How Effective Is the Early Management Bundle for Severe Sepsis/Septic Shock?

Sepsis is a significant cause of mortality, and improving survival has gained a lot of attention over the last 2 decades as a measure for quality improvement. Mortality rates from sepsis as high as 49.7% were the stimulus for Rivers et al to develop early goal-directed therapy in 2001, resulting in significantly lower mortality rates (30.5%). In 2002, the Surviving Sepsis Campaign, an international effort led by intensivists, began promoting early recognition and treatment of sepsis. This campaign ultimately led to the adoption of Early Management Bundle for Severe Sepsis/Septic Shock (SEP-1) by the US Centers for Medicare&Medicaid Services (CMS) in October 2015. At almost the same time, 3 randomized clinical trials of early goal-directed therapy vs usual care were published. The Protocolised Care for Early Septic Shock (ProCESS) trial, Australasian Resuscitation in Sepsis Evaluation (ARISE) trial, and Protocolised Management in Sepsis (ProMISe) trial found no survival benefit in patients with sepsis between early goal-directed therapy and usual care. The final version of the SEP-1 bundle adopted by CMS removed the invasive monitoring requirement from early goal-directed therapy and adopted the fluid volume and the repeated lactate metrics without significant evidenced-based support.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research

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No recommendation exists about the timing and setting for tracheal intubation and mechanical ventilation in septic shock.
Source: Annals of Intensive Care - Category: Intensive Care Authors: Tags: Research Source Type: research
Condition:   Trans Cranial Doppler Ultrasonography in Heamodynamic Optimisation in Septic Shock Intervention:   Procedure: hemodynamic optimisation aiming to achieve normal cerebral perfusion Sponsor:   Mongi Slim Hospital Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Objectives: Sepsis is the most common and costly diagnosis in U.S.’ hospitals. Despite quality improvement programs and heightened awareness, sepsis accounts for greater than 50% of all hospital deaths. A key modifier of outcomes is access to healthcare. The Affordable Care Act, passed in 2010, expanded access to health insurance coverage. The purpose of this study was to evaluate changes in insurance coverage and outcomes in patients with severe sepsis and septic shock as a result of the full implementation of the Affordable Care Act. Design: This retrospective study uses data from the Healthcare Cost and Utili...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Feature Articles Source Type: research
Conclusions: Severe B-cell abnormalities are present in the immunosuppressive phase of septic shock and are associated with prognosis.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Objectives: Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades. Data Source: Seven European ICUs. Study Selection: A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors ...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
No abstract available
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Editorials Source Type: research
rzych Sepsis-associated brain dysfunction (SABD) with increased intracranial pressure (ICP) is a complex pathology that can lead to unfavorable outcome. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is used for non-invasive assessment of ICP. We aimed to assess the role of ONSD as a SABD screening tool. This prospective preliminary study covered 10 septic shock patients (5 men; aged 65, IQR 50–78 years). ONSD was measured bilaterally from day 1 to 10 (n = 1), until discharge (n = 3) or death (n = 6). The upper limit for ONSD was set at 5.7 mm. Sequential organ failure assessment score was...
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Article Source Type: research
Condition:   Trans Cranial Doppler Ultrasonography in Heamodynamic Optimisation in Septic Shock Intervention:   Procedure: hemodynamic optimisation aiming to achieve normal cerebral perfusion Sponsor:   Mongi Slim Hospital Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
This study aimed to compare the 28 ‐day mortality of patients with septic shock, defined by Sepsis‐3 criteria, and patients with vasoplegic or cryptic shock who are excluded from this new definition.ObjectivesThis retrospective observational study was performed using a tertiary emergency department ’s septic shock registry and investigated the records of patients managed between January 2010 and December 2015. 2,138 total patients, 1004 (47.0%) had septic shock, 476 (22.2%) had vasoplegic shock, and 655 (30.6%) had cryptic shock.ResultsThere was significant variation in 28 ‐day mortality among the three groups:...
Source: The Clinical Respiratory Journal - Category: Respiratory Medicine Authors: Tags: ORIGINAL ARTICLE Source Type: research
CONCLUSION: Increased levels of plasma F-actin measured in the ED were associated with incremental illness severity as measured by the qSOFA score and need for ICU admission. F-actin may have utility in risk stratification of undifferentiated patients in the ED presenting with signs and symptoms of sepsis. PMID: 32421363 [PubMed - as supplied by publisher]
Source: Biomarkers - Category: Research Tags: Biomarkers Source Type: research
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