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https://www.readbyqxmd.com/read/27910086/higher-vs-lower-haemoglobin-threshold-for-transfusion-in-septic-shock-subgroup-analyses-of-the-triss-trial
#1
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...
December 2, 2016: 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
#2
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
#3
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
#4
Evangelos J Giamarellos-Bourboulis, Thomas Tsaganos, Iraklis Tsangaris, Malvina Lada, Christina Routsi, Dimitrios Sinapidis, Marina Koupetori, Magdalini Bristianou, George Adamis, Konstantinos Mandragos, George N Dalekos, Ioannis Kritselis, George Giannikopoulos, Ioannis Koutelidakis, Maria Pavlaki, Eleni Antoniadou, Glykeria Vlachogiannis, Vasilios Koulouras, Athanassios Prekates, George Dimopoulos, Antonia Koutsoukou, Ioannis Pnevmatikos, Aikaterini Ioakeimidou, Anastasia Kotanidou, Stylianos E Orfanos, Apostolos Armaganidis, Charalambos Gogos
OBJECTIVES: Sepsis-3 definitions generated controversies regarding their general applicability. The Sepsis-3 Task Force outscored the need of validation with emphasis on quick SOFA (qSOFA) score. This was done in a prospective cohort coming from a different health-care setting. METHODS: Patients with infections and at least two signs of the systemic inflammatory response syndrome (SIRS) were analyzed. Sepsis was defined as total SOFA ≥2 outside the ICU or as 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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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)
https://www.readbyqxmd.com/read/27777118/the-occurrence-of-infective-endocarditis-with-staphylococcus-lugdunensis-bacteremia-a-retrospective-cohort-study-and-systematic-review
#11
Lemuel R Non, Carlos A Q Santos
BACKGROUND: Staphylococcus lugdunensis is a coagulase-negative staphylococcus with similar virulence characteristics as S. aureus. Whether S. lugdunensis causes infective endocarditis (IE) in a similar proportion of cases as S. aureus (reported to be 12.6% in a definitive multicenter prospective study) is unclear. METHODS: We conducted a retrospective cohort study of adult patients with at least one blood culture positive for S. lugdunensis at our institution from January 2006 to December 2014...
October 21, 2016: Journal of Infection
https://www.readbyqxmd.com/read/27771598/absolute-lactate-value-vs-relative-reduction-as-a-predictor-of-mortality-in-severe-sepsis-and-septic-shock
#12
Sharukh Lokhandwala, Lars W Andersen, Sunil Nair, Parth Patel, Michael N Cocchi, Michael W Donnino
PURPOSE: Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values. MATERIALS AND METHODS: We performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate ≥4mmol/L and suspected infection...
October 6, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27765172/a-series-of-transbronchial-removal-of-intracavitary-pulmonary-aspergilloma
#13
David R Stather, Alain Tremblay, Elaine Dumoulin, Paul MacEachern, Alex Chee, Christopher Hergott, Jacob Gelberg, Gary A Gelfand, Paul Burrowes, John H MacGregor, Christopher H Mody
BACKGROUND: Intracavitary pulmonary aspergilloma is a chronic, debilitating fungal infection. Without definitive therapy, death can occur from massive hemoptysis, cachexia, or secondary infection. Although surgical resection is the standard therapy, it is not possible for many patients owing to poor pulmonary function or medical comorbidities. Aspergilloma removal through bronchoscopy is an important alternative therapy that may be available in select cases. METHODS: We retrospectively reviewed all cases referred to the University of Calgary Interventional Pulmonary Service for transbronchial removal of intracavitary aspergilloma from January 1, 2009, to January 1, 2014...
October 17, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27747458/acute-on-chronic-liver-failure
#14
Shiv Kumar Sarin, Ashok Choudhury
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame...
December 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27744308/ast-to-alt-ratio-is-elevated-in-disseminated-histoplasmosis-as-compared-to-localized-pulmonary-disease-and-other-endemic-mycoses
#15
Andrej Spec, Christopher R Barrios, Usama Ahmad, Laurie A Proia
Severe pulmonary or disseminated histoplasmosis often necessitates presumptive antifungal treatment while awaiting definitive diagnosis. Histoplasma antigen assays have improved sensitivity but results may lag up to 7 days. In order to increase diagnostic certainty, "soft clues" may be looked for in laboratory and radiologic data, such as elevated alkaline phosphatase or ferritin levels and findings of mediastinal adenopathy or hepatosplenomegaly. To determine if elevated aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio is specific to histoplasmosis or a non-specific marker for disseminated fungal infection or sepsis in general, we retrospectively examined records of all patients diagnosed with an endemic fungal infection (EFI) at Rush University Medical Center from January of 1997 to October of 2012, and a cohort of septic patients with elevated liver enzymes...
October 14, 2016: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
https://www.readbyqxmd.com/read/27733132/differences-in-reported-sepsis-incidence-according-to-study-design-a-literature-review
#16
Saga Elise Mariansdatter, Andreas Halgreen Eiset, Kirstine Kobberøe Søgaard, Christian Fynbo Christiansen
BACKGROUND: Sepsis and severe sepsis are common conditions in hospital settings, and are associated with high rates of morbidity and mortality, but reported incidences vary considerably. In this literature review, we describe the variation in reported population-based incidences of sepsis and severe sepsis. We also examine methodological and demographic differences between studies that may explain this variation. METHODS: We carried out a literature review searching three major databases and reference lists of relevant articles, to identify all original studies reporting the incidence of sepsis or severe sepsis in the general population...
October 12, 2016: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/27733100/oxidative-stress-biomarkers-in-pediatric-sepsis-a-prospective-observational-pilot-study
#17
Víctor Molina, Bettina von Dessauer, Ramón Rodrigo, Cristian Carvajal
OBJECTIVES: Oxidative stress is known to participate in the progression of sepsis. Definite data regarding the behavior of oxidative stress biomarkers in pediatric sepsis is still lacking. This study hypothesized that oxidative stress occurs in pediatric sepsis and that the magnitude of the redox derangement is associated with worse clinical progression. METHODS: Forty-two previously healthy pediatric patients with sepsis and a group of control subjects were included...
October 13, 2016: Redox Report: Communications in Free Radical Research
https://www.readbyqxmd.com/read/27720289/new-mandated-centers-for-medicare-and-medicaid-services-requirements-for-sepsis-reporting-caution-from-the-field
#18
Emily L Aaronson, Michael R Filbin, David F M Brown, Kathy Tobin, Elizabeth A Mort
BACKGROUND: The release of the Center for Medicare and Medicaid Service's (CMS) latest quality measure, Severe Sepsis/Septic Shock Early Management Bundle (SEP-1), has intensified the long-standing debate over optimal care for severe sepsis and septic shock. Although the last decade of research has demonstrated the importance of comprehensive bundled care in conjunction with compliance mechanisms to reduce patient mortality, it is not clear that SEP-1 achieves this aim. The heterogeneous and often cryptic presentation of severe sepsis and septic shock, along with the multifaceted criteria for the definition of this clinical syndrome, pose a particular challenge for fitting requirements to this disease, and implementation could have unintended consequences...
October 5, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27713884/resistance-mechanisms
#19
Yasemin Cag, Hulya Caskurlu, Yanyan Fan, Bin Cao, Haluk Vahaboglu
By definition, the terms sepsis and septic shock refer to a potentially fatal infectious state in which the early administration of an effective antibiotic is the most significant determinant of the outcome. Because of the global spread of resistant bacteria, the efficacy of antibiotics has been severely compromised. S. pneumonia, Escherichia coli (E. coli), Klebsiella, Acinetobacter, and Pseudomonas are the predominant pathogens of sepsis and septic shock. It is common for E. coli, Klebsiella, Acinetobacter and Pseudomonas to be resistant to multiple drugs...
September 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27713883/epidemiologic-trends-of-sepsis-in-western-countries
#20
Alejandro Suarez De La Rica, Fernando Gilsanz, Emilio Maseda
Since the American College of Chest Physicians (ACCP) and the Society of Critical care Medicine (SCCM) published the first consensus definition of syndromes related to sepsis in 1992, the knowledge of epidemiology of sepsis has clearly improved, although no prospective studies have been performed to analyse the incidence of sepsis in general population. There are differences in epidemiologic trends in sepsis between western countries and low-income and middle-income countries. In the United States (US), most of epidemiologic studies have been based on large, administrative databases, reporting an increase in the incidence of severe sepsis over years...
September 2016: Annals of Translational Medicine
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