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Sepsis guidelines

Jaime Fernández-Sarmiento, Joseph A Carcillo, Claudia M Salinas, Edgar F Galvis, Paula A López, Andrés Jagua-Gualdrón
OBJECTIVES: To evaluate adherence to the sepsis bundle before and after an educational strategy and its impact on hospital stay. DESIGN: A prospective, analytic, before-and-after study of children with severe sepsis and septic shock who presented to the emergency department. SETTING: Carried out from January to December 2014 in the emergency department of a quaternary care hospital. PATIENTS: Of a total of 19,836 children who presented to the emergency department, 4,383 had an infectious pathology, with 203 of these showing severe sepsis and septic shock (124 pre intervention, and 79 post intervention)...
March 14, 2018: Pediatric Critical Care Medicine
R Cuthbert, C Deutsch, A Roy, P Stimpson, H Patel
Introduction The free jejunal flap represents the gold standard for circumferential defects in upper digestive tract reconstruction. It is a technically demanding procedure with significant failure rates. Unrecognised failure leads to flap necrosis and potentially fatal sequelae, including sepsis and carotid artery bleed. Despite these catastrophic consequences, however, there remains no consensus on an optimum method for postoperative flap monitoring. Our unit has pioneered the use of external colour duplex ultrasound to monitor flap vascularity...
March 15, 2018: Annals of the Royal College of Surgeons of England
Brian H Nathanson
No abstract text is available yet for this article.
April 2018: Critical Care Medicine
Maureen Campion, Gail Scully
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections...
January 1, 2018: Journal of Intensive Care Medicine
Tetsuro Akashi, Yuichi Tachibana, Susumu Matsuo, Junya Gibo
Acute cholangitis is a fatal condition if inadequately treated. It is possible to underestimate the severity of the condition because bacterial cultures are not immediately available. We evaluated the clinical features of patients with cholangitis due to bile duct stones who were diagnosed with severe bacteremia at the time of hospitalization, but not at the time of the initial visit. We conducted a retrospective analysis of cases of endoscopic retrograde cholangiopancreatography performed between January 2007 and October 2011 in patients with bile duct stones complicated by cholangitis...
February 2018: Gastroenterology Research
Bruno Levy, Caroline Fritz, Elsa Tahon, Audrey Jacquot, Thomas Auchet, Antoine Kimmoun
Vasoplegia is a ubiquitous phenomenon in all advanced shock states, including septic, cardiogenic, hemorrhagic, and anaphylactic shock. Its pathophysiology is complex, involving various mechanisms in vascular smooth muscle cells such as G protein-coupled receptor desensitization (adrenoceptors, vasopressin 1 receptors, angiotensin type 1 receptors), alteration of second messenger pathways, critical illness-related corticosteroid insufficiency, and increased production of nitric oxide. This review, based on a critical appraisal of the literature, discusses the main current treatments and future approaches...
February 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
N D B Ehelepola, R K G M Rajapaksha, D M U B Dhanapala, T D K Thennekoon, S Ponnamperuma
BACKGROUND: Concurrent presence of dengue hemorrhagic fever (DHF), tropical pyomyositis and septicemia due to methicillin-resistant Staphylococcus aureus (MRSA) in a previously healthy person has never been reported. These three conditions even individually are potentially fatal. "Here we describe a case of a patient contracting dengue and developing DHF along with concurrent pyomyositis likely to be due to MRSA, leading to MRSA septicemia with abscesses formed by MRSA". CASE PRESENTATION: A 44-year old previously healthy Sinhalese man presented on day 3 of the illness with fever, headache, arthralgia and myalgia and watery loose stools...
February 27, 2018: BMC Infectious Diseases
Sheryll Lat, Wendy Mashlan, Susan Heffey, Bridie Jones
Sepsis is a common condition caused by the body's immune and coagulation systems being 'switched on' by the presence of infection, either through bacteria or viruses in the blood. If untreated, sepsis can be life-threatening and is a leading cause of death in hospital patients worldwide. However, awareness of sepsis is low. This article provides an overview of the important role played by nurses in acute hospital settings in the early identification and treatment of suspected sepsis in frail older patients, and in escalating the care and management of deteriorating patients...
February 26, 2018: Nursing Older People
F J Kranenburg, S A Willems, S Le Cessie, P J Marang-van de Mheen, J G van der Bom, M S Arbous
BACKGROUND AND OBJECTIVES: Most guidelines recommend a restrictive transfusion trigger of 7 g/dl. It is unclear whether this resulted in more uniform transfusion practices. The primary objective was to uncover the extent of variation in transfusion decisions within four scenarios of critically ill patients among critical care physicians in the Netherlands. MATERIALS AND METHODS: An online survey comprising four different hypothetical clinical scenarios was sent to all members of the Dutch Society of Intensive Care...
February 23, 2018: Vox Sanguinis
Kiren Ghag, Cathy Winter, Rachna Bahl, Mary Lynch, Nayda Bautista, Rogelio Ilagan, Timothy J Draycott
OBJECTIVE: To describe the adaptation of an obstetric emergencies training program to align with local clinical practice. METHODS: A feasibility study was conducted to investigate the potential implementation of the PRactical Obstetric Multi-Professional Training (PROMPT) program at eight urban tertiary hospitals in the Philippines. Multi-professional teams attended a 2-day course on September 23 and 24, 2015, that comprised a demonstration PROMPT course (day 1) and a Train-the-Trainers session (day 2)...
February 22, 2018: International Journal of Gynaecology and Obstetrics
Kassam Mahomed, Kellie Wild, Christopher R Weekes
BACKGROUND: Pre-labour rupture of membranes (PROM) at term is a common event with early induction of labour reducing infectious morbidity without increasing the caesarean rate. Syntocinon is commonly used for induction but prostaglandins are also routinely used. Large studies have shown no difference in the maternal and neonatal outcomes with either method. AIM: To assess the safety and efficacy of vaginal prostaglandin (PG) compared to syntocinon for induction of labour in term-PROM...
February 22, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
Ismail Mohamed Elhawary, Eman Abdel Ghany Abdel Ghany, Walaa Alsharany Aboelhamed, Shahinaz Gamal Eldin Ibrahim
BACKGROUND: To determine the incidence and risk factors of post-phototherapy rebound hyperbilirubinemia because data about bilirubin rebound in neonates are lacking and few studies have concerned this condition. METHODS: A prospective observational study was conducted on 500 neonates with indirect hyperbilirubinemia who were treated according to standard guidelines. Total serum bilirubin (TSB) was measured at 24-36 h after phototherapy; significant bilirubin rebound (SBR) is considered as increasing TSB that needs reinstitution of phototherapy...
February 20, 2018: World Journal of Pediatrics: WJP
Arthur Jason Vaught
Sepsis is a leading cause of maternal morbidity and mortality in developed and developing nations. Obstetric practitioners should be familiar with guidelines that promote the safe and expeditious recovery of those affected. This article will provide the reader with rational steps to aid in the recovery of such a patient.
February 2018: Seminars in Perinatology
Mathew R Johnson, T Patrick Reed, Denise K Lowe, William D Cahoon
Fluid resuscitation, to restore intravascular volume and improve oxygen delivery, is a crucial step in early resuscitation efforts of patients with sepsis or septic shock. The 2016 Surviving Sepsis Campaign guidelines suggest the use of dynamic versus static measures of fluid responsiveness and fluid resuscitation with at least 30 mL/kg of intravenous crystalloid within the first 3 hours followed by fluid administration if hemodynamic factors continue to improve. Despite these recommendations, risks to this practice may exist as multiple studies have demonstrated an association between a positive fluid balance and/or administration of large fluid volume and increase in mortality...
January 1, 2018: Journal of Pharmacy Practice
Daniel M Beswick, Reza Vaezeafshar, Yifei Ma, Peter H Hwang, Jayakar V Nayak, Zara M Patel
Objectives Venous thromboembolism (VTE) contributes to significant patient morbidity, yet the incidence of VTE following endoscopic sinus surgery (ESS) is unknown. Quality improvement criteria are prompting increased standardization of perioperative VTE prophylaxis. Risk stratification for VTE may better define best practice measures to balance limiting VTE development with avoiding unnecessary chemoprophylaxis. Study Design Retrospective cohort study. Setting Tertiary institution. Subjects and Methods Adult patients who underwent ESS without perioperative chemoprophylaxis from 2008 to 2016 were evaluated...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Erik Refsland Kaspersen, Johan Ræder, Vegard Dahl
BAKGRUNN: Det finnes internasjonale og nasjonale retningslinjer for behandling av sepsis. I tillegg har nesten alle norske sykehus utarbeidet egne retningslinjer for behandling av tilstanden. Formålet med denne studien var å vurdere i hvilken grad de lokale retningslinjene stemmer overens med de nasjonale. MATERIALE OG METODE: Alle offentlige norske sykehus med indremedisinsk akuttfunksjon ble kontaktet og forespurt om lokale retningslinjer for behandling av sepsis...
February 19, 2018: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
E Sabrina Twilhaar, Rebecca M Wade, Jorrit F de Kieviet, Johannes B van Goudoever, Ruurd M van Elburg, Jaap Oosterlaan
Importance: Despite apparent progress in perinatal care, children born extremely or very preterm (EP/VP) remain at high risk for cognitive deficits. Insight into factors contributing to cognitive outcome is key to improve outcomes after EP/VP birth. Objective: To examine the cognitive abilities of children of EP/VP birth (EP/VP children) and the role of perinatal and demographic risk factors. Data Sources: PubMed, Web of Science, and PsycINFO were searched without language restriction (last search March 2, 2017)...
February 19, 2018: JAMA Pediatrics
Siba Prosad Paul, Kerrie Richardson
No abstract text is available yet for this article.
February 19, 2018: Evidence-based Nursing
Takahiro Niimura, Yoshito Zamami, Toru Imai, Kanako Nagao, Masafumi Kayano, Hidenori Sagara, Mitsuhiro Goda, Naoto Okada, Masayuki Chuma, Kenshi Takechi, Masaki Imanishi, Toshihiro Koyama, Tadashi Koga, Hironori Nakura, Toshiaki Sendo, Keisuke Ishizawa
PURPOSE: Although the 2016 Japanese guidelines for the management of sepsis recommend de-escalation of treatment after identification of the causative pathogen, adherence to this practice remain unknown. The objective of this study was to evaluate the benefits of de-escalating treatment for sepsis patients at an advanced critical care and emergency medical centre. METHODS: Based on electronic patient information, 85 patients who were transported to the centre by ambulance, and diagnosed with sepsis between January 2008 and September 2013 were enrolled and evaluated...
2018: Journal of Pharmacy & Pharmaceutical Sciences: a Publication of the Canadian Society for Pharmaceutical Sciences
S H Howitt, M Herring, I Malagon, C N McCollum, S W Grant
BACKGROUND: The Sepsis-3 guidelines diagnose sepsis based on organ dysfunction in patients with either proven or suspected infection. The objective of this study was to assess the incidence and outcomes of sepsis diagnosed using these guidelines in patients in a cardiac intensive care unit (CICU) after cardiac surgery. METHODS: Daily sequential organ failure assessment (SOFA) scores were calculated for 2230 consecutive adult cardiac surgery patients between January 2013 and May 2015...
March 2018: British Journal of Anaesthesia
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