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Definition of sepsis and septic shock

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https://www.readbyqxmd.com/read/28933172/-development-of-views-on-pathophysiology-of-sepsis
#1
Jiří Beneš
Sepsis was understood as a disease caused by an invasive bacterial infection associated with deluging of organism with bacterial toxins (blood poisoning). Schottmüllers definition emphasized the existence of a focus as the source of invading bacteria. Further research led to the discovery of the cytokine cascade and to the recognition that sepsis is induced by our own endogenous mediators. The dysfunction or failure of various organs in sepsis can be explained both by hemodynamic disorders which originate in the altered microcapillars but also by a complex transformation of metabolism...
2017: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28916973/myeloperoxidase-can-differentiate-between-sepsis-and-non-infectious-sirs-and-predicts-mortality-in-intensive-care-patients-with-sirs
#2
Irene T Schrijver, Hans Kemperman, Mark Roest, Jozef Kesecioglu, Dylan W de Lange
BACKGROUND: Systemic inflammatory response syndrome (SIRS) is a clinical syndrome following inflammation. Clinically, it is difficult to distinguish SIRS following an infection, i.e., sepsis, from non-infectious SIRS. Myeloperoxidase is a hemeprotein stored in the neutrophil azurophilic granules and is one of the main pillars of neutrophil attack. Therefore, we hypothesized that myeloperoxidase can differentiate between sepsis and non-infectious SIRS in patients with systemic inflammatory response syndrome in the intensive care unit (ICU)...
September 15, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28903154/incidence-and-trends-of-sepsis-in-us-hospitals-using-clinical-vs-claims-data-2009-2014
#3
Chanu Rhee, Raymund Dantes, Lauren Epstein, David J Murphy, Christopher W Seymour, Theodore J Iwashyna, Sameer S Kadri, Derek C Angus, Robert L Danner, Anthony E Fiore, John A Jernigan, Greg S Martin, Edward Septimus, David K Warren, Anita Karcz, Christina Chan, John T Menchaca, Rui Wang, Susan Gruber, Michael Klompas
Importance: Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time. Objective: To estimate the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. Design, Setting, and Population: Retrospective cohort study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014...
September 13, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28882016/new-sepsis-criteria-do-they-replace-or-complement-what-is-known-in-the-approach-to-the-infectious-patient
#4
REVIEW
J González Del Castillo, C Clemente, F J Candel, F J Martín-Sánchez
There have recently been profound changes in both the definitions of sepsis and septic shock and the diagnostic criteria established for daily clinical practice. In addition, a new screening tool known as qSOFA has been introduced to identify patients at risk of a poor short-term outcome. This score has been accompanied by some controversy due to presenting a lower sensitivity than the systemic inflammatory response criteria previously used to identify such patients. In this article, we shall summarise and analyse the most important recently published studies in relation to these new criteria...
September 2017: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/28876571/duodenectomy-managing-the-fistula
#5
M Govender, O Matsevych, F Ghoor, N Singh, C Molenaar
BACKGROUND: Duodenectomy is rarely indicated, however, in certain circumstances may have be performed. Enterocutaneous fistula (ECF) is the main cause of serious adverse outcomes. Its management remains challenging. METHOD: Two cases of emergency duodenectomy are presented. The management of ECF is described and discussed. RESULTS: Case 1: A 22-year-old male presented in septic shock with perforated duodenal ulcer, suffered two cardiac arrests before index surgery...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28874949/sepsis-definitions-the-search-for-gold-and-what-cms-got-wrong
#6
REVIEW
Annahieta Kalantari, Haney Mallemat, Scott D Weingart
On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are premature and inconsistent with evidence-based definitions.
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28841902/markers-of-acute-kidney-injury-in-patients-with-sepsis-the-role-of-soluble-thrombomodulin
#7
Shinshu Katayama, Shin Nunomiya, Kansuke Koyama, Masahiko Wada, Toshitaka Koinuma, Yuya Goto, Ken Tonai, Jun Shima
BACKGROUND: Endothelial activation and damage occur early during sepsis, with activated coagulopathy and playing a major role in the pathophysiology of sepsis-induced acute kidney injury (AKI). The aim of this study was to compare the various biomarkers of endothelial injury with the biomarkers of coagulation and inflammation and to determine a significant predictor of AKI in patients with sepsis. METHODS: We conducted a single-center, retrospective, observational study on patients with sepsis fulfilling the Third International Consensus Definitions for Sepsis and Septic Shock criteria admitted to an adult intensive care unit (ICU) at a university hospital from June 2011 to December 2016...
August 25, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28834779/revisiting-the-prognostic-value-of-monocyte-chemotactic-protein-1-and-interleukin-6-in-the-sepsis-3-era
#8
Max Barre, Michael Behnes, Sonja Hamed, Dominic Pauly, Dominic Lepiorz, Siegfried Lang, Ibrahim Akin, Martin Borggrefe, Thomas Bertsch, Ursula Hoffmann
BACKGROUND: Monocyte Chemotactic Protein 1 (MCP1) and latest sepsis-3 criteria are poorly represented within studies evaluating biomarkers in sepsis. Therefore, this study evaluates the prognostic value of MCP-1 compared to interleukin-6 (IL-6) in patients with sepsis and septic shock according to sepsis-3 criteria. METHODS: 136 patients with sepsis or septic shock were included within 24h of intensive care unit (ICU) admission. MCP-1, IL-6, procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC) were measured on days 1, 3 and 8...
August 15, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28793880/diagnostic-value-of-pentraxin-3-in-patients-with-sepsis-and-septic-shock-in-accordance-with-latest-sepsis-3-definitions
#9
Sonja Hamed, Michael Behnes, Dominic Pauly, Dominic Lepiorz, Max Barre, Tobias Becher, Siegfried Lang, Ibrahim Akin, Martin Borggrefe, Thomas Bertsch, Ursula Hoffmann
BACKGROUND: Pentraxin-3 (PTX-3) is an acute-phase protein involved in inflammatory and infectious processes. This study assesses its diagnostic and prognostic value in patients with sepsis or septic shock in a medical intensive care unit (ICU). METHODS: The study includes 213 ICU patients with clinical criteria of sepsis and septic shock. 77 donors served as controls. Plasma levels of PTX-3, procalcitonin (PCT) and interleukin-6 were measured on day 1, 3 and 8. RESULTS: PTX-3 correlated with higher lactate levels as well as with APACHE II and SOFA scores (p = 0...
August 9, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28789803/preliminary-performance-on-the-new-cms-sepsis-1-national-quality-measure-early-insights-from-the-emergency-quality-network-e-qual
#10
Arjun K Venkatesh, Todd Slesinger, Jessica Whittle, Tiffany Osborn, Emily Aaronson, Craig Rothenberg, Nalani Tarrant, Pawan Goyal, Donald M Yealy, Jeremiah D Schuur
STUDY OBJECTIVE: We describe current hospital-level performance for the Centers for Medicare & Medicaid Services' Severe Sepsis/Septic Shock Early Management Bundle (SEP-1) quality measure and qualitatively assess emergency department (ED) sepsis quality improvement best practice implementation. METHODS: Using a standardized Web-based submission portal, we surveyed quality improvement data from volunteer hospital-based EDs participating in the Emergency Quality Network Sepsis Initiative...
August 5, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28783810/adaptation-and-validation-of-a-pediatric-sequential-organ-failure-assessment-score-and-evaluation-of-the-sepsis-3-definitions-in-critically-ill-children
#11
Travis J Matics, L Nelson Sanchez-Pinto
Importance: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) uses the Sequential Organ Failure Assessment (SOFA) score to grade organ dysfunction in adult patients with suspected infection. However, the SOFA score is not adjusted for age and therefore not suitable for children. Objectives: To adapt and validate a pediatric version of the SOFA score (pSOFA) in critically ill children and to evaluate the Sepsis-3 definitions in patients with confirmed or suspected infection...
August 7, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28756405/the-recognition-and-management-of-sepsis-and-septic-shock-a-guide-for-non-intensivists
#12
REVIEW
Alexander Keeley, Paul Hine, Emmanuel Nsutebu
Sepsis is common, often fatal and requires rapid interventions to improve outcomes. While the optimal management of sepsis in the intensive care setting is the focus of extensive research interest, the mainstay of the recognition and initial management of sepsis will occur outside the intensive care setting. Therefore, it is key that institutions and clinicians remain well informed of the current updates in sepsis management and continue to use them to deliver appropriate and timely interventions to enhance patient survival...
July 29, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/28752002/changing-definitions-of-sepsis
#13
REVIEW
Fethi Gül, Mustafa Kemal Arslantaş, İsmail Cinel, Anand Kumar
Sepsis is one of the main causes of morbidity and mortality in critically ill patients despite the use of modern antibiotics and resuscitation therapies. Outcomes in sepsis have improved overall, probably because of an enhanced focus on early diagnosis and other improvements in supportive care, but mortality rates still remain unacceptably high. The diagnosis and definition of sepsis is a critical problem due to the heterogeneity of this disease process. Although it is apparent that much more needs to be done to advance our understanding, sepsis and related terms remain difficult to define...
June 2017: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/28743646/sepsis-and-septic-shock-new-definitions-new-diagnostic-and-therapeutic-approaches
#14
REVIEW
Silvano Esposito, Giuseppe De Simone, Giovanni Boccia, Francesco De Caro, Pasquale Pagliano
Sepsis and septic shock are common life-threatening pathologies associated with high mortality and substantial costs for healthcare system. Clinical guidelines and bundles for the management of patients with sepsis have recently been updated. Herein, we review the history of sepsis and related conditions definitions from the first consensus conference in 1991 to nowadays, the epidemiologic data resulting from worldwide studies on incidence and mortality, the diagnostic approaches including the microbiological assessment of infection and the use of several prognostic and diagnostic biomarkers and finally we review the main therapeutic measures as the intravenous immunoglobulin therapy and the administration of appropriate antibiotic treatment to provide patients with sepsis a favourable outcome in the antibiotic-resistance era...
September 2017: Journal of Global Antimicrobial Resistance
https://www.readbyqxmd.com/read/28742549/readmissions-for-recurrent-sepsis-new-or-relapsed-infection
#15
Kimberley Marie DeMerle, Stephanie C Royer, Mark E Mikkelsen, Hallie C Prescott
OBJECTIVES: Sepsis hospitalizations are frequently followed by hospital readmissions, often for recurrent sepsis. However, it is unclear how often sepsis readmissions are for relapsed/recrudescent versus new infections. The aim of this study was to assess the extent to which 90-day readmissions for recurrent sepsis are due to infection of the same site and same pathogen as the initial episode. DESIGN: Retrospective cohort study. SETTING: University of Michigan Health System...
October 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28709458/markers-of-nitric-oxide-are-associated-with-sepsis-severity-an-observational-study
#16
Martin Sebastian Winkler, Stefan Kluge, Maximilian Holzmann, Eileen Moritz, Linda Robbe, Antonia Bauer, Corinne Zahrte, Marion Priefler, Edzard Schwedhelm, Rainer H Böger, Alwin E Goetz, Axel Nierhaus, Christian Zoellner
BACKGROUND: Nitric oxide (NO) regulates processes involved in sepsis progression, including vascular function and pathogen defense. Direct NO measurement in patients is unfeasible because of its short half-life. Surrogate markers for NO bioavailability are substrates of NO generating synthase (NOS): L-arginine (lArg) and homoarginine (hArg) together with the inhibitory competitive substrate asymmetric dimethylarginine (ADMA). In immune cells ADMA is cleaved by dimethylarginine-dimethylaminohydrolase-2 (DDAH2)...
July 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28697503/update-of-sepsis-in-the-intensive-care-unit
#17
Kelly Roveran Genga, James A Russell
Sepsis, the most common cause of admission to an intensive care unit (ICU), has had an increased incidence and prevalence over the last years with a simultaneous decrease in its short-term mortality. Sepsis survivors are more frequently discharged from hospital and often experience long-term outcomes such as late mortality, immune dysfunction, secondary infections, impaired quality of life, and unplanned readmissions. Early recognition and management of sepsis have challenged emergency care and critical care physicians and nurses...
2017: Journal of Innate Immunity
https://www.readbyqxmd.com/read/28696597/-sepsis-particularities-in-the-elderly-patients
#18
Xavier Roux, Benedikt Huttner, Jérôme Pugin, Virginie Prendki, Jean-Luc Reny
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection. The clinical presentation of sepsis in the elderly is very variable and sepsis is therefore challenging to diagnose in this population. The new sepsis definitions published in 2016, which are based on objective clinical and biological scores, should lead to earlier recognition and diagnosis. Treatment should start as soon as possible because the specific pathophysiological changes of aging increase the risk of a sudden deterioration to septic shock...
November 9, 2016: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28687209/new-sepsis-and-septic-shock-definitions-clinical-implications-and-controversies
#19
REVIEW
Chanu Rhee, Michael Klompas
New sepsis definitions shift emphasis from the systemic inflammatory response syndrome to organ dysfunction, quantified using the Sequential Organ Failure Assessment (SOFA) score. The new definitions also propose Quick SOFA criteria to rapidly identify potentially infected patients at risk for poor outcomes. The diagnosis of septic shock requires vasopressor dependence and increased lactate levels. Strengths of these definitions include their simplicity and clear association with adverse outcomes. However, their utility in identifying patients with serious infections before frank sepsis ensues remains to be seen...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28654446/sepsis-in-obstetrics-pathophysiology-and-diagnostic-definitions
#20
Sheryl E Parfitt, Mary L Bogat, Sandra L Hering, Cheryl Roth
In spite of many medical breakthroughs, sepsis continues to be challenging to identify, treat, and successfully resolve, including among the obstetric population. Sepsis is the result of an overactive, complex inflammatory response that is not completely understood. Currently there are no nationally agreed-upon criteria for systemic inflammatory response syndrome or sepsis in pregnant or peripartum women, as the physiologic changes of pregnancy have not been taken into consideration.This article is the first in a series of three that discuss the importance of sepsis and septic shock in pregnancy...
July 2017: MCN. the American Journal of Maternal Child Nursing
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