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https://www.readbyqxmd.com/read/28914215/-treatment-of-sepsis-in-perspective-what-have-25-years-of-sepsis-definition-brought-us
#1
M J M M van der Steen, P Dieperink, P Pickkers
The first official definition of sepsis was published in 1992. Last year, in 2016, the third version was published. In this article we discuss the various definitions, the evolving insights into pathophysiology and several of the treatments that have been implemented over the last 25 years.
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28914210/-sepsis-new-insights-new-definition
#2
W J Wiersinga, A R H van Zanten, K A Kaasjager, T van der Poll
- Incidence of sepsis is increasing, partly due to an ageing population, increased use of immunosuppressants, and antibiotic resistance. Sepsis survival has improved substantially, in part because of continuously improving intensive care and implementation of evidence-based guidelines.- Sepsis is defined as 'life-threatening organ dysfunction due to a dysregulated host response to infection'. The Sequential Organ Failure Assessment (SOFA) score can be used to estimate organ dysfunction severity.- In this article, we discuss the new sepsis definitions - including reactions to these definitions, an overview of current insights in sepsis pathogenesis, and the new treatment guidelines...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28903154/incidence-and-trends-of-sepsis-in-us-hospitals-using-clinical-vs-claims-data-2009-2014
#3
Chanu Rhee, Raymund Dantes, Lauren Epstein, David J Murphy, Christopher W Seymour, Theodore J Iwashyna, Sameer S Kadri, Derek C Angus, Robert L Danner, Anthony E Fiore, John A Jernigan, Greg S Martin, Edward Septimus, David K Warren, Anita Karcz, Christina Chan, John T Menchaca, Rui Wang, Susan Gruber, Michael Klompas
Importance: Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time. Objective: To estimate the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. Design, Setting, and Population: Retrospective cohort study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014...
September 13, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28884313/endocan-as-an-early-biomarker-of-severity-in-patients-with-acute-respiratory-distress-syndrome
#4
Diego Orbegozo, Lokmane Rahmania, Marian Irazabal, Manuel Mendoza, Filippo Annoni, Daniel De Backer, Jacques Creteur, Jean-Louis Vincent
BACKGROUND: Plasma concentrations of endocan, a proteoglycan preferentially expressed in the pulmonary vasculature, may represent a biomarker of lung (dys)function. We sought to determine whether the measurement of plasma endocan levels early in the course of acute respiratory distress syndrome (ARDS) could help predict risk of death or of prolonged ventilation. METHODS: All patients present in the department of intensive care during a 150-day period were screened for ARDS (using the Berlin definition)...
September 7, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28876598/spectrum-of-disease-and-outcome-of-primary-amputation-for-diabetic-foot-sepsis
#5
S Cheddie, C Manneh, H Zulu
BACKGROUND: Guillotine amputation for diabetic foot sepsis followed by an elective refashioning of the stump is regarded as standard practice. Primary amputation is associated with higher reamputation rates. METHOD: A prospective cohort study of 85 patients who underwent surgery for diabetic foot sepsis from 2014 to 2016 at Madadeni Provincial Hospital, KwaZulu-Natal was done. Ethical approval was granted. The Wagner classification (Wag) was used to classify disease severity...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28874949/sepsis-definitions-the-search-for-gold-and-what-cms-got-wrong
#6
REVIEW
Annahieta Kalantari, Haney Mallemat, Scott D Weingart
On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are premature and inconsistent with evidence-based definitions.
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28789803/preliminary-performance-on-the-new-cms-sepsis-1-national-quality-measure-early-insights-from-the-emergency-quality-network-e-qual
#7
Arjun K Venkatesh, Todd Slesinger, Jessica Whittle, Tiffany Osborn, Emily Aaronson, Craig Rothenberg, Nalani Tarrant, Pawan Goyal, Donald M Yealy, Jeremiah D Schuur
STUDY OBJECTIVE: We describe current hospital-level performance for the Centers for Medicare & Medicaid Services' Severe Sepsis/Septic Shock Early Management Bundle (SEP-1) quality measure and qualitatively assess emergency department (ED) sepsis quality improvement best practice implementation. METHODS: Using a standardized Web-based submission portal, we surveyed quality improvement data from volunteer hospital-based EDs participating in the Emergency Quality Network Sepsis Initiative...
August 5, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28743646/sepsis-and-septic-shock-new-definitions-new-diagnostic-and-therapeutic-approaches
#8
REVIEW
Silvano Esposito, Giuseppe De Simone, Giovanni Boccia, Francesco De Caro, Pasquale Pagliano
Sepsis and septic shock are common life-threatening pathologies associated with high mortality and substantial costs for healthcare system. Clinical guidelines and bundles for the management of patients with sepsis have recently been updated. Herein, we review the history of sepsis and related conditions definitions from the first consensus conference in 1991 to nowadays, the epidemiologic data resulting from worldwide studies on incidence and mortality, the diagnostic approaches including the microbiological assessment of infection and the use of several prognostic and diagnostic biomarkers and finally we review the main therapeutic measures as the intravenous immunoglobulin therapy and the administration of appropriate antibiotic treatment to provide patients with sepsis a favourable outcome in the antibiotic-resistance era...
September 2017: Journal of Global Antimicrobial Resistance
https://www.readbyqxmd.com/read/28742549/readmissions-for-recurrent-sepsis-new-or-relapsed-infection
#9
Kimberley Marie DeMerle, Stephanie C Royer, Mark E Mikkelsen, Hallie C Prescott
OBJECTIVES: Sepsis hospitalizations are frequently followed by hospital readmissions, often for recurrent sepsis. However, it is unclear how often sepsis readmissions are for relapsed/recrudescent versus new infections. The aim of this study was to assess the extent to which 90-day readmissions for recurrent sepsis are due to infection of the same site and same pathogen as the initial episode. DESIGN: Retrospective cohort study. SETTING: University of Michigan Health System...
October 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28729906/update-on-pediatric-sepsis-a-review
#10
REVIEW
Tatsuya Kawasaki
BACKGROUND: Sepsis is one of the leading causes of mortality among children worldwide. Unfortunately, however, reliable evidence was insufficient in pediatric sepsis and many aspects in clinical practice actually depend on expert consensus and some evidence in adult sepsis. More recent findings have given us deep insights into pediatric sepsis since the publication of the Surviving Sepsis Campaign guidelines 2012. MAIN TEXT: New knowledge was added regarding the hemodynamic management and the timely use of antimicrobials...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28709458/markers-of-nitric-oxide-are-associated-with-sepsis-severity-an-observational-study
#11
Martin Sebastian Winkler, Stefan Kluge, Maximilian Holzmann, Eileen Moritz, Linda Robbe, Antonia Bauer, Corinne Zahrte, Marion Priefler, Edzard Schwedhelm, Rainer H Böger, Alwin E Goetz, Axel Nierhaus, Christian Zoellner
BACKGROUND: Nitric oxide (NO) regulates processes involved in sepsis progression, including vascular function and pathogen defense. Direct NO measurement in patients is unfeasible because of its short half-life. Surrogate markers for NO bioavailability are substrates of NO generating synthase (NOS): L-arginine (lArg) and homoarginine (hArg) together with the inhibitory competitive substrate asymmetric dimethylarginine (ADMA). In immune cells ADMA is cleaved by dimethylarginine-dimethylaminohydrolase-2 (DDAH2)...
July 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28709443/severity-of-acute-gastrointestinal-injury-grade-is-a-predictor-of-all-cause-mortality-in-critically-ill-patients-a-multicenter-prospective-observational-study
#12
Bangchuan Hu, Renhua Sun, Aiping Wu, Yin Ni, Jingquan Liu, Feng Guo, Lijun Ying, Guoping Ge, Aijun Ding, Yunchao Shi, Changwen Liu, Lei Xu, Ronglin Jiang, Jun Lu, Ronghai Lin, Yannan Zhu, Weidong Wu, Bo Xie
BACKGROUND: In 2012, the European Society of Intensive Care Medicine proposed a definition for acute gastrointestinal injury (AGI) based on current medical evidence and expert opinion. The aim of the present study was to evaluate the feasibility of using the current AGI grading system and to investigate the association between AGI severity grades with clinical outcome in critically ill patients. METHODS: Adult patients at 14 general intensive care units (ICUs) with an expected ICU stay ≥24 h were prospectively studied...
July 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28697503/update-of-sepsis-in-the-intensive-care-unit
#13
Kelly Roveran Genga, James A Russell
Sepsis, the most common cause of admission to an intensive care unit (ICU), has had an increased incidence and prevalence over the last years with a simultaneous decrease in its short-term mortality. Sepsis survivors are more frequently discharged from hospital and often experience long-term outcomes such as late mortality, immune dysfunction, secondary infections, impaired quality of life, and unplanned readmissions. Early recognition and management of sepsis have challenged emergency care and critical care physicians and nurses...
2017: Journal of Innate Immunity
https://www.readbyqxmd.com/read/28682024/-cardio-renal-axis-pathophysiological-evidences-and-clinical-implications
#14
Luca Di Lullo, Claudio Ronco
According to the recent definition proposed by the Consensus conference on Acute Dialysis Quality Initiative Group, the term cardio-renal syndrome CRS has been used to define different clinical conditions in which heart and kidney dysfunction overlap. Type 1 CRS acute cardio - renal syndrome is characterized by acute worsening of cardiac function leading to AKI in the setting of active cardiac disease such as ADHF, while type - 2 CRS occurs in a setting of chronic heart disease. Type 3 CRS is closely link to acute kidney injury, while type 4 represent cardiovascular involvement in chronic kidney disese patients...
March 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28638427/colopharyngoplasty-in-patients-with-severe-pharyngoesophageal-corrosive-injury-a-complicated-but-worthwhile-procedure-to-restore-gi-tract-continuity-a-case-series
#15
Mahdi Zangi, Seyed Reza Saghebi, Ali Biharas Monfared, Seyedamirmohammad Lajevardi, Mohammad Behgam Shadmehr
BACKGROUND: Pharyngoesophageal strictures (PES) after corrosive injury impose a problematic condition for both physicians and patients in terms of their management and patients' quality of life. Colopharyngoplasty is a complex procedure, which is used to restore swallowing in these severely disabled patients. We describe our experience in treating nine patients with severe PES after corrosive injuries in a referral center. MATERIALS AND METHODS: A retrospective analysis of our database from 2009 to 2014 showed nine patients (seven men; age range: 18 to 47 years) with severe PES who underwent colopharyngoplasty ∼6 months (range: 4-10) after caustic material ingestion...
2017: Tanaffos
https://www.readbyqxmd.com/read/28637738/the-reanimation-low-immune-status-markers-realism-project-a-protocol-for-broad-characterisation-and-follow-up-of-injury-induced-immunosuppression-in-intensive-care-unit-icu-critically-ill-patients
#16
Mary-Luz Rol, Fabienne Venet, Thomas Rimmele, Virginie Moucadel, Pierre Cortez, Laurence Quemeneur, David Gardiner, Andrew Griffiths, Alexandre Pachot, Julien Textoris, Guillaume Monneret
INTRODUCTION: The host response to septic shock is dynamic and complex. A sepsis-induced immunosuppression phase has recently been acknowledged and linked to bad outcomes and increased healthcare costs. Moreover, a marked suppression of the immune response has also been partially described in patients hospitalized in intensive care unit (ICU) for severe trauma or burns. It has been hypothesized that immune monitoring could enable identification of patients who might most benefit from novel, adjunctive immune-stimulating therapies...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28637565/is-percutaneous-cholecystostomy-a-good-alternative-treatment-for-acute-cholecystitis-in-high-risk-patients
#17
Davide Papis, Eiman Khalifa, Ricky Bhogal, Amit Nair, Saboor Khan, Zaed Hamady, Jawad Ahmed, Gabriele Marangoni
Cholecystectomy is the treatment of choice for acute cholecystitis but the management of high-risk surgical patients is a difficult dilemma. Percutaneous cholecystostomy (PC) could represent a safer and less invasive option. The aim of the study was to assess the outcomes of PC in high-risk patients. This is a retrospective single-center study; data were collected from our hospital electronic record system. From February 2009 to March 2014, there were 753 patients admitted with acute cholecystitis. Of these 39 were considered high risk for surgery and underwent PC during their hospital stay...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28613918/new-sepsis-definition-sepsis-3-and-community-acquired-pneumonia-mortality-a-validation-and-clinical-decision-making-study
#18
Otavio T Ranzani, Elena Prina, Rosario Menéndez, Adrian Ceccato, Catia Cilloniz, Raul Méndez, Albert Gabarrus, Enric Barbeta, Gianluigi Li Bassi, Miquel Ferrer, Antoni Torres
RATIONALE: Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown. OBJECTIVE: To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia (CAP). METHODS: Cohort study including adult patients with CAP from two Spanish university-hospitals...
June 14, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28611227/lung-injury-etiology-and-other-factors-influencing-the-relationship-between-dead-space-fraction-and-mortality-in-ards
#19
Richard H Kallet, Hanjing Zhuo, Kelly Ho, Michael S Lipnick, Antonio Gomez, Michael A Matthay
BACKGROUND: In ARDS, elevated pulmonary dead-space fraction (VD/VT) is a particularly strong indicator of mortality risk. Whether the magnitude of VD/VT is modified by the underlying etiology of ARDS and whether this influences the strength of its association with mortality remains unknown. We sought to elucidate the impact of ARDS etiology on VD/VT and also to determine whether ARDS severity, as classified by the Berlin definition, has correspondence with changes in VD/VT. METHODS: This single-center, retrospective, observational study (2010-2016) measured VD/VT in 685 subjects with ARDS as part of clinical management with lung-protective ventilation...
June 13, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28607338/blood-purification-with-continuous-veno-venous-hemofiltration-in-patients-with-sepsis-or-ards-a-systematic-review-and-meta-analysis
#20
Alessandro Putzu, Ming-Xing Fang, Martina Boscolo Berto, Alessandro Belletti, Luca Cabrini, Tiziano Cassina, Giovanni Landoni
INTRODUCTION: Severe inflammatory conditions, as severe sepsis/septic shock and acute respiratory distress syndrome (ARDS), are related to high morbidity and mortality. We performed a meta-analysis of randomized trials to assess if blood purification with continuous veno-venous hemofiltration (CVVH) reduces mortality in these settings. EVIDENCE ACQUISITION: Online databases were searched for pertinent studies up to March 2017. We included randomized-controlled trials on the use of CVVH as blood purification technique in comparison to conventional therapy in adult patients with severe sepsis/septic shock or ARDS but no acute kidney injury needing renal replacement therapy...
August 2017: Minerva Anestesiologica
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