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By Paul Ross ICUnurses
Kirsi-Maija Kaukonen, Michael Bailey, David Pilcher, D Jamie Cooper, Rinaldo Bellomo
BACKGROUND: The consensus definition of severe sepsis requires suspected or proven infection, organ failure, and signs that meet two or more criteria for the systemic inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and construct validity of this approach. METHODS: We studied data from patients from 172 intensive care units in Australia and New Zealand from 2000 through 2013. We identified patients with infection and organ failure and categorized them according to whether they had signs meeting two or more SIRS criteria (SIRS-positive severe sepsis) or less than two SIRS criteria (SIRS-negative severe sepsis)...
April 23, 2015: New England Journal of Medicine
Paul R Mouncey, Tiffany M Osborn, G Sarah Power, David A Harrison, M Zia Sadique, Richard D Grieve, Rahi Jahan, Sheila E Harvey, Derek Bell, Julian F Bion, Timothy J Coats, Mervyn Singer, J Duncan Young, Kathryn M Rowan
BACKGROUND: Early, goal-directed therapy (EGDT) is recommended in international guidelines for the resuscitation of patients presenting with early septic shock. However, adoption has been limited, and uncertainty about its effectiveness remains. METHODS: We conducted a pragmatic randomized trial with an integrated cost-effectiveness analysis in 56 hospitals in England. Patients were randomly assigned to receive either EGDT (a 6-hour resuscitation protocol) or usual care...
April 2, 2015: New England Journal of Medicine
P E Marik
A protocol for the quantitative resuscitation of severe sepsis and septic shock known as early goal-directed therapy (EGDT) was published in 2001. Despite serious limitations, this study became widely adopted around the world and formed the basis of the Surviving Sepsis Campaign 6 h resuscitation bundle. Subsequently, a large number of observational before-and-after studies were published which demonstrated that EGDT reduced mortality. However, during this time period, there has been a substantial reduction in the mortality from sepsis in many Western nations that appears unrelated to EGDT...
May 2015: Acta Anaesthesiologica Scandinavica
Manu Shankar-Hari, Clifford S Deutschman, Mervyn Singer
No abstract text is available yet for this article.
May 2015: Intensive Care Medicine
Colin K Grissom, Eliotte L Hirshberg, Justin B Dickerson, Samuel M Brown, Michael J Lanspa, Kathleen D Liu, David Schoenfeld, Mark Tidswell, R Duncan Hite, Peter Rock, Russell R Miller, Alan H Morris
OBJECTIVES: In the Fluid and Catheter Treatment Trial (FACTT) of the National Institutes of Health Acute Respiratory Distress Syndrome Network, a conservative fluid protocol (FACTT Conservative) resulted in a lower cumulative fluid balance and better outcomes than a liberal fluid protocol (FACTT Liberal). Subsequent Acute Respiratory Distress Syndrome Network studies used a simplified conservative fluid protocol (FACTT Lite). The objective of this study was to compare the performance of FACTT Lite, FACTT Conservative, and FACTT Liberal protocols...
February 2015: Critical Care Medicine
Giora Landesberg, Phillip D Levin, Dan Gilon, Sergey Goodman, Milena Georgieva, Charles Weissman, Allan S Jaffe, Charles L Sprung, Vivian Barak
BACKGROUND: In vitro studies suggested that circulating inflammatory cytokines cause septic myocardial dysfunction. However, no in vivo clinical study has investigated whether serum inflammatory cytokine concentrations correlate with septic myocardial dysfunction. METHODS: Repeated echocardiograms and concurrent serum inflammatory cytokines (IL-1β, IL-6, IL-8, IL-10, IL-18, tumor necrosis factor-α, and monocyte chemoattractant protein-1) and cardiac biomarkers (high-sensitivity [hs] troponin-T and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) were examined in 105 patients with severe sepsis and septic shock...
July 2015: Chest
Zhongheng Zhang
OBJECTIVE: The present study aimed to combine observational evidence with randomised controlled trials (RCTs) by using the Bayesian approach. DATA SOURCES: Electronic databases, including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, EMBASE and EBSCO were searched from inception to January 2014. STUDY ELIGIBILITY: RCTs and observational studies (OS) investigating the effectiveness of activated protein C (aPC) on mortality reduction were included for analysis...
2015: BMJ Open
Robert Flaumenhaft
No abstract text is available yet for this article.
January 15, 2015: New England Journal of Medicine
Karen Rosenberg, Andrea Kayyali
No abstract text is available yet for this article.
November 2014: American Journal of Nursing
Chizobam Ani, Siavash Farshidpanah, Amy Bellinghausen Stewart, H Bryant Nguyen
OBJECTIVE: Recent studies have reported decreased overall severe sepsis mortality, but associations with organism trends have not yet been investigated. This study explored organism-specific severe sepsis mortality trends from 1999 to 2008 in a large hospital-based administrative database. DESIGN: Secondary data analysis using the Nationwide Inpatient Sample. SETTING: United States hospitals sampled in the Nationwide Inpatient Sample dataset...
January 2015: Critical Care Medicine
Ruth Kleinpell, Christa A Schorr
Sepsis is the body's systemic response to infection that can be complicated by acute organ dysfunction and is associated with high mortality rates and adverse outcomes for acute and critically ill patients. The 2012 Surviving Sepsis Campaign guidelines advocated for implementation of evidence-based practice care for sepsis, with a focus on quality improvement. Nurses are directly involved in identification and management of sepsis. Implementing performance improvement strategies aimed at early recognition and targeted treatment can further improve sepsis care and patient outcomes...
April 2014: AACN Advanced Critical Care
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