Management of Severe Sepsis and Septic Shock

Samaha, Georges; Casserly, Brian; Stevens, J. M.

doi:10.5772/29876

Cited by 3 publications

(9 citation statements)

References 81 publications

(118 reference statements)

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“…Bakterietoksiner og inflammatoriske mediatorer har ved septisk sjokk negativ effekt på hjertets kontraktilitet 7,9,19,20 . Dette kompenseres delvis ved at afterload er redusert grunnet den store vasodilatasjonen som letter hjertets arbeid, samtidig som myocards compliance øker slik at det endediastoliske volumet blir større selv ved normale fylningstrykk.…”

Section: Påvirkning Av Hjertets Arbeidunclassified

“…Ønskede verdier forsøkes oppnådd ved hjelp av vaesketerapi, vasopressor og inotrop støttebehandling. SvO 2 har vist seg å vaere et pålitelig surrogat for cardiac output som mål for hemodynamisk terapi når pasienten ikke har innlagt PA kateter(pulmonalt arterie kateter) 1,20,24 . Studier har også vist at SvO 2 verdier er akseptert på lik linje med blandet venøs oksygenmetning hvis det er vanskelig å få lagt inn PAkateter.…”

Section: Koagulasjonsforstyrrelserunclassified

“…Ideelt sett skal dette oppnås før infusjoner med vasopressorer og inotropi startes opp. Det kan vaere aktuelt å gi så mye som 610 liter krystalloider og 24 liter kolloider de første 24 timer for å optimalisere preload, minuttvolum og vevsperfusjon 20,25 .…”

Section: Koagulasjonsforstyrrelserunclassified

“…Etter vaeskeresuscitering blir det en hyperdynamisk tilstand med økende venøs retur og dermed økende preload. Stiger ikke blodtrykket har vi fortsatt en hypotensiv tilstand med redusert afterload for venstre ventrikkel 20 . Som følge av nedsatt regulering av flowdistribusjon til vevene og øket minuttvolum, samt cellenes reduserte evne til å utnytte oksygen i en septisk tilstand, reduseres O 2 ekstraksjonen og sentralvenøs metning stiger.…”

Section: Vasopressorer Og Inotropiunclassified

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Inspira 1 2012

Leonardsen

2012

inspira

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Dette er en fulltekst av tidsskriftet Inspira nummer 1, 2012. Merk at tidsskriftet publiseres av Cappelen Damm Akademisk fra og med 15. januar 2021. Tidsskriftet ble godkjent som vitenskapelig publiseringskanal i november 2018. Innhold Leder: Marit og Hildegunn Hvordan sikre vevsperfusjon hos pasienter med alvorlig sepsis og septisk sjokk?: Ingrid K. Kolstad Kan hjertestans under sementering av hofteprotese forebygges?: Mia Ulfeldt Organdonasjon -Hvordan kan intensivsykepleieren medvirke til at pårørende samtykker?: Karine Omberg og Ann Cathrine Solberg E-læringskurs: Barn på intensiv- og postoperativavdeling Trygge barn – sykepleierens utfordring: Karin Hartviksen og Erlend Hagenes Ann Mari Støen til minne Aktivitetskalender ALNSF – nytt NSFLIS – nytt

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Section: Påvirkning Av Hjertets Arbeidunclassified

Section: Koagulasjonsforstyrrelserunclassified

Section: Vasopressorer Og Inotropiunclassified

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Inspira 1 2012

Leonardsen

2012

inspira

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“…Traditional assessment indicators, such as CVP, are widely used to evaluate effective circulating blood volume and guide fluid therapy because of their easy availability 39-40 . During breathing, the intrathoracic pressure will rise and fall periodically, resulting in a decrease and increase in the blood return to the heart, and the diameter of the inferior vena cava changes accordingly [41][42] .…”

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confidence: 99%

Clinical value of CVP+VIVC in predicting fluid resuscitation in patients with septic shock

Zhang,

Liu,

Cao

et al. 2023

Afr H. Sci.

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Objective: To explore the clinical value of central venous pressure (CVP) + inferior vena cava respiratory variability (VIVC) in fluid resuscitation in spontaneously breathing patients with septic shock. Methods: In retrospective observational study, during October 2019 to December 2021, 145 patients with septic shock treated in our hospital were enrolled by the method of observational study. According to the change rate of cardiac output (△ CO) ≥15% or △ CO<15% after 30 minutes, they were assigned into volume-responsive and volume-unresponsive group depending early fluid resuscitation in sepsis. The clinical value of combination of CVP and VIVC in predicting fluid resuscitation in patients with septic shock was compared. Results: The CVP of the study group was higher at 12h and 24h after fluid resuscitation, and the VIVC level of the study group at 6h, 12h and 24h after fluid resuscitation was higher (P<0.05). Pearson correlation analysis indicated that CVP, and VIVC levels were noticeably correlated with fluid resuscitation in patients with septic shock (P<0.05). The area under curve (AUC) of receiver operating characteristic curve (ROC) of CVP for predicting fluid resuscitation in septic shock patients was 0.694 and the cut-off value was 0.932, the sensitivity was 46.9%, and the specificity was 87.5%. VIVC predicted fluid resuscitation in septic shock patients with an AUC of 0.776, which was a cut-off value of 0.688, a sensitivity of 50.0%, and a specificity of 90.0%. Combination of CVP and VIVC predicted fluid resuscitation in septic shock patients with an AUC of 0.948, which was a cut-off value of 1.420, a sensitivity of 90.6%, and a specificity of 87.5%. Conclusion: Combination of CVP and VIVC may have a good effect on the evaluation of volume responsiveness in patients with septic shock, which is better than single CVP and VIVC. Combination of CVP and VIVC can be adopted to predict fluid responsiveness volume responsiveness in septic shock patients, which is of great significance for guiding clinical fluid responsiveness therapy. Keywords: Septic shock; fluid resuscitation; CVP; VIVC.

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Factors for predicting 28‐day mortality in older patients with suspected of having sepsis in the emergency department

Sanguanwit,

Yuksen,

Khorana

et al. 2024

Hong Kong j. emerg. med.

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BackgroundOlder patients face increased sepsis risk, requiring precise prognostic tools in the emergency department (ED). This study aimed to explore factors predicting 28‐day mortality among older (≥60 years) patients with suspicion of sepsis in the ED.MethodsWe performed a retrospective cohort study. Data for all older patients with clinical suspected sepsis presenting to the ED from 1 October 2018 to 31 December 2018, were collected. Prognostic factors, characteristics, comorbidities, vital signs at triage, the emergency severity score, initial laboratory results, and sepsis bundle treatment were analyzed using univariable and multivariable Cox regression. Hazard ratios (HR) were calculated using these analytical methodologies to prognosticate 28‐day mortality.ResultsA total of 329 older patients with suspected sepsis were included. The overall 28‐day mortality was 10.33%. Independent prognostic factors that were significantly associated with 28‐day mortality were malignancy (adjusted hazard ratio [aHR]: 3.67; 95% confidence interval [CI]: 1.90, 7.09; p < 0.01), oxygen saturation ≤93% (aHR: 3.37; 95% CI: 1.79, 3.43; p < 0.01), and dependent status (hazard ratio [HR]: 2.27; 95% CI: 1.14, 4.53; p = 0.02).ConclusionsThis study suggests that “MOD”; M‐Malignancy, O‐Oxygen saturation ≤93%, and D‐Dependent status are significant prognostic indicators for 28‐day mortality among older patients with suspected sepsis in the ED.Trial registrationThe trial was retrospectively registered in the Thai Clinical Trial Registry on 06/05/2022, identification number TCTR20220506006.

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Management of Severe Sepsis and Septic Shock

Cited by 3 publications

References 81 publications

Inspira 1 2012

Inspira 1 2012

Clinical value of CVP+VIVC in predicting fluid resuscitation in patients with septic shock

Factors for predicting 28‐day mortality in older patients with suspected of having sepsis in the emergency department

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