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Latest & greatest articles for sepsis
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on sepsis or other clinical topics then use Trip today.
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Efficacy and safety of monoclonal antibody to human tumor necrosis factor alpha in patients with sepsis syndrome. A randomized, controlled, double-blind, multicenter clinical trial. TNF-alpha MAb Sepsis Study Group. To evaluate the efficacy and safety of anti-tumor necrosis factor alpha monoclonal antibody (TNF-alpha MAb) in the treatment of patients with sepsis syndrome.Randomized, prospective, multicenter, double-blind, placebo-controlled clinical trial.A total of 31 hospitals in the United (...) States and Canada.There were 994 patients with sepsis syndrome enrolled in this clinical trial, and 971 patients were infused with the study drug.Patients were prospectively stratified into shock or nonshock groups and then randomized to receive a single infusion of 15 mg/kg of TNF-alpha MAb, 7.5 mg/kg of TNF-alpha MAb, or placebo. Patients received standard aggressive medical and surgical care during the 28-day postinfusion period.Twenty-eight-day all-cause mortality.The distribution of variables
The influence of clinical study design on cost-effectiveness projections for the treatment of Gram-negative sepsis with human anti-endotoxin antibody The influence of clinical study design on cost-effectiveness projections for the treatment of Gram-negative sepsis with human anti-endotoxin antibody The influence of clinical study design on cost-effectiveness projections for the treatment of Gram-negative sepsis with human anti-endotoxin antibody Linden P K, Angus D C, Chelluri L, Branch R (...) A Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Using human anti-endotoxin antibody (HA-1A) in patients with sepsis and suspicion of gram-negative bacteremia (GNB). Type of intervention Treatment. Economic study type Cost
Steroid controversy in sepsis and septic shock: a meta-analysis Steroid controversy in sepsis and septic shock: a meta-analysis Steroid controversy in sepsis and septic shock: a meta-analysis Lefering R, Neugebauer E A Authors' objectives To conduct a meta-analysis to asses the clinical evidence for the use of corticosteroids on patients with septic shock, and to evaluate treatment effects in specific subgroups of patients. Searching MEDLINE was searched from 1966 to 1992. The authors' own (...) literature file, and references in trial reports and review articles, were also examined. Experts in the field of sepsis research were contacted for additional material. Study selection Study designs of evaluations included in the review Prospective randomised controlled trials (RCTs), which evaluated the effectiveness of corticosteroids in the management of septic shock, were included if they fulfilled the following criteria: a primary intention to assess the effectiveness of corticosteroids, a control
Accuracy of leukocyte indices and C-reactive protein for diagnosis of neonatal sepsis: a critical review Accuracy of leukocyte indices and C-reactive protein for diagnosis of neonatal sepsis: a critical review Accuracy of leukocyte indices and C-reactive protein for diagnosis of neonatal sepsis: a critical review Da Silva O, Ohlsson A, Kenyon C Authors' objectives To evaluate the accuracy of C-reactive protein (CRP) and leukocyte indices in the diagnosis of infants suspected of having (...) septicaemia in a neonatal intensive care setting. Searching EMBASE and MEDLINE were searched from 1988 and 1966, respectively, to May 1994 using the following search terms: 'infant', 'new-born', 'C-reactive protein', 'leukocyte count', and 'sepsis' or 'septicaemia' or 'infection'. The bibliographies of primary and review articles were also searched, as were the authors' personal files. No language restrictions were applied. Study selection Study designs of evaluations included in the review No inclusion
Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature Cronin L, Cook D J, Carlet J, Heyland D K, King D, Lansang M A, Fisher C J Authors' objectives To determine the effect of corticosteroid therapy on morbidity and mortality in patients with sepsis. Searching MEDLINE (...) and EMBASE were searched from 1966 to 1993 using the following MeSH terms: 'sepsis' and 'steroids' or 'corticosteroids', and 'septic shock and 'steroids' or 'corticosteroids'. The Science Citation Index was searched using the terms 'sepsis' and (explode) 'corticosteroid', and 'septic shock' and (explode) 'corticosteroid'. Index Medicus was handsearched from 1951 onwardusing the terms 'corticosteroids', 'steroids', 'sepsis' and 'septic shock'. Personal files, reference lists of relevant primary and review
Early-onset neonatal group B streptococcal sepsis: economics of various prevention strategies Early-onset neonatal group B streptococcal sepsis: economics of various prevention strategies Early-onset neonatal group B streptococcal sepsis: economics of various prevention strategies Garland S M, Kelly N Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results (...) and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Prevention strategies for early-onset neonatal group B streptococcal sepsis. Type of intervention Screening and primary prevention. Economic study type Cost-effectiveness analysis. Study population Pregnant women with and without obstetric risk factors. Setting The setting was hospital obstetric centres. Australian data were used where possible. Dates to which data relate
The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. To compare the effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in patients with hyperdynamic sepsis.A randomized short-term, interventional study.An intensive care unit of a university hospital.Twenty septic patients with a cardiac index greater than 3.2 L-min-1.m-2 and either a mean arterial pressure (MAP) less than 60 mm Hg (...) oxygen requirements in septic patients. Norepinephrine, however, may have a more favorable hemodynamic profile and improve splanchnic tissue oxygen utilization in sepsis.
Safety and potential efficacy of an aerosolized surfactant in human sepsis-induced adult respiratory distress syndrome. To evaluate the safety and potential efficacy of aerosolized surfactant in intubated patients with adult respiratory distress syndrome (ARDS).A prospective, double-blind, placebo-controlled, randomized, parallel, multicenter pilot clinical trial.A total of 51 patients with sepsis-induced ARDS were entered into the study within 18 hours of developing sepsis or sepsis (...) treated with 12 hours and 24 hours of surfactant per day, respectively.Aerosolized surfactant was well tolerated when administered on a continuous basis for up to 5 days; however, at the doses given, it did not result in significant improvements in patients with sepsis-induced ARDS.
Recombinant human interleukin 1 receptor antagonist in the treatment of patients with sepsis syndrome. Results from a randomized, double-blind, placebo-controlled trial. Phase III rhIL-1ra Sepsis Syndrome Study Group. To further define the safety and efficacy of recombinant human interleukin 1 receptor antagonist (rhIL-1ra) in the treatment of sepsis syndrome.Randomized, double-blind, placebo-controlled, multicenter, multinational clinical trial.A total of 893 patients with sepsis syndrome (...) of one or more organs and a predicted risk of mortality of 24% or greater (n = 411; linear dose-response, P = .002).There was not a statistically significant increase in survival time for rhIL-1ra treatment compared with placebo among all patients who received the study medication or among patients with shock at study entry. Secondary and retrospective analyses of efficacy suggest that treatment with rhIL-1ra results in a dose-related increase in survival time among patients with sepsis who have
Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group. HA-1A is a human monoclonal IgM antibody that binds specifically to the lipid A domain of endotoxin and prevents death in laboratory animals with gram-negative bacteremia and endotoxemia.To evaluate the efficacy and safety of HA-1A, we conducted a randomized, double-blind trial in patients with sepsis (...) and a presumed diagnosis of gram-negative infection. The patients received either a single 100-mg intravenous dose of HA-1A (in 3.5 g of albumin) or placebo (3.5 g of albumin). Other interventions, including the administration of antibiotics and fluids, were not affected by the study protocol.Of 543 patients with sepsis who were treated, 200 (37 percent) had gram-negative bacteremia as proved by blood culture. For the patients with gram-negative bacteremia followed to death or day 28, there were 45 deaths
Cost-effectiveness of HA-1A monoclonal antibody for gram-negative sepsis. Economic assessment of a new therapeutic agent. To assess the cost-effectiveness of the HA-1A monoclonal antibody for the treatment of gram-negative bacteremia.Cost-effectiveness analysis of a randomized, double-blind, placebo-controlled trial using clinical efficacy data reported in the medical literature.Hospitalized patients with sepsis.543 patients with sepsis and suspected gram-negative infection. Patients enrolled (...) in the study met strict criteria for sepsis, including fever or hypothermia (less than 35.6 degrees C or greater than 38.3 degrees C), tachycardia (greater than 90 beats per minute), tachypnea (greater than 20 breaths per minute), and hypotension or two of six signs of systemic toxicity.HA-1A vs placebo in addition to usual care.We determined the range of possible cost-effectiveness ratios for HA-1A therapy, using modeling techniques when clinical or economic variables were unknown. We subjected the model
A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. The XOMA Sepsis Study Group. To assess the efficacy of adjunctive monoclonal antibody antiendotoxin immunotherapy in patients with gram-negative sepsis.Double-blind, randomized, placebo-controlled trial.Thirty-three university-affiliated centers, including Veterans Affairs, community, and municipal hospitals.Hospitalized adults with signs of gram-negative infection (...) and a systemic septic response.Patients were assigned to receive either 2 mg/kg of a murine monoclonal antibody directed against gram-negative endotoxin (E5) or placebo. A second infusion was administered 24 hours later.Mortality over the 30-day study period, resolution of organ failures, and safety.Four hundred eighty-six patients were enrolled. Three hundred sixteen had confirmed gram-negative sepsis (54% bacteremic, 46% nonbacteremic). The survival difference was not statistically significant for all
Plasma tumor necrosis factor levels in patients with presumed sepsis. Results in those treated with antilipid A antibody vs placebo. Using an enzyme-linked immunosorbent assay, we measured plasma levels of tumor necrosis factor (TNF) in 38 patients who were treated with either antilipid A antibody or a placebo for presumed gram-negative bacteremia. Sixteen of the 38 patients had positive blood cultures: 14 with gram-negative rods and 2 with Streptococcus pneumoniae. Initial serum samples (...) for TNF determinations were obtained within 2 to 72 hours (mean, 18.8 hours) after the onset of clinical signs of sepsis. Six (16%) of 38 patients had detectable TNF levels: 4 of 14 with positive blood cultures for gram-negative rods but only 2 of 22 with negative blood cultures (odds ratio, 4; 95% confidence limits, 0.5 and 24.3). Of the 6 patients, 4 had received the placebo and 2 had received the antibody. Tumor necrosis factor levels did not predict adult respiratory distress syndrome, shock
Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. The Veterans Administration Systemic Sepsis Cooperative Study Group. We conducted a multicenter randomized, double-blind, placebo-controlled trial of early short-term, high-dose methylprednisolone sodium succinate in 223 patients with clinical signs of systemic sepsis and a normal sensorium (112 received glucocorticoid and 111 placebo). Patients also received antibiotics and intravenous (...) fluids. Glucocorticoid or placebo was administered intravenously by a bolus (30 mg per kilogram of body weight over 15 minutes) followed by infusion of 5 mg per kilogram per hour for nine hours. The average time between the diagnosis of sepsis and infusion was 2.8 hours. The principal end point was 14-day mortality, which was similar in the placebo (22 percent) and glucocorticoid (21 percent) groups (P = 0.97). Mortality was also not significantly different between those receiving placebo and those
A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. The use of high-dose corticosteroids in the treatment of severe sepsis and septic shock remains controversial. Our study was designed as a prospective, randomized, double-blind, placebo-controlled trial of high-dose methylprednisolone sodium succinate for severe sepsis and septic shock. Diagnosis was based on the clinical suspicion of infection plus the presence of fever (...) patients treated with methylprednisolone, significantly more deaths were related to secondary infection. We conclude that the use of high-dose corticosteroids provides no benefit in the treatment of severe sepsis and septic shock.
Effect of catheter tunnelling and a nutrition nurse on catheter sepsis during parenteral nutrition. A controlled trial. In a three-year controlled trial of subcutaneous catheter tunnelling as a method of reducing total parenteral nutrition (TPN) catheter sepsis 99 silicone catheters (52 tunnelled, 47 untunnelled) were inserted into the subclavian (94%) or jugular (6%) veins under aseptic conditions. The influence of a nutrition nurse, who joined the nutrition team after 18 months, on catheter (...) sepsis rate was also documented. Catheter sepsis was confirmed in 13 of 47 (28%) untunnelled catheters and only 6 of 52 (11.5%) tunnelled catheters (p less than 0.05). A nutrition nurse reduced sepsis rate from 33% (tunnelled 6, untunnelled 11) to 4% (0 tunnelled; 2 untunnelled) (p less than 0.001). There was no significant difference between tunnelled and untunnelled catheters in sepsis rates after the arrival of the nutrition nurse. Although 85% patients had concurrent internal sepsis
Clinical and economic consequences of wound sepsis after appendicectomy and their modification by metronidazole or povidone iodine. The effects of intrarectal metronidazole and intraincisional povidone iodine on sepsis after emergency appendicectomy were compared in a double-blind randomised controlled trial in 496 patients. Wound sepsis occurred in 12.3% of metronidazole-treated patients compared with 24% in the povidone-iodine group and 23.5% in an untreated control group. The metronidazole