Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Revisited

Otero, Ronny M.; Nguyen, H. Bryant; Huang, David T.; Gaieski, David F.; Goyal, Munish; Gunnerson, Kyle J.; Trzeciak, Stephen; Sherwin, Robert; Holthaus, Christopher V.; Osborn, Tiffany M.; Rivers, Emanuel P.

doi:10.1378/chest.130.5.1579

Cited by 264 publications

(192 citation statements)

References 112 publications

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“…(13,14,(25)(26)(27)(28) There is evidence that therapeutic intervention with hemodynamic resuscitation and antibiotic therapy are associated to lower mortality rates. (7)(8)(9)(10)(11)(12)15) As such, agile and adequate treatment is the "mainstay" for a successful approach to severe sepsis. (18)(19)(20) Goal directed early therapy proposed by Rivers et al (13) , an early hemodynamic resuscitation protocol, provided an evident decrease of mortality in patients with severe sepsis and septic shock.…”

Section: Discussionmentioning

confidence: 99%

“…(7,8,(11)(12)(13)(14)(15)(16) At the second stage, even if there had not been a greater compliance to the bundles, mortality decreased considerably, showing that prognosis does not rely on compliance to the therapeutic bundles, but also on the earlier diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…(1) It was proven that adopting the therapeutic strategy proposed by the Serving Sepsis Campaign (SSC) that includes early tissue reperfusion and control of the infection focus, (2,5,6) bring about decreased mortality. (7)(8)(9)(10)(11)(12)(13)(14) In our hospital, as well as in other Brazilian institutions, notwithstanding adhesion to SSC, mortality rates continue to be unacceptably high. (15)(16)(17) Perhaps this was related to delay in diagnosis of sepsis.…”

Section: Introductionmentioning

confidence: 99%

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Estratégia de detecção precoce e redução de mortalidade na sepse grave

Westphal¹,

Feijó²,

Andrade³

et al. 2009

Rev. bras. ter. intensiva

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Objective: To evaluate the impact of implementing an institutional policy for detection of severe sepsis and septic shock.Methods: Study before (stage I), after (stage II) with prospective data collection in a 195 bed public hospital.. Stage I: Patients with severe sepsis or septic shock were included consecutively over 15 months and treated according to the Surviving Sepsis Campaign guidelines. Stage II: In the 10 subsequent months, patients with severe sepsis or septic shock were enrolled based on an active search for signs suggesting infection (SSI) in hospitalized patients. The two stages were compared for demographic variables, time needed for recognition of at least two signs suggesting infection (SSIΔt), compliance to the bundles of 6 and 24 hours and mortality.Results: We identified 124 patients with severe sepsis or septic shock, 68 in stage I and 56 in stage II. The demographic variables were similar in both stages. The Δt-SSI was 34 ± 54 hours in stage I and 7 ± 8.4 hours in stage II (p <0.001). There was no difference in compliance to the bundles. In parallel there was significant reduction of mortality rates at 28 days (54.4% versus 30%, p <0.02) and hospital (67.6% versus 41%, p <0.003). Conclusion: The strategy used helped to identify early risk of sepsis and resulted in decreased mortality associated with severe sepsis and septic shock.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Estratégia de detecção precoce e redução de mortalidade na sepse grave

Westphal¹,

Feijó²,

Andrade³

et al. 2009

Rev. bras. ter. intensiva

View full text Add to dashboard Cite

show abstract

“…[7][8][9][10][11][12][13] There have also been questions concerning costs, pharmaceutical involvement and a one size fits all approach. [14][15][16][17] As part of the campaign, guidelines were developed by evaluating this research with a GRADE approach, a structured system for rating quality of evidence that also takes into account an assessment of the balance between benefits versus risks, burden, and cost. 18 …”

Section: Surviving Sepsis Campaign Backgroundmentioning

confidence: 99%

Surviving Sepsis Campaign

2014

Critical Care Medicine

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“…Despite intensive treatment with aggressive resuscitation, blood pressure control and adequate supply of oxygen, patients with sepsis often persist showing signs of tissue hypoperfusion, which can lead to acidosis and eventually multiple organ failure [2][3][4] . Researchers have shown that sepsis is characterized by decreased velocity of microcirculatory flow, increased flow heterogeneity, increasing vascular stasis and decreasing perfused capillaries 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Effects of cococonut water and simvastatin in the treatment of sepsis and hemorrhagic shock in rats

et al. 2016

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PURPOSE:To evaluate the effects of modified coconut water as fluid of resuscitation combined with simvastatin in hemorrhagic shock and sepsis model in rats. METHODS:Four groups of Wistar rats with hemorrhagic shock and abdominal sepsis were studied (n=8/group). Rats were bled and maintained at a mean blood pressure 35mmHg for 60min. They were then resuscitated with: 1) saline 0.9%; 2) coconut water+3% NaCl;3) coconut water+NaCl 3%+simvastatin microemulsion (10 mg/kg i.v.; 4) normal coconut water. At 8h post-resuscitation, blood and lungs were collected for exams. RESULTS:Clinical scores, TNF-α, IL-1β, liver/kidney proof levels, and lung injury were significantly reduced in coconut water+NaCl 3%+simvastatin group treated rats, comparing with the other resuscitation treatments. CONCLUSIONS:Resuscitation with coconut water with Nacl 3%+simvastatin had a significant beneficial effect on downregulating cytokines and decreasing lung injury in a rat model of abdominal sepsis and hemorrhagic shock. We also demonstrated that coconut water with Nacl 3%+simvastatin administration clearly made liver and kidney function better and improved clinical score.Key words: Shock, Hemorrhagic. Sepsis. Resuscitation. Simvastatin. Foods Containing Coconut. Rats. Effects of cococonut water and simvastatin in the treatment of sepsis and hemorrhagic shock in rats

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Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Revisited

Cited by 264 publications

References 112 publications

Estratégia de detecção precoce e redução de mortalidade na sepse grave

Estratégia de detecção precoce e redução de mortalidade na sepse grave

Surviving Sepsis Campaign

Effects of cococonut water and simvastatin in the treatment of sepsis and hemorrhagic shock in rats

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