Sepsis
Guillermo Ortiz-Ruiz Carmelo Dueñas-Castell Editors Sepsis Third Edition
Editors Guillermo Ortiz-Ruiz Department of Internal Medicine Pulmonary Medicine and Critical Care Hospital Santa Clara Universidad del Bosque Bogotá Colombia Carmelo Dueñas-Castell Department of Critical Care Clínica Gestión Salud Universidad de Cartagena Cartagena Colombia ISBN 978-1-4939-7332-3 ISBN 978-1-4939-7334-7 (ebook) https://doi.org/10.1007/978-1-4939-7334-7 Library of Congress Control Number: 2017954326 Springer Science+Business Media LLC 2004, 2006, 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Science+Business Media LLC The registered company address is: 233 Spring Street, New York, NY 10013, USA
To my parents to whom I owe everything; to my family for their self-denial, support, and sacrifice; and to my patients for their teachings. (Carmelo Dueñas) To my patients, my students, and my family. (Guillermo Ortiz)
Preface Sepsis is a global public health problem; it generates more than 3,000,000 hospitalizations per year. Despite the advances in modern medicine, more than 5.3 million people die from sepsis annually. It remains the leading cause of death in critically ill patients in noncoronary intensive care units, with an estimated overall mortality of about 30%. In order to face a problem of such magnitude, it is essential to have an objective, a clear and universal definition. Although the first description dates back to more than 3,500 years, it was only in 1992 that an effort was made to reach a consensus on a definition. From a definition by a consensus of experts in 1992, a switch was made to another one based on a compilation of clinical studies that included a large number of patients. We present a historical summary of the changes that the definition of sepsis and septic shock has undergone and the fundamentals of these changes. The latest publication in 2016, despite being a gigantic achievement, has been the subject of ample questions that show that the definition of sepsis is still under construction. The present text aims to review the basic aspects of sepsis from its definition, the immunity in sepsis, and the implementation of biomarkers and their actual usefulness. We also reviewed the cost and overall impact of sepsis as well as the total economic cost of antibiotic resistance. Estimates vary but have ranged as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars). We present the extent of diagnostic imaging in the workup of sepsis, organ dysfunction, and mechanisms of resistance. The information we obtain and extract from the antibiogram has a great clinical and epidemiological impact, because, on one hand, it serves as a guide to choose the antimicrobial treatment in an infectious process and, on the other hand, it avoids the use of other antibiotics in an unnecessary way, thus leading to a reduction in the ecological impact. vii
viii Preface In one chapter, we develop the antibiogram and its objective, importance, and interpretation in the health environment. Finally we review the non- antibiotic management of sepsis and septic shock, the new strategies for training high- performance teams, and the role of simulation in sepsis. We hope that this text will be useful to the kind readers and generates such a concern that will allow us all to diminish the great uncertainty existing about a pathology as old as not yet known. Bogotá, Colombia Cartagena, Colombia Guillermo Ortiz-Ruiz Carmelo Dueñas-Castell
Contents 1 Sepsis: A Definition Under Construction... 1 Carmelo Dueñas-Castell, Guillermo Ortiz-Ruiz, and Diana Borré-Naranjo 2 Economic Impact of Infections and Antibiotics... 11 Nelson Alvis-Guzman, Fernando De la Hoz-Restrepo, and Hernando Pinzon-Redondo 3 Immunity in Sepsis... 25 Nelson Javier Fonseca-Ruiz 4 Biomarkers in Sepsis... 39 Mario Lora-Andosilla, Kevin Cantillo-García, Diana Borré-Naranjo, Melkis Buelvas-Villalba, Guillermo Ortiz-Ruiz, and Carmelo Dueñas-Castell 5 Diagnostic Imaging in Sepsis of Pulmonary Origin... 51 Jorge Alberto Carrillo-Bayona and Liliana Arias-Alvarez 6 Multiorgan System Failure in Sepsis... 67 Marco A. Gonzalez and Cristhiaan D. Ochoa 7 Resistance Mechanisms: A Problem and an Approach to the Solution... 73 Gerson Arias-León 8 Interpretive Reading of the Antibiogram: A Tool for Clinical Practice... 95 Wilfrido Coronell-Rodríguez, Cindy Arteta-Acosta, and Carmelo Dueñas-Castell 9 Sepsis Management: Non-antibiotic Treatment of Sepsis and Septic Shock... 117 Manuel Garay-Fernández ix
x Contents 10 New Strategies for Training High-Performance Teams... 135 Carolina Martínez-Esparza, Andrea Martínez de la Vega Celorio, and Rodrigo Rubio-Martínez 11 Simulation and Sepsis: What Is the Best Evidence?... 151 Guillermo Ortiz-Ruiz, José M. Maestre, Demian Szyld, Ignacio Del Moral, Jenny W. Rudolph, and Germán Díaz Index... 167
Contributors Liliana Arias-Alvarez Hospital Universitario San Ignacio, Bogotá, Colombia Nelson Alvis-Guzman, MD, MPH, PhD Health Economics Research Group, Universidad de Cartagena, Avenida del consulado Campus Piedra de Bolivar, Cartagena, Bolivar, Colombia Universidad de la Costa, Barranquilla, Colombia Mario Lora-Andosilla Internal Medicine, Critical Medicine and Intensive Care, Universidad de Cartagena, Cartagena, Colombia Cindy Arteta-Acosta MPH Epidemiology, Universidad del Norte, Barranquilla, Colombia Medicine Universidad de Cartagena, Cartagena, Colombia Jorge Alberto Carrillo-Bayona Department of Diagnostic Imaging, Universidad Nacional de Colombia, Bogotá, Colombia Diana Borré-Naranjo Internal Medicine, Critical Medicine and Intensive Care, Universidad de Cartagena, Cartagena, Colombia Wilfrido Coronell-Rodríguez Pediatrician, Universidad del Valle, Cali, Colombia Infectious disease Universidad Autonoma de Mexico, Mexico City, Mexico Professor of Universidad de Cartagena, Tropical Medicine Universidad de Cartagena, Cartagena, Colombia Germán Díaz Hospital Santa Clara, Universidad el Bosque, Bogotá, Colombia Carmelo Dueñas-Castell Postgraduate Program in Critical Medicine and Intensive Care, Universidad de Cartagena, Intensive Care Unit, Gestion Salud, Cartagena, Bolivar, Colombia Universidad del Bosque, Bogotá, Colombia Critical Care Medicine, Universidad de la Sabana, Cundinamarca, Colombia Carolina Martínez-Esparza ABC Medical Center, Mexico City, Mexico xi
xii Contributors Manuel Garay-Fernández, MD Department of Critical Care, Hospital Santa Clara, Bogotá, Colombia Nelson Javier Fonseca-Ruiz Department of Critical Care, Clínica Medellín, Universidad CES, Medellín, Colombia Kevin Cantillo-García Internal Medicine, Critical Medicine and Intensive Care, Universidad de Cartagena, Cartagena, Colombia Marco A. Gonzalez, MD, MS, FCCM Division of Critical Care Medicine, Universidad Pontificia Bolivariana and Clinica Sagrado Corazon, Medellín, Antioquia, Colombia Torre Médica Ciudad del Río, Medellín, Antioquia, Colombia Fernando De la Hoz-Restrepo, MD, MPH, PhD Universidad Nacional de Colombia, Bogotá, Colombia Gerson Arias-León Clinica Shaio, Internal Medicine, Department of Infectious Diseases, National University, Bogotá, Colombia José M. Maestre Hospital Virtual Valdecilla, Santander, Spain Rodrigo Rubio-Martínez Anesthesia Department, ABC Medical Center, UNAM School of Medicine, Mexico City, Mexico Ignacio Del Moral Hospital Virtual Valdecilla, Santander, Spain Cristhiaan D. Ochoa, MD, PhD Physician-Scientist Training Program, Division of Pulmonary and Critical Care and Center for the Genetics of Host Defense, UT Southwestern Medical Center, Dallas, TX, USA Guillermo Ortiz-Ruiz, MD, PhD Department of Internal Medicine, Pulmonary Medicine and Critical Care Hospital Santa Clara, Universidad del Bosque, Bogotá, Colombia Hernando Pinzon-Redondo, MD Health Economics Research Group, Universidad de Cartagena, Avenida del consulado Campus Piedra de Bolivar, Cartagena, Bolivar, Colombia Jenny W. Rudolph Center for Medical Simulation, Boston, MA, USA Demian Szyld Center for Medical Simulation, Brigham and Women s Hospital, Boston, MA, USA Andrea Martínez de la Vega Celorio ABC Medical Center, Mexico City, Mexico Melkis Buelvas-Villalba Internal Medicine, Universidad Libre Barranquilla, Barranquilla, Colombia