The forgotten value of the clinical examination to individualize and guide fluid resuscitation in patients with sepsis

Shrestha, Gentle Sunder; Dünser, Martin W.; Mer, Mervyn

doi:10.1186/s13054-017-1898-4

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…However, this approach should be augmented by careful, frequent, and comprehensive patient evaluation to predict or recognise fluid overload early, particularly where critical care resources are constrained. Relevant consideration of the background pathology or pathological processes pertinent to the patient should also inform management [ 69 , 78 ].…”

Section: Screening and Early Treatmentmentioning

confidence: 99%

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

et al. 2021

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Section: Screening and Early Treatmentmentioning

confidence: 99%

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

et al. 2021

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“…However, this approach should be augmented by careful, frequent, and comprehensive patient evaluation to predict or recognize fluid overload early, particularly where critical care resources are constrained. Relevant consideration of the background pathology or pathological processes pertinent to the patient should also inform management (69, 78).…”

Section: Screening and Early Treatmentmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Evans

Rhodes

Alhazzani

et al. 2021

Critical Care Medicine

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shock (27). The specific components of performance improvement did not appear to be as important as the presence of a program that included sepsis screening and metrics.Sepsis screening tools are designed to promote early identification of sepsis and consist of manual methods or automated use of the electronic health record (EHR). There is wide variation in diagnostic accuracy of these tools with most having poor predictive values, although the use of some was associated with improvements in care processes (28)(29)(30)(31). A variety of clinical variables and tools are used for sepsis screening, such as systemic inflammatory response syndrome (SIRS) criteria, vital signs, signs of infection, quick Sequential Organ Failure Score (qSOFA) or Sequential Organ Failure Assessment (SOFA) criteria, National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS) (26,32). Machine learning may improve performance of screening tools, and in a meta-analysis of 42,623 patients from seven studies for predicting hospital acquired sepsis the pooled area under the receiving operating curve (SAUROC) (0.89; 95% CI, 0.86−0.92); sensitivity (81%; 95% CI, 80−81), and specificity (72%; 95% CI, 72−72) was higher for machine learning than the SAUROC for traditional screening tools such as SIRS (0.70), MEWS (0.50), and SOFA (0.78) (32).Screening tools may target patients in various locations, such as in-patient wards, emergency departments, or ICUs (28)(29)(30)32). A pooled analysis of three RCTs did not demonstrate a mortality benefit of active screening (RR, 0.90; 95% CI, 0.51−1.58) (33-35). However, while there is wide variation in sensitivity and specificity of sepsis screening tools, they are an important component of identifying sepsis early for timely intervention.Standard operating procedures are a set of practices that specify a preferred response to specific clinical circumstances (36). Sepsis standard operating procedures, initially specified as Early Goal Directed Therapy have evolved to "usual care" which includes a standard approach with components of the sepsis bundle, early identification, lactate, cultures, antibiotics, and fluids (37). A large study examined the association between implementation of state-mandated sepsis protocols, compliance, and mortality. A retrospective cohort study of 1,012,410 sepsis admissions to 509 hospitals in the United States in a retrospective cohort examined mortality before (27 months) and after (30 months) implementation of New York state sepsis regulations, with a concurrent control population from four other states (38). In this comparative interrupted time series, mortality was lower in hospitals with higher compliance with achieving the sepsis bundles successfully.Lower resource countries may experience a different effect. A meta-analysis of two RCTs in Sub-Saharan Africa found higher mortality (RR, 1.26; 95% CI, 1.00−1.58) with standard operating procedures compared with usual care, while it was decreased in one observational study (adjusted hazard ratio [HR]; 95% CI, 0.55...

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“…Therefore, clinical treatment should be timely and effective. 19 Sepsis not only seriously affects the immune function of patients but also may involve complex systemic inflammatory network effects and even lead to abnormal coagulation function and important organ damage. Timely judgement of the patient's condition and discovery of early sepsis complications are helpful in the treatment and prognosis of patients with sepsis.…”

Section: Discussionmentioning

confidence: 99%

Practice and effect evaluation of early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department: a retrospective cohort study

Zhang

Wang

et al. 2023

JBI Evidence Implementation

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To explore the practice and effect evaluation of the early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department.Methods: A total of 239 sepsis patients, who were treated in the emergency department of our hospital from January to September 2020, were selected as the participants of this study, and a retrospective analysis was performed. According to different methods of fluid resuscitation, they were divided into an improved group and a control group. One hundred and twelve patients who received restrictive fluid resuscitation were in the improved group; another 127 patients who received adequate fluid resuscitation were in the control group. The ICU stay time, ventilator use time, and 28-day mortality rate of the two groups were observed. The hemodynamic indices, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and complications of the two groups before and after treatment were compared.Results: After treatment, in the improved group, the APACHE II and SOFA scores were lower than in the control group, fluid replacement decreased, lactate clearance increased, ICU admission time shortened and the proportion of ventilator time to ICU admission time decreased. The incidence of acute respiratory distress syndrome (ARDS), cTn I and brain natriuretic peptic in the improved group were significantly lower than those in the control group. From the dimension within the group, the APACHE II score, SOFA score, heart rate and shock index were lower after treatment than before treatment in both the improved and control groups. Conclusion:Restricted fluid resuscitation can effectively alleviate the condition of emergency sepsis patients, improve hemodynamics, reduce the incidence of ARDS, and prevent patient deaths. It is worthy of clinical application.

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The forgotten value of the clinical examination to individualize and guide fluid resuscitation in patients with sepsis

Cited by 6 publications

References 6 publications

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Practice and effect evaluation of early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department: a retrospective cohort study

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