Adjunctive therapies in sepsis: An evidence-based review

Cariou, Alain; Vinsonneau, Christophe; Dhainaut, Jean-François

doi:10.1097/01.ccm.0000142910.01076.a5

Cited by 57 publications

(38 citation statements)

References 94 publications

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“…159 High-volume hemofiltration with removal of inflammatory cytokines is another therapeutic strategy that may afford a mortality benefit for patients with early severe sepsis or septic shock. 160 In a recent preliminary multicentre trial, patients admitted to ICU with severe community-acquired pneumonia received protocol-guided antibiotic treatment and were randomly assigned to hydrocortisone infusion or placebo groups. Hydrocortisone was given as an intravenous 200-mg bolus followed by infusion at a rate of 10 mg/h for 7 days.…”

Section: Future Directionsmentioning

confidence: 99%

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity

Rivers

McIntyre

Morro

et al. 2005

Canadian Medical Association Journal

141

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Section: Future Directionsmentioning

confidence: 99%

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity

Rivers

McIntyre

Morro

et al. 2005

Canadian Medical Association Journal

141

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“…In addition to classical sepsis protocols, there are many adjunctive therapies in severe sepsis to reduce the mortality further [3]. A strategy of glycemic control in patients with severe sepsis should include a nutrition protocol with the preferential use of the enteral route [26]. This recommendation was supported by the demonstration of a greater harm than benefit ratio with routine parenteral nutrition in postoperative patients because of higher blood glucose levels [27].…”

Section: Discussionmentioning

confidence: 99%

Does Total Parenteral Nutrition Increase the Mortality of Patients with Severe Sepsis in the ICU?

et al. 2015

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OBJECTIVES:We aimed to evaluate the independent association between total parenteral nutrition (TPN) and nosocomial infection and intensive care unit (ICU) mortality in patients with severe pulmonary sepsis. MATERIAL AND METHODS:The present study was designed as a retrospective observational cohort study. We enrolled all patients with severe sepsis due to pulmonary infections who stayed more than 24 h in the respiratory ICU between January 2009 and December 2010. We recorded demographic characteristics, ICU severity scores, Acute Physiologic and Chronic Health Evaluation II (APACHE II) and first day Sequential Organ Failure Assessment (SOFA) score in the ICU, TPN because of intolerance to enteral feeding, ICU data, and mortality. To evaluate the risk factors for mortality, we performed adjusted logistic regression test for TPN, nosocomial infection, and SOFA in the model. RESULTS:Five hundred and fifty patients (males=375, females=175) with severe sepsis were involved in the study during the study period. The median and interquartile range (IQR) of age, APACHE II, and SOFA score at the time of admission to the ICU were 65 years (53-73), 20 (16-25), and 4 (3-6), respectively. Mortality rate was 18% (n=99). Adjusted odds ratio (OR), confidence intervals (CI) 95%, and p values of TPN, nosocomial infection, and first day SOFA score for mortality were as follows: OR:3.8, CI:2.3-6.1, p<0.001; OR:2.4, CI: 1.4-3.9, p<0.001; and OR: 1.3, CI:1.2-1.4, p<0.001, respectively. CONCLUSION:Nosocomial infection and the need for TPN because of intolerance of enteral nutrition (EN) is associated with a higher mortality rate in patients with severe sepsis in the ICU. Rational use of antibiotics and application of hospital acquired infection control program will further reduce mortality. KEYWORDS:

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“…39,40 Peritoneal dialysis has been used in patients with contraindication for hemodialysis, especially those with severe hemodynamic instability, and also because it is easy to use and its use has become traditional in pediatrics. Although it is not the therapy of choice to treat MAC, the use of solutions containing sodium bicarbonate is beneficial to the acid-base balance, with greater efficacy if compared to lactate solutions in children.…”

Section: 75mentioning

confidence: 99%

Acidose metabólica na infância: por que, quando e como tratá-la?

Andrade¹,

Ihara²,

Troster³

2007

J. Pediatr. (Rio J.)

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Objectives: To critically discuss the treatment of metabolic acidosis and the main mechanisms of disease associated with this disorder; and to describe controversial aspects related to the risks and benefits of using sodium bicarbonate and other therapies. Sources:Review of PubMed/MEDLINE, LILACS and Cochrane Library databases for articles published between 1996 and 2006 using the following keywords: metabolic acidosis, lactic acidosis, ketoacidosis, diabetic ketoacidosis, cardiopulmonary resuscitation, sodium bicarbonate, treatment. Classical publications concerning the topic were also reviewed. The most recent and representative were selected, with emphasis on consensus statements and guidelines. Summary of the findings:There is no evidence of benefits resulting from the use of sodium bicarbonate for the hemodynamic status, clinical outcome, morbidity and mortality in high anion gap metabolic acidosis associated with lactic acidosis, diabetic ketoacidosis and cardiopulmonary resuscitation. Therefore, the routine use of sodium bicarbonate is not indicated. Potential side effects must be taken into consideration. Treating the underlying disease is essential to reverse the process. The efficacy of other alternative therapies has not been demonstrated in large-scale studies. Conclusions:Despite the known effects of acidemia on the organism in critical situations, a protective role of acidemia in hypoxic cells and the risk of alkalemia secondary to drug interventions are being considered. There is consensus regarding the advantages of alkali and sodium bicarbonate therapy in cases with normal anion gap; however, in the presence of high anion gap acidosis, especially lactic acidosis, diabetic acidosis and cardiopulmonary resuscitation, the use of sodium bicarbonate is not beneficial and has potential adverse effects, limiting its indication.The only points of agreement in the literature refer to the early treatment of the underlying disease and the mechanisms generating metabolic acidemia. Other promising treatment alternatives have been proposed; however, the side effects and absence of controlled studies with pediatric populations translate into lack of evidence to support the routine use of such treatments. J Pediatr (Rio J). 2007;83(2 Suppl):S11-21:Acidosis/therapy, acidosis, lactic, diabetic ketoacidosis, sodium bicarbonate, child.

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Adjunctive therapies in sepsis: An evidence-based review

Cited by 57 publications

References 94 publications

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity

Does Total Parenteral Nutrition Increase the Mortality of Patients with Severe Sepsis in the ICU?

Acidose metabólica na infância: por que, quando e como tratá-la?

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