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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/28329088/short-course-adjunctive-gentamicin-as-empirical-therapy-in-patients-with-severe-sepsis-and-septic-shock-a-prospective-observational-cohort-study
#2
David S Y Ong, Jos F Frencken, Peter M C Klein Klouwenberg, Nicole Juffermans, Tom van der Poll, Marc Bonten, Olaf Cremer
Background.: Meta-analyses failed to demonstrate clinical benefits of beta lactam plus aminoglycoside combination therapy, compared to beta lactam monotherapy, in patients with sepsis. However, few data exist on the effects of short-course adjunctive aminoglycoside therapy in sepsis patients with organ failure or shock. Methods.: We prospectively enrolled consecutive patients with severe sepsis or septic shock in two intensive care units in the Netherlands from 2011 to 2015...
February 28, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28328650/exosomes-in-critical-illness
#3
Nora Terrasini, Vincenzo Lionetti
OBJECTIVE: Exosomes are small, cell-released vesicles (40-100 nm in size) with the potential to transfer proteins, lipids, small RNAs, messenger RNAs, or DNA between cells via interstitial fluids. Due to their role in tissue homeostasis, exosomes have emerged as a new type of therapeutic and diagnostic (theranostic) tool in the noninvasive assessment of organ response to injury or treatment and in the development of reliable organ-protective intensive therapy. Our review provides current insights into the role of exosomes in the personalized management of injury and repair responses in critical illness...
March 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28306558/monitoring-of-the-physical-exam-in-sepsis
#4
Radu Postelnicu, Laura Evans
PURPOSE OF REVIEW: Monitoring of mental status and peripheral circulatory changes can be accomplished noninvasively in patients in the ICU. Emphasis on physical examination in conditions such as sepsis have gained increased attention as these evaluations can often serve as a surrogate marker for short-term treatment efficacy of therapeutic interventions. Sepsis associated encephalopathy and mental status changes correlate with worse prognosis in patients. Evaluation of peripheral circulation has been shown to be a convenient, easily accessible, and accurate marker for prognosis in patients with septic shock...
March 16, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28291783/oesophageal-heat-exchangers-with-a-diameter-of-11mm-or-14-7mm-are-equally-effective-and-safe-for-targeted-temperature-management
#5
Daniel C Schroeder, Maria Guschlbauer, Alexandra C Maul, Daniel A Cremer, Ingrid Becker, David de la Puente Bethencourt, Peter Paal, Stephan A Padosch, Wolfgang A Wetsch, Thorsten Annecke, Bernd W Böttiger, Anja Sterner-Kock, Holger Herff
BACKGROUND: Targeted temperature management (TTM) is widely used in critical care settings for conditions including hepatic encephalopathy, hypoxic ischemic encephalopathy, meningitis, myocardial infarction, paediatric cardiac arrest, spinal cord injury, traumatic brain injury, ischemic stroke and sepsis. Furthermore, TTM is a key treatment for patients after out-of-hospital cardiac-arrest (OHCA). However, the optimal cooling method, which is quick, safe and cost-effective still remains controversial...
2017: PloS One
https://www.readbyqxmd.com/read/28286823/protocol-adherence-for-severe-sepsis-and-septic-shock-management-in-the-emergency-department-a-clinical-audit
#6
Mostafa Alavi-Moghaddam, Ali Anvari, Reaza Soltani Delgosha, Hamid Kariman
INTRODUCTION: Although significant development in the field of medicine is achieved, sepsis is still a major issue threatening humans' lives. This study was aimed to audit the management of severe sepsis and septic shock patients in emergency department (ED) according to the present standard guidelines. METHOD: This is a prospective audit on approaching adult septic patients who were admitted to ED. The audit checklist was created based on the protocols of Surviving Sepsis Campaign and British Royal College recommendations...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28286376/high-mobility-group-box-1-protein-and-outcomes-in-critically-ill-surgical-patients-requiring-open-abdominal-management
#7
Michelle S Malig, Craig N Jenne, Chad G Ball, Derek J Roberts, Zhengwen Xiao, Andrew W Kirkpatrick
Background. Previous studies assessing various cytokines in the critically ill/injured have been uninformative in terms of translating to clinical care management. Animal abdominal sepsis work suggests that enhanced intraperitoneal (IP) clearance of Damage-Associated Molecular Patterns (DAMPs) improves outcome. Thus measuring the responses of DAMPs offers alternate potential insights and a representative DAMP, High Mobility Group Box-1 protein (HMGB-1), was considered. While IP biomediators are being recognized in critical illness/trauma, HMGB-1 behaviour has not been examined in open abdomen (OA) management...
2017: Mediators of Inflammation
https://www.readbyqxmd.com/read/28284298/severe-sepsis-and-septic-shock-trials-process-arise-promise-what-is-optimal-resuscitation
#8
REVIEW
Tiffany M Osborn
Between 2014 and 2015, 3 independent, multicenter, randomized controlled trials evaluated early goal-directed therapy (EGDT) in severe sepsis and septic shock: Protocolized Care for Early Septic Shock (ProCESS) from the United States; Australasian Resuscitation in Sepsis Evaluation (ARISE), and Protocolised Management in Sepsis (ProMISe) in the United Kingdom. All 3 trials confirmed that there was no survival benefit of EGDT compared to usual resuscitation. How should we define usual care for sepsis given these study findings? Furthermore, the definition of sepsis has now been updated...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28279777/sutureless-vs-sutured-gastroschisis-closure-a-prospective-randomized-controlled-trial
#9
Matias Bruzoni, Joshua D Jaramillo, Jonathan L Dunlap, Claire Abrajano, Shobha W Stack, Susan R Hintz, Tina Hernandez-Boussard, Sanjeev Dutta
BACKGROUND: Sutureless gastroschisis repair involves covering the abdominal wall defect with the umbilical cord or a synthetic dressing to allow closure by secondary intention. No randomized studies have described the outcomes of this technique. Our objective was to prospectively compare short-term outcomes of sutureless versus sutured closure in a randomized fashion. STUDY DESIGN: We recruited patients who presented with gastroschisis between 2009 and 2014 and were randomized into either sutureless or sutured treatment groups...
March 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28275488/early-management-of-sepsis-with-emphasis-on-early-goal-directed-therapy-ame-evidence-series-002
#10
REVIEW
Zhongheng Zhang, Yucai Hong, Nathan J Smischney, Han-Pin Kuo, Panagiotis Tsirigotis, Jordi Rello, Win Sen Kuan, Christian Jung, Chiara Robba, Fabio Silvio Taccone, Marc Leone, Herbert Spapen, David Grimaldi, Sven Van Poucke, Steven Q Simpson, Patrick M Honore, Stefan Hofer, Pietro Caironi
Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials...
February 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28271573/sepsis-like-acute-hypersensitivity-syndrome-related-with-mesna
#11
Nazli Ercan, Ertugrul Aysegul, Bilgin Burcak, Bostanci Ilknur
Mesna (Sodyum 2-merkaptoethan sulfonat) is a synthetic sulfhydryl compound used as an adjuvant in cancer chemotherapy(. 1-3) Herein we report a case of acute hypersensitivity syndrome related with mesna administration that was misdiagnosed as sepsis. A 6-year-old girl diagnosed with acute lymphoblastic leukemia was initially treated with St. Jude Total Therapy XV protocol. This article is protected by copyright. All rights reserved.
March 8, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/28264831/head-to-head-comparison-of-procalcitonin-and-presepsin-for-the-diagnosis-of-sepsis-in-critically-ill-adult-patients-a-protocol-for-a-systematic-review-and-meta-analysis
#12
Kei Hayashida, Yutaka Kondo, Yoshitaka Hara, Morio Aihara, Kazuma Yamakawa
INTRODUCTION: Early diagnosis and immediate therapeutic intervention, including appropriate antibiotic therapy and goal-directed resuscitation, are necessary to reduce mortality in patients with sepsis. However, a single clinical or biological marker indicative of sepsis has not been adopted unanimously. Although procalcitonin and presepsin are promising biomarkers that can effectively differentiate between sepsis/infection and systemic inflammatory response syndrome of non-infectious origin, little is known about which marker is superior...
March 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28261497/integrated-approaches-for-the-management-of-staple-line-leaks-following-sleeve-gastrectomy
#13
Mauro Montuori, Domenico Benavoli, Stefano D'Ugo, Luca Di Benedetto, Emanuela Bianciardi, Achille L Gaspari, Paolo Gentileschi
Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication...
2017: Journal of Obesity
https://www.readbyqxmd.com/read/28257335/serial-procalcitonin-predicts-mortality-in-severe-sepsis-patients-results-from-the-multicenter-procalcitonin-monitoring-sepsis-moses-study
#14
Philipp Schuetz, Robert Birkhahn, Robert Sherwin, Alan E Jones, Adam Singer, Jeffrey A Kline, Michael S Runyon, Wesley H Self, D Mark Courtney, Richard M Nowak, David F Gaieski, Stefan Ebmeyer, Sascha Johannes, Jan C Wiemer, Andrej Schwabe, Nathan I Shapiro
OBJECTIVES: To prospectively validate that the inability to decrease procalcitonin levels by more than 80% between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. DESIGN: Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-approved protocol. SETTING: Thirteen U.S.-based emergency departments and ICUs...
March 2, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28225634/journal-club-ultrasound-guided-breast-interventions-low-incidence-of-infectious-complications-with-use-of-an-uncovered-probe
#15
Chris Reisenauer, Robert T Fazzio, Gina Hesley
OBJECTIVE: The purpose of this study was to determine the incidence of infectious complications after ultrasound-guided breast interventions performed with an intermediate-level disinfection protocol without an ultrasound probe cover. MATERIALS AND METHODS: Two independent institutional databases were searched to identify breast infections in patients who underwent ultrasound-guided interventions between January 2005 and July 2013. The departments of radiology and infectious diseases independently maintained these databases...
February 22, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28224092/language-and-cognitive-outcome-for-high-risk-neonates-at-the-age-of-2-3-years-experience-from-an-arab-country
#16
Tamer Abou-Elsaad, Hesham Abdel-Hady, Hemmat Baz, Doaa ElShabrawi
AIM: To investigate the effect of different neonatal risk factors on different language parameters as well as cognitive abilities among Arabic speaking Egyptian children at the age of two to three years of life and to find out which risk factor(s) had the greatest impact on language and cognitive abilities. METHODS: This retrospective cohort study was conducted on 103 children with age range of 2-3 years (median age 31 mo). They were 62 males and 41 females who were exposed to different high-risk factors in the perinatal period, with exclusion of metabolic disorders, sepsis/meningitis, congenital anomalies and chromosomal aberrations...
February 8, 2017: World Journal of Clinical Pediatrics
https://www.readbyqxmd.com/read/28202033/use-of-stepwise-lactate-kinetics-oriented-hemodynamic-therapy-could-improve-the-clinical-outcomes-of-patients-with-sepsis-associated-hyperlactatemia
#17
Xiang Zhou, Dawei Liu, Longxiang Su, Bo Yao, Yun Long, Xiaoting Wang, Wenzhao Chai, Na Cui, Hao Wang, Xi Rui
BACKGROUND: Setting lactate kinetics at >30% might improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. The aim of this study was to explore the outcome benefits of stepwise lactate kinetics vs central venous oxygen saturation (ScvO2)-oriented hemodynamic therapy at 6 h as the protocol goal during early resuscitation. METHODS: The relevant parameters and adverse events after different targets in 360 randomly assigned patients with sepsis-associated hyperlactatemia were recorded and compared...
February 16, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28190560/filtering-authentic-sepsis-arising-in-the-icu-using-administrative-codes-coupled-to-a-sirs-screening-protocol
#18
Christopher L Sudduth, Elizabeth C Overton, Peter F Lyu, Ramzy H Rimawi, Timothy G Buchman
PURPOSE: Using administrative codes and minimal physiologic and laboratory data, we sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. MATERIALS AND METHODS: We studied all patients discharged from an academic hospital between September 1, 2013 and October 31, 2014. Administrative codes and minimal physiologic and laboratory criteria were used to identify patients at high risk of developing the onset of sepsis in the ICU...
February 3, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28165586/efficacy-of-postoperative-polymyxin-b-hemoperfusion-in-secondary-peritonitis-patients-with-septic-shock-a-propensity-matched-analysis
#19
Kuo-Ching Yuan, Shang-Yu Wang, Ming-Chin Yu, Yu-Pao Hsu, Heng-Chih Pan, Yung-Chang Chen
INTRODUCTION: Severe sepsis and septic shock is still a challenge. Polymyxin B hemoperfusion (PMX) is a device designed to remove circulating endotoxin by adsorption, which is reported to improve treatment outcomes. This study aimed to further verify the efficacy of PMX on postoperative, peritonitis, septic shock patients. METHODS: This study prospectively analyzed 20 of 155 patients who presented with postoperative septic shock and were treated with PMX in a single institute during the period March 2013 to September 2014 (Clinical Trial Protocol number: ChiCTR-ONC-16008160)...
February 4, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28159975/use-of-a-supplemental-oxygen-protocol-to-suppress-progression-of-retinopathy-of-prematurity
#20
Tarah T Colaizy, Susannah Longmuir, Kevin Gertsch, Michael David Abràmoff, Jonathan M Klein
Purpose: To compare progression of retinopathy of prematurity (ROP) before and after institution of an oxygen therapy protocol to inhibit active proliferation and progression of ROP in premature infants. Methods: A retrospective cohort study was performed of premature infants undergoing ROP screening before (cohort A) and after (cohort B) implementation of an oxygen therapy protocol to inhibit further progression for those with stage 2 ROP or worse. Statistical analysis with χ2, Fisher's exact test, or Wilcoxon rank sum test was performed; and logistic regression models were created to determine the odds ratio of cohort B developing ROP progression beyond stage 2, compared to cohort A, adjusting for other risk factors for ROP...
February 1, 2017: Investigative Ophthalmology & Visual Science
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