The European Society of Intensive Care and the European Shock Society selected a group of expert scientists and clinicians in the field of septic shock to define the acquired knowledge, the present controversies and the priorities for future research. This conference was held in Brussels on March 1-2, 1987. The reports of the discussion have been collected in this "state of the art" update on septic shock.
Septic shock is difficult to define, difficult to investigate, and even more difficult to treat (mortality rates are greater than 50 percent). For these reasons, septic shock has become the bete noire of an entire generation of intensive care physicians. This book explores the subject from two broad viewpoints: pathophysiology and clinical management.
The book is multiauthored and has a distinctly Gallic flavor: most of the contributors are from France, and a few are from the Netherlands and the United Kingdom. It contains a wealth of information and is more a reference book on critical care than an account of research in progress. Topics are discussed in detail, and most of the chapters conclude with a brief, useful summary; overall, the thoroughly referenced text is well organized, with frequent highlighted headings and clearly displayed paragraphs. However, there is a paucity of tables and diagrams (and the latter are reproduced in black and white only).
The book has five sections. The first deals with definitions and epidemiology. Concise definitions of the categories of sepsis are clearly outlined in a table. There is a brief discussion of their historical development and the current controversies about categorizing sepsis as separate entities. This section also discusses the increased incidence of sepsis, trends in identified organisms, and risk factors.
The second section, on the pathophysiology of sepsis, is the focus of the book. It gives a detailed account of the various inflammatory mediators in sepsis and the metabolic and organ-specific changes of the syndrome. There are brief descriptions of the clinical features and systemic complications associated with sepsis. Each organ system is considered separately, with a final, brief discussion of the multiple organ dysfunction syndrome. The last and most clinically relevant section discusses the diagnosis, assessment, and management of sepsis. Guidelines for treatment are clearly described. The importance of early and appropriate antimicrobial treatment and adequate fluid resuscitation, as well as the benefits of ventilation, inotropes, and nutritional support, are highlighted. Controversial issues such as the optimal hematocrit and choice of resuscitation fluids are presented well and in an unbiased fashion. Key topics such as the limitations of invasive monitoring and the optimization of respiratory support are also discussed. The approach is not to review all the current literature, but rather to present a brief outline of these topics.
This excellent textbook covers all the important areas relevant to sepsis. Given the rapid changes in our knowledge of the basis of sepsis, such a textbook will always lag behind current research and may not appeal to the expert. Even so, the basics do not change, and this book (particularly the last two sections) is informative, well researched, and well written.
Jane Standen, M.B., B.S.
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