Greg Bleakley, Mark Cole
Caring for a patient with suspected sepsis is a challenging nursing role. Early recognition and appropriate management of a patient with sepsis saves lives. Nurses play a fundamental role in detecting changes in physiological observations that could indicate the onset of sepsis. Additionally, an awareness of the pathophysiology of sepsis allows the nurse to better understand how rapid intervention prevents the onset of septic shock. Furthermore, knowledge and use of clinical guidelines and sepsis screening tools are established methods to help reduce patient mortality...
November 26, 2020: British Journal of Nursing: BJN
Alvin Hy Lo, Adrian Cl Kee, Andrew Li, Francesca Rubulotta
Sepsis is life-threatening and might potentially progress from dysregulation to severe organ dysfunction. It is recognised by the World Health Organisation as a global health priority. The mortality rate for sepsis has decreased in many countries, and this is credited to the earlier recognition and treatment of this complex syndrome. In 2002, the Surviving Sepsis Campaign was launched, and there have been several revisions to the sepsis recommendations therefrom. The latest sepsis guidelines focus on viral as well as bacterial infections, and advise that initiating resuscitation and management should take place within one hour from when sepsis is initially suspected...
September 2020: Annals of the Academy of Medicine, Singapore
Pierre-François Laterre, Miguel Sánchez-García, Tom van der Poll, Olga de la Rosa, Kathy-Ann Cadogan, Eleuterio Lombardo, Bruno François
BACKGROUND: Community-acquired bacterial pneumonia (CABP) can lead to sepsis and is associated with high mortality rates in patients presenting with shock and/or respiratory failure and who require mechanical ventilation and admission to intensive care units, thus reflecting the limited effectiveness of current therapy. Preclinical studies support the efficacy of expanded allogeneic adipose-derived mesenchymal stem cells (eASCs) in the treatment of sepsis. In this study, we aim to test the safety, tolerability and efficacy of eASCs as adjunctive therapy in patients with severe CABP (sCABP)...
November 25, 2020: BMC Pulmonary Medicine
Maurizio Zizzo, Carolina Castro Ruiz, Magda Zanelli, Maria Chiara Bassi, Francesca Sanguedolce, Stefano Ascani, Valerio Annessi
BACKGROUND: Acute colonic diverticulitis (ACD) complications arise in approximately 8% to 35% patients and the most common ones are represented by phlegmon or abscess, followed by perforation, peritonitis, obstruction, and fistula. In accordance with current guidelines, patients affected by generalized peritonitis should undergo emergency surgery. However, decisions on whether and when to operate ACD patients remain a substantially debated topic while algorithm for the best treatment has not yet been determined...
November 25, 2020: Medicine (Baltimore)
Guillermo Kohn-Loncarica, Ana Fustiñana, Franco Díaz-Rubio, Juan C Jaramillo-Bustamante, Sebastián González-Dambrauskas, Pablo Vásquez-Hoyos, Jaime Fernández-Sarmiento, Gustavo González, Alejandro Mansur, Javier Ponce, Roberto Jabornisky
Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis...
December 2020: Archivos Argentinos de Pediatría
Tim Cooksley, Carme Font, Florian Scotte, Carmen Escalante, Leslie Johnson, Ronald Anderson, Bernardo Rapoport
Patients with cancer are at higher risk of more severe COVID-19 infection and have more associated complications. The position paper describes the management of cancer patients, especially those receiving anticancer treatment, during the COVID-19 pandemic. Dyspnea is a common emergency presentation in patients with cancer with a wide range of differential diagnoses, including pulmonary embolism, pleural disease, lymphangitis, and infection, of which SARS-CoV-2 is now a pathogen to be considered. Screening interviews to determine whether patients may be infected with COVID-19 are imperative to prevent the spread of infection, especially within healthcare facilities...
November 23, 2020: Supportive Care in Cancer
Stéphane Bar, Pierre Boivin, Younes El Amine, Richard Descamps, Mouhamed Moussa, Osama Abou Arab, Marc-Olivier Fischer, Hervé Dupont, Emmanuel Lorne, Pierre-Grégoire Guinot
BACKGROUND: Observational studies have suggested that a high respiratory exchange ratio (RER) is associated with the occurrence of postoperative complications. The study's primary objective is to demonstrate that the incidence of postoperative complications is lower in an interventional group (patients monitored using a hemodynamic algorithm that incorporates the RER) than in a control group (treated according to standard practice). METHODS: We shall perform a prospective, multicenter, randomized, open-label, superiority trial of consecutive patients undergoing major noncardiac surgery (i...
November 23, 2020: Trials
B Heijkoop, E Galiabovitch, N York, D Webb
PURPOSE: To review the existing available information regarding urolithiasis management and the impact of COVID-19 on this, and propose recommendations for management of emergency urolithiasis presentations in the COVID-19 era. METHODS: Review of published guidelines produced by Urological Governing Bodies, followed by the literature review regarding urolithiasis management during the COVID-19 pandemic. RESULTS: Consistent recommendations across guidelines and literature were that urolithiasis with concurrent sepsis or renal failure remains a urological emergency warranting urgent intervention within the pandemic environment...
November 23, 2020: World Journal of Urology
Hiroyuki Ohbe, Kazuma Yamakawa, Kohei Taniguchi, Kojiro Morita, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
Introduction: Clinical guidelines state that disseminated intravascular coagulation (DIC) treatment should be based on three clinical phenotypes: the marked bleeding type (e.g. leukemia, trauma, obstetric diseases, or aortic diseases); organ failure type (sepsis or pancreatitis); and asymptomatic type of DIC (solid cancer). However, among the various underlying disorders of DIC, the clinical presentations of bleeding or organ failure have not to date been well documented. The present study aimed to evaluate whether underlying disorders of DIC would affect clinical outcome including death, organ failure, and bleeding...
October 15, 2020: JMA journal
Johan Gyllensvärd, Fredrik Ingemansson, Elisabet Hentz, Marie Studahl, Anders Elfvin
BACKGROUND: Early-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. In the study we evaluated if a quality improvement initiative could reduce unwarranted antibiotic use in a safe way in term neonates with culture-negative sepsis. METHODS: The quality improvement initiative included new treatment guidelines and were introduced on 11 June 2018...
November 20, 2020: BMC Pediatrics
Michael A Ward, Hani I Kuttab, Joseph D Lykins V, Kristen Wroblewski, Michelle D Hughes, Eric P Keast, Jason A Kopec, Erron M Rourke, John Purakal
PURPOSE: The Surviving Sepsis Campaign guidelines recommend 30 mL/kg of fluids within 3 hours (30by3) of sepsis-induced hypoperfusion, but a national mandate released an allowance for dosing based on ideal instead of actual body weight (IBW/ABW) for obese patients. This study aims to determine the dose-effect of 30by3 for patients with severe sepsis or septic shock (SS/SS) with respect to body mass index (BMI) categories and secondarily, examine the clinical impact of IBW vs. ABW-based dosing...
November 20, 2020: Journal of Intensive Care Medicine
Federica Dal Bello, Michael Zorzi, Riccardo Aigotti, Davide Medica, Vito Fanelli, Vincenzo Cantaluppi, Eleonora Amante, Viviana Teresa Orlandi, Claudio Medana
Quorum sensing (QS) is the ability of some bacteria to detect and to respond to population density through signalling molecules. QS molecules are involved in motility and cell aggregation mechanisms in diseases such as sepsis. Few biomarkers are currently available to diagnose sepsis, especially in high-risk conditions. The aim of this study was the development of new analytical methods based on liquid chromatography-mass spectrometry for the detection and quantification of QS signalling molecules, including N-acyl homoserine lactones (AHL) and hydroxyquinolones (HQ), in biofluids...
November 18, 2020: Analytical and Bioanalytical Chemistry
Annette Hennigs, Johannes Jochum
Infectious diseases are a frequent reason for medical consultations both in the inpatient and outpatient setting. Inadequate management is associated with increased costs, morbidity and mortality. In times of rising antibiotic resistance rational therapy and antimicrobial stewardship are of utmost importance. While it is crucial to avoid excessively broad antimicrobial coverage and unnecessary therapies, serious conditions must be treated effectively. The article highlights common infections and gives recommendations for empiric and targeted antibiotic treatment...
November 2020: Deutsche Medizinische Wochenschrift
Nikhil Jagan, Lee E Morrow, Ryan W Walters, Robert W Plambeck, Tej M Patel, Karson F Kalian, Jeffrey C Macaraeg, Emily D Dyer, Adam A Bergh, Aaron J Fried, Douglas R Moore, Mark A Malesker
BACKGROUND: Although resuscitation with intravenous fluids (IVF) is the cornerstone of sepsis management, consensus regarding their association with improvement in clinical outcomes is lacking. RESEARCH QUESTION: Is there a difference in the incidence of respiratory failure in patients with sepsis who received guideline-recommended initial intravenous fluid bolus of 30 cc/kg or more conservative resuscitation of fewer than 30 cc/kg? STUDY DESIGN AND METHODS: Retrospective analysis of prospectively collected clinical data conducted at an academic medical center in Omaha, Nebraska...
November 13, 2020: Chest
Hussain Ahmed Raza, Ainan Arshad, Ahmed Ayaz, Mohummad H R Raja, Fatima Gauhar, Maria Khan, Bushra Jamil
Objectives: Guidelines recommend use of norepinephrine as the first-line treatment for fluid-refractory septic shock and if septic shock persists vasopressin may be initiated. Since there are limited data from low middle-income countries with high disease burden of sepsis, we aimed to compare the outcomes of using vasopressin adjunct to norepinephrine in comparison with norepinephrine alone. Design: Retrospective cohort study. Setting: Aga Khan University Hospital, Karachi, Pakistan...
November 2020: Critical care explorations
Danielle Piper, Gemma Smith, James E Archer, Hugo Woffenden, Deepa Bose
Septic arthritis remains an orthopaedic emergency that requires prompt diagnosis and management. During the 2020 COVID-19 pandemic, British Orthopaedic Association (BOAST) guidelines dictated that medical treatment (closed-needle aspiration + antibiotic therapy) should be offered to patients as first-line management, and operative treatment (arthroscopic joint washout +/- synovectomy) be reserved for patients exhibiting signs of sepsis. Literature has previously shown that for native joint septic arthritis, operative treatment is not superior to medical treatment...
November 9, 2020: Curēus
Mehmood Shaikh, Muhammad Hanif, Rafia Gul, Wajid Hussain, Hemandas Hemandas, Ashraf Memon
Background Neonatal sepsis is one of the most common causes of neonatal mortality and morbidity, particularly in developing countries. Its causative bacteria and their respective sensitivity patterns are different in each hospital and region. The objective of this study was to determine the causative bacteria and their antibiotics sensitivity patterns at the neonatal unit. Methods This prospective study was carried out at the Neonatology Unit of Kharadar General Hospital (KGH) from January 2017 to Jun 2019...
October 13, 2020: Curēus
Yue-E Wu, Tao Wang, Hua-Liang Yang, Bo-Hao Tang, Li Kong, Xin Li, Qi Gao, Xue Li, Bu-Fan Yao, Hai-Yan Shi, Xin Huang, Wen-Qi Wang, Evelyne Jacqz-Aigrain, Karel Allegaert, John van den Anker, Xiu-Ying Tian, Wei Zhao
OBJECTIVES: Nowadays, real-world data can be used to improve currently available dosing guidelines and to support regulatory approval of drugs for use in neonates by overcoming practical and ethical hurdles. This proof-of-concept study aimed to assess the population pharmacokinetics of azlocillin in neonates using real-world data, to make subsequent dose recommendations and to test these in neonates with early-onset sepsis (EOS). METHODS: This prospective, open-label, investigator-initiated study of azlocillin in neonates with EOS was conducted using an adaptive two-step design...
November 14, 2020: Journal of Antimicrobial Chemotherapy
Nouf Abutheraa, June Grant, Alexander B Mullen
(1) Background: Sepsis is the leading cause of maternal death in 11-15% of women worldwide. This emphasises the importance of administrating timely and appropriate antibiotic therapy to women with sepsis. We aimed to evaluate the appropriateness of antimicrobial prescribing in women diagnosed with peripartum sepsis. (2) Method: A prospective observational cohort study in a single Scottish health region with 12,233 annual live births. Data were collected on women diagnosed with sepsis in the peripartum period using physical and electronic medical records, drug Kardex® (medication administration) and ward handover records...
November 11, 2020: Pharmacy (Basel, Switzerland)
Catherine A Farrell
Sepsis is a systemic inflammatory response to suspected or proven infection. Given its importance in terms of morbidity and mortality, a number of initiatives by several professional societies in recent years have led to the development of guidelines for the recognition and timely management of sepsis. The principal elements of the most recent guidelines are summarized in this practice point. These elements include recognition of changes in clinical condition and vital signs, such as fever, tachycardia, and changes in peripheral perfusion, which should raise concern for sepsis; initial stabilization of airway, breathing, and circulation; timely administration of empiric antimicrobial therapy; use of fluid boluses and vasoactive medications; and specific considerations in patients with underlying medical conditions, such as the use of corticosteroids for possible adrenal insufficiency due to hypothalamic-adrenal suppression...
November 2020: Paediatrics & Child Health
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