Sepsis: source control
https://doi.org/10.21292/2078-5658-2021-18-5-89-96
Abstract
Sepsis is a life-threatening condition, which is manifested by the development of organ dysfunction due to generalized inflammation caused by the infection of various nature. Timely lesion debridement combined with adequate antibiotic therapy are important components of the successful treatment of sepsis. At the moment, there is no consensus about the volume and time of intervention in the development of surgical sepsis. The article discusses modern approaches to solving the problem of adequate sanitation of the source of infection. The results of few randomized trials in this area are presented.
Source control is absolutely essential for the successful treatment of sepsis. However, it is difcult to create a unifed algorithm for surgical control for all cases due to different approaches depending on the infection location. Properly designed clinical trials are necessary to determine the optimal timing of surgery for sepsis and septic shock as least.
About the Authors
V. V. Kulabukhov
N. V. Sklifosovsky Research Institute of Emergency Medicine
Russian Federation
Russian Federation
Vladimir V. Kulabukhov Candidate of Medical Sciences, Associate Professor, Leading Researcher
3, Bolshaya Sukharevskaya Sq., Moscow, 107045
N. A. Zubareva
E. A. Vagner Perm State Medical University
Russian Federation
Russian Federation
Nadezhda A. Zubareva Doctor of Medical Sciences, Professor,
General Surgery Department no. 1
26, Petropavlovskaya St., Perm, 614015
P. A. Yartsev
N. V. Sklifosovsky Research Institute of Emergency Medicine
Russian Federation
Russian Federation
Petr A. Yartsev Doctor of Medical Sciences, Professor, Head of Department of Emergency Surgery, Endoscopy and Intensive Care
3, Bolshaya Sukharevskaya Sq., Moscow, 107045
References
1. Аbdominalnaya khirurgicheskaya infektsiya. Rossiyskie natsionalnye rekomendatsii. [Abdominal surgical infection, Russian national guidelines]. 2nd ed., reviewed and supplemented. B.R. Gelfand, А.I. Kirienko, N.N. Khachatryan, eds., Moscow, Meditsinskoye Informatsionnoye Agentstvo Publ., 2018, 168 p.
2. Sepsis: klassifikatsiya, kliniko-diagnosticheskaya kontseptsiya i lecheniye. [Sepsis: classification, clinical and diagnostic concept and treatment]. 4th ed., reviewed and supplemented. B.R. Gelfand, eds., Moscow, OOO MIA-MED Publ., 2017, 408 p.
3. Khirurgicheskiye infektsii kozhi i myagkikh tkaney. Rossiyskiye natsionalnye rekomendatsii. [Surgical skin and soft tissue infections. Russian national guidelines]. B.R. Gelfand, eds., Moscow, OOO Kompaniya Borges Publ., 2015, 115 p.
4. Agor J. K., Paramita N. L. P., Ozaltin O. Y. Prediction of sepsis related mortality: an optimization approac // IEEE J. Biomed. Health Inform. ‒ 2021. ‒ doi: 10.1109/JBHI.2021.3096470.
5. Armstrong B. A., Betzold R. D., May A. K. Sepsis and septic shock strategies // Surg. Clin. North. Am. ‒ 2017. ‒ Vol. 97, № 6. ‒ P. 1339‒1379. doi:10.1016/j.suc.2017.07.003.
6. Azuhata T., Kinoshita K., Kawano D. et al. Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock // Crit. Care. ‒ 2014. ‒ Vol. 18. ‒ R87. doi:10.1186/cc13854.
7. Bassetti M., Montero J. G., Paiva J. A. When antibiotic treatment fails // Intens. Care Med. ‒ 2018. ‒ Vol. 44. ‒ P. 73–75. doi:10.1007/s00134-017-4962-2.
8. Becher R. D., Pietzman A. B., Sperry J. L. et al. Damage control operations in non-trauma patients: Defining criteria for the staged rapid source control laparotomy in emergency general surgery // World J. Emerg. Surg. ‒ 2016. ‒ Vol. 11. ‒ P. 10. doi:10.1186/s13017-016-0067-4.
9. Bloos F., Rüddel H., Thomas-Rüddel D. et al. Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial // Intens. Care Med. ‒ 2017. ‒ Vol. 43. ‒ P. 1602–1612. https://doi:10.1007/s00134-017-4782-4.
10. Cecconi M., Evans L., Levy M. et al. Sepsis and septic shock // Lancet. ‒ 2018. ‒ Vol. 392. ‒ P. 75‒87. doi: 10.1016/S0140-6736(18)30696-2.
11. Ceresoli M., Lo Bianco G., Gianotti L. et al. Inflammation management in acute diverticulitis: current perspectives // J. Inflamm Res. ‒ 2018. ‒ Vol. 11. ‒ P. 239‒246. doi: 10.2147/JIR.S142990.
12. Dellinger R. P., Levy M. M., Rhodes A. et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012 // Crit. Care Med. ‒ 2013. ‒ Vol. 41, № 2. ‒ P. 580‒637. doi:10.1097/CCM.0b013e31827e83af.
13. De Waele J., De Bus L. How to treat infections in a surgical intensive care unit // BMC. Infect. Dis. ‒ 2014. ‒ Vol. 14. ‒ P. 193. doi: 10.1186/1471-2334-14-193.
14. De Waele J. J., Abdominal sepsis // Curr. Infect. Dis. Rep. ‒ 2016. ‒ Vol. 18. ‒ P. 23. doi:10.1007/s11908-016-0531-z.
15. Eckmann C. The importance of source control in the management of severe skin and soft tissue infections // Curr. Opin. Infect. Dis. ‒ 2016. ‒ Vol. 29. ‒ P. 139–144. doi:10.1097/QCO.0000000000000240.
16. Hecker A., Reichert M., Reub C. J. et al. Intra-abdominal sepsis: new definitions and current clinical standards // Langenbecks Arch. Surg. ‒ 2019. ‒ Vol. 404, № 3. ‒ P. 257‒271. doi: 10.1007/s00423-019-01752-7.
17. Heming N., Azabou E., Cazaumayou X. et al. Sepsis in the critically ill patient: current and emerging management strategies // Exp. Rev. Anti-infect. Ther. ‒ 2021. ‒ Vol. 19, № 5. ‒ Р. 635‒647. doi: 10.1080/14787210.2021.1846522.
18. Kim H., Chung S. P., Choi S. H. et al. Impact of timing to source control in patients with septic shock: A prospective multi-center observational study // J. Crit. Care. ‒ 2019. ‒ Vol. 53. ‒ P. 176‒182. doi:10.1016/ j. jcrc.2019.06.012.
19. Kumar A. An alternate pathophysiologic paradigm of sepsis and septic shock: implications for optimizing antimicrobial therapy // Virulence. ‒ 2014. ‒ Vol. 5. ‒ P. 80–97. doi: 10.4161/viru.26913.
20. Lagunes L., Encina B., Ramirez-Estrada S. Current understanding in source control management in septic shock patients: a review // Ann. Transl. Med. ‒ 2016. ‒ Vol. 4, № 17. ‒ P. 330. doi:10.21037/atm.2016.09.02.
21. Leppäniemi A., Tolonen M., Tarasconi A. et al. 2019 WSES guidelines for the management of severe acute pancreatitis // World J. Emerg. Surgery. ‒ 2019. ‒ Vol. 14. ‒ P. 14‒27. doi.org/10.1186/s13017-019-0247-0.
22. Marshall J. C. Principles of source control in the early management of sepsis // Curr. Infect. Dis. Rep. ‒ 2010. ‒ Vol. 12. ‒ P. 345–353. doi:10.1007/s11908-010-0126-z.
23. Marshall J. C., Maier R. V., Jimenez M. et al. Source control in the management of severe sepsis and septic shock: an evidence-based review // Crit. Care Med. ‒ 2004. ‒ Vol. 32 (11 Suppl.). ‒ S. 513–526. doi:10.1097/01.ccm.0000143119.41916.5d.
24. Marshall J. C., Naqbiё A. Principles of source control in the management of sepsis // Crit. Care Nurs. Clin. N. Am. ‒ 2013. ‒ Vol. 23. ‒ P. 99–114. doi:10.1016/j.ccell.2010.12.006.
25. Martinez M. L., Ferrer R., Torrents E. et al. Impact of source control in patients with severe sepsis and septic shock // Crit. Care Med. ‒ 2017. ‒ Vol. 45, № 1. ‒ P. 11–19. doi.: 10.1097/CCM.0000000000002011.
26. Martin-Loeches J. F., Timsit J. F., Leone M. et al. Clinical сontroversies in abdominal sepsis. Insights for critical care settings // J. Crit. Care. ‒ 2019. ‒ Vol. 53. ‒ P. 53‒58. doi.org/10.1016/j.jcrc.2019.05.023.
27. Mazuski J. E., Tessier J. M., May A. K. et al. The surgical infection society revised guidelines on the management of intra-abdominal infection // Surg. Infect. (Larchmt). ‒ 2017. ‒ Vol. 18, № 1. ‒ P. 1‒76. doi: 10.1089/sur.2016.261.
28. Montravers P., Blot S., Dimopoulos G. et al. Therapeutic management of peritonitis: a comprehensive guide for intensivists // Intens. Care Med. ‒ 2016. ‒ Vol. 42. ‒ P. 1234‒1247. doi: 10.1007/s00134-016-4307-6.
29. Montravers P., Dupont H., Leone M. et al. Management of intra-abdominal infections. Guidelines for management of intraabdominal infections // Anaesth. Crit. Care Pain Med. ‒ 2015. ‒ Vol. 34, № 2. ‒ P. 117‒130. doi: 10.1016/j.accpm.2015.03.005.
30. Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery UK National Surgical Research Collaborative // Brit. J. Surg. ‒ 2017. ‒ 104. ‒ Р. e165–e171. doi: 10.1002/bjs.10825.
31. Oliver Z. P., Perkins J. Source Identification and Source Control // Emerg. Med. Clin. N Am. ‒ 2017. ‒ Vol. 35, № 1. ‒ P. 43–58. doi: 10.1016/j.emc.2016.08.005.
32. Opal S. M. Source control in sepsis urgent or not so fast? // Crit. Care Med. ‒ 2017. ‒ Vol. 45, № 1. ‒ P. 130‒132. doi:10.1097/CCM.0000000000002123.
33. Patel A., Nunnally M. E. The Septic patient // Anesth. Clin. ‒ 2020. ‒ Vol. 38, № 4. ‒ P. 889‒899. doi: 10.1016/j.anclin.2020.08.004.
34. Peetermans M., de Prost N., Eckmann C. et al. Necrotizing skin and soft tissue infections in the intensive care unit // Clin. Microbiol. Infect. ‒ 2019. ‒ Vol. 5. ‒ Р. S1198‒S1743. doi: 10.1016/j.cmi.2019.06.031.
35. Person B., Dorfman T., Bahuth H. et al. Abbreviated emergency laparotomy in the non-trauma setting // World J. Emerg. Surg. ‒ 2009. ‒ Vol. 4. ‒ P. 41. doi:10.1186/1749-7922-4-41.
36. Rhodes A., Evans L. E., Alhazzani W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016 // Intens. Care Med. ‒ 2017. ‒ Vol. 43. ‒ P. 304–377. doi:10.1007/s00134-017-4683-6.
37. Rudd K. E., Johnson S., Agesa K. M. et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study // Lancet. ‒ 2020. ‒ Vol. 395. ‒ P. 200‒211. doi: 10.1016/S0140-6736(19)32989-7.
38. Sartelli M., Chichom-Mefire A., Labricciosa F. M. et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intraabdominal infections // World J. Emerg. Surg. ‒ 2017. ‒ Vol. 12. ‒ P. 29. doi. 10.1186/s13017-017-0141-6.
39. Sartelli M., Guirao X., Hardcastle T. C. et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections // World J. Emerg. Surg. ‒ 2018. ‒ Vol. 13. ‒ P. 58. doi. org/10.1186/s13017-018-0219-9.
40. Scriba M. F., Laing G. L., Bruce J. L. et al. The role of planned and on-demand relaparotomy in the developing world // World J. Surg. ‒ 2016. ‒ Vol. 40, № 7. ‒ P. 1558‒1564. doi: 10.1007/s00268-015-3379-8.
41. Solomkin J. S., Ristagno R. L., Das A. F. et al. Source control review in clinical trials of anti-infective agents in complicated intra-abdominal infections // Clin. Infect. Dis. ‒ 2013. ‒ Vol. 56. ‒ P. 1765–1773. doi:10.1093/cid/cit128.
42. Stevens D. L., Bryant A. E. Necrotizing soft-tissue infections // New Engl. J. Med. ‒ 2017. ‒ Vol. 377. ‒ P. 2253‒2265. doi: 10.1056/NEJMra1600673.
43. Stigliano S., Sternby H. de Madaria E. et al. Early management of acute pancreatitis: A review of the best evidence // Dig. Liver Dis. ‒ 2017. ‒ Vol. 49, № 6. ‒ P. 585‒594. doi: 10.1016/j.dld.2017.01.168.
44. Tolonen M., Coccolini F., Ansaloni L. et al. Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria // World J. Emerg. Surg. ‒ 2018. ‒ Vol. 13. ‒ P. 17. doi:10.1186/s13017-018-0177-2.
45. Van de Groep K., Verhoeff T. L., Verboom D. M. et al. MARS consortium Epidemiology and outcomes of source control procedures in critically ill patients with intra-abdominal infection // J. Crit. Care. ‒ 2019. ‒ Vol. 52. ‒ P. 258‒264. doi: 10.1016/j.jcrc.2019.02.029.
46. Vincent J. L. Update on surgical sepsis syndrome // Br. J. Surg. ‒ 2017. ‒ Vol. 104, № 2. ‒ Р. e34‒e40. doi: 10.1002/bjs.10451.
47. Vogler J., Hart L., Holmes Sh. et al. Rapid source-control laparotomy: is there a mortality benefit in septic shock? // Surg. Infect. (Larchmt). ‒ 2018. ‒ Vol. 19, № 2. ‒ P. 225‒229. doi: 10.1089/sur.2017.191.
48. Willms A. G., Fortelny R. H., Berrevoet F. et al. editorial: open abdominal treatment: how much evidence do we have? // Front Surg. ‒ 2021. ‒ Vol. 8. doi: 10.3389/fsurg.2021.696296.
49. Zhou X., Su L. X., Zhang J. H. et al. Rules of anti-infection therapy for sepsis and septic shock // Chin. Med. J. (Engl.). ‒ 2019. ‒ Vol. 132, № 5. ‒ P. 589‒596. doi: 10.1097/CM9.0000000000000101.
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For citations:
Kulabukhov V.V., Zubareva N.A., Yartsev P.A. Sepsis: source control. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2021;18(5):89-96. (In Russ.) https://doi.org/10.21292/2078-5658-2021-18-5-89-96
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