Endotoxin Induced-Shock: a Multidisciplinary Approach in Critical Care

Description

This book provides easy consultation and guidance for an appropriate understanding and management of endotoxic shock. Endotoxic shock results from a severe, generalized inflammatory response induced by bloodstream infection with gram-negative bacteria. However, endotoxin-induced inflammatory activation may be disconnected by Gram-Negative threats (e.g. Gram-Positive and yeast infections) as well as occur in multiple clinical scenarios like post-cardiac arrest syndrome and trauma, possibly due to gut barrier dysfunction and consequent endotoxin translocation. The clinical management is structured focusing and dedicating a chapter for antibiotics, corticosteroids, volume support, vasoactive and cardiostimulating drug, coagulopathy and nutritional support. In addition, this book is remarkable because describing polymixin b hemoperfusion points out molecular interactions, and hydrodynamics of Sorption. Each section includes •) brief pathophysiology; •) principles of management; •) key messages. Readers can find updated tips related to the diagnosis and management of endotoxic shock with a multidisciplinary approach drawing a pathway from endotoxin structure and source and the related pathophysiology of endotoxic shock underling the specific clinical aspect and focusing on medical clinical management of endotoxemia and extracorporeal removal. The book – written by international opinion leaders of this field – is addressed to healthcare providers working in intensive care and represents a point of reference for intensivists, infectious disease physicians, nephrologists and critical care nurses involved in the management of endotoxic shock and enriched with useful downloadable material. Contents List of Downloadable PPTs 1: Endotoxin: Structure Source and Effects 1.1 Endotoxin 1.2 Pathway of LPS 1.2.1 Toll-Like Receptor 4-Myeloid Differentiation Protein 2 (TLR4-MD-2) Pathway 1.2.2 Transient Receptor Potential (TRP) Ion Channels 1.2.3 Intracellular LPS Pathways 1.2.4 Endotoxic Shock and Organ Damage Caused by LPS 1.2.5 The Kidney 1.2.6 The Lung 1.2.7 The Heart 1.2.8 The Liver 1.2.9 The Vascular Endothelium 1.3 Evaluation of Endotoxin-Induced Shock References 2: Pathophysiology of Endotoxic Shock 2.1 Introduction 2.2 Endotoxin Effects and Interaction with Immune System 2.3 Pathophysiology of Endotoxin Organ Dysfunction and Shock 2.4 Conclusions References 3: Host Resistance to Endotoxic Shock 3.1 Introduction 3.2 The Concept of Endotoxin Tolerance 3.3 Molecular Pathways of Endotoxin Tolerance 3.4 Immune Cell Phenotype Modifications Associated with Endotoxin Tolerance 3.5 Clinical Relevance of Endotoxin Tolerance in Sepsis and Non-infectious Diseases 3.6 Conclusions References 4: Endotoxin and Organ Cross-Talk 4.1 Introduction 4.2 Endotoxemia 4.3 Sepsis-Induced Cardiomyopathy 4.4 Sepsis and AKI 4.5 Acute Respiratory Distress Syndrome (ARDS) 4.6 Sepsis-Associated Encephalopathy (SAE) 4.7 Immunosuppression 4.8 Conclusions References 5: Endotoxin Measurement in Septic Shock 5.1 Introduction 5.2 Endotoxin Detection References 6: Clinical Management of Endotoxemia: Antibiotics 6.1 Introduction 6.2 Timing and Adequacy of Antibiotic Therapy in Septic Shock 6.3 PK-PD Principles to Optimize Antimicrobic Treatment 6.4 The Placement of New Molecules Against Gram-Negative Bacteria 6.5 Polymyxins in the Clinical Practice 6.6 Conclusions References 7: Clinical Management of Endotoxemia: Volume Support 7.1 Introduction 7.2 Vasoplegia and Endotoxemia 7.3 Fluid Therapy: Rationale and Modalities 7.3.1 Passive Leg Raising 7.3.2 Central Venous Pressure 7.3.3 Pulse Pressure Variations (PPV) 7.3.4 Inferior Vena Cava (IVC) Collapsibility Index 7.3.5 End-Expiratory Occlusion Test (EEOT) 7.3.6 Velocity Time Integral (VTI) 7.3.7 Hemodynamic Monitoring Devices 7.4 Conclusions References 8: Clinical Management of Endotoxemia: Corticosteroids 8.1 Introduction 8.2 Corticosteroids and Immunomodulation in Sepsis 8.3 Hypothalamic–Pituitary–Adrenal Axis in Sepsis 8.4 Desirable and Undesirable Effects 8.5 Corticosteroids Dose in Sepsis 8.6 Conclusions References 9: Clinical Management of Endotoxemia: Vasoactive and Cardiostimulant Drugs 9.1 Introduction 9.2 Vasoactive Agents 9.3 Use in Clinical Practice References 10: Clinical Management of Endotoxemia: Source Control 10.1 Introduction 10.2 Timing 10.3 Intra-abdominal Infections 10.3.1 Appendicitis 10.3.2 Cholecystitis 10.3.3 Perforation 10.3.4 Soft Tissues and Skin Infection 10.4 Non-pneumonic Thoracic Infections 10.5 Conclusion References 11: Clinical Management of Endotoxemia: Treatment of DIC 11.1 Introduction 11.2 Pathophysiology 11.2.1 The Coagulation Cascade 11.2.2 Cytokines Endotoxin and Coagulopathy 11.3 Clinical Features of DIC 11.3.1 Differential Diagnosis in ICU 11.3.2 Diagnosis 11.3.2.1 Laboratory Findings 11.3.2.2 Thromboelastography 11.4 Extracorporeal Support During Septic DIC and the Coagulation Response 11.4.1 Blood Purification with oXiris Filter: Effect on Endotoxemia and Coagulation 11.4.1.1 Clinical Experience References 12: Clinical Management of Endotoxemia: Metabolic and Nutritional Support 12.1 Introduction 12.2 Gut Microbiota and Metabolic Endotoxemia 12.3 The Timing, Dose, and Titration of Enteral Nutrition in Septic/Endotoxic Shock 12.4 Controversies of Parenteral Nutrition 12.5 The Influence of Probiotics, Symbiotics, and Prebiotics on Endotoxemia 12.6 Fecal Microbial Transplantation to Mitigate Multiple Organ Dysfunction in the ICU References 13: Strategies to Reduce Endotoxin Activity 13.1 Endotoxin as a Therapeutic Target 13.2 Extracorporeal Endotoxin Removal Strategies 13.2.1 Polymyxin B Hemoperfusion Therapy 13.2.2 Other Blood Purification Techniques 13.3 Immune-Modulating Strategies 13.3.1 Recombination Cytokines 13.3.2 Therapies Targeting Specific Pro-inflammatory Mediators 13.3.3 Immune Checkpoint Inhibitors 13.3.4 Therapies Targeting Epigenetic Modifications 13.3.5 Corticosteroids 13.3.6 Intravenous Immunoglobulins (IVIG) 13.3.7 Stem Cells 13.3.8 Vitamin C 13.4 Conclusions References 14: Extracorporeal Removal of Endotoxin 14.1 Adsorption Mechanism and Hemoperfusion for Endotoxin Removal 14.2 Clinical Use of PMX-HP Therapy 14.3 Other Blood Purification Technique: The oXiris 14.4 The Golden Hour for Extracorporeal Removal of Endotoxin in Endotoxic Shock 14.5 Case Vignette: Endotoxic Shock 14.6 Conclusions References