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Invasive hemodynamic monitoring in obstetrics
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Luis D. Pacheco, Shannon Clark, Gary D. V. Hankins
Thus, a patient is equally likely to respond to fluid with a low or a high CVP (20). Despite lack of scientific evidence, the 2008 Surviving Sepsis Campaign still recommends utilizing CVP as an end point for fluid resuscitation in the setting of septic shock (21).
The immune and lymphatic systems, infection and sepsis
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Michelle Treacy, Caroline Smales, Helen Dutton
To avoid progression on the continuum of infection to sepsis, comprehensive assessment skills noting key clinical indicators and timely interventions are required by the health care team, in particular the health care professionals who carry out vital signs assessment. Early recognition and treatment are essential to reduce sepsis-related mortality (RCP 2017). In hospitals, nurses are often the first to recognise deterioration in a patient. The Surviving Sepsis Campaign promotes the assessment of every patient, every shift, and every day for sepsis (Rhodes et al. 2017). It is imperative that nurses have the skills, competence and critical thinking skills to carry out systematic assessments (Treacy and Stayt 2019).
Rapid Infectious Diseases Diagnostics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Bronwen Garner, Kimberly Hanson
Standard clinical care is to immediately initiate empiric broad spectrum antibiotic therapy, after blood is collected for culture, in patients suspected to have sepsis. In fact, the surviving sepsis campaign guidelines recommend administration of empiric broad spectrum antibiotics as soon as possible, and within 1 hour maximum, from recognition of severe sepsis or septic shock [63]. In the guidelines, physicians should continue until they identify the etiological agent of sepsis and antimicrobial susceptibility test (AST) results are available to tailor therapy. Unfortunately, empiric antimicrobial treatment choices are often inadequate or excessively broad in a significant proportion of patients [64]. Ineffective empiric choices are associated with increased mortality [65]. Thus, new technologies that more quickly and accurately identify a microbial cause of sepsis are important tools for the intensivist. In this section, we focus our review on new approaches to the rapid diagnosis of BSI. Blood cultures remain the diagnostic gold standard for BSI, and there are new complementary tools that can be applied to pure organism isolates, positive blood culture bottle aliquots, or directly to whole blood for more rapid organism detection.
Burden and mortality of sepsis and septic shock at a high-volume, single-center in Vietnam: a retrospective study
Published in Hospital Practice, 2022
Truong Hong Hieu, Pham Thi Ngoc Thao, Federica Cucè, Nguyen Hai Nam, Abdullah Reda, Osman Gamal Hassan, Le Thanh Hung, Dinh Thi Kim Quyen, Jeza M Abdul Aziz, Loc Le Quang, Alison Marie Carameros, Nguyen Tien Huy
Patients’ main cause of death was considered sepsis, if on admission to the ICU they had positive blood cultures and met SEPSIS 3 criteria, but vasopressors were not needed to maintain perfusive blood pressure. While patients registered as dead because of septic shock were septic patients with positive blood culture that also needed vasopressors to maintain an average BP of ≥65 mmHg and had a lactate blood level >2 mmol/l (18 mg/dl), despite adequate rehydration (30 ml/kg). Treatment of sepsis/septic shock followed the surviving sepsis campaign bundle 2018 [13] with doses of antibiotics and vasopressors based strictly on the hospital’s guidelines. Sensitive to empiric antibiotics was defined as the isolated bacteria being susceptible to at least one of the antimicrobials empirically administered as the first dose or 24 hours later. Otherwise, it was considered inappropriate/resistant to empiric antibiotics [14,15].
Antibiotic treatment in patients with sepsis: a narrative review
Published in Hospital Practice, 2022
Erika P. Plata-Menchaca, Ricard Ferrer, Juan Carlos Ruiz Rodríguez, Rui Morais, Pedro Póvoa
Sepsis is a life-threatening condition and a significant public health issue that affects millions of people worldwide, representing one of the leading causes of death [1]. Sepsis begins with an initial infection that elicits a dysregulated inflammatory response leading to organ dysfunction [2]. In the elderly, there is a higher prevalence of chronic and debilitating diseases leading to an increased incidence of sepsis [3]. Despite the advances in knowledge on sepsis pathophysiology, several observational studies and clinical trials have failed to identify effective adjuvant therapies that could modify the course of the disease [4–8]. In the absence of any specific sepsis treatment, it is crucial to treat sepsis as a medical emergency, to seek for the early control of infection and organ support [9–13]. Since time is paramount in the prognosis of sepsis, the 2016 Surviving Sepsis Campaign (SCC) guidelines advocate for antibiotic prescriptions to be started as soon as possible and ideally within the first hour after a sepsis diagnosis [11,14].
Appropriateness of empirical antibiotic therapy and added value of adjunctive gentamicin in patients with septic shock: a prospective cohort study in the ICU
Published in Infectious Diseases, 2021
Rob G. H. Driessen, Rald V. M. Groven, Johan van Koll, Guy J. Oudhuis, Dirk Posthouwer, Iwan C. C. van der Horst, Dennis C. J. J. Bergmans, Ronny M. Schnabel
We systematically screened all patients admitted to the ICU for sepsis since 2012 and enrolled all patients admitted with sepsis in a prospectively recorded database. Admission with sepsis was defined as any ICU admission clinically coded as infection and at least one organ dysfunction, according to the Surviving Sepsis Campaign guidelines of 2012 [17]. For this study, we included the subset of patients with septic shock due to (suspected) abdominal, urogenital, and unknown focus of infection between 2012 and 2017. Septic shock was defined as sepsis with circulatory failure and lactate levels >2 mmol/L despite adequate fluid resuscitation and requiring vasopressor treatment to maintain adequate mean arterial pressure (MAP) of ≥65 mmHg, according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-)3 criteria [1].