RCEM audit finds sepsis care in UK Emergency Departments is improving

This audit shows an improvement in the proportion of patients receiving the best care for severe sepsis and septic shock, but that improvements are needed to make treatment available faster
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news

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This study looks to predict severe sepsis/septic shock in ED patients. The authors conducted a retrospective case-control study of patients ≥18 admitted to two urban hospitals with a combined ED census of 162,000. Study cases included patients with severe sepsis/septic shock admitted via the ED. Controls comprised admissions without severe sepsis/septic shock. Using multivariate logistic regression, a prediction rule was const ructed - BOMBARD. The model's AUROC was internally validated using 1000 bootstrap samples. BOMBARD was more accurate than SIRS and qSOFA at predicting severe sepsis/septic shock and sepsis mortality.
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
This study examined the value of P(v-a)CO2/C(a-v)O2 compared with ScvO2 as a target for clinical resuscitation of severe sepsis/septic shock. P(v-a)CO2/C(a-v)O2-directed resuscitation did not improve prognosis compared with ScvO2 in severe sepsis and septic shock.
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
Condition:   Septic Shock Interventions:   Drug: Combination (Hydrocortisone and Fludrocortisone);   Drug: Hydrocortisone Sponsor:   University of Tennessee Medical Center Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Publication date: Available online 16 October 2018Source: Journal of Critical CareAuthor(s): En-Pei Lee, Shao-Hsuan Hsia, Chung-Chi Huang, Kuo-Chin Kao, Oi-Wa Chan, Chia-Ying Lin, Ya-Ting Su, I-Meng Hu, Jainn-Jim Lin, Han-Ping WuAbstractPurposeTo compare systemic vascular resistance index (SVRI) as measured by invasive transpulmonary indicator dilution (TPID) and non-invasive Doppler-derived resistive index in septic patients.MethodsWe measured the snuffbox resistive index (SBRI) in both hands of septic patients who received hemodynamic monitoring by TPID prospectively.ResultsThirty-six patients with septic shock were enro...
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research
We report a 10-year-old child with an unremarkable past history who presented with septic shock including hypotension, prolonged capillary refill time, decreased urine output (
Source: The Turkish Journal of Pediatrics - Category: Pediatrics Authors: Tags: Turk J Pediatr Source Type: research
CONCLUSION: This analysis identified two molecularly distinct AKI sub-phenotypes with different clinical outcomes and response to vasopressin therapy. Identification of AKI sub-phenotypes could improve risk prognostication and may be useful for predictive enrichment in clinical trials. PMID: 30334632 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Am J Respir Crit Care Med Source Type: research
Conclusions: Compared with norepinephrine, vasopressin could not improve the postoperative outcomes in patients with pLVD after cardiac surgery. Vasopressin should be cautious to be used as a first-line vasopressor agent in postcardiac vasoplegic shock.
Source: Shock - Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
In this study, 57 adults with septic shock on mechanical ventilators were enrolled. Macroscopic tongue ischemia upon intensive care unit (ICU) admission was assessed by two independent intensivists. We used intestinal fatty-acid binding protein (I-FABP) as a biomarker of enterocyte injury and evaluated the association with tongue ischemia. Demographic variables, risk factor data, and 28-day mortality information were also collected. Compared with patients with normal tongues (n = 45), those with ischemic tongues (n = 12) had a significantly higher Acute Physiology and Chronic Health Evaluation II score (29.0 [25.0&...
Source: Shock - Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Severe sepsis and septic shock are the biggest cause of mortality in critically ill patients. Obesity today is one of the world's greatest health challenges. Little is known about the extent of involvement of the white adipose tissue (WAT) in sepsis and how it is being modified by obesity. We sought to explore the involvement of the WAT in sepsis. We hypothesize that sepsis induces browning of the WAT and that obesity alters the response of WAT to sepsis. Six-week-old C57BL/6 mice were randomized to a high-fat diet to induce obesity (obese group) or control diet (nonobese group). After 6 to 11 weeks of feeding, polymicrobi...
Source: Shock - Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Acute lung injury (ALI) and its severe form, acute respiratory distress syndrome, remain the leading causes of morbidity and mortality in intensive care units. Ulinastatin (UTI), a serine protease inhibitor, possesses anti-inflammatory properties and has been suggested to modulate lipopolysaccharide (LPS)-induced sepsis; thus, it is now widely used in the treatment of pancreatitis, sepsis, and septic shock. Toll-like receptor 4 (TLR4), an essential LPS signaling receptor, plays a critical role in the activation of innate immunity. The aim of this study was to investigate whether UTI alleviates ALI by attenuating TLR4 expre...
Source: Shock - Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
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