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https://www.readbyqxmd.com/read/28099689/effectiveness-and-safety-of-procalcitonin-evaluation-for-reducing-mortality-in-adults-with-sepsis-severe-sepsis-or-septic-shock
#1
REVIEW
Brenda Ng Andriolo, Regis B Andriolo, Reinaldo Salomão, Álvaro N Atallah
BACKGROUND: Serum procalcitonin (PCT) evaluation has been proposed for early diagnosis and accurate staging and to guide decisions regarding patients with sepsis, severe sepsis and septic shock, with possible reduction in mortality. OBJECTIVES: To assess the effectiveness and safety of serum PCT evaluation for reducing mortality and duration of antimicrobial therapy in adults with sepsis, severe sepsis or septic shock. SEARCH METHODS: We searched the Central Register of Controlled Trials (CENTRAL; 2015, Issue 7); MEDLINE (1950 to July 2015); Embase (Ovid SP, 1980 to July 2015); Latin American Caribbean Health Sciences Literature (LILACS via BIREME, 1982 to July 2015); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO host, 1982 to July 2015), and trial registers (ISRCTN registry, ClinicalTrials...
January 18, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28063688/crystalloid-fluid-choice-and-clinical-outcomes-in-pediatric-sepsis-a-matched-retrospective-cohort-study
#2
Scott L Weiss, Luke Keele, Fran Balamuth, Neika Vendetti, Rachael Ross, Julie C Fitzgerald, Jeffrey S Gerber
OBJECTIVE: To test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis. STUDY DESIGN: We performed matched analyses using data from 12 529 patients <18 years of age with severe sepsis/septic shock at 382 US hospitals between 2000 and 2013 to compare outcomes with vs without LR as part of initial resuscitation. Patients receiving LR were matched 1:1 to patients receiving only NS (NS group), including separate matches for any (LR-any group) or exclusive (LR-only group) LR use...
January 4, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28060151/new-or-progressive-multiple-organ-dysfunction-syndrome-in-pediatric-severe-sepsis-a-sepsis-phenotype-with-higher-morbidity-and-mortality
#3
John C Lin, Philip C Spinella, Julie C Fitzgerald, Marisa Tucci, Jenny L Bush, Vinay M Nadkarni, Neal J Thomas, Scott L Weiss
OBJECTIVES: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. DESIGN: Secondary analysis of a prospective, cross-sectional, point prevalence study. SETTING: International, multicenter PICUs. PATIENTS: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. INTERVENTIONS: None...
January 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28053267/assessment-of-resuscitation-as-measured-by-markers-of-metabolic-acidosis-and-features-of-injury
#4
D S Weinberg, A S Narayanan, T A Moore, H A Vallier
AIMS: The best time for definitive orthopaedic care is often unclear in patients with multiple injuries. The objective of this study was make a prospective assessment of the safety of our early appropriate care (EAC) strategy and to evaluate the potential benefit of additional laboratory data to determine readiness for surgery. PATIENTS AND METHODS: A cohort of 335 patients with fractures of the pelvis, acetabulum, femur, or spine were included. Patients underwent definitive fixation within 36 hours if one of the following three parameters were met: lactate < 4...
January 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28052152/types-of-myocardial-infarction-among-human-immunodeficiency-virus-infected-individuals-in-the-united-states
#5
Heidi M Crane, Pathmaja Paramsothy, Daniel R Drozd, Robin M Nance, J A Chris Delaney, Susan R Heckbert, Matthew J Budoff, Greer A Burkholder, James H Willig, Michael J Mugavero, William C Mathews, Paul K Crane, Richard D Moore, Joseph J Eron, Sonia Napravnik, Peter W Hunt, Elvin Geng, Priscilla Hsue, Carla Rodriguez, Inga Peter, Greg S Barnes, Justin McReynolds, William B Lober, Kristina Crothers, Mathew Feinstein, Carl Grunfeld, Michael S Saag, Mari M Kitahata
Importance: The Second Universal Definition of Myocardial Infarction (MI) divides MIs into different types. Type 1 MIs result spontaneously from instability of atherosclerotic plaque, whereas type 2 MIs occur in the setting of a mismatch between oxygen demand and supply, as with severe hypotension. Type 2 MIs are uncommon in the general population, but their frequency in human immunodeficiency virus (HIV)-infected individuals is unknown. Objectives: To characterize MIs, including type; identify causes of type 2 MIs; and compare demographic and clinical characteristics among HIV-infected individuals with type 1 vs type 2 MIs...
January 4, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28050898/impact-of-transfusion-on-patients-with-sepsis-admitted-in-intensive-care-unit-a-systematic-review-and-meta-analysis
#6
REVIEW
Claire Dupuis, Romain Sonneville, Christophe Adrie, Antoine Gros, Michael Darmon, Lila Bouadma, Jean-François Timsit
Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. A threshold of 7 g/dL for stabilized patients with sepsis is commonly proposed, although debated. The aim of the study was to compare the benefit and harm of restrictive versus liberal RBCT strategies in order to guide physicians on RBCT strategies in patients with severe sepsis or septic shock. Four outcomes were assessed: death, nosocomial infection (NI), acute lung injury (ALI) and acute kidney injury (AKI)...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/27997816/recent-early-clinical-drug-development-for-acute-kidney-injury
#7
Kevin M Gallagher, Stephen O'neill, Ewen M Harrison, James A Ross, Stephen J Wigmore, Jeremy Hughes
Despite significant need and historical trials, there are no effective drugs in use for the prevention or treatment of acute kidney injury (AKI). There are several promising agents in early clinical development for AKI and two trials have recently been terminated. There are also exciting new findings in pre-clinical AKI research. There is a need to take stock of current progress in the field to guide future drug development for AKI. Areas covered: The main clinical trial registries, PubMed and pharmaceutical company website searches were used to extract the most recent clinical trials for sterile, transplant and sepsis-associated AKI...
December 27, 2016: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/27942538/sepsis-incidence-a-population-based-study
#8
Lisa Mellhammar, Sven Wullt, Åsa Lindberg, Peter Lanbeck, Bertil Christensson, Adam Linder
BACKGROUND: Although sepsis is a major health problem, data on sepsis epidemiology are scarce. The aim of this study was to assess the incidence of sepsis, based on clinical findings in all adult patients treated with intravenous antibiotic in all parts of all hospitals in an entire population. METHODS: This is a retrospective chart review of patients ≥18 years, living in 2 regions in Sweden, who were started on an intravenous antibiotic therapy on 4 dates, evenly distributed over the year of 2015...
October 2016: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/27941979/impact-and-effectiveness-of-10-and-13-valent-pneumococcal-conjugate-vaccines-on-hospitalization-and-mortality-in-children-aged-less-than-5-years-in-latin-american-countries-a-systematic-review
#9
Lucia Helena de Oliveira, Luiz Antonio B Camacho, Evandro S F Coutinho, Martha S Martinez-Silveira, Ana Flavia Carvalho, Cuauhtemoc Ruiz-Matus, Cristiana M Toscano
BACKGROUND: Several Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs. OBJECTIVES: We aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region. METHODS: We conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis...
2016: PloS One
https://www.readbyqxmd.com/read/27940455/sepsis-for-the-anaesthetist
#10
M E Nunnally
Sepsis is as a dysregulated systemic response to infection. Morbidity and mortality of the syndrome are very high worldwide. Recent definitions have redefined criteria for sepsis. The new definition (Sepsis-3) classifies sepsis as infection with organ dysfunction (the old 'severe sepsis'). Septic patients are at risk for secondary injuries, thus aggressive source control, resuscitation, and antibiotic therapy are the mainstays of management. Central to sepsis physiology is vasodilated shock. Many patients respond to i...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27910086/higher-vs-lower-haemoglobin-threshold-for-transfusion-in-septic-shock-subgroup-analyses-of-the-triss-trial
#11
S L Rygård, L B Holst, J Wetterslev, P I Johansson, A Perner
BACKGROUND: Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. METHODS: In post-hoc analyses of the full trial population of 998 patients from the Transfusion Requirements in Septic Shock (TRISS) trial, we investigated the intervention effect on 90-day mortality in patients with severe comorbidity (chronic lung disease, haematological malignancy or metastatic cancer), in patients who had undergone surgery (elective or acute) and in patients with septic shock as defined by the new consensus definition: lactate above 2 mmol/l and the need for vasopressors to maintain a mean arterial pressure above 65 mmHg...
February 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27909859/sofa-score-and-left-ventricular-systolic-function-as-predictors-of-short-term-outcome-in-patients-with-sepsis
#12
Francesca Innocenti, Vittorio Palmieri, Aurelia Guzzo, Valerio Teodoro Stefanone, Chiara Donnini, Riccardo Pini
In a group of septic patients, we assess the short-term prognostic value of LV systolic performance, evaluated through conventional left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (LV GLS). One hundred forty-seven patients with sepsis were recruited; LVEF by planimetry and peak GLS by 2D speckle tracking could be assessed within 24 h. The study population was stratified according to SOFA tertiles assessed at the time of the echocardiogram (G1: SOFA score <5; G2: SOFA score 5-7; G3: SOFA score >7)...
December 1, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27908326/defining-and-diagnosing-sepsis
#13
REVIEW
Michael C Scott
Sepsis is a heterogeneous clinical syndrome that encompasses infections of many different types and severity. Not surprisingly, it has confounded most attempts to apply a single definition, which has also limited the ability to develop a set of reliable diagnostic criteria. It is perhaps best defined as the different clinical syndromes produced by an immune response to infection that causes harm to the body beyond that of the local effects of the infection.
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27856268/validation-of-the-new-sepsis-3-definitions-proposal-for-improvement-in-early-risk-identification
#14
E J Giamarellos-Bourboulis, T Tsaganos, I Tsangaris, M Lada, C Routsi, D Sinapidis, M Koupetori, M Bristianou, G Adamis, K Mandragos, G N Dalekos, I Kritselis, G Giannikopoulos, I Koutelidakis, M Pavlaki, E Antoniadou, G Vlachogiannis, V Koulouras, A Prekates, G Dimopoulos, A Koutsoukou, I Pnevmatikos, A Ioakeimidou, A Kotanidou, S E Orfanos, A Armaganidis, C Gogos
OBJECTIVES: Sepsis-3 definitions generated controversies regarding their general applicability. The Sepsis-3 Task Force outlined the need for validation with emphasis on the quick Sequential Organ Failure Assessment (qSOFA) score. This was done in a prospective cohort from a different healthcare setting. METHODS: Patients with infections and at least two signs of systemic inflammatory response syndrome (SIRS) were analysed. Sepsis was defined as total SOFA ≥2 outside the intensive care unit (ICU) or as an increase of ICU admission SOFA ≥2...
November 14, 2016: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/27854510/variation-in-post-sepsis-readmission-patterns-a-cohort-study-of-veterans-affairs-beneficiaries
#15
Hallie C Prescott
RATIONALE: Re-hospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations. OBJECTIVES: To examine the variation in post-sepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries. METHODS: Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009-2011) at 114 VA hospitals, stratified by age (<65 versus ≥ 65 years), nursing home usage (none, chronic, or acute), year of admission (2009, 2010, 2011), and hospital...
November 17, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27846034/an-update-on-classification-and-management-of-urosepsis
#16
Florian M E Wagenlehner, Zafer Tandogdu, Truls E Bjerklund Johansen
PURPOSE OF REVIEW: The urinary tract is the infection site in severe sepsis/septic shock in 10-30%. RECENT FINDINGS: There is a new Sepsis definition focusing on severe sepsis. Urosepsis is mainly due to obstructed uropathy of the upper urinary tract. The pathogenesis of sepsis is complex and is driven by the innate immune system. In the further course immunosuppression is developing.Management of urosepsis includes early diagnosis, early initiation of treatment such as identification and control of the complicating factor in the urinary tract and the specific sepsis therapy...
November 14, 2016: Current Opinion in Urology
https://www.readbyqxmd.com/read/27816128/surgical-critical-care-for-the-patient-with-sepsis-and-multiple-organ-dysfunction
#17
REVIEW
Gary J Kaml, Kimberly A Davis
Sepsis and multiple organ dysfunction syndrome (MODS) is common in the surgical intensive care unit. Sepsis involves infection and the patient's immune response. Timely recognition of sepsis and swift application of evidence-based interventions is critical to the success of therapy. This article reviews the nature of the septic process, existing definitions of sepsis, and current evidence-based treatment strategies for sepsis and MODS. An improved understanding of the process of sepsis and its relation to MODS has resulted in clinical definitions and scoring systems that allow for the quantification of disease severity and guidelines for treatment...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27807819/sepsis-3-definitions-predict-icu-mortality-in-a-low-middle-income-country
#18
Bruno Adler Maccagnan Pinheiro Besen, Thiago Gomes Romano, Antonio Paulo Nassar, Leandro Utino Taniguchi, Luciano Cesar Pontes Azevedo, Pedro Vitale Mendes, Fernando Godinho Zampieri, Marcelo Park
BACKGROUND: Sepsis-3 definitions were published recently and validated only in high-income countries. The aim of this study was to assess the new criteria's accuracy in stratifying mortality as compared to its predecessor (Sepsis-2) in a Brazilian public intensive care unit (ICU) and to investigate whether the addition of lactate values would improve stratification. METHODS: Retrospective cohort study conducted between 2010 and 2015 in a public university's 19-bed ICU...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27793427/clinical-and-microbiological-features-of-maternal-sepsis-a-retrospective-study
#19
G Abir, S Akdagli, A Butwick, B Carvalho
BACKGROUND: Identifying pregnant women with sepsis is challenging because diagnostic clinical and laboratory criteria overlap with normal pregnant physiologic indices. Our primary study aim was to describe clinical and laboratory characteristics of women diagnosed with sepsis, severe sepsis and septic shock. Our secondary aim was to determine positive predictive values for International Classification of Disease (ICD)-9 billing codes for sepsis, severe sepsis, and septic shock. METHODS: After gaining Institutional Review Board approval, we identified women with ICD-9 codes for sepsis, severe sepsis and septic shock who were admitted to a single tertiary obstetric center from 2007-2013...
September 10, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27787367/treatment-strategy-for-treating-atrial-esophageal-fistula-esophageal-stenting-or-surgical-repair-a-case-report-and-literature-review
#20
Bing Zhou, Xue-Jiang Cen, Lin-Yan Qian, Jie Pang, Hai Zou, Ya-Hui Ding
INTRODUCTION: Atrial-esophageal fistula (AEF) is a rare severe disease, which may be associated with radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) or intraoperative radiofrequency ablation of atrial fibrillation (IRAAF). CLINICAL FINDINGS: We reported a case of a 67-year-old man with AEF following RFCA of AF, who treated with esophageal stenting and surgical repair. OUTCOMES: He was attacked by out-of-control sepsis and infectious shock after surgery and died...
October 2016: Medicine (Baltimore)
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