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AbstractText: The effect of an early resuscitation protocol on sepsis outcomes in developing countries remains unknown AbstractText: To determine whether ... Patients were randomized 1:1 to either (1) an early resuscitation protocol for sepsis (n = 107) that included intravenous fluid bolus administration with monitoring ... In the 6 hours after presentation to the emergency department, patients in the sepsis protocol group received a median of 3.5 L (interquartile range ...
Immune System Diseases (1) Sepsis (12), Hypotension (5), Infections (1), more mentions
We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensivecare units (ICUs) and association of ICU organisational factors with outcome ... day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample... 95% CI 237·9-351·2) of adult cases of ICU-treated sepsis per year, which yields about 420 000 cases annually, of ...
ICU mortality was compared between the patient group fulfilling Sepsis-3 definition for septic shock and those that met Sepsis-2 ... Serum lactate values ≥6 mmol/L, were significantly associated with increased ICU mortality.Patients classified according to Sepsis-3 criteria had a higher ICU mortality compared with Sepsis-2 criteria ...
... article is to determine the preferred intravenous fluid for the resuscitation of patients with severe sepsis and septicshock AbstractText: A MEDLINE literature review was completed to identify studies that investigated the type of resuscitation fluid in the management of patients with severe sepsis and septic shock ... systemic reviews AbstractText: Crystalloids are the preferred solution for the resuscitation of emergency department patients with severe sepsis and septicshock.
The authors then systematically evaluated each study, which formed the basis for this clinical statement AbstractText: Patients with severe sepsis and septicshock should receive early and appropriate antibiotics in the emergency department. Patients with septic shock who received appropriate antimicrobial therapy within 1 h of recognition had the greatest benefit in mortality Keyword: antibiotic.
Infectious Diseases (7) Septic Shock (6), Sepsis (6), more mentions
ICU admissions identified either as Sepsis-3 sepsis or septicshock and as Sepsis-2 severe sepsis or septic shock had ... The predictive validity was greatest for Sepsis-3 septicshock AbstractText: In an ICU database, compared with Sepsis-2, Sepsis-3 identifies a similar sepsis population with 92% overlap and ...
AbstractText: To assess the agreement between transpulmonary thermodilution (TPT) and criticalcare echocardiography (CCE) in ventilated patients with septicshock AbstractText: Ventilated patients in sinus rhythm requiring advanced hemodynamic assessment for septic shock were included in this prospective multicenter descriptive study. Patients were assessed successively using TPT and CCE in random order.
... septic shock in this specific population are limited AbstractText: We aimed to evaluate the clinical presentation and factors associated with outcome among ESRD patients with acute septicshock AbstractText: We reviewed patients prospectively enrolled in an emergency department (ED) septicshock treatment pathway registry between January 2014 and May 2016.
Kidney Disease (5), Men's Health (3) Chronic Kidney Failure (20), Septic Shock (12), Infections (1), more mentions
... We reviewed the recent advances in the initial approach to resuscitation of sepsis and septicshock patients AbstractText: Sepsis and septicshock are life-threatening emergencies ... vasopressor, and inotrope selection remains limited AbstractText: Though the early resuscitation of sepsis and septicshock is key to improving outcomes, ideal resuscitation targets are elusive ...
AbstractText: Severe sepsis and septicshock represent common presentations in the emergency department (ED) and have high rates of mortality. Guideline-recommended goals of care have been shown to benefit these patients, but can be difficult to provide AbstractText: To determine whether the use of a premixed bag consisting of 2 g cefepime and 1 g vancomycin in 1000 mL ...
Infectious Diseases (6), Men's Health (3) Sepsis (8), Septic Shock (5), more mentions
BACKGROUND: Sepsis is one of the leading causes of death in the UK.
AIMS: The aims of this study were to identify the rate of inactive antimicrobial therapy (AMT) in the ICU and whether inactive AMT had an effect on in hospital mortality, ICU mortality, 90-day mortality and length of hospital stay. Additionally, we wanted to identify risk factors for receiving inactive AMT.
METHODS: This was a retrospective observational study conducted at Glasgow Royal Infirmary ICU between January 2010 and December 2013, with 12,000 blood cultures taken over this time period, of which n=127 were deemed clinically significant. Multivariate logistic regression was used to identify risk factors independently associated with mortality. To identify risk factors for receiving inactive AMT a univariable and a subsequent multivariate analysis was constructed.
RESULTS: The rate of inactive AMT was 47% (n =60). Our multivariate analysis showed that receiving antibiotics within the first 24 hours of ICU admission led to a reduced mortality (RR 1.70; 95% CI 1.19-2.44.) Furthermore, it showed that severity of illness (as defined by SIRS criteria sepsis vs septic shock) increased mortality (OR 9.87; 95% CI 1.73-55.5). However, inactive AMT did not increase mortality (OR 1.07; 95% CI 0.47-2.41) or length of hospital stay (53.2 vs 69.1 days p=0.348.) We identified fungal bloodstream infection as a risk factor for receiving inactive AMT (OR 5.10;95% CI 1.29-20.14.
CONCLUSION: Mortality from sepsis is influenced by multiple factors. We were unable to demonstrates that inactive AMT had an effect on mortality in sepsis.
... XN and C reactive protein (CRP), for early diagnosis of sepsis during intensivecare unit (ICU) stay AbstractText: The study population consisted of 62 ICU patients, 21 of whom developed sepsis during ICU stay and 41 who did not ... The association with the risk of developing sepsis during ICU stay was also assessed.
Blood Disorders and Hematology (1) Sepsis (13), Infections (1), more mentions
STUDY OBJECTIVE: Quantify the correlation between blood pressure variability (BPV) and markers of illness severity: serum lactate (LAC) or Sequential Organ Failure Assessment (SOFA) scores.
METHODS: We performed a secondary analysis of data from a prospective, observational study evaluating fluid resuscitation on adult, septic, ED patients. Vital signs and fluid infusion volumes were recorded every 15min during the 3h following ED arrival. BPV was assessed via average real variability (ARV): the average of the absolute differences between consecutive BP measurements. ARV was calculated for the time periods before and after 3 fluid infusion milestones: 10-, 20-, and 30-mL/kg total body weight (TBW). Spearman's rho correlation coefficient analysis was utilized. A p-value<0.05 was considered statistically significant.
RESULTS: Forty patients were included. Mean fluid infusion was 33.7mL/kg TBW (SD 22.1). All patients received fluid infusion≥10mL/kg TBW, 25 patients received fluid infusion>20mL/kg TBW, and 16 patients received fluid infusion>30mL/kg TBW. Mean initial LAC was 4.0mmol/L (SD 3.2). Mean repeat LAC was 3.1mmol/L (SD 3.2), obtained an average of 6.6h (SD 5.3) later. Mean SOFA score was 7.0 (SD 4.4). BPV correlated with both follow-up LAC (r=0.564; p=0.023) and SOFA score (r=0.544; p=0.024) among the cohort that received a fluid infusion>20-mL/kg TBW.
CONCLUSION: With the finding of a positive correlation between BPV and markers of illness severity (LAC and SOFA scores), this pilot study introduces BPV analysis as a real-time, non-invasive tool for continuous sepsis monitoring in the ED.
... to decide on the ideal course of action AbstractText: This study aims to evaluate the performance of Mortality in Emergency Department Sepsis Score (MEDS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) for predicting the mortality risk of adult splenic abscess patients ...
OBJECTIVE: To examine the ability of the low-frequency/high-frequency (LF/HF) ratio of heart rate variability (HRV) analysis to identify patients with sepsis at risk of early deterioration.
METHODS: This is a prospective observational cohort study of patients with sepsis presenting to the Montefiore Medical Center ED from December 2014 through September 2015. On presentation, a single ECG Holter recording was obtained and analysed to obtain the LF/HF ratio of HRV. Initial Sequential Organ Failure Assessment (SOFA) scores were computed. Patients were followed for 72 hours to identify those with early deterioration.
RESULTS: 466 patients presenting to the ED with sepsis were analysed. Thirty-two (7%) reached at least one endpoint within 72 hours. An LF/HF ratio <1 had a sensitivity and specificity of 34% (95% CI (19% to 53%)) and 82% (95% CI (78% to 85%)), respectively, with positive and negative likelihood ratios of 1.9 (95% CI (1.1 to 3.2)) and 0.8 (95% CI (0.6 to 1.0)). An initial SOFA score ≥3 had a sensitivity and specificity of 38% (95% CI (22% to 56%)) and 92% (95% CI (89% to 95%)), with positive and negative likelihood ratios of 4.9 (95% CI (2.8 to 8.6)) and 0.7 (95% CI (0.5 to 0.9)). The composite measure of HRV+SOFA had improved sensitivity (56%, 95% CI (38% to 73%)) but at the expense of specificity (77%, 95% CI (72% to 80%)), with positive and negative likelihood ratios of 2.4 (95% CI (1.7 to 3.4)) and 0.6 (95% CI (0.4 to 0.9)). Receiver operating characteristic analysis did not identify a superior alternate threshold for the LF/HF ratio. Kaplan-Meier survival functions differed significantly (p=0.02) between low (<1) and high (≥1) LF/HF groups.
CONCLUSIONS: While we found a statistically significant relationship between HRV, SOFA and HRV+SOFA, and early deterioration, none reliably functioned as a clinical predictive tool. More complex multivariable models will likely be required to construct models with clinical utility.
Men's Health (2), Infectious Diseases (1) Sepsis (4), Communicable Diseases (1), more mentions
The SOFA is complex and unfamiliar to most emergency physicians, while qSOFA is insensitive for sepsis screening and may result in missed cases of sepsis ... easy-to-use simple SOFA score for use in the emergency department (ED) AbstractText: Retrospective study of ED patients with sepsis with in-hospital mortality as the primary outcome ...
Men's Health (2) Sepsis (9), Infections (1), Septic Shock (1), more mentions
... challenging due to the heterogeneity of the syndrome, and the lack of an objective standard diagnostic test. While overall mortality rates from sepsis appear to be falling, there is an increasing burden of morbidity among survivors. This largely reflects the growing proportion of older patients with comorbid illnesses among those treated for sepsis Keyword: emergency service. Keyword: hospital. Keyword: sepsis.
OBJECTIVE: Due to atypical symptom presentation older patients are more prone to delayed sepsis recognition. We investigated whether initial disease severity before emergency department (ED) treatment (including treatable acute organ dysfunction), quality of ED sepsis care and the impact on mortality was different between patients older and younger than 70 years. If differences exist, improvements are needed for ED management of older patients at risk for sepsis.
METHODS: In this observational multicenter study, ED patients who were hospitalized with a suspected infection were stratified by age <70 and ≥70 years. The presence of treatable and potentially reversible acute organ dysfunction was measured by the RO components of the Predisposition, Infection, Response and Organ dysfunction (PIRO) score, reflecting acute sepsis-related organ dysfunction developed before ED presentation. Quality of care, as assessed by the full compliance with nine quality performance measures and the standardized mortality ratio (SMR: observed/expected in-hospital mortality), was compared between older and younger patients.
RESULTS: The RO-components of the PIRO score were 8 (interquartile range; 4-9) in the 833 older patients, twice as high as the 4 (2-8; P<0.001) in the 1537 younger patients. However, full compliance with all nine quality performance measures was achieved in 34.2 (31.0-37.4)% of the older patients, not higher than the 33.0 (30.7-35.4)% in younger patients (P = 0.640). In-hospital mortality was 9.2% (95%-CI, 7.3-11.2) in patients ≥70, twice as high as the 4.6% (3.6-5.6) in patients <70 years, resulting in an SMR (in study period) of ~0.7 in both groups (P>0.05).
CONCLUSION: Older sepsis patients are sicker at ED presentation but are not treated more expediently or reliably despite their extra acuity The presence of twice as much treatable acute organ dysfunction before ED treatment suggests that acute organ dysfunction is recognized relatively late by general practitioners or patients in the out of hospital setting.