: 373: 369: 365: 364:immune system 360: 358: 354: 345: 341: 336: 334: 330: 327: 323: 319: 316: 312: 309: 305: 301: 298: 294: 291: 287: 284: 282: 278: 272: 269: 267: 264: 262: 259: 257: 254: 252: 249: 247: 244: 242: 239: 236: 235: 233: 231: 227: 223: 220: 216: 212: 208: 202: 199: 197: 194: 192: 189: 187: 184: 183: 181: 179: 178:Complications 175: 169: 166: 164: 161: 159: 156: 154: 151: 149: 146: 144: 141: 139: 136: 134: 131: 130: 128: 126: 122: 119: 116: 114: 110: 101: 72: 71: 69: 67:Pronunciation 65: 60: 56: 51: 46: 40: 36: 34: 19: 10713:Döhle bodies 10701:Arneth count 10688:Granulocytes 10551:Anisochromia 10529:Stomatocyte 10440:Microcytosis 10435:Macrocytosis 10430:Anisocytosis 10364:Traumatology 10265:Hemodynamics 10239:SAPS II 10206:Vasopressors 10124:Induced coma 9981: 9972:Iatrogenesis 9962:Stress ulcer 9866:Spinal shock 9823:Septic shock 9812: 9663: 9652: 9641: 9617: 9606: 9591: 9564: 9545: 9521: 9484: 9469: 9419: 9415: 9405: 9375:(1): 77–93. 9372: 9368: 9362: 9329: 9325: 9319: 9274: 9270: 9260: 9248:. Retrieved 9239: 9229: 9194: 9190: 9180: 9147: 9143: 9133: 9121:. Retrieved 9106: 9097: 9075: 9064: 9034: 8983: 8979: 8969: 8924: 8920: 8910: 8897: 8887: 8852: 8848: 8838: 8803: 8799: 8789: 8754: 8750: 8740: 8707: 8703: 8697: 8672: 8668: 8661: 8629:(1): 20–24. 8626: 8622: 8612: 8577: 8573: 8563: 8530: 8526: 8520: 8503: 8497: 8491: 8479:. Retrieved 8465: 8462:"Bacteremia" 8456: 8444:. Retrieved 8440: 8384: 8380: 8374: 8351: 8341: 8311:(12): 2077. 8308: 8304: 8298: 8273: 8269: 8263: 8228: 8224: 8214: 8184: 8173: 8146: 8142: 8132: 8106: 8069: 8063: 8022: 8018: 8012: 7977: 7973: 7963: 7938: 7934: 7927: 7890: 7886: 7876: 7843: 7839: 7833: 7796: 7792: 7782: 7749: 7745: 7739: 7702: 7698: 7688: 7655: 7651: 7645: 7610: 7606: 7558: 7554: 7544: 7507: 7503: 7493: 7456: 7452: 7442: 7407: 7403: 7393: 7360: 7356: 7350: 7315: 7311: 7301: 7276: 7272: 7266: 7233: 7229: 7222: 7205: 7201: 7157: 7153: 7143: 7108: 7104: 7051:(1): 17–60. 7048: 7044: 7000: 6994: 6957: 6953: 6943: 6910: 6906: 6899: 6866: 6862: 6856: 6823: 6819: 6813: 6792: 6782: 6749: 6745: 6700: 6696: 6690: 6655: 6651: 6641: 6616: 6612: 6606: 6571: 6567: 6519: 6515: 6461: 6457: 6407: 6403: 6393: 6358: 6354: 6306: 6302: 6292: 6257: 6253: 6243: 6218: 6214: 6207: 6172: 6168: 6158: 6131: 6127: 6117: 6082: 6078: 6028: 6024: 6014: 5989: 5985: 5978: 5943: 5939: 5929: 5917:. Retrieved 5910:the original 5891: 5889:(May 2014). 5881: 5854: 5850: 5840: 5829:the original 5816: 5812: 5771: 5767: 5761: 5726: 5722: 5712: 5677: 5673: 5641: 5637: 5627: 5590: 5586: 5576: 5543: 5539: 5533: 5500: 5496: 5490: 5457: 5453: 5446: 5438: 5406: 5402: 5392: 5383: 5361: 5357: 5347: 5312: 5308: 5266: 5260: 5246: 5211: 5207: 5197: 5172: 5168: 5141:. Retrieved 5128: 5116:. Retrieved 5093: 5058: 5054: 5004: 5000: 4962: 4958: 4952: 4915: 4911: 4901: 4869:(1): 57–69. 4866: 4862: 4822: 4818: 4812: 4787: 4783: 4776: 4741: 4737: 4727: 4692: 4688: 4678: 4643: 4639: 4629: 4621: 4601: 4597: 4541: 4537: 4527: 4504: 4450: 4446: 4436: 4401: 4397: 4387: 4364: 4358: 4326:(1): 53–58. 4323: 4319: 4281: 4228:(6): 29426. 4225: 4221: 4174:(1): 41–52. 4171: 4167: 4157: 4125:(1): 48–79. 4122: 4118: 4108: 4094: 4090: 4076:(1): 44–53. 4073: 4069: 4034:. New York: 4031: 3982: 3978: 3927: 3923: 3883:11343/273829 3865: 3861: 3821: 3817: 3811: 3784: 3780: 3770: 3745: 3741: 3735: 3700: 3696: 3648: 3644: 3596: 3592: 3582: 3555: 3551: 3457: 3453: 3411: 3407: 3359: 3355: 3311: 3307: 3205: 3201: 3149: 3145: 3109: 3070:. Retrieved 3057: 2998: 2964: 2953: 2947: 2941: 2935: 2929: 2923: 2917: 2911: 2905: 2899: 2881: 2862: 2855: 2838: 2824:drug targets 2816: 2802: 2796: 2781: 2759: 2732: 2721: 2706: 2696: 2677: 2669:major trauma 2653: 2637: 2626: 2623:Epidemiology 2617: 2609: 2605: 2596: 2580:erythromycin 2556:feeding tube 2517: 2505: 2482: 2471: 2468: 2456: 2447: 2429: 2417: 2403: 2379: 2351: 2315:tidal volume 2312: 2289:pancreatitis 2285:septic shock 2270: 2254: 2227: 2219:vasopressors 2212: 2209:Vasopressors 2195:antithrombin 2155: 2132: 2103: 2082: 2070:itraconazole 2050:echinocandin 2035: 2022: 2014: 2008: 1992: 1964: 1923:hemodialysis 1916: 1904: 1864: 1816: 1804: 1788: 1780: 1765:total serum 1733:(INR) > 2 1603:> 5 mEq/L 1601:base deficit 1595:unexplained 1575: 1486:Examples of 1485: 1455: 1445:Septic shock 1443: 1433: 1427: 1398: 1286: 1271: 1236: 1210: 1181:nitric oxide 1174: 1095: 1075:CD4+ T cells 1028: 1025:Host factors 968: 946:that act as 942:. 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