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Sepsis,septic shock,resuscitation

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https://www.readbyqxmd.com/read/28522141/venous-to-arterial-carbon-dioxide-difference-in-the-resuscitation-of-patients-with-severe-sepsis-and-septic-shock-a-systematic-review
#1
J J Diaztagle Fernández, J C Rodríguez Murcia, J J Sprockel Díaz
INTRODUCTION: The way to assess tissue perfusion during the resuscitation of patients with severe sepsis and septic shock is a current subject of research and debate. Venous oxygen saturation and lactate concentration have been the most frequently used criteria, though they involve known limitations. The venous-to-arterial difference of carbon dioxide (pCO2 delta) is a parameter than can be used to indicate tissue perfusion, and its determination therefore may be useful in these patients...
May 15, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28509730/american-college-of-critical-care-medicine-clinical-practice-parameters-for-hemodynamic-support-of-pediatric-and-neonatal-septic-shock
#2
Alan L Davis, Joseph A Carcillo, Rajesh K Aneja, Andreas J Deymann, John C Lin, Trung C Nguyen, Regina S Okhuysen-Cawley, Monica S Relvas, Ranna A Rozenfeld, Peter W Skippen, Bonnie J Stojadinovic, Eric A Williams, Tim S Yeh, Fran Balamuth, Joe Brierley, Allan R de Caen, Ira M Cheifetz, Karen Choong, Edward Conway, Timothy Cornell, Allan Doctor, Marc-Andre Dugas, Jonathan D Feldman, Julie C Fitzgerald, Heidi R Flori, James D Fortenberry, Ana Lia Graciano, Bruce M Greenwald, Mark W Hall, Yong Yun Han, Lynn J Hernan, Jose E Irazuzta, Elizabeth Iselin, Elise W van der Jagt, Howard E Jeffries, Saraswati Kache, Chhavi Katyal, Niranjan Tex Kissoon, Alexander A Kon, Martha C Kutko, Graeme MacLaren, Timothy Maul, Renuka Mehta, Fola Odetola, Kristine Parbuoni, Raina Paul, Mark J Peters, Suchitra Ranjit, Karin E Reuter-Rice, Eduardo J Schnitzler, Halden F Scott, Adalberto Torres, Jacki Weingarten-Abrams, Scott L Weiss, Jerry J Zimmerman, Aaron L Zuckerberg
OBJECTIVES: The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock." DESIGN: Society of Critical Care Medicine members were identified from general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (2006-2014)...
June 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28509668/norepinephrine-in-septic-shock-when-and-how-much
#3
Olfa Hamzaoui, Thomas W L Scheeren, Jean-Louis Teboul
PURPOSE OF REVIEW: Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension because of depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension of when high doses of norepinephrine are required to reach the target. RECENT FINDINGS: Recent literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoid fluid overload...
May 13, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28446775/delivering-prolonged-intensive-care-to-a-non-human-primate-a-high-fidelity-animal-model-of-critical-illness
#4
P Guillaume Poliquin, Mia Biondi, Charlene Ranadheera, Mable Hagan, Alexander Bello, Trina Racine, Mark Allan, Duane Funk, Gregory Hansen, B J Hancock, Murray Kesselman, Todd Mortimer, Anand Kumar, Shane Jones, Anders Leung, Allen Grolla, Kaylie N Tran, Kevin Tierney, Xiangguo Qiu, Darwyn Kobasa, James E Strong
Critical care needs have been rising in recent decades as populations age and comorbidities increase. Sepsis-related admissions to critical care contribute up to 50% of volume and septic shock carries a 35-54% fatality rate. Improvements in sepsis-related care and mortality would have a significant impact of a resource-intensive area of health care delivery. Unfortunately, research has been hampered by the lack of an animal model that replicates the complex care provided to humans in an intensive care unit (ICU)...
April 26, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28411114/circulating-biologically-active-adrenomedullin-bio-adm-predicts-hemodynamic-support-requirement-and-mortality-during-sepsis
#5
Pietro Caironi, Roberto Latini, Joachim Struck, Oliver Hartmann, Andreas Bergmann, Giuseppe Maggio, Marco Cavana, Gianni Tognoni, Antonio Pesenti, Luciano Gattinoni, Serge Masson
BACKGROUND: The biological role of adrenomedullin, a hormone involved in hemodynamic homeostasis, is controversial in sepsis, since administration of either the peptide or an antibody against it may be beneficial. METHODS: Plasma bio-ADM was assessed on days 1, 2 and 7 after randomization of 956 patients with sepsis or septic shock to albumin or crystalloids for fluid resuscitation in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial. We tested the association of bio-ADM and its time-dependent variation with fluid therapy, vasopressor administration, organ failures and mortality...
April 11, 2017: Chest
https://www.readbyqxmd.com/read/28409028/impact-of-delayed-admission-to-the-intensive-care-unit-from-the-emergency-department-upon-sepsis-outcomes-and-sepsis-protocol-compliance
#6
Michael Agustin, Lori Lyn Price, Augustine Andoh-Duku, Peter LaCamera
Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission)...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/28404756/infusion-compatible-antibiotic-formulations-for-rapid-administration-to-improve-outcomes-in-cancer-outpatients-with-severe-sepsis-and-septic-shock-the-sepsis-stat-pack
#7
Jason D Goldman, Amelia Gallaher, Rupali Jain, Zach Stednick, Manoj Menon, Michael J Boeckh, Paul S Pottinger, Stephen M Schwartz, Corey Casper
Background: Patients with cancer are at high risk for severe sepsis and septic shock (SS/SSh), and a delay in receiving effective antibiotics is strongly associated with mortality. Delays are due to logistics of clinic flow and drug delivery. In an era of increasing antimicrobial resistance, combination therapy may be superior to monotherapy for patients with SS/SSh. Patients and Methods: At the Seattle Cancer Care Alliance, we implemented the Sepsis STAT Pack (SSP) program to simplify timely and effective provision of empiric antibiotics and other resuscitative care to outpatients with cancer with suspected SS/SSh before hospitalization...
April 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/28388526/sepsis-associated-in-hospital-cardiac-arrest-epidemiology-pathophysiology-and-potential-therapies
#8
REVIEW
Ryan W Morgan, Julie C Fitzgerald, Scott L Weiss, Vinay M Nadkarni, Robert M Sutton, Robert A Berg
Sepsis-associated cardiac arrest is a relatively common occurrence with especially poor outcomes. Of the greater than 200,000 in-hospital cardiac arrests that occur in the United States annually, between 30,000 and 60,000 occur in patients with underlying sepsis. These patients are less likely to survive than cardiac arrest victims without sepsis. In this review, we discuss the epidemiology of sepsis-associated in-hospital cardiac arrest in adults and children, the relevant physiology responsible for its pathogenesis and poor outcomes, and potential therapeutic interventions based on this pathophysiology...
March 31, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28328652/delayed-second-dose-antibiotics-for-patients-admitted-from-the-emergency-department-with-sepsis-prevalence-risk-factors-and-outcomes
#9
Daniel Leisman, Victor Huang, Qiuping Zhou, Jeanie Gribben, Andrea Bianculli, Michelle Bernshteyn, Mary Frances Ward, Sandra M Schneider
OBJECTIVE: 1) Determine frequency and magnitude of delays in second antibiotic administration among patients admitted with sepsis; 2) Identify risk factors for these delays; and 3) Exploratory: determine association between delays and patient-centered outcomes (mortality and mechanical ventilation after second dose). DESIGN: Retrospective, consecutive sample sepsis cohort over 10 months. SETTING: Single, tertiary, academic medical center. PATIENTS: All patients admitted from the emergency department with sepsis or septic shock (defined: infection, ≥ 2 systemic inflammatory response syndrome criteria, hypoperfusion/organ dysfunction) identified by a prospective quality initiative...
March 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28321823/cardiovascular-disease-and-resuscitated-septic-shock-lead-to-the-downregulation-of-the-h2s-producing-enzyme-cystathionine-%C3%AE-lyase-in-the-porcine-coronary-artery
#10
Tamara Merz, Tatjana Stenzel, Benedikt Nußbaum, Martin Wepler, Csaba Szabo, Rui Wang, Peter Radermacher, Oscar McCook
BACKGROUND: Downregulation of the hydrogen sulfide (H2S)-producing enzymes cystathionine-γ-lyase (CSE), cystathionine-β-synthase (CBS), and/or 3-mercaptopyruvate sulfurtransferase (3-MST) is associated with chronic cardiovascular pathologies. Nevertheless, equivocal data are available on both the expression and function of these enzymes in coronary arteries (CA). We recently reported that atherosclerotic pigs subjected to sepsis developed impaired cardiac function, which coincided with decreased myocardial CSE expression and increased nitrotyrosine formation...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28306558/monitoring-of-the-physical-exam-in-sepsis
#11
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...
June 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28299952/n-acetylcysteine-s-role-in-sepsis-and-potential-benefit-in-patients-with-microcirculatory-derangements
#12
Jason Chertoff
OBJECTIVE: To review the data surrounding the utility of N-acetylcysteine (NAC) in sepsis and identify areas needed for additional research. DATA SOURCES: A review of articles describing the mechanisms of action and clinical use of NAC in sepsis. SUMMARY OF REVIEW: Despite many advances in critical care medicine, still as many as 50% of patients with septic shock die. Treatments thus far have focused on resuscitation and restoration of macrocirculatory targets in the early phases of sepsis, with less focus on microcirculatory dysfunction...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28289047/are-patients-with-cancer-with-sepsis-and-bacteraemia-at-a-higher-risk-of-mortality-a-retrospective-chart-review-of-patients-presenting-to-a-tertiary-care-centre-in-lebanon
#13
Gilbert Abou Dagher, Christopher El Khuri, Ahel Al-Hajj Chehadeh, Ali Chami, Rana Bachir, Dina Zebian, Ralphe Bou Chebl
OBJECTIVE: Most sepsis studies have looked at the general population. The aim of this study is to report on the characteristics, treatment and hospital mortality of patients with cancer diagnosed with sepsis or septic shock. SETTING: A single-centre retrospective study at a tertiary care centre looking at patients with cancer who presented to our tertiary hospital with sepsis, septic shock or bacteraemia between 2010 and 2015. PARTICIPANTS: 176 patients with cancer were compared with 176 cancer-free controls...
March 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28284298/severe-sepsis-and-septic-shock-trials-process-arise-promise-what-is-optimal-resuscitation
#14
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/28281216/a-hypoperfusion-context-may-aid-to-interpret-hyperlactatemia-in-sepsis-3-septic-shock-patients-a-proof-of-concept-study
#15
Leyla Alegría, Magdalena Vera, Jorge Dreyse, Ricardo Castro, David Carpio, Carolina Henriquez, Daniela Gajardo, Sebastian Bravo, Felipe Araneda, Eduardo Kattan, Pedro Torres, Gustavo Ospina-Tascón, Jean-Louis Teboul, Jan Bakker, Glenn Hernández
BACKGROUND: Persistent hyperlactatemia is particularly difficult to interpret in septic shock. Besides hypoperfusion, adrenergic-driven lactate production and impaired lactate clearance are important contributors. However, clinical recognition of different sources of hyperlactatemia is unfortunately not a common practice and patients are treated with the same strategy despite the risk of over-resuscitation in some. Indeed, pursuing additional resuscitation in non-hypoperfusion-related cases might lead to the toxicity of fluid overload and vasoactive drugs...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28270914/sepsis-induced-cardiac-dysfunction-and-%C3%AE-adrenergic-blockade-therapy-for-sepsis
#16
REVIEW
Takeshi Suzuki, Yuta Suzuki, Jun Okuda, Takuya Kurazumi, Tomohiro Suhara, Tomomi Ueda, Hiromasa Nagata, Hiroshi Morisaki
Despite recent advances in medical care, mortality due to sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, remains high. Fluid resuscitation and vasopressors are the first-line treatment for sepsis in order to optimize hemodynamic instability caused by vasodilation and increased vascular permeability. However, these therapies, aimed at maintaining blood pressure and blood flow to vital organs, could have deleterious cardiac effects, as cardiomyocyte damage occurs in the early stages of sepsis...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28250600/a-comparison-of-residents-knowledge-regarding-the-surviving-sepsis-campaign-2012-guideline
#17
Onnicha Suntornlohanakul, Bodin Khwannimit
BACKGROUND: Recently, Surviving Sepsis Campaign (SSC) guideline was updated. Our objective was to evaluate the knowledge of residents in different departments regarding the SSC 2012. METHODS: A cross-sectional, descriptive self-questionnaire was distributed to interns and residents in the Departments of Internal Medicine, Surgery, and Emergency Medicine. RESULTS: The response rate was 136 (89%) from 153 residents. The residents included 46 (33%) interns, 42 (31%) internal medicine residents, 41 (30%) surgical residents, and 7 (5%) emergency residents...
February 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28248722/mortality-is-greater-in-septic-patients-with-hyperlactatemia-than-with-refractory-hypotension
#18
Robert Gotmaker, Sandra L Peake, Andrew Forbes, Rinaldo Bellomo
BACKGROUND: In septic patients, it is uncertain whether isolated hyperlactatemia (lactate ≥ 4 mmol/L without refractory hypotension) can be used to diagnose septic shock and whether mortality rate differs from that of isolated refractory hypotension (refractory to 1000 ml or greater fluid bolus). AIMS: To compare baseline characteristics, treatments and outcomes of participants enrolled into the Australian Resuscitation in Sepsis Evaluation (ARISE) trial according to the presence of isolated hyperlactatemia or isolated refractory hypotension...
February 28, 2017: Shock
https://www.readbyqxmd.com/read/28236396/challenges-in-sepsis-care-new-sepsis-definitions-and-fluid-resuscitation-beyond-the-central-venous-pressure
#19
REVIEW
Maureen A Seckel, Thomas Ahrens
There are two important recent changes in sepsis care. The first key change is the 2016 Sepsis-3 definitions from the recent consensus workgroup with new sepsis and septic shock definitions. Useful tools for assessing patients that have a greater risk of mortality include Sequential Organ Failure Assessment (SOFA) in intensive care units and quick SOFA outside intensive care units. The second change involves management of fluid resuscitation and measures of volume responsiveness. Measures such as blood pressure and central venous pressure are not reliable...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28159011/fluids-and-sepsis-changing-the-paradigm-of-fluid-therapy-a-case-report
#20
Hori Hariyanto, Corry Quando Yahya, Monika Widiastuti, Primartanto Wibowo, Oloan Eduard Tampubolon
BACKGROUND: Over the past 16 years, sepsis management has been guided by large-volume fluid administration to achieve certain hemodynamic optimization as advocated in the Rivers protocol. However, the safety of such practice has been questioned because large-volume fluid administration is associated with fluid overload and carries the worst outcome in patients with sepsis. Researchers in multiple studies have declared that using less fluid leads to increased survival, but they did not describe how to administer fluids in a timely and appropriate manner...
February 4, 2017: Journal of Medical Case Reports
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