Sepsis

The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC).  

According to a new study published by the Centers for Disease Control and Prevention, estimates of sepsis-related death rates vary widely, depending on the data source analyzed.  

All Anaesthetics Analgesia Anatomy Conditions Emergency Medicine ICU Immunology Intubation Pharmacology Physics Physiology Renal Sepsis Techniques Vaccine #WDSD16  

: Diabetes is associated with a markedly increased risk for community-acquired <em>Staphylococcus aureus</em> bacteremia, particularly for diabetes of long duration with poor glycemic control and complications.  

Introduction with a case 0 Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock.   

emDocs post containing very useful emergency medicine information  

Which ICU patients are most at risk for mortality after contracting hospital-acquired fungemias? This study identifies the prognostic factors.  

So the ED crowd have stolen a march on us following the recent publication of the Sepsis 3.0 Consensus Definitions. And fair play to them for doing so; it has really helped to get the details out in the open.  

What factors might influence mortality and outcome in patients with S. aureus bacteremia?  

Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.  

How do patients with sepsis and acute respiratory distress syndrome fare one year after treatment with rosuvastatin?  

A new series of definitions of sepsis1 along with simple guidance for early diagnosis has recently been published, and a NICE guideline is due shortly.2 Sepsis is an extreme manifestation of the body responding to a severe infection—in part adaptive and protective, but potentially maladaptive and life threatening. Naturally, perhaps, the focus has been on early diagnosis and management. This is not always performed well, as highlighted by a 2015 report from the UK National Confidential Enquiry into Patient Outcome and Death.3 In a linked paper, Prescott and colleagues (doi:10.1136/bmj.i2375) report that patients who survive an episode of sepsis have a significant excess risk of mortality for a prolonged period of time.4 In the past, staff working in intensive care units discharged patients to the rest of the hospital with a feeling of a job well done; somehow that part of the patient’s journey had come to an end and recovery was about to begin. Since then numerous publications have challenged this optimistic assumption. For substantial numbers of patients, leaving the intensive care unit does not represent the end of something, rather it represents the start of something else, often not anticipated by them or understood by others. Many studies have described the difficulties sustained by patients and of course their families. Such difficulties include loss of muscle mass and strength,5 cognitive dysfunction, anxiety and depression,6 and post-traumatic stress.7 Along with this come challenges, both medical and financial, for those who become informal caregivers.8 9 In the UK this has been addressed, at least in ambition, with the publication of NICE guidelines for rehabilitation after critical illness.10  

 

Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular, cell, and intact organ level. Despite uncertainties in hemodynamic management and several treatments that have failed in clinical trials, investigational therapies increasingly target sepsis induced organ and immune dysfunction. Outcomes in sepsis have greatly improved overall, probably because of an enhanced focus on early diagnosis and fluid resuscitation, the rapid delivery of effective antibiotics, and other improvements in supportive care for critically ill patients. These improvements include lung protective ventilation, more judicious use of blood products, and strategies to reduce nosocomial infections.  

Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular, cell, and intact organ level. Despite uncertainties in hemodynamic management and several treatments that have failed in clinical trials, investigational therapies increasingly target sepsis induced organ and immune dysfunction. Outcomes in sepsis have greatly improved overall, probably because of an enhanced focus on early diagnosis and fluid resuscitation, the rapid delivery of effective antibiotics, and other improvements in supportive care for critically ill patients. These improvements include lung protective ventilation, more judicious use of blood products, and strategies to reduce nosocomial infections.  

What accounts for the variability in the diagnosis of severe sepsis -- and what approaches may help improve consistency?  

In previous discussions, we have addressed that IV fluid choices affect patient outcomes in septic shock, and we have shown the evidence that invasive monitoring coupled with aggressive treatments are actually harming our patients.  The question we now face is what is the result of over-resuscitation?   

Patients who are recovering from Ebola virus infection probably pose little risk to healthcare workers six weeks after viremia has cleared, according to a new study.  

A new study looks at the long-term post-discharge survival among ICU patients with sepsis who received in-hospital cardiopulmonary resuscitation.