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Severe sepsis and septic shock in adults: Treatment

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5 papers 1000+ followers Questioning Medicine upcoming podcast #FOAMed #MedQuestioning
By Joe Weatherly FM/Hospitalist-CoFounder of QuestioningMedicine and PCRAP contributor.
Sarah J Lee, Kannan Ramar, John G Park, Ognjen Gajic, Guangxi Li, Rahul Kashyap
BACKGROUND: The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time. METHODS: This is a retrospective cohort study of consecutive adults with severe sepsis and septic shock admitted to a quaternary care medical ICU between January 2007 and December 2009...
October 2014: Chest
Chanu Rhee, Shruti Gohil, Michael Klompas
Sepsis, the syndrome of dysregulated inflammation that occurs with severe infection, affects millions of people worldwide each year. Multiple studies suggest that the incidence of sepsis is dramatically increasing. According to the Centers for Disease Control and Prevention (CDC), for example,..
May 1, 2014: New England Journal of Medicine
Pierre Asfar, Ferhat Meziani, Jean-François Hamel, Fabien Grelon, Bruno Megarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, René Robert, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Pierre Guezennec, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, Damien du Cheyron, Claude Guerin, Alain Mercat, Jean-Louis Teboul, Peter Radermacher
BACKGROUND: The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown. METHODS: In a multicenter, open-label trial, we randomly assigned 776 patients with septic shock to undergo resuscitation with a mean arterial pressure target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group)...
April 24, 2014: New England Journal of Medicine
Derek C Angus, Tom van der Poll
New England Journal of Medicine, Volume 369, Issue 9, Page 840-851, August 2013.
August 29, 2013: New England Journal of Medicine
Todd A Seigel, Michael N Cocchi, Justin Salciccioli, Nathan I Shapiro, Michael Howell, Amy Tang, Michael W Donnino
BACKGROUND: Early treatment of sepsis in Emergency Department (ED) patients has lead to improved outcomes, making early identification of the disease essential. The presence of systemic inflammatory response criteria aids in recognition of infection, although the reliability of these markers is variable. STUDY OBJECTIVE: This study aims to quantify the ability of abnormal temperature, white blood cell (WBC) count, and bandemia to identify bacteremia in ED patients with suspected infection...
March 2012: Journal of Emergency Medicine
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