Infection and sepsis

Crit Care Nurs Clin N Am 15 (2003) xiii – xiv

Preface

Infection and sepsis

Marilyn Sawyer Sommers, PhD, RN, FAAN Guest Editor

Sepsis and its consequences are the leading causes of death in intensive care units, the third leading cause of infectious death, and the tenth leading cause of death overall in the United States [1,2]. Almost 400,000 patients with sepsis are treated by critical care practitioners in the United States each year, and the mortality rate of septic shock can approach 80% [3,4]. Caring for patients with severe sepsis and septic shock is one of the most complex tasks facing critical care practitioners in the twenty-first century. This issue of Critical Care Nursing Clinics synthesizes the information available from basic and applied science on bacterial infection in the intensive care unit. With this information, health care practitioners should be able to formulate strategies to treat acutely and critically ill patients with infection, sepsis, and septic shock. The challenges are enormous. In addition to high mortality rates and costly hospital stays, the vigilance and interventions needed by nurses to manage these patients are extraordinary. The science behind the care is rapidly changing and is based on not only the more familiar areas of physiology, such as the cardiovascular, pulmonary, renal, and hematologic systems, but also on immunology and genetics, two specialties not readily understood by many critical care nurses. To provide the foundations of evidenced-based practice and care based on science, this issue presents basic scientific information and then discusses appli-

cations to clinical practice. The first section, an overview of infection and sepsis, is composed of two articles that explore the cellular basis of infection, sepsis, and septic shock, and a third article that gives an overview of assessment and management. The second section on gender and life span issues includes a discussion of sepsis in neonates, children, and women. The issue concludes with several articles dealing with the economics of antibiotic administration, the role of plants as vectors for infection, and the role of nutrition. Populations of particular concern that are addressed include persons with diabetes mellitus, heart transplantation, and cancer. It is the intent of the editor and authors to present state-of-the-art information to critical care practitioners. We hope that we have achieved a marriage of the art of nursing and the science that underlies practice. Patients with these complex problems deserve our highest level of caring and intellectual functioning, and it is hoped that these skills are enhanced with this issue.

References [1] Bone RC, Grodzin CJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest 1997;112:235 – 43. [2] Minino AM, Smith BL. Deaths: preliminary data for 2000. Natl Vital Stat Rep 2001;49:1 – 40. [3] Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epi-

0899-5885/03/$ – see front matter D 2003, Elsevier Science (USA). All rights reserved. PII: S 0 8 9 9 - 5 8 8 5 ( 0 2 ) 0 0 0 4 5 - X

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M.S. Sommers / Crit Care Nurs Clin N Am 15 (2003) xiii–xiv demiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303 – 10.

[4] Glauser MP. Pathophysiologic basis of sepsis: considerations for future strategies of intervention. Crit Care Med 2000;28:S4 – 8.

Marilyn Sawyer Sommers, PhD, RN, FAAN College of Nursing University of Cincinnati Cincinnati, OH 45221-0038, USA E-mail address: [email protected]