Endotoxin Induced-Shock: a Multidisciplinary Approach in Critical Care

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.

Table of contents :

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