SEVERE SEPSIS AND SEPTIC SHOCK – UNDERSTANDING A SERIOUS KILLER Edited by Ricardo Fernandez Severe Sepsis and Septic Shock – Understanding a Serious Killer Edited by Ricardo Fernandez Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Silvia Vlase Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Severe Sepsis and Septic Shock – Understanding a Serious Killer, Edited by Ricardo Fernandez p. cm. ISBN 978-953-307-950-9 Contents Preface IX Part 1 Definition and Epidemiology 1 Chapter 1 Epidemiology of Severe Sepsis and Septic Shock 3 Arturo Artero, Rafael Zaragoza and José Miguel Nogueira Part 2 Etiology 25 Chapter 2 Septic Shock by Gram-Negative Infections: Role of Outer Membrane Proteins 27 Marilena Galdiero, Marco Cantisani, Rossella Tarallo, Annarita Falanga and Stefania Galdiero Chapter 3 Transfusion-Associated Bacterial Sepsis 47 Jolanta Korsak Part 3 Pathological Findings 69 Chapter 4 The Autopsy Pathology of Sepsis-Related Death 71 Sebastian Lucas Part 4 Pathophysiology 101 Chapter 5 Biomarkers and Physiological Agents in Severe Sepsis and Septic Shock 103 D. Paramythiotis, E. Digkas and G. Dryllis Chapter 6 Immune Cell Dysfunction as a Consequence of Severe Sepsis 125 William F. Carson IV and Steven L. Kunkel Chapter 7 Microparticles and Exosomes: Are They Part of Important Pathways in Sepsis Pathophysiology? 155 Luciano C. P. Azevedo VI Contents Chapter 8 Cellular Mechanisms of MOF During Severe Sepsis and Septic Shock 167 Barbara Assenzio and Erica L. Martin-Conte Chapter 9 Impact of Severe Sepsis or Septic Shock on Drug Response 187 Marta Vázquez, Pietro Fagiolino, Cecilia Maldonado, Manuel Ibarra and Anna Boronat Part 5 Management 201 Chapter 10 Update in the Treatment of Severe Sepsis and Septic Shock 203 D. Boodoosingh, C. Cruz, M. Egozcue, R. Fernandez, V. Salinas and S. Valentin Chapter 11 Management of Severe Sepsis and Septic Shock 227 Georges Samaha, Brian Casserly and John-Michael Stevens Chapter 12 Applied Physiology and the Hemodynamic Management of Septic Shock Utilizing the Physiologic Optimization Program 255 William McGee and Patrick Mailloux Part 6 Pediatric Sepsis 273 Chapter 13 Management of Septic Shock in Children 275 Martin C. J. Kneyber Chapter 14 Septic Shock in Neonates 285 Lidia Decembrino ,Giulia Ruffinazzi, Armando D’Angelo, Nunzia Decembrino, Paolo Manzoni, Agata Boncimino and Mauro Stronati Part 7 Septic Shock in Obstetrics and Gynecology 309 Chapter 15 Septic Shock in Obstetrics and Gynecology 311 Apostolos Kaponis, Theodoros Filindris and George Decavalas Part 8 Novel and Alternative Therapies 335 Chapter 16 Alternative Therapies for Septic Shock: Beyond Early Goal-Directed Therapy 337 Megan Rech, Megan Prasse and Payal Gurnani Chapter 17 Hormonal Therapies in Severe Sepsis 359 Karen Choong Contents VII Chapter 18 Anti-Inflammatory Role of Natural Polyphenols and Their Degradation Products 379 Balázs Veres Part 9 Outcomes 411 Chapter 19 Cellular and Molecular Markers of Outcome in Septic Shock 413 Jorge Monserrat, Raúl de Pablo, David Díaz, Miguel-Angel Sánchez, Eduardo Reyes, Alfredo Prieto and Melchor Álvarez de Mon Preface Sepsis has been defined as a serious condition in which there is a systemic inflammation secondary to an infectious process. This can progress to a level at which it results in a complex disorder, leading to multiple organ failure and eventually death. Although it has been well recognized as one of the top killers worldwide, its incidence continues to rise dramatically with some studies showing approximately 1,400 daily deaths. Some experts usually consider sepsis as one of the most challenging conditions because of its multiple presentations and the variety of its complications. Since severe sepsis/septic shock is one of the leading causes of intensive care units admissions, the costs are overwhelming . There is no doubt that the development and implementation of standards of care should help provide an adequate management and improve the patient’s outcome. For instance, various investigators from all over the world got their chance, in this book, to provide important information regarding this deadly disease . The chapters of this book have been guided by numerous references designed to understand the mechanism, consequences and recommended therapies for severe sepsis and septic shock. The book is divided in multiple sections in order to study all of the aspects of sepsis and fulfil the readers‘ interest in this condition. We hope that the efforts of these investigators will result in a useful way to not only create consciousness of early diagnosis and treatment, but also to continue with intense work and interest for the care of our patients. We also want to appreciate the assistance of the publishing manager and all of the people that collaborated with the book. X Preface Finally, I personally want to congratulate all of the authors for their contributions. Sincerly, Dr Ricardo Fernandez Gonzalez, FCCP American College of Chest Physician American College of Critical Care Medicine American Thoracic Society Pulmonary Training Program San Juan City Hospital Puerto Rico . 27 Marilena Galdiero, Marco Cantisani, Rossella Tarallo, Annarita Falanga and Stefania Galdiero Chapter 3 Transfusion-Associated Bacterial Sepsis 47 Jolanta Korsak Part 3 Pathological Findings. SEVERE SEPSIS AND SEPTIC SHOCK – UNDERSTANDING A SERIOUS KILLER Edited by Ricardo Fernandez Severe Sepsis and Septic Shock – Understanding a Serious Killer Edited. Barbara Assenzio and Erica L. Martin-Conte Chapter 9 Impact of Severe Sepsis or Septic Shock on Drug Response 187 Marta Vázquez, Pietro Fagiolino, Cecilia Maldonado, Manuel Ibarra and Anna