Tag: septic shock
Presenting Symptoms Independently Predict Mortality in Septic Shock
More than one third of patients with septic shock presented to the emergency department with vague symptoms that were not specific to infection. These patients had delayed antibiotic administration and higher risk of mortality... read more
Decatecholaminisation during sepsis
While necessary and life-saving in the early fight or flight reaction to any insult, prolonged adrenergic stress is detrimental and contributes to organ dysfunction. In the largest trial to date, Morelli et al. enrolled septic... read more
Hemodynamic Support of Pediatric and Neonatal Septic Shock
Margaret Parker, MD, MCCM, speaks with Joseph A. Carcillo, MD, about the article, "American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock," published... read more
In vitro comparison of the adsorption of inflammatory mediators by blood purification devices
Septic shock, a leading cause of acute kidney injury, induces release of pro-/anti-inflammatory mediators, leading to increased mortality and poor renal recovery. This is the first in vitro study directly comparing three... read more
The Relationship Between ICU Hypotension and In-hospital Mortality and Morbidity in Septic Patients
Current guidelines recommend maintaining a mean arterial pressure (MAP)≥ 65 mmHg in septic patients. However, the relationship between hypotension and major complications in septic patients remains unclear. We, therefore,... read more
Pushing Pressors in the Periphery
The mantra of the Broome Docs site is "bringing great care, out there." And today's topic goes right to the heart of that theme. It is one of my pet topics – so apologies in advance if the rant is too long or detailed.... read more
Incidence of hypotension according to the discontinuation order of vasopressors in the management of septic shock
Tapering NE rather than AVP may be associated with a higher incidence of hypotension in patients recovering from septic shock who are on concomitant NE and AVP. However, further studies with larger sample sizes are required... read more
The Ten Pitfalls of Lactate Clearance in Sepsis
Clearance is the removal of a substance from blood, expressed as a volume (milliliters) over time (minutes). However, changes in lactate levels are the sum of ongoing production and removal from the blood by excretion (e.g.,... read more
Low-dose Corticosteroids for Adult Patients with Septic Shock
The results of this systematic review provide an evidence summary to inform clinicians regarding decisions to use corticosteroids in adult patients with septic shock. We found that assignment to treatment with corticosteroids... read more
Guidelines for the Diagnosis and Management of CIRCI in Critically Ill Patients
This part II of the guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients is related to acute illnesses that may be complicated by CIRCI. We... read more
Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock
Children receiving fluid boluses over 5–10 minutes each had a higher risk of intubation than those receiving boluses over 15–20 minutes each. Notwithstanding the lack of difference in risk of mortality and the possibility... read more
Sepsis-3, a New Definition. Solutions or New Problems?
Before we can discuss the "Sepsis-3" definitions, we need to look back at the history of Sepsis definitions, and what the rationale was leading the authors to create a new definition. Below is a brief, albeit non-exhaustive,... read more
Unexplained Mortality Differences Between Septic Shock Trials
Although the definition of septic shock has been standardized, some variation in mortality rates among clinical trials is expected. Insights into the sources of heterogeneity may influence the design and interpretation of... read more
On Diagnosing Sepsis
Two years ago, a panel appointed by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, referred to as a consensus conference, proposed a new definition for sepsis and new diagnostic... read more
R.E.B.E.L. EM – Fluid Responsiveness and the Six Guiding Principles of Fluid Resuscitation
Fluid resuscitation is a crucial aspect of emergency and critical care. Since the advent of the concept of early goal-directed therapy, we have placed a huge emphasis on aggressive fluid resuscitation in patients with severe... read more
Polymyxin B‑immobilised Hemoperfusion and Mortality in Critically Ill Patients with Sepsis/Septic Shock
Sepsis and septic shock originate from a dysregulated immune response to pathogens and cause millions of deaths worldwide. Endotoxin, a principal component of the outer membrane of Gram-negative bacteria, is a potent trigger... read more
Pharmacokinetics of meropenem in septic patients on sustained low-efficiency dialysis
The aim of the study was to describe the population pharmacokinetics (PK) of meropenem in critically ill patients receiving sustained low-efficiency dialysis (SLED). We found a relevant PK variability for meropenem in patients... read more
Predictors, Prevalence, and Outcomes of Early Crystalloid Responsiveness Among Initially Hypotensive Patients With Sepsis and Septic Shock
Two in three hypotensive sepsis patients were responsive to initial fluid resuscitation. Heart failure, hypothermia, immunocompromise, hyperlactemia, and coagulopathy were associated with the refractory phenotype. Fluid resuscitation... read more
Managing Sepsis and Septic Shock Current Guidelines and Definitions
While sepsis defies simple definition, it's generally understood to be a clinical syndrome caused by infection that may have profound adverse physiologic consequences. Although its precise incidence is unknown, sepsis is... read more
The ADRENAL Trial: Steroids in Septic Shock
Randomized clinical trials evaluating the efficacy of adjunctive corticosteroids in septic shock have shown conflicting evidence of clinical relevance. Two trials in particular looked at lower dose hydrocortisone (200mg/day)... read more
Importance of Second Antibiotic Doses in ED Sepsis Patients
Most studies evaluating early antibiotic administration in sepsis patients focus on timing of the first dose. We highlight many of these studies in our recent review article on Appropriate Antibiotic Therapy in Emergency... read more
Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock
Targeting higher blood pressure targets may increase mortality in patients who have been treated with vasopressors for more than 6 h. Lower blood pressure targets were not associated with patient‑important adverse events... read more
