[Latest treatments for septic shock and the current state of research]. / Nouveautés dans les traitements du choc septique et état de la recherche.

The treatment of septic shock is a medical emergency. International guidelines advise immediate care and the first hour is generally critical. It is an emergency on both an etiological and symptomatic level.

[From sepsis to septic shock]. / Du sepsis au choc septique.

Septic shock, defined as the combination of sepsis, a requirement for catecholamines to maintain systolic blood pressure above 65 mmHg and a serum lactate level above 2 mmol/L despite adequate volume resuscitation is a life-threatening condition. The Quick Sepsis-related Organ Failure Assessment (qSOFA), which can be used by all nurses with a high-risk patient presenting with infection, enables the patient to be transferred rapidly to specialist care units.

[Réhabilitation and multiple limb amputation secondary to septic shock]. / Rééducation après amputations multiples des quatre membres à la suite d'un choc septique.

The amputation of multiple limbs is a rare but serious consequence of septic shock. It concerns young and active populations. The aim of rehabilitation is to enable patients to regain their independence and former everyday life. An overview of this specific care is presented here through a clinical case.

[Septic shock, organisation and nursing care]. / Choc septique, organisation et soins infirmiers.

As septic shock is a life-threatening condition, acting quickly is a crucial element of its treatment. Nurses must be equipped with the skills to be able to recognise the warning signs and notify the doctor quickly.

[Ethical décision making and septic shock]. / Décision éthique et choc septique.

Nurses can contribute to the decision-making process in emergency situations in cases of septic shock, particularly if the patient has not drawn up advance directives and/or nominated a health care proxy. They can undertake or facilitate the collective decision making on the legal and ethical level. The team's habitus in terms of ethical analysis and the gathering of initial data can help to ensure the patients wishes are respected.

Effects of ATP-sensitive potassium channel blockers on vascular hyporeactivity, mesenteric blood flow, and survival in lipopolysaccharide-induced septic shock model.

In this study, the possible therapeutic effects of various ATP-sensitive potassium channel (KATP) blockers (glibenclamide, repaglinide, 5-HD, HMR-1098) have been tested in experimental septic shock model. Rats were given lipopolysaccharide (1 mg·kg(-1)) to create experimental shock model and 4 h later, under 400 mg·kg(-1) chloral hydrate anesthesia, parameters such as blood pressure, mesenteric blood flow, the response of mesenteric circulation to phenylephrine (vasoconstrictor stimulation), and organ and oxidative damage were analyzed. Also 75 mg·kg(-1) lethal dose of lipopolysaccharide was given to mice and effects of KATP blockers on survival have been tested. Non-selective blocker glibenclamide with sulphonylurea structure and sarcolemmal KATP channel blocker HMR-1098, which have the similar chemical structure, have improved the pathological parameters such as decrease in mesenteric blood flow, vascular hyporeactivity, but could not prevent the decrease in blood pressure, and oxidative and organ damage that were observed in the shock model. Also, both blockers have decreased the mortality rate from 80% to 40%-50%. Similar (preventive) therapeutic effects were not observed with non-selective blocker repaglinide and mitochondrial KATP channel blocker 5-HD, which were non-sulphonylurea structure. As a result, only KATP channel blockers that have sulphonylurea structure can be a new therapeutic approach in septic shock.

Vasoplegia in sepsis depends on the vascular system, vasopressor, and time-point: a comparative evaluation in vessels from rats subjected to the cecal ligation puncture model.

We evaluated the effects of phenylephrine, norepinephrine, angiotensin II, and vasopressin in mesenteric, renal, carotid, and tail arteries, and in perfused mesenteric vascular bed from rats subjected to the cecal ligation and puncture (CLP) model of sepsis. Phenylephrine and angiotensin II were less efficacious in mesenteric arteries from the CLP 6 h and CLP 18 h groups than in preparations from non-septic animals, but no differences were found for norepinephrine and vasopressin between the preparations. In renal arteries, none of the vasoconstrictors had impaired activity in the CLP groups. Nonetheless, carotid arteries from the CLP 18 h group presented reduced reactivity to all vasoconstrictors tested, but only phenylephrine and norepinephrine had their effects reduced in carotid arteries from the CLP 6 h group. Despite the reduced responsiveness to phenylephrine, tail arteries from septic rats were hyperreactive to vasopressin and norepinephrine at 6 h and 18 h after the CLP surgery, respectively. The mesenteric vascular bed from CLP groups was hyporeactive to phenylephrine, norepinephrine, and angiotensin II, but not to vasopressin. The vascular contractility in sepsis varies from the well-described refractoriness, to unaltered or even hyperresponsiveness to vasoconstrictors, depending on the vessel, the vasoactive agent, and the time period evaluated.

[Training student nurses in taking blood cultures]. / Formation des étudiants en soins infirmiers à la réalisation des hémocultures.

In cases of septic shock, high quality blood cultures are essential for identifying the causative agent and adapting the antibiotic treatment. Student nurses are relatively unfamiliar with recent guidelines on collecting blood cultures. Improving how they are taught during initial training, a key moment for the learning of best care practices, should help to optimise the global management of septic shock.

[A fatal septic shock due to Capnocytophaga canimorsus and review of literature]. / Infection fulminante fatale à Capnocytophaga canimorsus : à propos d'un cas et revue de la littérature.

INTRODUCTION: Capnocytophaga canimorsus is a Gram-negative bacterium present in normal dogs and cats mouths. It can be responsible for septic shocks after dog or cat bite, especially in asplenic patients. CASE REPORT: We report here a case of C. canimorsus infection rapidly presenting as a multiple organ dysfonction syndrome in an immunocompetent 54 years old patient, who lives near a dog, without any sign of bite. The evolution was a rapidly fatal fulminant septic shock. CONCLUSION: Among patients with a septic shock of unknown etiology, fatal evolution due to C. canimorsus should be avoided by systematic use of early antibiotherapy with amoxicilline and clavulanic acid, especially in patients who live near a pet, even if they are immunocompetent.

[Small bowel obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia]. / Occlusion iléale par infestation massive par des ankylostomes responsable d'une septicémie plurimicrobienne d'évolution fatale.

INTRODUCTION: Intestinal symptoms (cramping, flatulence) and iron deficient anemia are classical presenting manifestations of duodenal hookworm infestation in patients living in endemic area. CASE REPORT: We report a 45-year-old immunocompetent metropolitan man who presented with intestinal obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia with refractory septic shock. CONCLUSION: We report a case of acute surgical abdominal presentation with septicemia and refractory shock syndrome due to ileal translocation secondary to massive hookworm infestation. To the best of our knowledge, such a case has not yet been reported.

[Severe pulmonary tuberculosis in the ICU, diagnosis and treatment]. / Diagnostic et traitement d'une pneumonie tuberculeuse grave en réanimation.

INTRODUCTION: Pulmonary tuberculosis can rarely lead to acute respiratory distress syndrome and anti-tuberculous therapy initiation depends on this difficult diagnosis in ICU. CASE REPORT: A 50-year-old man presented a septic shock and acute respiratory distress syndrome with bilateral infiltrates mainly in the upper lobes on chest radiography. Diagnosis of pulmonary tuberculosis was made 10days after admission on examination of cavitary and diffuse infiltrates on a second CT scan, in addition to presence of acid-fast bacilli on smear examination of bronchial aspirates. Amikacin, with four first-line anti-tuberculous drugs, was started in the case of a resistant strain and seriousness of the illness. After 14weeks, he left on rifampicin and isoniazid treatment. CONCLUSIONS: There are no specific recommendations concerning pulmonary tuberculosis in ICU but a delay in initiation of anti-tuberculous therapy is a factor of poor prognosis. Using a second-line anti-tuberculous drug, like amikacin or/and fluoroquinolones, within initial treatment may accelerate improvement of sepsis and immediately treat resistant strains, when genomic methods for detection of resistance are not available in routine.

[Super high-flux continuous hemodialysis in septic shock: a case report]. / Hémodialyse continue avec membrane super high-flux au cours d'un choc septique : application clinique.

Continuous renal replacement therapy (CRRT) with a high cutoff (HCO) membrane is proposed for septic shock as a blood purification technique. The aim of this therapy is to modulate the immune response through the increase of the clearances of the inflammatory mediators as compared to standard CRRT. The use of HCO membranes in daily clinical practice is limited due to the related theoretical albumin loss. Super high-flux (SHF) membranes have an optimized cutoff and, when used in a diffusive mode, may allow for high clearances of middle molecules with limited albumin loss. We report the case of a patient with pneumonia and septic shock treated with continuous hemodialysis with a SHF membrane in order to present the clinical application of this new extracorporeal blood purification technique.