Rev Esp Quimioter 2018; 31(4): 298-315
Current aspects in sepsis approach. Turning things around
FRANCISCO JAVIER CANDEL, MARCIO BORGES SÁ, SYLVIA BELDA, GERMÁN BOU, JOSÉ LUIS DEL POZO, ORIOL ESTRADA, RICARD FERRER, JUAN GONZÁLEZ DEL CASTILLO, AGUSTÍN JULIÁN-JIMÉNEZ, IGNACIO MARTÍN-LOECHES, EMILIO MASEDA, MAYRA MATESANZ, PAULA RAMÍREZ, JOSÉ TOMÁS RAMOS, JORDI RELLO, BORJA SUBERVIOLA, ALEJANDRO SUÁREZ DE LA RICA, PABLO VIDAL
The incidence and prevalence of sepsis depend on the definitions and records that we use and we may be underestimating their impact. Up to 60% of the cases come from the community and in 30-60% we obtain microbiological information. Sometimes its presentation is ambiguous and there may be a delay in its detection, especially in the fragile population. Procalcitonin is the most validated biomarker for bacterial sepsis and the one that best discriminates the non-infectious cause. Presepsin and pro-adrenomedullin are useful for early diagnosis, risk stratification and prognosis in septic patients. The combination of biomarkers is even more useful to clarify an infectious cause than any isolated biomarker. Resuscitation with artificial colloids has worse results than crystalloids, especially in patients with renal insufficiency. The combination of saline solution and balanced crystalloids is associated with a better prognosis. Albumin is only recommended in patients who require a large volume of fluids. The modern molecular methods on the direct sample or the identification by MALDI-TOF on positive blood culture have helped to shorten the response times in diagnosis, to optimize the antibiotic treatment and to facilitate stewardship programs. The hemodynamic response in neonates and children is different from that in adults. In neonatal sepsis, persistent pulmonary hypertension leads to an increase in right ventricular afterload and heart failure with hepatomegaly. Hypotension, poor cardiac output with elevated systemic vascular resistance (cold shock) is often a terminal sign in septic shock. Developing ultra-fast Point-of-Care tests (less than 30 minutes), implementing technologies based on omics, big data or massive sequencing or restoring “healthy” microbiomes in critical patients after treatment are the main focuses of research in sepsis. The main benefits of establishing a sepsis code are to decrease the time to achieve diagnosis and treatment, improve organization, unify criteria, promote teamwork to achieve common goals, increase participation, motivation and satisfaction among team members, and reduce costs.
Rev Esp Quimioter 2018; 31(4): 298-315 [Full-text PDF]