Sepsis Research Paper
Maternal mortality due to sepsis is worryingly increasing through developed and developing countries. This is despite a worldwide effort towards reducing maternal death, maternal sepsis during pregnancy remains one of the worlds leading causes of preventable maternal death. In developed countries 3% of all maternal mortality is due to sepsis, whilst that figure jumps to 12% in developing countries. Pregnancy affected by severe sepsis or septci shock, run the risk of pre-term labour, fetal infect and pre-term delivery https://www.ncbi.nlm.nih.gov/pubmed/22914482 , all which run several risk in themselves.
What is the meaning of; Sepsis: Sepsis is a medical condition which happens in response to an infection. The immune system is forced into over drive which causes a release of chemicals into the blood in order to combat the infection. Microbes are released into the blood, urine, lungs, skin and other tissues throughout the body. This triggers cellular injury to the body tissues (inflammation), I the body can not regulate the immune response, it will then overwhelm the normal blood processes of the body. Sepsis can be described as an acute inflammatory response syndrome (SIRS).
Severe Sepsis: Severe Sepsis is essentially sepsis except the severe sepsis can lead to inadequate blood flow to certain parts of the body …show more content…
(hypoperfusion), hypotension and usually organ dysfunction. Severe sepsis usually affects the following systems; cardiovascular, respiratory, renal, hepatic, central nervous system, or it can be hematological. (http://www.msdmanuals.com/en-au/home/infections/bacteremia,-sepsis,-and-septic-shock/sepsis,-severe-sepsis,-and-septic-shock)
Septic shock: Septic shock is another subset of Sepsis, resulting in severe abnormalities of cellular metabolism and circulation. Septic shock can be differentiated from severe sepsis from the persistent hypotension which needs vasopressors to maintain the arterial pressure at > 65 mm Hg, and the elevated serum lactate despite adequate volume resuscitation.
Singer M, Deutschman CS, Seymour CW, et al: The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801-810, 2016.
What are the early warning signs of sepsis?
Sepsis can be suspected when a patient has two or more of the follow symptoms;
• Body temperature of >38°C or < 36°C
• Heart rate >90 beats/min
• Respiratory rate >20
• White blood cell count >12,000 cells/mm3 or <4,000 cells/mm3
What are the common sources of sepsis during pregnancy?
The common sources of maternal sepsis include, urinary tract infections (pyelonephritis), pelvic structures (chorioamnionitis and endometritis), infections including pneumonia, acute appendicitis and intrauterine death just too name a few. Sepsis is generally uncommon in pregnancy, the increasing obesity rates and other pre-existing morbidities including anemia and diabetes in pregnancy are expected to add to the already increase in sepsis rates. (PPG’s) What is the pathophysiology of
sepsis?
The pathophysiology of sepsis involves a complicated systematic inflammatory response to an infection, which involves the activation of immune cells which release large quantities of pro-inflammatory cytokines and the coagulation cascade is activated also. These cytokines activate the endothelial issue which result in the production of various SIRS effectors and an extensive range of systemic changes (slide). The first pro-inflammatory phase is activated by bacterial cell wall components, which can either be Gram-positive, or Gram-negative bacteria i.e. streptococci or lipoteichoic acid. https://www.fastbleep.com/medical-notes/other/15/197 Theses bacteria are responsible for activating recognition receptors on the surface of macrophages and monocytes, which in turn promotes the release of the pro-inflammatory suppress fibrinolysis, which in turn promotes universal thrombosis. Disseminated intravascular coagulation (DIC) can arise from this if unregulated. The final result of sepsis is the unbalance between oxygen supply and consumption, this is caused by an increased systemic vascular permeability. This is followed by tissue hypoperfusion, cell hypoxia, anaerobic metabolism and academia, all of which can cause multiple organ dysfunction (septic shock). http://www.scielo.br/scielo.php?pid=S0103-507X2013000400334&script=sci_arttext&tlng=en The basic pathophysiology of severe sepsis and septic shock includes: Vasodilation, third spacing (due to capillary leakage) and myocardial dysfunction, and is show in the concept map below.
The body is all ready undergoing immense physiological changes in pregnancy. For Fiona, the sepsis induced changes along with the normal changes in pregnancy can cause combined effects which can become fatal if adequate care is not received.
Pregnancy induced changes in the cardiovascular system include; a lower systemic vascular resistance with vasodilation, up to a 40% increase in blood volume, increased heart rate and cardiac output, decreased blood pressure and aorta-caval compression. Similarly, sepsis induced changes include; vasodilation and a reduced systemic vascular resistance, tachycardia, myocardial depression and hypotension. The combined affect of these changes can lead to inadequate arterial blood flow to organs, which is basically a hemodynamic collapse.
Pregnancy induced changes in the respiratory system include; low pulmonary vascular resistance and plasma colloid osmotic pressure, increased tidal volume, decreased residual volume and capacity and increased minute ventilation with compensated respiratory alkalosis. Sepsis induced changes include, pulmonary microvascular pressure and permeability and sepsis induced acute lung injuries. Together, these changes can cause increase susceptibility to pulmonary oedema, a rapid decline in oxygenation, respiratory distress syndrome and decreased ability to compensate for metabolic acidosis. The coagulation system is also undergoing major changes thanks to pregnancy, these changes include, elevated factors of VII, VIII, IX, X, XII, reduced protein S, and decreased firbrinolytic activity. Sepsis induced changes include; an increase in thrombin production and a reduction In the activated protein C which is associated with platelet aggregation. Together this changes can result in an increase risk of DIC, tissue hypoperfusion, an increase in microvascular fibrin thrombi and can also lead to organ dysfunction.
Lastly, the pregnancy induced changes in the renal system include; increased glomerular filtration rate, increase renal plasma flow, the renal collecting system dilates and there’s a tendency to contracting a urinary tract infection. The sepsis induced changes include, ischemia, vasoconstriction, cytokine mediated renal cell injury and angiotensin activity, the combined affect of these changes can be renal failure and acute tubular necrosis.
What is the meaning of; Sepsis: Sepsis is a medical condition which happens in response to an infection. The immune system is forced into over drive which causes a release of chemicals into the blood in order to combat the infection. Microbes are released into the blood, urine, lungs, skin and other tissues throughout the body. This triggers cellular injury to the body tissues (inflammation), I the body can not regulate the immune response, it will then overwhelm the normal blood processes of the body. Sepsis can be described as an acute inflammatory response syndrome (SIRS).
Severe Sepsis: Severe Sepsis is essentially sepsis except the severe sepsis can lead to inadequate blood flow to certain parts of the body …show more content…
(hypoperfusion), hypotension and usually organ dysfunction. Severe sepsis usually affects the following systems; cardiovascular, respiratory, renal, hepatic, central nervous system, or it can be hematological. (http://www.msdmanuals.com/en-au/home/infections/bacteremia,-sepsis,-and-septic-shock/sepsis,-severe-sepsis,-and-septic-shock)
Septic shock: Septic shock is another subset of Sepsis, resulting in severe abnormalities of cellular metabolism and circulation. Septic shock can be differentiated from severe sepsis from the persistent hypotension which needs vasopressors to maintain the arterial pressure at > 65 mm Hg, and the elevated serum lactate despite adequate volume resuscitation.
Singer M, Deutschman CS, Seymour CW, et al: The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801-810, 2016.
What are the early warning signs of sepsis?
Sepsis can be suspected when a patient has two or more of the follow symptoms;
• Body temperature of >38°C or < 36°C
• Heart rate >90 beats/min
• Respiratory rate >20
• White blood cell count >12,000 cells/mm3 or <4,000 cells/mm3
What are the common sources of sepsis during pregnancy?
The common sources of maternal sepsis include, urinary tract infections (pyelonephritis), pelvic structures (chorioamnionitis and endometritis), infections including pneumonia, acute appendicitis and intrauterine death just too name a few. Sepsis is generally uncommon in pregnancy, the increasing obesity rates and other pre-existing morbidities including anemia and diabetes in pregnancy are expected to add to the already increase in sepsis rates. (PPG’s) What is the pathophysiology of
sepsis?
The pathophysiology of sepsis involves a complicated systematic inflammatory response to an infection, which involves the activation of immune cells which release large quantities of pro-inflammatory cytokines and the coagulation cascade is activated also. These cytokines activate the endothelial issue which result in the production of various SIRS effectors and an extensive range of systemic changes (slide). The first pro-inflammatory phase is activated by bacterial cell wall components, which can either be Gram-positive, or Gram-negative bacteria i.e. streptococci or lipoteichoic acid. https://www.fastbleep.com/medical-notes/other/15/197 Theses bacteria are responsible for activating recognition receptors on the surface of macrophages and monocytes, which in turn promotes the release of the pro-inflammatory suppress fibrinolysis, which in turn promotes universal thrombosis. Disseminated intravascular coagulation (DIC) can arise from this if unregulated. The final result of sepsis is the unbalance between oxygen supply and consumption, this is caused by an increased systemic vascular permeability. This is followed by tissue hypoperfusion, cell hypoxia, anaerobic metabolism and academia, all of which can cause multiple organ dysfunction (septic shock). http://www.scielo.br/scielo.php?pid=S0103-507X2013000400334&script=sci_arttext&tlng=en The basic pathophysiology of severe sepsis and septic shock includes: Vasodilation, third spacing (due to capillary leakage) and myocardial dysfunction, and is show in the concept map below.
The body is all ready undergoing immense physiological changes in pregnancy. For Fiona, the sepsis induced changes along with the normal changes in pregnancy can cause combined effects which can become fatal if adequate care is not received.
Pregnancy induced changes in the cardiovascular system include; a lower systemic vascular resistance with vasodilation, up to a 40% increase in blood volume, increased heart rate and cardiac output, decreased blood pressure and aorta-caval compression. Similarly, sepsis induced changes include; vasodilation and a reduced systemic vascular resistance, tachycardia, myocardial depression and hypotension. The combined affect of these changes can lead to inadequate arterial blood flow to organs, which is basically a hemodynamic collapse.
Pregnancy induced changes in the respiratory system include; low pulmonary vascular resistance and plasma colloid osmotic pressure, increased tidal volume, decreased residual volume and capacity and increased minute ventilation with compensated respiratory alkalosis. Sepsis induced changes include, pulmonary microvascular pressure and permeability and sepsis induced acute lung injuries. Together, these changes can cause increase susceptibility to pulmonary oedema, a rapid decline in oxygenation, respiratory distress syndrome and decreased ability to compensate for metabolic acidosis. The coagulation system is also undergoing major changes thanks to pregnancy, these changes include, elevated factors of VII, VIII, IX, X, XII, reduced protein S, and decreased firbrinolytic activity. Sepsis induced changes include; an increase in thrombin production and a reduction In the activated protein C which is associated with platelet aggregation. Together this changes can result in an increase risk of DIC, tissue hypoperfusion, an increase in microvascular fibrin thrombi and can also lead to organ dysfunction.
Lastly, the pregnancy induced changes in the renal system include; increased glomerular filtration rate, increase renal plasma flow, the renal collecting system dilates and there’s a tendency to contracting a urinary tract infection. The sepsis induced changes include, ischemia, vasoconstriction, cytokine mediated renal cell injury and angiotensin activity, the combined affect of these changes can be renal failure and acute tubular necrosis.