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new sepsis definition

Aiko Okubo, Ayumu Nakashima, Shigehiro Doi, Toshinori Ueno, Kensuke Sasaki, Takashi Esaki, Takao Masaki
BACKGROUND: The definition of sepsis was updated to sepsis-3 in February 2016. Currently, direct hemoperfusion therapy using the polymyxin B-immobilized fiber cartridge (PMX-DHP) is widely performed to treat sepsis and septic shock. However, the prognostic factors of PMX-DHPs in patients with sepsis using the new definition are unclear. We retrospectively assessed prognostic factors in patients who had received PMX-DHP therapy for sepsis and septic shock. METHODS: We included 71 patients with severe infection who underwent PMX-DHP treatment from January 2006 to August 2015 in this study...
February 24, 2018: Clinical and Experimental Nephrology
Byuk Sung Ko, Kyuseok Kim, Sung-Hyuk Choi, Gu Hyun Kang, Tae Gun Shin, You Hwan Jo, Seung Mok Ryoo, Jin Ho Beom, Woon Yong Kwon, Kap Su Han, Han Sung Choi, Sung Phil Chung, Gil Joon Suh, Tae Ho Lim, Won Young Kim
BACKGROUND: Septic shock can be defined both by the presence of hyperlactatemia and need of vasopressors. Lactate levels should be measured after volume resuscitation (as per the Sepsis-3 definition). However, currently, no studies have evaluated patients who have been excluded by the new criteria for septic shock. The aim of this study was to determine the clinical characteristics and prognosis of these patients, based on their lactate levels after initial fluid resuscitation. METHODS: This observational study was performed using a prospective, multi-center registry of septic shock, with the participation of 10 hospitals in the Korean Shock Society, between October 2015 and February 2017...
February 24, 2018: Critical Care: the Official Journal of the Critical Care Forum
Robert Goulden, Marie-Claire Hoyle, Jessie Monis, Darran Railton, Victoria Riley, Paul Martin, Reynaldo Martina, Emmanuel Nsutebu
BACKGROUND: The third international consensus definition for sepsis recommended use of a new prognostic tool, the quick Sequential Organ Failure Assessment (qSOFA), based on its ability to predict inhospital mortality and prolonged intensive care unit (ICU) stay in patients with suspected infection. While several studies have compared the prognostic accuracy of qSOFA to the Systemic Inflammatory Response Syndrome (SIRS) criteria in suspected sepsis, few have compared qSOFA and SIRS to the widely used National Early Warning Score (NEWS)...
February 21, 2018: Emergency Medicine Journal: EMJ
Lena M Napolitano
BACKGROUND: Sepsis is a global healthcare issue and continues to be the leading cause of death from infection. Early recognition and diagnosis of sepsis is required to prevent the transition into septic shock, which is associated with a mortality rate of 40% or more. DISCUSSION: New definitions for sepsis and septic shock (Third International Consensus Definitions for Sepsis and Septic Shock [Sepsis-3]) have been developed. A new screening tool for sepsis (quick Sequential Organ Failure Assessment [qSOFA]) has been proposed to predict the likelihood of poor outcome in out-of-intensive care unit (ICU) patients with clinical suspicion of sepsis...
February 2018: Surgical Infections
Kapil Sahnan, Phil J Tozer, Samuel O Adegbola, Matthew J Lee, Nick Heywood, Angus G K McNair, Daniel Hind, Nuha Yassin, Alan J Lobo, Steven R Brown, Shaji Sebastian, Robin K S Phillips, Phillip F C Lung, Omar D Faiz, Kay Crook, Sue Blackwell, Azmina Verjee, Ailsa L Hart, Nicola S Fearnhead
OBJECTIVE: Lack of standardised outcomes hampers effective analysis and comparison of data when comparing treatments in fistulising perianal Crohn's disease (pCD). Development of a standardised set of outcomes would resolve these issues. This study provides the definitive core outcome set (COS) for fistulising pCD. DESIGN: Candidate outcomes were generated through a systematic review and patient interviews. Consensus was established via a three-round Delphi process using a 9-point Likert scale based on how important they felt it was in determining treatment success culminating in a final consensus meeting...
February 3, 2018: Gut
Robert Tidswell, Mervyn Singer
Sepsis is a common and often devastating medical emergency with a high mortality rate and, in many survivors, long-term morbidity. It is defined as the dysregulated host response to infection resulting in organ dysfunction, and its incidence is increasing as the population ages. However, it is a treatable and potentially reversible condition, especially if identified and treated promptly. A sound understanding of sepsis is crucial for optimal care. Although general guidelines are available for management, here we provide a foundation of understanding to encourage thoughtful, personalised management of sepsis during the acute phase...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Tim Rahmel
The new guideline of the Surviving Sepsis Campaign was revised in 2016 and presented in 2017. Furthermore, "Sepsis-3" in 2016 completely changed the definition of Sepsis from inflammation plus infection to a "life-threatening organ dysfunction caused by a dysregulated host response". To cope with the great challenge to unite the new evidence of sepsis treatment with the new definition of sepsis, the guidelines have been completely reconstructed and comprehensively deal with new evidence...
February 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Thorsten Brenner, Sebastian O Decker, Silke Grumaz, Philip Stevens, Thomas Bruckner, Thomas Schmoch, Mathias W Pletz, Hendrik Bracht, Stefan Hofer, Gernot Marx, Markus A Weigand, Kai Sohn
BACKGROUND: Sepsis remains a major challenge, even in modern intensive care medicine. The identification of the causative pathogen is crucial for an early optimization of the antimicrobial treatment regime. In this context, culture-based diagnostic procedures (e.g., blood cultures) represent the standard of care, although they are associated with relevant limitations. Accordingly, culture-independent molecular diagnostic procedures might be of help for the identification of the causative pathogen in infected patients...
February 2018: Medicine (Baltimore)
Massimo Sartelli, Yoram Kluger, Luca Ansaloni, Timothy C Hardcastle, Jordi Rello, Richard R Watkins, Matteo Bassetti, Eleni Giamarellou, Federico Coccolini, Fikri M Abu-Zidan, Abdulrashid K Adesunkanmi, Goran Augustin, Gian L Baiocchi, Miklosh Bala, Oussema Baraket, Marcelo A Beltran, Asri Che Jusoh, Zaza Demetrashvili, Belinda De Simone, Hamilton P de Souza, Yunfeng Cui, R Justin Davies, Sameer Dhingra, Jose J Diaz, Salomone Di Saverio, Agron Dogjani, Mutasim M Elmangory, Mushira A Enani, Paula Ferrada, Gustavo P Fraga, Sabrina Frattima, Wagih Ghnnam, Carlos A Gomes, Souha S Kanj, Aleksandar Karamarkovic, Jakub Kenig, Faryal Khamis, Vladimir Khokha, Kaoru Koike, Kenneth Y Y Kok, Arda Isik, Francesco M Labricciosa, Rifat Latifi, Jae G Lee, Andrey Litvin, Gustavo M Machain, Ramiro Manzano-Nunez, Piotr Major, Sanjay Marwah, Michael McFarlane, Ziad A Memish, Cristian Mesina, Ernest E Moore, Frederick A Moore, Noel Naidoo, Ionut Negoi, Richard Ofori-Asenso, Iyiade Olaoye, Carlos A Ordoñez, Mouaqit Ouadii, Ciro Paolillo, Edoardo Picetti, Tadeja Pintar, Alfredo Ponce-de-Leon, Guntars Pupelis, Tarcisio Reis, Boris Sakakushev, Hossein Samadi Kafil, Norio Sato, Jay N Shah, Boonying Siribumrungwong, Peep Talving, Cristian Tranà, Jan Ulrych, Kuo-Ching Yuan, Fausto Catena
The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
2018: World Journal of Emergency Surgery: WJES
Philip S Barie
BACKGROUND: Discussion of outcomes of surgical sepsis is no longer straightforward. Definitions of sepsis have changed recently and updated data are scant. Surgical patient populations are often heterogeneous; the patient population being considered must be described with precision. Traditional 30-d operative mortality may not be the most relevant outcome to consider. What should change or be the emphasis going forward? METHODS: Review and synthesis of pertinent English-language literature...
February 2, 2018: Surgical Infections
Mary Beth Flynn Makic, Elizabeth Bridges
: Sepsis is a leading cause of critical illness and hospital mortality. Early recognition and intervention are essential for the survival of patients with this syndrome. In 2002, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) launched the Surviving Sepsis Campaign (SSC) to reduce overall patient morbidity and mortality from sepsis and septic shock by driving practice initiatives based on current best evidence. The SSC guidelines have been updated every four years, with the most recent update completed in 2016...
February 2018: American Journal of Nursing
Mile Stanojcic, Roohi Vinaik, Marc G Jeschke
Burns are a common form of trauma that account for more than 300,000 deaths each year worldwide. Survival rates have improved over the past decades because of improvements in nutritional and fluid support, burn wound care, and infection control practices. Death, however, remains unacceptably high. The primary cause of death has changed over the last decades from anoxic causes to now predominantly infections and sepsis. Sepsis and septic complications are not only major contributors to poor outcomes, but they further result in longer hospital stay and higher healthcare costs...
February 2018: Surgical Infections
Alistair E W Johnson, Jerome Aboab, Jesse D Raffa, Tom J Pollard, Rodrigo O Deliberato, Leo A Celi, David J Stone
OBJECTIVES: To evaluate the relative validity of criteria for the identification of sepsis in an ICU database. DESIGN: Retrospective cohort study of adult ICU admissions from 2008 to 2012. SETTING: Tertiary teaching hospital in Boston, MA. PATIENTS: Initial admission of all adult patients to noncardiac surgical ICUs. INTERVENTIONS: Comparison of five different algorithms for retrospectively identifying sepsis, including the Sepsis-3 criteria...
January 4, 2018: Critical Care Medicine
Hiroshi Fukushima, Masaki Kobayashi, Keizo Kawano, Shinji Morimoto
PURPOSE: The Sepsis-3 Task Force proposed a new definition of sepsis based on SOFA and introduced a novel scoring system, qSOFA, for screening high-risk patients for sepsis. Their clinical usefulness, however, is unclear. Therefore, we investigated their predictive performance for mortality in APN-UTC patients. MATERIALS AND METHODS: This retrospective study included 141 consecutive patients clinically diagnosed with APN-UTC outside the ICU. We evaluated the performance of qSOFA, SOFA, and SIRS in predicting in-hospital mortality and ICU admission using the AUC of the ROC curve, NRI, IDI, and decision curve analysis...
December 29, 2017: Journal of Urology
Theodoros Retsas, Klaus Huse, Lazaros-Dimitrios Lazaridis, Niki Karampela, Michael Bauer, Matthias Platzer, Virginia Kolonia, Eirini Papageorgiou, Evangelos J Giamarellos-Bourboulis, George Dimopoulos
OBJECTIVES: Several manuscripts provide conflicting results for the role of single nucleotide polymorphisms (SNPs) at the promoter region of TNF for susceptibility to sepsis. Former manuscripts were based on previous sepsis definitions. We investigated the influence of TNF haplotypes on sepsis development using the new Sepsis-3 definitions. METHODS: DNA was isolated from patients suffering from infection and systemic inflammatory response syndrome; haplotyping was performed for six SNPs of TNF...
December 20, 2017: International Journal of Infectious Diseases: IJID
Ian J Barbash, Kimberly J Rak, Courtney C Kuza, Jeremy M Kahn
BACKGROUND: In October 2015, the Centers for Medicare and Medicaid Services (CMS) implemented the Sepsis CMS Core Measure (SEP-1) program, requiring hospitals to report data on the quality of care for their patients with sepsis. OBJECTIVE: We sought to understand hospital perceptions of and responses to the SEP-1 program. DESIGN: A thematic content analysis of semistructured interviews with hospital quality officials. SETTING: A stratified random sample of short-stay, nonfederal, general acute care hospitals in the United States...
December 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Joey Ho Yi Chan, Anthony Yuen Bun Teoh
The gold standard for treatment of acute cholecystitis is laparoscopic cholecystectomy. However, cholecystectomy is often not suitable for surgically unfit patients who are too frail due to various co-morbidities. As such, several less invasive endoscopic treatment modalities have been developed to control sepsis, either as a definitive treatment or as a temporizing modality until the patient is stable enough to undergo cholecystectomy at a later stage. Recent developments in endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with endoscopic ultrasound (EUS)-specific stents having lumen-apposing properties have demonstrated potential as a definitive treatment modality...
November 17, 2017: Clinical Endoscopy
Maurice LeGuen, Yvonne Ballueer, Richard McKay, Glenn Eastwood, Rinaldo Bellomo, Daryl Jones
AIM: A new definition of sepsis released by an international task-force has introduced the concept of quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA). This study aimed to measure the proportion of patients who fulfilled qSOFA criteria during a Rapid Response Team (RRT) review and to assess their associated outcomes. METHODS: We conducted a prospective study of adult RRT reviews over a one month period between 6th June and 10th July 2016 in a large tertiary hospital in Melbourne Australia RESULTS: Over a one-month period, there were 282 RRT reviews, 258 of which were included...
January 2018: Resuscitation
Bracken A Armstrong, Richard D Betzold, Addison K May
Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: early, appropriate antimicrobial therapy; restoration of adequate cellular perfusion; timely source control. The new definitions of sepsis and septic shock reflect the inadequate sensitivity, specify, and lack of prognostication of systemic inflammatory response syndrome criteria. Sequential (sepsis-related) organ failure assessment more effectively prognosticates in sepsis and critical illness. Inadequate cellular perfusion accelerates injury and reestablishing perfusion limits injury...
December 2017: Surgical Clinics of North America
M Shankar-Hari, D A Harrison, G D Rubenfeld, K Rowan
Background: New sepsis and septic shock definitions could change the epidemiology of sepsis because of differences in criteria. We therefore compared the sepsis populations identified by the old and new definitions. Methods: We used a high-quality, national, intensive care unit (ICU) database of 654 918 consecutive admissions to 189 adult ICUs in England, from January 2011 to December 2015. Primary outcome was acute hospital mortality. We compared old (Sepsis-2) and new (Sepsis-3) incidence, outcomes, trends in outcomes, and predictive validity of sepsis and septic shock populations...
October 1, 2017: British Journal of Anaesthesia
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