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Definition of sepsis and septic shock

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https://www.readbyqxmd.com/read/28063688/crystalloid-fluid-choice-and-clinical-outcomes-in-pediatric-sepsis-a-matched-retrospective-cohort-study
#1
Scott L Weiss, Luke Keele, Fran Balamuth, Neika Vendetti, Rachael Ross, Julie C Fitzgerald, Jeffrey S Gerber
OBJECTIVE: To test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis. STUDY DESIGN: We performed matched analyses using data from 12 529 patients <18 years of age with severe sepsis/septic shock at 382 US hospitals between 2000 and 2013 to compare outcomes with vs without LR as part of initial resuscitation. Patients receiving LR were matched 1:1 to patients receiving only NS (NS group), including separate matches for any (LR-any group) or exclusive (LR-only group) LR use...
January 4, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28056039/prediction-models-and-their-external-validation-studies-for-mortality-of-patients-with-acute-kidney-injury-a-systematic-review
#2
Tetsu Ohnuma, Shigehiko Uchino
OBJECTIVES: To systematically review AKI outcome prediction models and their external validation studies, to describe the discrepancy of reported accuracy between the results of internal and external validations, and to identify variables frequently included in the prediction models. METHODS: We searched the MEDLINE and Web of Science electronic databases (until January 2016). Studies were eligible if they derived a model to predict mortality of AKI patients or externally validated at least one of the prediction models, and presented area under the receiver-operator characteristic curves (AUROC) to assess model discrimination...
2017: PloS One
https://www.readbyqxmd.com/read/28050898/impact-of-transfusion-on-patients-with-sepsis-admitted-in-intensive-care-unit-a-systematic-review-and-meta-analysis
#3
REVIEW
Claire Dupuis, Romain Sonneville, Christophe Adrie, Antoine Gros, Michael Darmon, Lila Bouadma, Jean-François Timsit
Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. A threshold of 7 g/dL for stabilized patients with sepsis is commonly proposed, although debated. The aim of the study was to compare the benefit and harm of restrictive versus liberal RBCT strategies in order to guide physicians on RBCT strategies in patients with severe sepsis or septic shock. Four outcomes were assessed: death, nosocomial infection (NI), acute lung injury (ALI) and acute kidney injury (AKI)...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/27975124/-updated-definition-of-sepsis-implications-for-diagnostics-and-therapy-principles
#4
N Schlegel
Until a short time ago the criteria for sepsis were based on the assumption that sepsis is primarily caused by the inflammatory reaction of the body to an infection, which does not correspond to the current knowledge on the pathophysiology of sepsis. Accordingly, sepsis is now defined as a life-threatening organ dysfunction due to a falsely regulated response of the body to an infection. Septic shock occurs when a condition of persisting hypotension with the continuous need for vasopressor agents and serum lactate levels of >2 mmol/l despite administration of sufficient volume and fluid is present...
December 14, 2016: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/27940455/sepsis-for-the-anaesthetist
#5
M E Nunnally
Sepsis is as a dysregulated systemic response to infection. Morbidity and mortality of the syndrome are very high worldwide. Recent definitions have redefined criteria for sepsis. The new definition (Sepsis-3) classifies sepsis as infection with organ dysfunction (the old 'severe sepsis'). Septic patients are at risk for secondary injuries, thus aggressive source control, resuscitation, and antibiotic therapy are the mainstays of management. Central to sepsis physiology is vasodilated shock. Many patients respond to i...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27910086/higher-vs-lower-haemoglobin-threshold-for-transfusion-in-septic-shock-subgroup-analyses-of-the-triss-trial
#6
S L Rygård, L B Holst, J Wetterslev, P I Johansson, A Perner
BACKGROUND: Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. METHODS: In post-hoc analyses of the full trial population of 998 patients from the Transfusion Requirements in Septic Shock (TRISS) trial, we investigated the intervention effect on 90-day mortality in patients with severe comorbidity (chronic lung disease, haematological malignancy or metastatic cancer), in patients who had undergone surgery (elective or acute) and in patients with septic shock as defined by the new consensus definition: lactate above 2 mmol/l and the need for vasopressors to maintain a mean arterial pressure above 65 mmHg...
February 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27854510/variation-in-post-sepsis-readmission-patterns-a-cohort-study-of-veterans-affairs-beneficiaries
#7
Hallie C Prescott
RATIONALE: Re-hospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations. OBJECTIVES: To examine the variation in post-sepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries. METHODS: Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009-2011) at 114 VA hospitals, stratified by age (<65 versus ≥ 65 years), nursing home usage (none, chronic, or acute), year of admission (2009, 2010, 2011), and hospital...
November 17, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27846034/an-update-on-classification-and-management-of-urosepsis
#8
Florian M E Wagenlehner, Zafer Tandogdu, Truls E Bjerklund Johansen
PURPOSE OF REVIEW: The urinary tract is the infection site in severe sepsis/septic shock in 10-30%. RECENT FINDINGS: There is a new Sepsis definition focusing on severe sepsis. Urosepsis is mainly due to obstructed uropathy of the upper urinary tract. The pathogenesis of sepsis is complex and is driven by the innate immune system. In the further course immunosuppression is developing.Management of urosepsis includes early diagnosis, early initiation of treatment such as identification and control of the complicating factor in the urinary tract and the specific sepsis therapy...
November 14, 2016: Current Opinion in Urology
https://www.readbyqxmd.com/read/27816060/septic-shock-with-no-diagnosis-at-24-hours-a-pragmatic-multicenter-prospective-cohort-study
#9
Damien Contou, Damien Roux, Sébastien Jochmans, Rémi Coudroy, Emmanuel Guérot, David Grimaldi, Sylvie Ricome, Eric Maury, Gaëtan Plantefève, Julien Mayaux, Armand Mekontso Dessap, Christian Brun-Buisson, Nicolas de Prost
BACKGROUND: The lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others. METHODS: We conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France...
November 6, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27807819/sepsis-3-definitions-predict-icu-mortality-in-a-low-middle-income-country
#10
Bruno Adler Maccagnan Pinheiro Besen, Thiago Gomes Romano, Antonio Paulo Nassar, Leandro Utino Taniguchi, Luciano Cesar Pontes Azevedo, Pedro Vitale Mendes, Fernando Godinho Zampieri, Marcelo Park
BACKGROUND: Sepsis-3 definitions were published recently and validated only in high-income countries. The aim of this study was to assess the new criteria's accuracy in stratifying mortality as compared to its predecessor (Sepsis-2) in a Brazilian public intensive care unit (ICU) and to investigate whether the addition of lactate values would improve stratification. METHODS: Retrospective cohort study conducted between 2010 and 2015 in a public university's 19-bed ICU...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27793427/clinical-and-microbiological-features-of-maternal-sepsis-a-retrospective-study
#11
G Abir, S Akdagli, A Butwick, B Carvalho
BACKGROUND: Identifying pregnant women with sepsis is challenging because diagnostic clinical and laboratory criteria overlap with normal pregnant physiologic indices. Our primary study aim was to describe clinical and laboratory characteristics of women diagnosed with sepsis, severe sepsis and septic shock. Our secondary aim was to determine positive predictive values for International Classification of Disease (ICD)-9 billing codes for sepsis, severe sepsis, and septic shock. METHODS: After gaining Institutional Review Board approval, we identified women with ICD-9 codes for sepsis, severe sepsis and septic shock who were admitted to a single tertiary obstetric center from 2007-2013...
September 10, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27771598/absolute-lactate-value-vs-relative-reduction-as-a-predictor-of-mortality-in-severe-sepsis-and-septic-shock
#12
Sharukh Lokhandwala, Lars W Andersen, Sunil Nair, Parth Patel, Michael N Cocchi, Michael W Donnino
PURPOSE: Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values. MATERIALS AND METHODS: We performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate ≥4mmol/L and suspected infection...
February 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/27749763/the-new-sepsis-definitions-implications-for-the-basic-and-translational-research-communities
#13
Craig M Coopersmith, Clifford S Deutschman
New definitions of sepsis and septic shock were published in early 2016, updating old definitions that have not been revisited since 2001. These new definitions should profoundly affect sepsis research. In addition, these paper present clinical criteria for identifying infected patients who are highly likely to have or to develop sepsis or septic shock. In contrast to previous approaches, these new clinical criteria are evidence based. In this review, two of the authors of the new definitions detail the content of the papers and explore the implications for shock and sepsis researchers...
September 29, 2016: Shock
https://www.readbyqxmd.com/read/27720289/new-mandated-centers-for-medicare-and-medicaid-services-requirements-for-sepsis-reporting-caution-from-the-field
#14
Emily L Aaronson, Michael R Filbin, David F M Brown, Kathy Tobin, Elizabeth A Mort
BACKGROUND: The release of the Center for Medicare and Medicaid Service's (CMS) latest quality measure, Severe Sepsis/Septic Shock Early Management Bundle (SEP-1), has intensified the long-standing debate over optimal care for severe sepsis and septic shock. Although the last decade of research has demonstrated the importance of comprehensive bundled care in conjunction with compliance mechanisms to reduce patient mortality, it is not clear that SEP-1 achieves this aim. The heterogeneous and often cryptic presentation of severe sepsis and septic shock, along with the multifaceted criteria for the definition of this clinical syndrome, pose a particular challenge for fitting requirements to this disease, and implementation could have unintended consequences...
January 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27713884/resistance-mechanisms
#15
REVIEW
Yasemin Cag, Hulya Caskurlu, Yanyan Fan, Bin Cao, Haluk Vahaboglu
By definition, the terms sepsis and septic shock refer to a potentially fatal infectious state in which the early administration of an effective antibiotic is the most significant determinant of the outcome. Because of the global spread of resistant bacteria, the efficacy of antibiotics has been severely compromised. S. pneumonia, Escherichia coli (E. coli), Klebsiella, Acinetobacter, and Pseudomonas are the predominant pathogens of sepsis and septic shock. It is common for E. coli, Klebsiella, Acinetobacter and Pseudomonas to be resistant to multiple drugs...
September 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27709263/refractory-septic-shock-in-children-a-european-society-of-paediatric-and-neonatal-intensive-care-definition
#16
Luc Morin, Samiran Ray, Clare Wilson, Solenn Remy, Mohamed Rida Benissa, Nicolaas J G Jansen, Etienne Javouhey, Mark J Peters, Martin Kneyber, Daniele De Luca, Simon Nadel, Luregn Jan Schlapbach, Graeme Maclaren, Pierre Tissieres
PURPOSE: Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts' definition of paediatric RSS. METHODS: We conducted a two-round Delphi study followed by an observational multicentre retrospective study...
December 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27686355/incidence-of-severe-sepsis-and-septic-shock-in-german-intensive-care-units-the-prospective-multicentre-insep-study
#17
(no author information available yet)
PURPOSE: To estimate the incidence density, point prevalence and outcome of severe sepsis and septic shock in German intensive care units (ICUs). METHODS: In a prospective, multicentre, longitudinal observational study, all patients already on the ICU at 0:00 on 4 November 2013 and all patients admitted to a participating ICU between 0:00 on 4 November 2013 and 2359 hours on 1 December 2013 were included. The patients were followed up for the occurrence of severe sepsis or septic shock (SEPSIS-1 definitions) during their ICU stay...
December 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27684877/prevalence-and-risk-factors-of-sepsis-induced-cardiomyopathy-a-retrospective-cohort-study
#18
Ryota Sato, Akira Kuriyama, Tadaaki Takada, Michitaka Nasu, Sarah Kyuragi Luthe
The aim of the study is to evaluate the epidemiology and clinical features of sepsis-induced cardiomyopathy (SICM).A retrospective cohort study was conducted.A total of 210 adult patients with sepsis or septic shock admitted to a Japanese tertiary care hospital from January 1, 2013, to December 31, 2015, who underwent transthoracic echocardiography (TTE) on admission.The definition of SICM was ejection fraction (EF) < 50% and a ≥10% decrease compared to the baseline EF which recovered within 2 weeks, in sepsis or septic shock patients...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27627079/-sepsis-how-to-recognize-and-what-to-focus-on-back-to-basics-in-the-light-of-the-new-definition
#19
Jan Horák, Martin Harazim, Thomas Karvunidis, Jaroslav Raděj, Ivan Novák, Martin Matějovič
UNLABELLED: Sepsis is the primary cause of death from infection. However, its early recognition remains a fundamental challenge in clinical practice. In February 2016, a newly revised sepsis definition has been published (SEPSIS-3). Sepsis has been redefined as life-threatening organ dysfunction caused by a dysregulated host response to infection. In this article, we introduce the updated definition of sepsis, discuss its pros and cons and suggest practical implications. The emphasis is put on basic and comprehensive clinical assessment...
2016: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/27599399/prognostic-value-of-neglected-biomarker-in-sepsis-patients-with-the-old-and-new-criteria-predictive-role-of-lactate-dehydrogenase
#20
Ali Duman, Ayhan Akoz, Mucahit Kapci, Mevlut Ture, Serhat Orun, Kıvanc Karaman, Kenan Ahmet Turkdogan
OBJECTIVES: This study examined the pH, lactate dehydrogenase (LDH), and heart rate values on the first day of hospitalization in patients with a prediagnosis of sepsis and biomarkers that may predict mortality. METHODS: Patients hospitalized in an emergency intensive care unit with a diagnosis of systemic inflammatory response syndrome were classified as having sepsis (n = 28), septic shock (n = 8), or severe sepsis (n = 8) according to International Sepsis Guidelines (old criteria)...
June 7, 2016: American Journal of Emergency Medicine
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