Sepsis is a complex, often insidious, complication of an infectious process. It encompasses a wide range of systemic and cellular events adversely impacting circulation, tissue perfusion, coagulation, and other processes, ultimately leading to failure in 1 or several vital organs. The critical care nurse must promptly recognize and be prepared to respond to sepsis in order to limit morbidity and mortality associated with this condition. The manuscripts chosen for this issue address several aspects of predicting, identifying, and managing sepsis using a multidisciplinary team approach.
Chong, Dumont, Francis-Frank, and Balaan begin the issue with an introduction of sepsis in their article "Sepsis and Septic Shock: A Review." In their article, they discuss pathophysiology, predictors of sepsis, and sepsis bundles to provide general basis of knowledge in the area of sepsis.
The article "Pharmacology of Sepsis" by Pavlik, Simpson, Horn, King, and Finoli describes the role of intravenous fluids, vasoactive agents, antimicrobial agents, and corticosteroids in sepsis management. Glycemic control is also reviewed.
Benedict discusses the aspects of intensive care unit (ICU) care in her article "Surviving Sepsis in the Critical Care Environment." The initial resuscitation bundles, the ICU management of septic shock including hemodynamic monitoring and goals, fluid resuscitation, ventilation, sedation, blood products, and nursing aspects of pharmacological management are reviewed.
Kaufmann and Ramponi's article "Recognition of Risk Factors and Prognostic Indicators in Fournier's Gangrene" uses a case study approach to alert clinicians to the etiology, pathophysiology, risk factors for invasive necrosis, prognostic indicators, and current diagnostic and treatment recommendations for managing patients with Fournier's gangrene. It has been written from the perspective of the nurse practitioner.
In the article "Osteomyelitis: An Overview of Imaging Modalities," Bires, Kerr, and George detail how imaging studies can help in the identification of changes in the bones that occur with osteomyelitis. This article addresses the advantages and disadvantages of imaging modalities, with a focus on molecular imaging as a tool for the assessment of osteomyelitis.
Vioral and Wentley present the unique approach of sepsis in the oncologic population in the article "Managing Oncology Neutropenia and Sepsis in the Intensive Care Unit." The article presents an overview of cancer treatments, hematopoiesis, neutropenia, sepsis, and risk factors for the oncologic population.
The article "The Older Adult Experiencing Sepsis" by Englert and Ross examines this special population of critically ill patients who are especially vulnerable to the sepsis. The authors explain the rapid progression from a systemic inflammatory response to severe sepsis and septic shock if not recognized promptly and managed effectively.
Kurczewski, Sweet, McKnight, and Halbritter address screening and early identification of patients in their article "Reduction in Time to First Action As a Result of Electronic Alerts for Early Sepsis Recognition." The article describes how an electronic alerting system can be used to decrease the time to goal-directed therapy initiatives.
The sepsis topic concludes with the article from Hampe, "Physician-Led Sepsis Quality Improvement Team." In the article, the multidisciplinary approach to the identification and management of sepsis is outlined.
Three additional articles are included in the issue, basically unrelated to sepsis, but important to health care personnel. The article "Anesthetic Choices and Breast Cancer Recurrence: A Retrospective Pilot Study of Patient, Disease, and Treatment Factors" by Starnes-Ott, Goravanchi, and Meininger explores the variables of anesthetic choices as they relate to the outcomes for patients having outpatient surgical treatment of breast cancer. Chen and Malek revisit the use of an older agent in their work, "Follow Me Down the K-hole: Ketamine and Its Modern Applications." They consider its current applications for anesthesia, pain management, and procedural sedation. "A Study in Scarlet: Restrictive Red Blood Cell Transfusion Therapy," a final article by Chen, reviews the evidence that supports restrictive transfusion strategies in cases of severe trauma as well as for the treatment of anemia accompanying critical illness and sepsis.
-Lori Laux, MSN, RN-BC, CRNP
Katrina A. Pyo, PhD, RN, CCRN
Issue Editors