Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock
Rapid fluid resuscitation has become standard in sepsis care, despite " low-quality " evidence and absence of guidelines for populations " at risk " for volume overload. Our objectives include as follows: 1) identify predictors of reaching a 30 mL/kg crystalloid bolus within 3 hours of sepsis onset (30by3); 2) assess the impact of 30by3 and fluid dosing on clinical outcomes; 3) examine differences in perceived " at-risk " volume-sensitive populations, including end-stage renal disease, heart failure, obesity, advanced age, or with documentation of volume " overload " by bedside examination. Failure to reach 30by3 ...
Source: Current Awareness Service for Health (CASH) - September 19, 2019 Category: Consumer Health News Source Type: news

Vitamin C and Thiamine for Sepsis and Septic Shock
Sepsis and septic shock are medical emergencies resulting in significant morbidity and mortality. Intravenous (IV) vitamin C, thiamine, and hydrocortisone have shown promise in reducing hospital mortality. The Memphis Veterans Affairs Medical Center (VAMC) similarly implemented this regimen, called the vitamin C protocol, for patients presenting in sepsis or septic shock in the intensive care unit (ICU). Although no significant mortality benefit was observed, the vitamin C protocol was not associated with patient harm. In this Veteran population, there was reduced ICU length of stay, suggesting possible benefit. Th...
Source: Current Awareness Service for Health (CASH) - September 19, 2019 Category: Consumer Health News Source Type: news

Blood Purification and Mortality in Sepsis and Septic Shock Blood Purification and Mortality in Sepsis and Septic Shock
This study examined the potential benefit of hemoperfusion, hemofiltration, and plasmapheresis in the treatment of sepsis or septic shock. Can these blood purification techniques reduce mortality?Anesthesiology (Source: Medscape Critical Care Headlines)
Source: Medscape Critical Care Headlines - September 5, 2019 Category: Intensive Care Tags: Anesthesiology Journal Article Source Type: news

Sepsis in 2018: a review
This article provides a summary of the most recent clinical evidence and professional guidelines for the diagnosis and treatment of the sepsis in the critical care setting. (Source: Current Awareness Service for Health (CASH))
Source: Current Awareness Service for Health (CASH) - September 4, 2019 Category: Consumer Health News Source Type: news

Epidemiology and Changes in Mortality of Sepsis After the Implementation of Surviving Sepsis Campaign Guidelines
We set out to determine the epidemiology and outcome of severe sepsis and septic shock after 9 years of the implementation of the Surviving Sepsis Campaign (SSC) and to build a mortality prediction model. Although the incidence of sepsis/septic shock remained unchanged during a 10-year period, the implementation of the SSC guidelines resulted in a marked decrease in the overall mortality. The lower severity of patients on ICU admission and the reduced early mortality suggest an improvement in early diagnosis, better initial management, and earlier antibiotic treatment. (Source: Current Awareness Service for Health (CASH))
Source: Current Awareness Service for Health (CASH) - September 4, 2019 Category: Consumer Health News Source Type: news

The Comparative Epidemiology of Pediatric Severe Sepsis
To determine whether the coding strategies used to identify severe sepsis in administrative data sets could identify cases with comparable case mix, hospitalization characteristics, and outcomes as a cohort of children diagnosed with severe sepsis using strict clinical criteria. The ICD-9-CM codes for " severe sepsis " and " septic shock " identify smaller but higher acuity cohorts of patients that more closely resemble the children enrolled in the largest clinical trial of pediatric severe sepsis to date. (Source: Current Awareness Service for Health (CASH))
Source: Current Awareness Service for Health (CASH) - September 4, 2019 Category: Consumer Health News Source Type: news

Adjunctive Corticosteroid Treatment in Septic Shock Adjunctive Corticosteroid Treatment in Septic Shock
This article reviews the continuing uncertainty and the current state of the evidence regarding the utility of corticosteroids in treatment of septic shock. What are the implications for practice?Anesthesiology (Source: Medscape Today Headlines)
Source: Medscape Today Headlines - August 29, 2019 Category: Consumer Health News Tags: Anesthesiology Journal Article Source Type: news

Extracorporeal Membrane Oxygenation for Septic Shock Extracorporeal Membrane Oxygenation for Septic Shock
What benefits may extracorporeal membrane oxygenation offer to patients with septic shock?Critical Care Medicine (Source: Medscape Today Headlines)
Source: Medscape Today Headlines - August 6, 2019 Category: Consumer Health News Tags: Critical Care Journal Article Source Type: news

Effects of mean arterial pressure on arousal in sedated ventilated patients with septic shock: a SEPSISPAM post hoc exploratory study
It is unknown whether the recommended mean arterial pressure (MAP) target of 65 mmHg during initial resuscitation of septic shock is sufficient to maintain cerebral perfusion. Thus, we tested the hypothesis that a higher MAP target in patients with septic shock may improve level of arousal. In patients with septic shock who were mechanically ventilated and sedated, resuscitation with MAP target between 80 and 85 mmHg was associated with higher arousal level as compared to a MAP target between 65 and 70 mmHg. (Source: Current Awareness Service for Health (CASH))
Source: Current Awareness Service for Health (CASH) - July 24, 2019 Category: Consumer Health News Source Type: news

Future Challenges in Pediatric and Neonatal Sepsis: Emerging Pathogens and Antimicrobial Resistance
The incidence of severe infections caused by multidrug-resistant (MDR) pathogens is currently rising worldwide, and increasing numbers of neonates and children with serious bloodstream infections due to resistant bacteria are being reported. Severe sepsis and septic shock due to gram-negative bacteria represent a significant cause of morbidity and mortality, and contribute to high health care costs. Antimicrobial resistance among Enterobacteriaceae represents a major problem in both health care-associated and community-acquired infections, with extended-spectrum β-lactamases (ESBLs) and carbapenem-resistant Enterobacteria...
Source: Current Awareness Service for Health (CASH) - July 24, 2019 Category: Consumer Health News Source Type: news

Importance of diastolic arterial pressure in septic shock: PRO
Along with heart rate, the arterial blood pressure is the most commonly used variable to assess the cardiovascular status in the general population. Physicians caring patients with chronic hypertension are well aware of the necessity to target a very tight safe range of diastolic arterial pressure (DAP), when using anti-hypertensive drugs. We believe that the DAP as a marker of arterial tone and as the upstream pressure for the left ventricular perfusion, is as an important variable to be considered in patients with septic shock. Since the DAP is easily obtained in such patients using an arterial catheter, it would be regr...
Source: Current Awareness Service for Health (CASH) - July 24, 2019 Category: Consumer Health News Source Type: news

Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis
Septic shock is the most severe form of sepsis, in which profound underlying abnormalities in circulatory and cellular/metabolic parameters lead to substantially increased mortality. A clear understanding and up-to-date assessment of the burden and epidemiology of septic shock are needed to help guide resource allocation and thus ultimately improve patient care. The aim of this systematic review and meta-analysis was therefore to provide a recent evaluation of the frequency of septic shock in intensive care units (ICUs) and associated ICU and hospital mortality. Our literature review reaffirms the continued common occurren...
Source: Current Awareness Service for Health (CASH) - July 24, 2019 Category: Consumer Health News Source Type: news

PRagMatic Pediatric Trial of Balanced versus nOrmaL Saline FlUid in Sepsis: the PRoMPT BOLUS Randomized Controlled Trial Pilot Feasibility Study
Resuscitation with crystalloid fluid is a cornerstone of pediatric septic shock treatment. However, the optimal type of crystalloid fluid is unknown. We aimed to determine the feasibility of conducting a pragmatic randomized trial to compare balanced (lactated Ringer ' s [LR]) with 0.9% normal saline (NS) fluid resuscitation in children with suspected septic shock. A pragmatic study design proved feasible to study comparative effectiveness of LR versus NS fluid resuscitation for pediatric septic shock. (Source: Current Awareness Service for Health (CASH))
Source: Current Awareness Service for Health (CASH) - July 24, 2019 Category: Consumer Health News Source Type: news

The nitric oxide pathway antagonists in septic shock: Meta-analysis of controlled clinical trials
Nitric oxide antagonists are effective to reverse hypotension and septic shock. Nitric oxide antagonists decrease survival rate. Nitric oxide antagonists increase number of adverse effects and length of stay in the ICU. Our intention was to obtain a quantitative summary of these diverse antagonistic agent effects along the NO pathway using the available clinical trials. New drugs RCTs have systematically failed to prove a benefit in septic shock patient survival. Small trials often times suggest possible advantages that are denied by confirmatory larger trials. The absence of a prior power analysis by the small studies cou...
Source: Current Awareness Service for Health (CASH) - July 24, 2019 Category: Consumer Health News Source Type: news

Transfer hospitalizations for pediatric severe sepsis or septic shock: resource use and outcomes
Sepsis is a major cause of child mortality and morbidity. To enhance outcomes, children with severe sepsis or septic shock often require escalated care for organ support, sometimes necessitating interhospital transfer. The association between transfer admission for the care of pediatric severe sepsis or septic shock and in-hospital patient survival and resource use is poorly understood. One in four children with severe sepsis or septic shock required interhospital transfer for specialized care associated with greater use of invasive medical devices and specialized technology. Despite higher crude mortality and resource con...
Source: Current Awareness Service for Health (CASH) - July 24, 2019 Category: Consumer Health News Source Type: news