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Sepsis protocol

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https://www.readbyqxmd.com/read/100001003/emergency-management-of-sepsis-the-simple-stuff-saves-lives
#1
David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
https://www.readbyqxmd.com/read/28810616/single-blinded-randomized-and-controlled-clinical-trial-evaluating-the-effects-of-omega-3-fatty-acids-among-septic-patients-with-intestinal-dysfunction-a-pilot-study
#2
Huaisheng Chen, Wei Wang, Yingcai Hong, Huadong Zhang, Chengying Hong, Xueyan Liu
Sepsis is a systemic inflammatory reaction, which is aggravated by aspects of the immune response that are thought to be inhibited by Omega-3 fatty acids. The aim of the present study was to determine if Omega-3 fatty acid could modulate immunological function and improve survival rate among septic patients with intestinal dysfunction. A total of 48 mechanically ventilated patients with intestinal dysfunction were included in this prospective, randomized and single-blind clinical study. Patients were randomly divided into control (group A) and treatment groups (group B)...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28809612/a-retrospective-study-evaluating-the-efficacy-of-identification-and-management-of-sepsis-at-a-district-level-hospital-internal-medicine-department-in-the-western-cape-province-south-africa-in-comparison-with-the-guidelines-stipulated-in-the-2012-survivi
#3
Raisa Bhikoo, Sarah Versfeld, M M De V Basson, Almero H Oosthuizen
BACKGROUND: Currently there is little information on the identification, management and outcomes of patients with sepsis in developing countries. Simple cost-effective measures such as accurate identification of patients with sepsis and early antibiotic administration are achievable targets, within reach without having to make use of unsustainable protocols constructed in developed countries. OBJECTIVES: To assess the ability of clinicians at a district-level hospital to identify and manage sepsis, and to assess patient outcome in terms of in-hospital mortality and length of hospital stay given the above management...
July 28, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28801400/protein-misfolding-amyotrophic-lateral-sclerosis-and-guanabenz-protocol-for-a-phase-ii-rct-with-futility-design-promise-trial
#4
Eleonora Dalla Bella, Irene Tramacere, Giovanni Antonini, Giuseppe Borghero, Margherita Capasso, Claudia Caponnetto, Adriano Chiò, Massimo Corbo, Roberto Eleopra, Massimiliano Filosto, Fabio Giannini, Enrico Granieri, Vincenzo La Bella, Christian Lunetta, Jessica Mandrioli, Letizia Mazzini, Sonia Messina, Maria Rosaria Monsurrò, Gabriele Mora, Nilo Riva, Romana Rizzi, Gabriele Siciliano, Vincenzo Silani, Isabella Simone, Gianni Sorarù, Paolo Volanti, Giuseppe Lauria
INTRODUCTION: Recent studies suggest that endoplasmic reticulum stress may play a critical role in the pathogenesis of amyotrophic lateral sclerosis (ALS) through an altered regulation of the proteostasis, the cellular pathway-balancing protein synthesis and degradation. A key mechanism is thought to be the dephosphorylation of eIF2α, a factor involved in the initiation of protein translation. Guanabenz is an alpha-2-adrenergic receptor agonist safely used in past to treat mild hypertension and is now an orphan drug...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28800159/mouse-models-of-acinetobacter-baumannii-infection
#5
Greg Harris, Rhonda KuoLee, H Howard Xu, Wangxue Chen
This unit describes basic protocols for infecting mice through intranasal and intraperitoneal routes with Acinetobacter baumannii to induce associated pneumonia and sepsis, the two most common manifestations of clinical infections with this pathogen. By selecting the appropriate protocols and bacterial strains of different virulence, these mouse models provide an opportunity to study the infection pathogenesis and host-immune responses, and to evaluate the efficacies of prophylactic and therapeutic anti-A. baumannii candidates...
August 11, 2017: Current Protocols in Microbiology
https://www.readbyqxmd.com/read/28782112/lower-vs-higher-fluid-volumes-in-sepsis-protocol-for-a-systematic-review-with-meta-analysis
#6
T S Meyhoff, M H Møller, P B Hjortrup, M Cronhjort, A Perner, J Wetterslev
BACKGROUND: Intravenous fluid administration with crystalloids is recommended in the initial management of sepsis. However, the quality of evidence supporting the recommendation on fluid volumes is low, and clinical equipoise exists. Potential benefits of restricting fluid volumes has been suggested, but the overall benefit or harm in patients with sepsis is unknown. Accordingly, we aim to assess patient-important benefits and harms of lower vs. higher fluid volumes in resuscitation of adult patients with sepsis...
September 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28780548/effect-of-single-family-rooms-for-preterm-infants-on-neurodevelopment-study-protocol-for-a-systematic-review
#7
Nicole R van Veenendaal, Sophie R D van der Schoor, Jacqueline Limpens, Anne A M W van Kempen, Johannes B van Goudoever
INTRODUCTION: Preterm infants are at an increased risk for neurodevelopmental delay. They have to endure many stressors in early life, including parent-infant separation, noise and painful procedures during hospitalisation in the highly technological environment of the modern neonatal ward. Currently, a shift is being noticed in the architectural design of neonatal wards towards single family rooms instead of the common open bay units. The influence of the hospital environment on health and specifically neurodevelopment in this vulnerable patient population remains under discussion...
August 4, 2017: BMJ Open
https://www.readbyqxmd.com/read/28765125/sepsis-and-critical-illness-research-center-investigators-protocols-and-standard-operating-procedures-for-a-prospective-cohort-study-of-sepsis-in-critically-ill-surgical-patients
#8
Tyler J Loftus, Juan C Mira, Tezcan Ozrazgat-Baslanti, Gabriella L Ghita, Zhongkai Wang, Julie A Stortz, Babette A Brumback, Azra Bihorac, Mark S Segal, Stephen D Anton, Christiaan Leeuwenburgh, Alicia M Mohr, Philip A Efron, Lyle L Moldawer, Frederick A Moore, Scott C Brakenridge
INTRODUCTION: Sepsis is a common, costly and morbid cause of critical illness in trauma and surgical patients. Ongoing advances in sepsis resuscitation and critical care support strategies have led to improved in-hospital mortality. However, these patients now survive to enter state of chronic critical illness (CCI), persistent low-grade organ dysfunction and poor long-term outcomes driven by the persistent inflammation, immunosuppression and catabolism syndrome (PICS). The Sepsis and Critical Illness Research Center (SCIRC) was created to provide a platform by which the prevalence and pathogenesis of CCI and PICS may be understood at a mechanistic level across multiple medical disciplines, leading to the development of novel management strategies and targeted therapies...
August 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28753618/clinical-outcomes-and-mortality-before-and-after-implementation-of-a-pediatric-sepsis-protocol-in-a-limited-resource-setting-a-retrospective-cohort-study-in-bangladesh
#9
Teresa Bleakly Kortz, David M Axelrod, Mohammod J Chisti, Saraswati Kache
BACKGROUND: Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay...
2017: PloS One
https://www.readbyqxmd.com/read/28739652/in-hospital-quality-of-care-measures-for-pediatric-sepsis-syndrome
#10
Folafoluwa O Odetola, Gary Freed, Caroline Shevrin, Brian Madden, Julie McCormick, Kevin Dombkowski
BACKGROUND AND OBJECTIVES: Sepsis syndrome, comprising sepsis, severe sepsis, and septic shock, is a leading cause of child mortality and morbidity, for which the delivery of time-sensitive care leads to improved survival. We aimed to describe the development and testing of quality measures for in-hospital care of pediatric sepsis syndrome. METHODS: Seven measures of quality of care for children hospitalized with sepsis syndrome were developed by using an iterative process including literature review, development of concepts and candidate measures, and selection of measures for feasibility and importance by 2 panels of experts...
July 24, 2017: Pediatrics
https://www.readbyqxmd.com/read/28738837/assessment-of-cerebral-circulation-in-a-porcine-model-of-intravenously-given-e-coli-induced-fulminant-sepsis
#11
Levente Molnár, Norbert Németh, Mariann Berhés, Endre Hajdú, Lóránd Papp, Ábel Molnár, Judit Szabó, Ádám Deák, Béla Fülesdi
BACKGROUND: The aim of the present work was to assess cerebral hemodynamic changes in a porcine model of E.coli induced fulminant sepsis. METHODS: Nineteen healthy female Hungahib pigs, 10-12 weeks old, randomly assigned into two groups: Control (n = 9) or Septic Group (n = 10). In the Sepsis group Escherichia coli culture suspended in physiological saline was intravenously administrated in a continuously increasing manner according to the following protocol: 2 ml of bacterial culture suspended in physiological saline was injected in the first 30 min, then 4 ml of bacterial culture was administered within 30 min, followed by infusion of 32 ml bacterial culture for 2 h...
July 24, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28729904/impact-of-a-sepsis-bundle-in-wards-of-a-tertiary-hospital
#12
F Teles, W G Rodrigues, M G T C Alves, C F T Albuquerque, S M O Bastos, M F A Mota, E S Mota, F J L Silva
BACKGROUND: Sepsis is a prevalent disease worldwide and still exhibits high rates of mortality. In the last years, many interventions aiming a positive impact on sepsis evolution have been studied. One of the main is the use of managed care protocols (sepsis bundles), which consist in systematization of diagnosis and treatment, such as standardization of antibiotics, collection of specific tests (cultures, lactate), and fluid replacement. Some studies have shown a reduction in hospital costs and lower mortality with the use of these tools...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28729329/fluids-in-sepsis-and-septic-shock-fissh-protocol-for-a-pilot-randomised-controlled-trial
#13
Bram Rochwerg, Tina Millen, Peggy Austin, Michelle Zeller, Frédérick D'Aragon, Roman Jaeschke, Marie-Hélène Masse, Sangeeta Mehta, Francois Lamontagne, Maureen Meade, Gordon Guyatt, Deborah J Cook
INTRODUCTION: Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28718488/infectious-disease-morbidity-and-growth-among-young-hiv-exposed-uninfected-children-in-jamaica
#14
Russell B Pierre, Toni-Anne Fulford, Kaye Lewis, Paulette Palmer, Christine Walters, Celia D C Christie
Objective: There is a growing body of data that demonstrates increased infectious disease outcomes for HIV-exposed uninfected (HIV-EU) infants as compared to their HIV-unexposed (HU) counterparts. We hypothesized that these HIV-EU infants are at greater risk for infectious morbidity and mortality when compared to the general childhood population. We therefore aimed to characterize infections and growth outcomes among HIV-EU infants in Jamaica during their first two years of life. By identifying these outcomes, specific interventions could be implemented to mitigate this risk of morbidity and mortality...
December 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
https://www.readbyqxmd.com/read/28715801/fetal-urine-production-rate-in-preterm-premature-rupture-of-membranes-is-associated-with-adverse-neonatal-outcome-a-pilot-study
#15
Tehila Avitan, Lior Drukker, Hadass Pri-Chen, Ron Rabinowitz, Nurit Algur, Michael S Schimmel, Letizia Schreiber, Tali Bdolah-Abram, Arnon Samueloff, Sorina Grisaru-Granovsky
AIM: In this study, we evaluate the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). METHODS: We conducted a prospective pilot cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later managed until spontaneous labor (after 48 h of admission), chorioamnionitis, or induction by protocol at 35 + 0 weeks. FUPR was evaluated by 2D sonography at admission (corrected for gestational age)...
July 18, 2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28711318/procalcitonin-guided-decision-making-for-duration-of-antibiotic-therapy-in-neonates-with-suspected-early-onset-sepsis-a-multicentre-randomised-controlled-trial-neopins
#16
Martin Stocker, Wendy van Herk, Salhab El Helou, Sourabh Dutta, Matteo S Fontana, Frank A B A Schuerman, Rita K van den Tooren-de Groot, Jantien W Wieringa, Jan Janota, Laura H van der Meer-Kappelle, Rob Moonen, Sintha D Sie, Esther de Vries, Albertine E Donker, Urs Zimmerman, Luregn J Schlapbach, Amerik C de Mol, Angelique Hoffman-Haringsma, Madan Roy, Maren Tomaske, René F Kornelisse, Juliette van Gijsel, Eline G Visser, Sten P Willemsen, Annemarie M C van Rossum
BACKGROUND: Up to 7% of term and late-preterm neonates in high-income countries receive antibiotics during the first 3 days of life because of suspected early-onset sepsis. The prevalence of culture-proven early-onset sepsis is 0·1% or less in high-income countries, suggesting substantial overtreatment. We assess whether procalcitonin-guided decision making for suspected early-onset sepsis can safely reduce the duration of antibiotic treatment. METHODS: We did this randomised controlled intervention trial in Dutch (n=11), Swiss (n=4), Canadian (n=2), and Czech (n=1) hospitals...
July 12, 2017: Lancet
https://www.readbyqxmd.com/read/28706981/outcomes-of-liver-transplant-recipients-with-autoimmune-liver-disease-using-long-term-dual-immunosuppression-regimen-without-corticosteroid
#17
Sanjaya K Satapathy, Ollie D Jones, Jason M Vanatta, Faisal Kamal, Satish K Kedia, Yu Jiang, Satheesh P Nair, James D Eason
BACKGROUND: Liver transplant (LT) recipients with autoimmune liver disease (primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis) are at increased risk of developing acute cellular rejection (ACR), and in many cases graft failure due to recurrent disease. We describe our experience with dual immunosuppression without steroid maintenance and analyze its effect on disease recurrence; ACR; patient and graft survivals; and complications, such as sepsis and de novo malignancy...
July 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28706103/vitamin-d-levels-in-critically-ill-patients-with-acute-kidney-injury-a-protocol-for-a-prospective-cohort-study-vid-aki
#18
Lynda Katherine Cameron, Katie Lei, Samantha Smith, Nanci Leigh Doyle, James F Doyle, Kate Flynn, Nicola Purchase, John Smith, Kathryn Chan, Farida Kamara, Nardos Ghebremedhin Kidane, Lui G Forni, Dominic Harrington, Geeta Hampson, Marlies Ostermann
INTRODUCTION: Acute kidney injury (AKI) affects more than 50% of critically ill patients. The formation of calcitriol, the active vitamin D metabolite, from the main inactive circulating form, 25-hydroxyvitamin D (25(OH)D), occurs primarily in the proximal renal tubules. This results in a theoretical basis for reduction in levels of calcitriol over the course of an AKI. Vitamin D deficiency is highly prevalent in critically ill adults, and has been associated with increased rates of sepsis, longer hospital stays and increased mortality...
July 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28700186/-the-treatment-of-aki-in-nephrology-hospitalization-the-sle-hdf-15-litres-in-10-hours
#19
REVIEW
Marcello Napoli, Maria Luisa Lefons, Giovanni Sandri, Efisio Sozzo, Carmela Ambrosino
The AKI in intensive care has been widely treated by international and national guidelines. The treatment of AKI in patients not requiring admission in Intensive Care Unit, but often hospitalized in Nephrology Unit, it is showed of less relevance. For over 5 years we have used for the treatment of AKI of patients admitted in Nephrology Unit an intermittent slow technique, implemented in approximately 600 patients with AKI for a total of about 3000 treatments. In this study we report the clinical results obtained in 100 consecutive patients referred to our Nephrology Unit from 1st January 2014...
June 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28695270/maternal-use-of-prednisolone-is-unlikely-to-be-associated-with-neonatal-adrenal-suppression-a-single-center-study-of-16-cases
#20
Leanne de Vetten, Margriet van Stuijvenberg, Ido P Kema, Gianni Bocca
The use of supra-physiological, exogenous corticosteroids in pregnancy may lead to neonatal adrenal suppression. We report on a single-center, case series study carried out between 2006 and 2014, which included all newborns (n = 16) of mothers using prednisolone ≥10 mg/day during pregnancy. Newborns were routinely assessed according to hospital protocol, with follow-up until 6 weeks after birth. We investigated the clinical symptoms and biochemical findings of adrenal suppression occurring in the newborns...
August 2017: European Journal of Pediatrics
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