Tag: septic shock
Lactate-Guided Resuscitation Only Encourages Over-Resuscitation and Downstream Harms
The Centers for Medicare and Medicaid Services and the Surviving Sepsis Campaign both rushed to offer guidance on the appropriate management strategies for patients presenting with septic shock. In both cases, a lactate-guided... read more
Effect of High-dose Ascorbic Acid on Vasopressor’s Requirement in Septic Shock
In this study, administration of high-dose ascorbic acid significantly decreased the requirement for vasopressor's dose and duration in surgical critically ill patients with septic shock. Several mechanisms including anti-oxidant,... read more
TCR Activation Mimics CD127 low PD-1 high Phenotype and Functional Alterations of T Lymphocytes from Septic Shock Patients
The proportion of CD127lowPD-1high T cells in patients was increased compared with healthy volunteers, although no global CD127 regulation was observed. Our results suggest that TCR activation participates in the occurrence... read more
Loss of Sphingosine 1-Phosphate in Septic Shock is Predominantly Caused by Decreased Levels of HDL
Sphingosine 1-phosphate (S1P) is a signaling lipid essential in regulating processes involved in sepsis pathophysiology, including endothelial permeability and vascular tone. Serum S1P is progressively reduced in sepsis patients... read more
Updates and Controversies in the Early Management of Sepsis and Septic Shock
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: ... read more
Sepsis and Septic Shock – What Matters from EM Cases Course
In this podcast Dr. Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? How does SIRS, qSOFA and NEWS compare... read more
Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock
Worse global longitudinal strain (GLS) (less negative) values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for left ventricular ejection fraction... read more
Pooled Analysis of Higher vs 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 6h. Lower blood pressure targets were not associated with patient‑important adverse events... read more
New Guidelines for Hospital-acquired Pneumonia/Ventilator-associated Pneumonia
American and European guidelines have many areas of common agreement such as limiting antibiotic duration. Both guidelines were in favor of a close clinical assessment. Neither recommended a regular use of biomarkers but... read more
Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock
Among patients with septic shock, a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality. Among 424 patients... read more
Should We Stop Trending Lactate in Septic Shock?
There may be a tendency to cement guideline recommendations into our collective minds as inalienable and sacrosanct – as if carved onto stone tablets and brought down to us from the heights of Mount Sinai. Thoughtful medicine,... read more
Antibiotic timing in Severe Sepsis
Severe sepsis is a time dependent condition and this study builds on previous literature which supports that early identification and treatment of sepsis with antibiotics decreases mortality. Retrospective analysis of a large... read more
Optimizing Hemodynamic Support in Severe Sepsis and Septic Shock, An Issue of Critical Care Clinics
Guest Editor Dane Nichols, MD, has assembled a panel of experts focusing on Hemodynamic Support in Septic Shock. Topics include: Oxygen Delivery and Consumption: A Macro-Circulatory Perspective; Mean Arterial Pressure: Therapeutic... read more
Antifungal Treatment in the ICU
Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in critically ill patients. Almost 80% of IFIs are due to Candida spp., which are the third most common isolated microorganisms in the intensive... read more
Mimics of Sepsis: What do ED Physicians Need to Know?
SIRS and sepsis are common clinical entities. A wide range of estimates for prevalence exists, with 300 to 1000 cases per 100,000 persons per year. Once a septic patient is admitted, more than half will require at least step... read more
Metabolic Sepsis Resuscitation
There are roughly two strategies for adjusting the intensity of treatment: Titrated strategy: Treatment intensity is adjusted to match the severity of the disease. Escalation-deescalation strategy: Treatment intensity is... read more
Antibiotics for the Critically Ill Patient
We spend a lot of time obsessing over the finer details of critical care: which fluid is best? which vasopressor is best? will another liter of fluid help? These details are important, but for a septic patient something... read more
Sepsis Incidence and Mortality are Underestimated in Australian ICU Administrative Data
When compared with the reference standard — prospective clinical diagnosis — ANZICS CORE database criteria significantly underestimate the incidence of sepsis and overestimate the incidence of septic shock, and also result... read more
Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock
Thiamine administration within 24 hours of admission in patients presenting with septic shock was associated with improved lactate clearance and a reduction in 28-day mortality compared with matched controls. Patients who... read more
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... read more
Terlipressin vs. Norepinephrine As Infusion in Patients With Septic Shock
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... read more
Principles of Fluid Management and Stewardship in Septic Shock
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... read more
