ANESTHETIC CONSIDERATIONS FOR CRITICALLY ILL PATIENTS WITH SEPSIS
DOI:
https://doi.org/10.22159/ijcpr.2025v17i1.6021Keywords:
Sepsis, Anesthesia, Critically Ill, Hemodynamic management, Ventilatory strategiesAbstract
Objective: Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Critically ill patients with sepsis often require surgical interventions, presenting significant anesthetic challenges due to profound physiological alterations and multiple organ dysfunctions.
Methods: This systematic review aims to synthesize current evidence on anesthetic management strategies for critically ill patients with sepsis. A comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library databases for studies published up to October 2023. Inclusion criteria encompassed clinical trials, observational studies, reviews, and guidelines focusing on anesthetic considerations in septic patients.
Results: Key findings indicate that thorough preoperative assessment, vigilant hemodynamic monitoring, careful selection of anesthetic agents, and tailored ventilatory strategies are crucial for improving perioperative outcomes. Hemodynamic instability necessitates the use of invasive monitoring and vasoactive medications like norepinephrine. Etomidate and ketamine are preferred induction agents due to their hemodynamic stability, with considerations for their side effects. Maintenance anesthesia often favors total intravenous techniques to minimize cardiovascular depression. Protective lung ventilation strategies are essential due to the high risk of acute respiratory distress syndrome (ARDS). Postoperative care requires multidisciplinary collaboration to manage ongoing sepsis and prevent complications.
Conclusion: This review highlights the importance of individualized anesthetic plans and suggests that adherence to evidence-based practices can enhance patient outcomes in this high-risk group.
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References
Singer M, Deutschman CS, Seymour CW, Shankar Hari M, Annane D, Bauer M. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10. doi: 10.1001/jama.2016.0287, PMID 26903338.
Vincent JL, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet. 2013;381(9868):774-5. doi: 10.1016/S0140-6736(12)61815-7, PMID 23472921.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R. Surviving sepsis campaign: international guidelines for the management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304-77. doi: 10.1007/s00134-017-4683-6, PMID 28101605.
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American college of cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;64(22):e77-137. doi: 10.1016/j.jacc.2014.07.944, PMID 25091544.
Cecconi M, DE Backer D, Antonelli M, Beale R, Bakker J, Hofer C. Consensus on circulatory shock and hemodynamic monitoring task force of the European society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795-815. doi: 10.1007/s00134-014-3525-z, PMID 25392034.
Mc Gain F, Story D. Sepsis and anaesthesia. Curr Opin Anaesthesiol. 2012;25(3):398-403.
Russell JA. Vasopressor therapy in critically ill patients with shock. Intensive Care Med. 2019;45(11):1503-17. doi: 10.1007/s00134-019-05801-z, PMID 31646370.
Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-8. doi: 10.1056/NEJM200005043421801, PMID 10793162.
Papazian L, Aubron C, Brochard L, Chiche JD, Combes A, Dreyfuss D. Formal guidelines: management of acute respiratory distress syndrome. Ann Intensive Care. 2019;9(1):69. doi: 10.1186/s13613-019-0540-9, PMID 31197492.
Udy AA, Roberts JA, Shorr AF, Boots RJ, Lipman J. Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: identifying at-risk patients. Crit Care. 2013;17(1)R35. doi: 10.1186/cc12544.
Den Brinker M, Hokken Koelega AC, Hazelzet JA, DE Jong FH, Hop WC, Joosten KF. One single dose of etomidate negatively influences adrenocortical performance for at least 24h in children with meningococcal sepsis. Intensive Care Med. 2008;34(1):163-8. doi: 10.1007/s00134-007-0836-3, PMID 17710382.
Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57(5):449-61. doi: 10.1016/j.annemergmed.2010.11.030, PMID 21256625.
Saugel B, Scheeren TW, Teboul JL. Ultrasound-guided hemodynamic monitoring of the critically ill. Anesthesiology. 2017;126(6):1013-25.
Vincent JL, Abraham E, Kochanek PM, Moore FA. Textbook of critical care. 7th ed. Elsevier; 2017.
Marik PE. Fluid responsiveness and the six guiding principles of fluid resuscitation. Crit Care Med. 2016;44(10):1920-2. doi: 10.1097/CCM.0000000000001483, PMID 26571187.
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