Evolving Sepsis Criteria and New Management Guidelines Hold Lessons for PA/LTC

PHOENIX — The recently published Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) and newly updated Surviving Sepsis Campaign international guidelines for management emphasize the need for earlier recognition and more timely management of sepsis — and not only in the hosp ital setting.
Source: Caring for the Ages - Category: Health Management Authors: Source Type: news

Related Links:

This JAMA Performance Improvement article uses the case of a patient with end-stage renal disease admitted for septic shock, peritonitis, and calciphylaxis who erroneously underwent tunneled central catheter placement after he elected to pursue only hospice care to discuss unintended errors introduced by computerized order entry and opportunities for health information technology system improvements.
Source: JAMA - Journal of the American Medical Association - Category: General Medicine Source Type: research
Conclusion: The series evaluated had high mortality in the first 72 hours of treatment with vasopressin. The use of vasopressin in patients who are refractory to norepinephrine had little or no impact on mortality. It was not possible to exclude the possibility that the high mortality in the present study was linked to the relatively late onset (after established refractoriness of norepinephrine) of vasopressin; this hypothesis should be further evaluated in a randomized study.
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
Conclusion: Higher levels of IL-3 are shown to be independently associated with hospital mortality in septic patients but with poor clinical performance.
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
Conclusion: There was a persistently high systemic vascular resistance index in cold shock patients that influenced the stroke volume index, cardiac index, and velocity time integral. The use of echocardiograms for hemodynamic measurements is important in pediatric septic shock patients to adjust dilators, and vasopressor doses and achieve resuscitation targets in a timely manner.
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
The authors of this study state that the association of pulmonary hypertension (PH) in patients with sepsis is lesser understood. In patients with sepsis and septic shock, PH is common and is noted to be associated with higher short and long-term mortality. Further studies are needed to understand the mechanisms by which PH is associated with outcomes.
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
The authors of this article state that sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment o...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
The authors of this review article state that two and a half years after the introduction of Sepsis-3, clinicians continue not to document Sequential Organ Failure Assessment (SOFA) scores. The purpose of the review is to determine if the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were being utilized in defining sepsis in the clinical setting. There continue to be variations in what standard is accepted by both commercial payers and the Centers for Medicare and Medicaid (CMS) in diagnosing sepsis. Due to Sepsis-3 criteria not being accepted by CMS or the Infectious Disease Society of A...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
The authors of this journal article state that adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, they assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled ...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
Objectives: To characterize renin in critically ill patients. Renin is fundamental to circulatory homeostasis and could be a useful marker of tissue-perfusion. However, diurnal variation, continuous renal replacement therapy and drug-interference could confound its use in critical care practice. Design: Prospective observational study. Setting: Single-center, mixed medical-surgical ICU in Europe. Patients: Patients over 18 years old with a baseline estimated glomerular filtration rate greater than 30 mL/min/1.73 m2 and anticipated ICU stay greater than 24 hours. Informed consent was obtained from the pati...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Feature Articles Source Type: research
Objectives: Propofol-based sedation may increase hemodynamic instability by decreasing vascular tone and venous return. Incremental exogenous catecholamines doses may be required to counteract such effects, aggravating the deleterious effects of sympathetic overstimulation. α-2 adrenergic agonists have been reported to decrease norepinephrine requirements in experimental septic shock. The aim of the present study is to test the hypothesis that switching from sedation with propofol to the α-2 agonist dexmedetomidine may decrease norepinephrine doses in septic shock. Design: Prospective open-label crossover ...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research
More News: Lessons | Septic Shock