الفهرس 
PATHOPHYSIOLOGY OF SEPSISOnly 14 pages are availabe for public view
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Abstract
Sepsis is a leading cause of death in the intensive care unit (ICU) despite modern antibiotics and resuscitation therapies. Systemic inflammatory respons syndrome (SIRS) is characterized by two or more of the following : body temperature ≥ 38 °C or ≤ 36 °C, Heart rate ( HR) 90 beat per minute , WBC 12, 000 or 4000 cell per mm3 if source of infection is suspected or known this is known as sepsis if associated with organs dysfunction is called severe sepsis but septic shock in defined as severe sepsis associated with hypotension despite adequate fluid resuscitation.
Pathogenesis of sepsis involves interaction between multiple microbial factors and host factors and the out come depends on capability of the immune system, endothelium and haemostatic mechanism to contain and eliminate the process. Microbial factors include (gram positive, negative, mixed and fungal infection) and most common sources of infections are respiratory 50%, abdomen and pelvis 25%, urinary tract 10%, skin 5%, IV catheter 5% and others 5%.
Pathophysiology of sepsis includes coagulation system activation as activation of pro-coagulant pathway and imbalance of homeostasis; hypothalamic – adrenal axis dysfunction and microcirculatory dysfunction lead to multi organs failure. There are many hypotheses initiate and perpetuate multi organs failure as gut hypotheses, tissue hypothesis, two events hypotheses and integrated hypothesis.
Early diagnosis of sepsis is key for improving survival, Laboratory tests play an important role in identifying the infectious agents also blood culture is performed under optimum conditions to have the best possible chance for detecting bacteria and yeast responsible for infection.
Intensivists play a central role in the multidisciplinary management of patients with severe sepsis from their initial deterioration at ward level, transfer to the diagnostic imaging suite, and preoperative management for emergency surgery.
The timely administration of appropriate i.v. antimicrobial therapy is a crucial step in the care of patients with severe sepsis who may require surgery to control the source of sepsis.
Preoperative resuscitation, aimed at optimizing major organ perfusion, is based on judicious use of fluids, vasopressors, and inotropes.
Similar to acute myocardial infarction, stroke, or acute trauma, the initial hours (golden hours) of clinical management of severe sepsis represent an important opportunity to reduce morbidity and mortality. Rapid clinical assessment, resuscitation and surgical management by a focused multidisciplinary team, and early effective antimicrobial therapy are the key components to improved patient outcome.
Biomarkers have an important role because they can indicate the presence or absence and severity of infection in addition to differentiate bacterial from viral from fungal infection but there is no (gold standard) of diagnosis of sepsis .
Biomarkers have role in treatment and prognosis of sepsis as C- reactive protein (CRP) used as a prognostic marker for sepsis but Procalcitonin (Pct) more specific and better prognostic marker. By serial PCT measures antibiotics can be safely stopped once (PCT) level declines.
There is hope that improved molecular diagnostics and prognostics will not only result in a better understanding of the complexity of systemic inflammation but also lead to new diagnostic tools which help to recognize infection and sepsis earlier and differentiate between infectious and noninfectious inflammation. Such tools also hold promise for the identification of new therapeutic targets and the identification of patient populations that may benefit from specific interventions that are aimed at these targets.