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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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Recombinant human activated protein C for severe sepsis in neonates. Sepsis is a common problem in preterm and term infants. The incidence of neonatal sepsis has declined, but mortality remains high. Recombinant human activated protein C (rhAPC) possess a broad spectrum of activity modulating coagulation and inflammation. In septic adults it may reduce mortality, but no significant benefit has been reported in children with severe sepsis.To determine whether treatment with rhAPC reduces (...) to placebo or no intervention as an adjunct to antibiotic therapy of suspected or confirmed severe sepsis in term and preterm infants less than 28 days old. Eligible trials should report at least one of the following outcomes: mortality during initial hospital stay, neurodevelopmental assessment at two years of age or later, length of hospital stay, duration of ventilation, chronic lung disease, periventricular leukomalacia, intraventricular haemorrhage, necrotizing enterocolitis, bleeding, and any other
Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. Hydroxyethyl starch (HES) [corrected] is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis.In this multicenter, parallel-group, blinded trial, we randomly assigned patients with severe sepsis to fluid resuscitation in the ICU with either 6% HES 130/0.42 (Tetraspan) or Ringer's acetate at a dose of up to 33 ml per kilogram (...) by multivariate analyses, with adjustment for known risk factors for death or acute kidney injury at baseline.Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer's acetate. (Funded by the Danish Research Council and others; 6S ClinicalTrials.gov number, NCT00962156.).
Effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients with severe sepsis: a randomized trial. Early appropriate antimicrobial therapy leads to lower mortality rates associated with severe sepsis. The role of empirical combination therapy comprising at least 2 antibiotics of different mechanisms remains controversial.To compare the effect of moxifloxacin and meropenem with the effect of meropenem alone on sepsis-related organ (...) dysfunction.A randomized, open-label, parallel-group trial of 600 patients who fulfilled criteria for severe sepsis or septic shock (n = 298 for monotherapy and n = 302 for combination therapy). The trial was performed at 44 intensive care units in Germany from October 16, 2007, to March 23, 2010. The number of evaluable patients was 273 in the monotherapy group and 278 in the combination therapy group.Intravenous meropenem (1 g every 8 hours) and moxifloxacin (400 mg every 24 hours) or meropenem alone
Development and validation of a model that uses enhanced administrative data to predict mortality in patients with sepsis We aimed to determine whether a sepsis risk-adjustment model that uses only administrative data could be used when other intensive care unit risk-adjustment methods are unavailable.Cohort study with development and validation cohorts.The development cohort included 166,931 patients at 309 hospitals that cared for at least 100 patients with sepsis between 2004 and 2006 (...) . The validation cohort included 357 adult sepsis patients who were enrolled in Project IMPACT, 2002-2009.We developed a multilevel mixed-effects logistic regression model to predict mortality at the patient level. Predictors included patient demographics (age, sex, race, insurance type), site and source of sepsis, presence of 25 individual comorbidities, treatment (within the first 2 days of hospitalization) with mechanical ventilation and/or vasopressors, and/or admission to the intensive care unit (within 2
Immunosuppression in patients who die of sepsis and multiple organ failure. Severe sepsis is typically characterized by initial cytokine-mediated hyperinflammation. Whether this hyperinflammatory phase is followed by immunosuppression is controversial. Animal studies suggest that multiple immune defects occur in sepsis, but data from humans remain conflicting.To determine the association of sepsis with changes in host innate and adaptive immunity and to examine potential mechanisms for putative (...) immunosuppression.Rapid postmortem spleen and lung tissue harvest was performed at the bedsides of 40 patients who died in intensive care units (ICUs) of academic medical centers with active severe sepsis to characterize their immune status at the time of death (2009-2011). Control spleens (n = 29) were obtained from patients who were declared brain-dead or had emergent splenectomy due to trauma; control lungs (n = 20) were obtained from transplant donors or from lung cancer resections.Cytokine secretion assays
Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. New-onset atrial fibrillation (AF) has been reported in 6% to 20% of patients with severe sepsis. Chronic AF is a known risk factor for stroke and death, but the clinical significance of new-onset AF in the setting of severe sepsis is uncertain.To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe (...) sepsis.Retrospective population-based cohort of California State Inpatient Database administrative claims data from nonfederal acute care hospitals for January 1 through December 31, 2007.Data were available for 3,144,787 hospitalized adults. Severe sepsis (n = 49,082 [1.56%]) was defined by validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 995.92. New-onset AF was defined as AF that occurred during the hospital stay, after excluding AF cases present
Oral lactoferrin for the treatment of sepsis and necrotizing enterocolitis in neonates. Neonatal sepsis and necrotizing enterocolitis (NEC) cause significant neonatal mortality and morbidity in spite of appropriate antibiotic therapy. Enhancing host defence and modulating inflammation by using lactoferrin as an adjunct to antibiotics in the treatment of sepsis and/or NEC may improve clinical outcomes.The primary objective is to assess safety and efficacy of oral lactoferrin as an adjunct (...) to antibiotics in the treatment of neonates with suspected or confirmed sepsis and/or NEC.Relevant trials in any language were searched in July 2011 in the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, PREMEDLINE, EMBASE, CINAHL, web sites: www.clinicaltrials.gov and www.controlled-trials.com, abstracts from the annual meeting of Pediatric Academic Societies (1990 to July 2011), by contacting authors who have published in this field, from the reference lists
Oral lactoferrin for the prevention of sepsis and necrotizing enterocolitis in preterm infants. Lactoferrin, a normal component of human colostrum, milk, tears and saliva can enhance host defence and may be effective in the prevention of sepsis and necrotizing enterocolitis (NEC) in preterm neonates.To assess the safety and effectiveness of oral lactoferrin in the prevention of sepsis and NEC in preterm neonates.We used the search strategy of the Cochrane Neonatal Review Group (CNRG) including (...) searches of CENTRAL (The Cochrane Library), MEDLINE and PREMEDLINE, EMBASE and CINAHL. We also searched trials registries and the conference proceedings of Pediatric Academic Society. Searches updated in July 2011.Randomized or quasi-randomized controlled trials evaluating oral lactoferrin at any dose or duration for the prophylaxis of sepsis or NEC in preterm neonates.Data collection and analysis were performed according to the standard methods of the CNRG.One trial (Manzoni 2008) that randomized 472
The role of albumin as a resuscitation fluid for patients with sepsis: A systematic review and meta-analysis PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. To assess the compliance of Asian intensive care units and hospitals to the Surviving Sepsis Campaign's resuscitation and management bundles. Secondary objectives were to evaluate the impact of compliance on mortality and the organisational characteristics of hospitals that were associated with higher compliance.Prospective cohort study.150 intensive care units in 16 Asian countries.1285 (...) adult patients with severe sepsis admitted to these intensive care units in July 2009. The organisational characteristics of participating centres, the patients' baseline characteristics, the achievement of targets within the resuscitation and management bundles, and outcome data were recorded.Compliance with the Surviving Sepsis Campaign's resuscitation (six hours) and management (24 hours) bundles.Hospital mortality was 44.5% (572/1285). Compliance rates for the resuscitation and management
Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Proof of principle: the predisposition, infection, response, organ failure sepsis staging system In an effort to improve upon the traditional sepsis syndrome definitions, the predisposition, infection, response, organ dysfunction (PIRO) model was proposed to better characterize sepsis. The objective of this investigation was to derive and validate a sepsis staging system based on the PIRO concept that risk stratifies patients with suspected infection.Three independent, observational (...) ability with an area under the curve of 0.90 in the derivation cohort, 0.86 in internal validation, and 0.83 in external validation.This study provides evidence-based support for the PIRO approach to sepsis staging. Future efforts may utilize this approach with additional parameters (e.g., genetics and novel biochemical markers) to develop further the PIRO stratification system.
Does Resuscitation With Albumin-containing Solutions Improve Mortality in Sepsis? SystematicReviewSnapshot TAKE-HOME MESSAGE Albumin use during resuscitation of patients with sepsis may decrease mortality compared with other ?uid solutions. Until additional studies are published, clinicians should consider albumin use an option during the initial resuscitation of patients with sepsis. METHODS DATA SOURCES Electronic searches were con- ducted with MEDLINE, EMBASE, the Cochrane Central Register (...) of Controlled Trials databases (in- ception to April 10, 2010), and the MetaRegister of Controlled Trials, including Medical Editors Trials. Experts in the ?eld were contacted to identify unpublished trials. STUDY SELECTION Randomized controlled trials comparing ?uid resuscitation in sepsis with albumin-containing solutions versus other ?uid resus- citation regimens were selected. Studies that contained a subgroup of sepsis patients within a larger group were also included in the meta-analysis. Inclusion