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Critical Care

The Surviving Sepsis Campaign [1] advocates maintaining a mean arterial pressure (MAP) of at least 65 mm Hg in sepsis patients undergoing resuscitation. Leone and colleagues [2], in an article published in this journal, suggest considering higher MAP targets in the resuscitation of patients with a history of arterial hypertension so they do not progress to acute kidney injury. Asfar and colleagues [3], in a multicenter, open-label trial, showed no significant difference in mortality outcomes in septic shock patients undergoing resuscitation with an MAP target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). However, the study did show that chronic hypertensive patients in the higher-target group had lower incidences of acute kidney injury and renal replacement therapy. This likely stems from the need for higher MAPs in chronic hypertensive patients in order to maintain organ blood flow because of a shift of the organ’s autoregulatory range to the right. Thus, targeting a higher MAP for chronic hypertensive patients may help avoid the development of acute kidney injury and the need for renal replacement therapy. Renal replacement therapy carries with it inherent morbidity as well as additional cost. These costs include the need for dialysate fluid and extra personnel and the use of anticoagulation and the extracorporeal circuit [2]. However, chronic hypertensive patients in the high-target group had a greater incidence of new-onset atrial fibrillation (5.2% in the low-target group versus 9% in the high-target group). Patients with new-onset atrial fibrillation during sepsis have been shown to have increased incidences of in-hospital stroke and in-hospital mortality [4] as well as subsequent recurrence of atrial fibrillation and increased long-term risks for heart failure, ischemic stroke, and death [5]. This may offset any benefit of a higher MAP. The ideal target MAP may have to be individualized for specific patient populations. More studies are needed to determine whether baseline blood pressure plays a role in the ultimate determination of the ideal MAP target for patients with sepsis.  
ccforum.com
about 4 years ago
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Critical Care

Neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (Cys-C), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) are novel diagnostic biomarkers of acute kidney injury (AKI). We aimed to determine the diagnostic properties of these biomarkers for detecting AKI in critically ill patients with sepsis.  
ccforum.com
about 4 years ago
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REBELCast: Sepsis Care in 2015 - R.E.B.E.L. EM - Emergency Medicine Blog

This post is a summary of my lecture from the Texas College of Emergency Physicians meeting in Austin, TX (April 23rd - 26th, 2015) on sepsis, titled "Optimizing ED Management of Sepsis."  
rebelem.com
about 4 years ago
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Critical Care

The Tie2/angiopoietin (Tie2/Ang) and vascular endothelial growth factor receptor-ligand systems (VEGFR/VEGF) are recognized to play important roles in the regulation of microvascular endothelial function. Downregulation of these genes during sepsis has been implicated in the pathogenesis of sepsis-related microvascular leak and multiple organ dysfunction syndrome. Mechanisms responsible for dysregulation of angiogenic genes in sepsis are poorly defined.  
ccforum.com
about 4 years ago
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Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
about 4 years ago
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11

Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
about 4 years ago
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0
10

Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
about 4 years ago
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1

Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
about 4 years ago
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What can #meded learn from sepsis management?

By Damian Roland  The last of the trilogy of Early Goal Directed Therapy (EGDT) for sepsis management studies was published recently. The results, on the face of it, appeared surprising. There is no difference in outcome when either an algorithmic-based protocol or clinical gesalt is used in the management of patients with septic shock. The…  
icenetblog.royalcollege.ca
about 4 years ago
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Critical Care

Neutrophil CD64 (nCD64) expression appears to be a promising marker of bacterial infections. The aim of this meta-analysis was to assess the accuracy of nCD64 expression for the diagnosis of sepsis in critically ill adult patients.  
ccforum.com
about 4 years ago
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PODCAST: Pushing Pressors in the Periphery - Broome Docs

pressors sepsis noradrenaline peripheral infusion shock  
broomedocs.com
about 4 years ago
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Critical Care

The purpose of this study was to investigate whether common variants across the nuclear factor erythroid 2-like 2 (NFE2L2) gene contribute to the development of the acute respiratory distress syndrome (ARDS) in patients with severe sepsis. NFE2L2 is involved in the response to oxidative stress, and it has been shown to be associated with the development of ARDS in trauma patients.  
ccforum.com
about 4 years ago
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Critical Care

Intravenous fluid administration is an essential component of sepsis management, but a positive fluid balance has been associated with worse prognosis. We analyzed whether a positive fluid balance and its persistence over time was an independent prognostic factor in septic patients.  
ccforum.com
about 4 years ago
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Ventilator Pearls Explained Clearly

Dr. Seheult illustrates several key concepts and potential pitfalls with mechanical ventilation. Includes important considerations for patients with sepsis, ...  
youtube.com
about 4 years ago
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Problems of the neonate and young infant - Pocket Book of Hospital Care for Children - NCBI Bookshelf

This chapter provides guidance on essential newborn care and the management of problems in neonates and young infants, from birth to 2 months of age. It includes neonatal resuscitation, the recognition and management of neonatal sepsis and other bacterial infections, and the management of preterm and low-birth-weight infants. A table giving the doses of commonly used drugs for neonates and young infants is included at the end of this chapter, which also lists the dosages for low-birth-weight and premature infants.  
ncbi.nlm.nih.gov
about 4 years ago
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Critical Care

Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient’s spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.  
ccforum.com
about 4 years ago
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A 56 year old woman with syncope, weakness, and refractory hypotension

A 56 year old woman with hypothyroidism after total thyroidectomy presented to the emergency department after an episode of near syncope. When she arrived she had hypotension and atrial fibrillation, with a rapid ventricular response. She reported a history of progressive weakness, weight loss, polyuria, polydipsia, anorexia, and fatigue. Urine analysis was positive for leucocyte esterase and pyuria. She was admitted to the intensive care unit with a diagnosis of severe sepsis of urinary source and atrial fibrillation with a rapid ventricular response. After aggressive fluid resuscitation and the administration of intravenous antibiotics, her heart spontaneously converted to a normal rhythm and she appeared well perfused but remained hypotensive. Review of her medical record showed that her therapeutic thyroxine replacement had recently been decreased because of low thyrotrophin. On perusal of her records from an another facility it was noted that she had undergone pituitary mass resection and irradiation 20 years earlier.  
feeds.bmj.com
about 4 years ago
Www.bmj
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A 56 year old woman with syncope, weakness, and refractory hypotension

A 56 year old woman with hypothyroidism after total thyroidectomy presented to the emergency department after an episode of near syncope. When she arrived she had hypotension and atrial fibrillation, with a rapid ventricular response. She reported a history of progressive weakness, weight loss, polyuria, polydipsia, anorexia, and fatigue. Urine analysis was positive for leucocyte esterase and pyuria. She was admitted to the intensive care unit with a diagnosis of severe sepsis of urinary source and atrial fibrillation with a rapid ventricular response. After aggressive fluid resuscitation and the administration of intravenous antibiotics, her heart spontaneously converted to a normal rhythm and she appeared well perfused but remained hypotensive. Review of her medical record showed that her therapeutic thyroxine replacement had recently been decreased because of low thyrotrophin. On perusal of her records from an another facility it was noted that she had undergone pituitary mass resection and irradiation 20 years earlier.  
feeds.bmj.com
about 4 years ago
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Blast From the Past: Occult Sepsis, Lactic Acid, and Mortality

In this blast from the past study from 2007, Howell MD et al, answered the important question of does elevated lactic acid simply reflect a patient’s hemodynamic status or can it independently predict 28 day in-hospital mortality after controlling for other potential confounders in patients with sepsis.  
aliem.com
about 4 years ago