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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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De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock. Mortality rates among patients with sepsis, severe sepsis or septic shock are highly variable throughout different regions or services and can be upwards of 50%. Empirical broad-spectrum antimicrobial treatment is aimed at achieving adequate antimicrobial therapy, thus reducing mortality; however, there is a risk that empirical broad-spectrum antimicrobial treatment can expose patients to overuse (...) of antimicrobials. De-escalation has been proposed as a strategy to replace empirical broad-spectrum antimicrobial treatment by using a narrower antimicrobial therapy. This is done by reviewing the patient's microbial culture results and then making changes to the pharmacological agent or discontinuing a pharmacological combination.To evaluate the effectiveness and safety of de-escalation antimicrobial treatment for adult patients diagnosed with sepsis, severe sepsis or septic shock caused by any micro
Review: Etomidate increased mortality and adrenal insufficiency in adults with sepsis. 23420256 2013 04 11 2013 02 19 1539-3704 158 4 2013 Feb 19 Annals of internal medicine Ann. Intern. Med. ACP Journal Club. Review: etomidate increased mortality and adrenal insufficiency in adults with sepsis. JC10 10.7326/0003-4819-158-4-201302190-02010 Pearl Ronald G RG eng Comment Journal Article United States Ann Intern Med 0372351 0003-4819 Crit Care Med. 2012 Nov;40(11):2945-53 22971586 2013 2 20 6 0
High-volume haemofiltration for sepsis. Severe sepsis and septic shock are leading causes of death in the intensive care unit (ICU). This is despite advances in the management of patients with severe sepsis and septic shock including early recognition, source control, timely and appropriate administration of antimicrobial agents, and goal directed haemodynamic, ventilatory and metabolic therapies. High-volume haemofiltration (HVHF) is a blood purification technique which may improve outcomes (...) in critically ill patients with severe sepsis or septic shock. The technique of HVHF has evolved from renal replacement therapies used to treat acute kidney injury (AKI) in critically ill patients in the ICU.This review assessed whether HVHF improves clinical outcome in adult critically ill patients with sepsis in an ICU setting.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2011, Issue 7); MEDLINE (1990 to August 2011), EMBASE (1990 to August 2011); LILACS
Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
In Patients With Severe Sepsis, Does a Single Dose of Etomidate to Facilitate Intubation Increase Mortality? SystematicReviewSnapshot TAKE-HOME MESSAGE Currently, single-dose etomidate has not been shown to cause increased mortality in septic patients requiring intubation; however, suf?ciently powered randomized trials are required before de?nitive conclusions can be drawn. METHODS DATA SOURCES EMBASE, MEDLINE, Cochrane Data- base, and Evidence-Based Medical Reviews were searched from 1950 (...) with funnel plots and the trim- and-?ll method. In Patients With Severe Sepsis, Does a Single Dose of Etomidate to Facilitate Intubation Increase Mortality? EBEM Commentators Benton R. Hunter, MD Jonathan Kirschner, MD Department of Emergency Medicine Indiana University School of Medicine Indianapolis, IN Results One hundred six articles were identi- ?ed in the search; 58 were reviewed in full text. Ten total studies were included, 5 of which met criteria for the mortality endpoint and 7 for the endpoint
Effect of eritoran, an antagonist of MD2-TLR4, on mortality in patients with severe sepsis: the ACCESS randomized trial. Eritoran is a synthetic lipid A antagonist that blocks lipopolysaccharide (LPS) from binding at the cell surface MD2-TLR4 receptor. LPS is a major component of the outer membrane of gram-negative bacteria and is a potent activator of the acute inflammatory response.To determine if eritoran, a TLR4 antagonist, would significantly reduce sepsis-induced mortality.We performed (...) a randomized, double-blind, placebo-controlled, multinational phase 3 trial in 197 intensive care units. Patients were enrolled from June 2006 to September 2010 and final follow-up was completed in September 2011.Patients with severe sepsis (n = 1961) were randomized and treated within 12 hours of onset of first organ dysfunction in a 2:1 ratio with a 6-day course of either eritoran tetrasodium (105 mg total) or placebo, with n = 1304 and n = 657 patients, respectively.The primary end point was 28-day all
An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of informati Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Drotrecogin alfa (Activated) in severe sepsis: a systematic review of observational studies (Update of Report 29) Drotrecogin alfa (Activated) in severe sepsis: a systematic review of observational studies (Update of Report 29) Drotrecogin alfa (Activated) in severe sepsis: a systematic review of observational studies (Update of Report 29) Nicolau I, Pan I, Xie X, McGregor M, Dendukuri N Record Status This is a bibliographic record of a published health technology assessment. No evaluation (...) of the quality of this assessment has been made for the HTA database. Citation Nicolau I, Pan I, Xie X, McGregor M, Dendukuri N. Drotrecogin alfa (Activated) in severe sepsis: a systematic review of observational studies (Update of Report 29) Montreal: Technology Assessment Unit of the McGill University Health Centre (MUHC). Report number: 58. 2012 Authors' conclusions • The mortality rates reported in the observational studies we reviewed, were higher than the rates previously reported in RCTs (PROGRESS
Polyclonal intravenous immunoglobulin for the treatment of severe sepsis and septic shock in critically ill adults: A systematic review and meta-analysis PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Hydroxyethyl starch 130/0.42 increased death at 90 days compared with Ringer's acetate in severe sepsis. 23070508 2013 01 14 2012 10 16 1539-3704 157 8 2012 Oct 16 Annals of internal medicine Ann. Intern. Med. ACP Journal Club. Hydroxyethyl starch 130/0.42 increased death at 90 days compared with Ringer's acetate in severe sepsis. JC4-6 10.7326/0003-4819-157-8-201210160-02006 Elinoff Jason M JM Danner Robert L RL eng Comment Journal Article United States Ann Intern Med 0372351 0003-4819 N Engl
A randomised trial of granulocyte-macrophage colony-stimulating factor for neonatal sepsis: outcomes at 2 years The authors performed a randomised trial in very preterm small-for-gestational age (SGA) babies to determine if prophylaxis with granulocyte-macrophage colony-stimulating factor (GM-CSF) improves outcomes (the PROGRAMS trial). Despite increased neutrophil counts following GM-CSF, the authors reported no significant difference in neonatal sepsis-free survival.280 babies born <31 weeks
Combination biomarkers to diagnose sepsis in the critically ill patient Although the outcome of sepsis benefits from the prompt administration of appropriate antibiotics on correct diagnosis, the assessment of infection in critically ill patients is often a challenge for clinicians. In this setting, simple biomarkers, especially when used in combination, could prove useful.To determine the usefulness of combination biomarkers to diagnose sepsis.Three hundred consecutive patients were enrolled (...) concentrations of PCT and sTREM-1 and the PMN CD64 index were higher in patients with sepsis compared with all others (P < 0.001 for the three markers). These biomarkers were all independent predictors of infection, the best receiver-operating characteristic curve being obtained for the PMN CD64 index. The performance of the bioscore, better than that of each individual biomarker, was externally confirmed in the validation cohort.This prospective study, including inceptive and validation cohorts
Which fluid (colloids or crystalloids) is better in initial resuscitation of severe sepsis? BestBets: Which fluid (colloids or crystalloids) is better in initial resuscitation of severe sepsis? Which fluid (colloids or crystalloids) is better in initial resuscitation of severe sepsis? Report By: Chamika R Mapatuna - FTSTA ACCS2 Intensive Care Medicine Search checked by Jasmeet Soar - Consultant Intensive Care Medicine Institution: Anaesthetics Department, Southmead Hospital, North Bristol NHS (...) Trust, Bristol, BS10 5NB Date Submitted: 9th September 2008 Date Completed: 13th June 2012 Last Modified: 20th June 2012 Status: Green (complete) Three Part Question In [adult patients with severe sepsis], should [colloids or crystalloids be used for initial resuscitation] to [improve survival]. Clinical Scenario A 67-year-old woman presents to the Emergency Department (ED) with a 3-day history of a dysuria, nausea, vomiting and fever with rigours. She is confused and looks pale. Her respiratory
Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit To determine whether automated identification with physician notification of the systemic inflammatory response syndrome in medical intensive care unit patients expedites early administration of new antibiotics or improvement of other patient outcomes in patients with sepsis.: A prospective randomized, controlled, single center study.Medical intensive care unit of an academic (...) , but did not provide management recommendations.The median time to new antibiotics was similar between the intervention and usual care groups when comparing among all patients (6.0 hr vs. 6.1 hr, p = .95), patients with sepsis (5.3 hr vs. 5.1 hr; p = .90), patients on antibiotics at enrollment (5.2 hr vs. 7.0 hr, p = .27), or patients not on antibiotics at enrollment (5.2 hr vs. 5.1 hr, p = .85). The amount of fluid administered following detection of modified systemic inflammatory response syndrome
Relation between volume and outcome for patients with severe sepsis in United Kingdom: retrospective cohort study. To evaluate whether a relation exists between volume and outcome for admissions with severe sepsis to adult general critical care units in the United Kingdom.Retrospective cohort study using data from a pooled case mix and outcome database.Adult general critical care units participating in the case mix programme.Consecutive admissions to participating units for the years 2008-09 (...) meeting objective, standardised criteria for severe sepsis.Mortality at ultimate discharge from acute hospital.The primary exposure was volume of admissions with severe sepsis per unit per year. A multivariable logistic regression analysis, using generalised estimating equations, was used to assess the association between volume, modelled using fractional polynomials, and ultimate acute hospital mortality while adjusting for potential confounders. No relation was seen between volume and outcome
C1-esterase inhibitor infusion increases survival rates for patients with sepsis Systemic inflammatory response variability displays differing degrees of organ damage and differing outcomes of sepsis. C1-esterase inhibitor, an endogenous acute-phase protein, regulates various inflammatory and anti-inflammatory pathways, including the kallikrein-kinin system and leukocyte activity. This study assesses the influence of high-dose C1-esterase inhibitor administration on systemic inflammatory (...) protein concentrations were drawn on days 1, 3, 5, 7, 10, and 28.Quartile analysis of C1-esterase inhibitor activity in sepsis subjects revealed that the lowest quartile subgroup had similar activity levels (0.7-1.2 U/L), when compared to healthy volunteers (p > .05). These normal-level C1-esterase inhibitor sepsis patients nevertheless displayed increased C-reactive protein (p = .04) production and higher likelihoods of a more severe sepsis (p = .001). Overall, infusion of C1-esterase inhibitor