Tag: sepsis

Upvote Story 5
If peripheral perfusion-targeted resuscitation improves 28-day mortality, this could lead to simplified algorithms, assessing almost in real-time the reperfusion process, and pursuing more physiologically sound objectives. At the end, it might prevent the risk of over-resuscitation and lead to a better utilization of intensive care unit resources. ANDROMEDA-SHOCK is a randomized controlled trial which aims to determine if a peripheral perfusion-targeted resuscitation is associated with... Read More | Comment
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Angiotensin receptor blockers were associated with lower rates of sepsis and mortality than angiotensin-converting enzyme inhibitors in the patients with chronic obstructive pulmonary disease. The similar findings were also noted in subgroup analysis. The primary outcome was sepsis, and the secondary outcome was death. The occurrence rate of sepsis was 3.67 per 100 person-years for the patients receiving angiotensin-converting enzyme inhibitors and 2.87 per 100... Read More | Comment
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This book describes the techniques, strategies, and drugs that have been demonstrated by multicenter randomized trials to influence survival in critically ill patients, defined as those who have acute failure of at least one organ, due to either a pathological condition or a medical intervention, and require intensive care treatment. Each chapter focuses on a specific procedure, device, or drug. The scope is accordingly wide,... Read More | Comment
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The field of critical care medicine is in the midst of a dramatic change. Technological and scientific advances during the last decade have resulted in a fundamental change in the way we view disease processes, such as sepsis, shock, acute lung injury, and traumatic brain injury. Pediatric intensivists have been both witness to and active participants in bringing about these changes and it is imperative... Read More | Comment
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A crash course in Critical Care! Stabilize, treat, and save your sickest patients in the ed or the field – with ACEP’s ultimate resuscitation guide. packed with succinct evidence-based chapters written by the nation’s foremost authorities. With an in-depth and up-to-date description of the unique presentation, differential diagnosis, and management of specific critical illness, this second edition emphasizes on ECMO, sepsis, neuro, critical care, pulmonary... Read More | Comment
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Patients with sepsis and a pre-existing diagnosis of insulin-treated diabetes (ITD) may show a different relationship between hospital mortality and highest glucose levels and glycemic variability in the first 24 hours than patients without ITD, according to a study published in the Journal of Critical Care. In Australia and New Zealand, 11% to 15% of intensive care unit (ICU) admissions are comprised of patients with... Read More | Comment
Upvote Story 15
Norepinephrine in Septic Shock
Norepinephrine (NE) is both an alpha1- and beta1-agonist, and is therefore able to increase vascular tone and contractility. Recent guidelines recommend NE as the first-line vasopressor in septic shock. However, because septic shock is a syndrome that results from a variable combination of decreased venous return, myocardial depression and decreased vascular tone, the place for NE in initial resuscitation is not straightforward. There is no... Read More | Comment
Upvote Story 26
This recently released practically oriented book provides an up-to-date overview of all significant aspects of the pathogenesis of sepsis and its management, including within the ICU. Readers will find information on the involvement of the coagulation and endocrine systems during sepsis and on the use of biomarkers to diagnose sepsis and allow early intervention. International clinical practice guidelines for the management of sepsis are presented,... Read More | Comment
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In this multicentre, randomised, double‑blinded trial, we observed no difference in mortality between terlipressin and NE infusion in patients with septic shock. Patients in the terlipressin group had a higher number of serious adverse events. Patients with septic shock recruited from 21 intensive care units in 11 provinces of China were randomised (1:1) to receive either terlipressin (20–160 µg/h with maximum infusion rate of 4... Read More | Comment
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The utility of steroids in sepsis has been debated passionately for decades. There is hope that steroids might improve mortality, but also fear that they could increase infectious complications. Practice varies widely. What does the data truly indicate? This belief is based on the first modern RCT of stress-dose steroids in sepsis by Annane et al. 2002. This study randomized 299 patients with severe vasopressor-refractory... Read More | Comment
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In this meta-analysis of 37 RCTs (including 9564 patients), corticosteroid treatment was significantly associated with reduced 28-day mortality, ICU mortality, and in-hospital mortality among patients with sepsis. However, this survival benefit was not replicated with 90-day mortality. Subgroup analyses based on treatment modalities demonstrated that the beneficial effect in 28-day mortality was associated with the use of low-dose corticosteroids. The association with 28-day mortality was... Read More | Comment
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This volume provides a comprehensive overview of hematologic issues that clinicians regularly encounter in the critical care environment. The text features hematologic scenarios that affect the adult ICU patient, outlines pathogenesis and challenges associated with the hematologic disorder, and offers treatment modalities. Hematologic issues covered include anemia, hemostatic abnormalities, and risks of transfusion. The book also details challenges in specific ICU populations, such as patients... Read More | Comment
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There are only four major indications for fluid administration in the critically ill: resuscitation, maintenance, replacement and nutrition (enteral or parenteral). In this review, a conceptual framework is presented looking at fluids as drugs by taking into account the four D’s (drug selection, dose, duration and de-escalation) and the four phases of fluid therapy within the ROSE concept (resuscitation, optimization, stabilization and evacuation). The four... Read More | Comment
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In this dose-finding, phase 2 adaptive randomized trial, patients with septic shock and moderate organ dysfunction were treated early in the course of illness with low (6 g), medium (12 g), or high (18 g) doses of levocarnitine or an equivalent volume of saline placebo administered as a 12-hour infusion. None of the tested doses of levocarnitine meaningfully reduced cumulative organ failure at 48 hours.... Read More | Comment
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For patients in the ED who are suspected of having sepsis, swift, effective management is vital to improving outcomes. This issue reviews the latest evidence on the diagnosis and treatment of sepsis and septic shock: How do the definitions of sepsis affect treatment decisions – and CMS quality measurements? Is SOFA scoring in the ED possible? Is quickSOFA scoring helpful? How can you identify the... Read More | Comment