Abstract:Implementation of a standardized sepsis order set and algorithm to improve compliance with the non-invasive elements of EGDT for sepsis in cancer patients in the emergency center setting was associated with a decreased 28-day in-hospital mortality rate.
“…Other observational and quasiexperimental studies reported similar results (40,55,(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92). When EGDT was incorporated into a clinical pathway for the treatment of severe sepsis and septic shock, hospital mortality could be decreased (93).…”
Section: Compliance With Surviving Sepsis Campaign (Ssc) Bundlesupporting
Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.
“…Other observational and quasiexperimental studies reported similar results (40,55,(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92). When EGDT was incorporated into a clinical pathway for the treatment of severe sepsis and septic shock, hospital mortality could be decreased (93).…”
Section: Compliance With Surviving Sepsis Campaign (Ssc) Bundlesupporting
Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.
“…Of the 81 potentially relevant publications identified, 33 met our inclusion criteria (Figure 3 ) [ 36 - 68 ]. In total, 17 of these described the physiological changes occurring following FBT [ 36 , 39 , 40 , 45 , 46 , 48 , 50 , 53 - 55 , 57 , 59 , 60 , 62 , 63 , 65 , 66 ] and seven studies described patient-orientated outcome measures [ 37 , 42 , 43 , 49 , 58 , 59 , 64 ]. Figure 3 Study selection.…”
Section: Resultsmentioning
confidence: 99%
“…In the five studies describing finite volumes of resuscitation fluid, the median volume administered was 2,200 ml (range 1,000 to 5,060 ml) [ 38 , 47 , 51 , 53 , 58 ]. The five remaining studies reported weight-dependent volumes of between 20 and 30 ml/kg of resuscitation (Table 2 ) [ 41 , 43 , 49 , 56 , 57 ].…”
Section: Resultsmentioning
confidence: 99%
“…Overall, seven studies described clinically orientated outcomes [ 37 , 43 , 44 , 49 , 58 , 59 , 64 ]. All reported the effects of complex interventions, such as early goal-directed therapy.…”
Fluid bolus therapy (FBT) is a standard of care in the management of the septic, hypotensive, tachycardic and/or oliguric patient. However, contemporary evidence for FBT improving patient-centred outcomes is scant. Moreover, its physiological effects in contemporary ICU environments and populations are poorly understood. Using three electronic databases, we identified all studies describing FBT between January 2010 and December 2013. We found 33 studies describing 41 boluses. No randomised controlled trials compared FBT with alternative interventions, such as vasopressors. The median fluid bolus was 500 ml (range 100 to 1,000 ml) administered over 30 minutes (range 10 to 60 minutes) and the most commonly administered fluid was 0.9% sodium chloride solution. In 19 studies, a predetermined physiological trigger initiated FBT. Although 17 studies describe the temporal course of physiological changes after FBT in 31 patient groups, only three studies describe the physiological changes at 60 minutes, and only one study beyond this point. No studies related the physiological changes after FBT with clinically relevant outcomes. There is a clear need for at least obtaining randomised controlled evidence for the physiological effects of FBT in patients with severe sepsis and septic shock beyond the period immediately after its administration.‘Just as water retains no shape, so in warfare there are no constant conditions’Sun Tzu (‘The Art of War’)Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0696-5) contains supplementary material, which is available to authorized users.
“…Falhas na identificação de alterações nos parâmetros fisiológicos têm sido associadas a desfechos clínicos desfavoráveis, tais como retorno do paciente à unidade de emergência, tempo prolongado de permanência na instituição, transferência não planejada à unidade de cuidados intensivos e aumento das taxas de mortalidade (BRISTOW et al, 2000;SCHULL;MICHAEL et al, 2011;HANZELKA et al, 2013;CALDER et al, 2014;HOSKING et al, 2014;ANDERSEN et al, 2016).…”
Section: O Papel Da Equipe De Enfermagem No Reconhecimento De Alteraçunclassified
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