Surviving Sepsis Campaign

Dellinger, R.P.; Mm, Levy; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Sm, Opal; Je, Sevransky; Sprung, CL; Douglas, Ivor S.; Jaeschke, Roman; Osborn, Tiffany M.; Me, Nunnally; Reinhart, Konrad; Kleinpell, Ruth; Angus, DC; Cs, Deutschman; Machado, FR; Rubenfeld, GD; Sa, Webb; Beale, RJ; Vincent, Jean‐Louis; Moreno, Rui P.

doi:10.1097/ccm.0b013e31827e83af

Cited by 5,366 publications

(1,985 citation statements)

References 604 publications

Supporting

Mentioning

1,926

Contrasting

Unclassified

Order By: Relevance

“…Secondly, unemployment, which is likely to relate to social exclusion, will require intersectoral and interagency work between health and social services to ensure that women's social, psychological and health needs are addressed. Finally, this study supports the international consensus guidelines for the early recognition and treatment of sepsis,16 recognising the role of local audits and quality improvement programmes in improving adherence to the most important interventions 15, 21…”

Section: Resultssupporting

confidence: 71%

“…As such, there are sever al clinical implications which emphasise the need for improved adherence to current national and international guidelines 16, 18, 19, 38, 39. First, there must be continued vigilance for the risks of infection in women with medical comorbidities, including anaemia, the significance of which can be under‐appreciated.…”

Section: Resultsmentioning

confidence: 99%

“…Our access to clinical records, for women who died, showed that timely administration of antibiotics and measurement of lactate levels were inadequate. This is despite the emphasis of both factors in the Surviving Sepsis Campaign bundles and guidelines from the Royal College of Obstetricians and Gynaecologists 16, 18, 19. Given the evidence supporting early interventions, such findings emphasise the role of clinical audit as a means of improving adherence to guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the role of factors specific to the management of sepsis, such as the timing and indication for antibiotic usage, have been understudied, despite clear guidelines from the Surviving Sepsis Campaign15, 16, 17 and Royal College of Obstetricians and Gynaecologists (RCOG)18, 19 on the importance of prompt diagnosis and resuscitation. This is most likely due to the difficulty of studying management factors through the use of administrative data sources, as access to medical records is often needed to delineate the time delay from diagnosis to antibiotics 20, 21…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis

Mohamed-Ahmed

Nair

Acosta

et al. 2015

BJOG

View full text Add to dashboard Cite

ObjectiveTo identify factors associated with progression from pregnancy‐associated severe sepsis to death in the UK.DesignA population‐based case‐control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD).SettingAll pregnancy care and death settings in UK hospitals.PopulationAll non‐influenza sepsis‐related maternal deaths (January 2009 to December 2012) were included as cases (n = 43), and all women who survived severe non‐influenza sepsis in pregnancy (June 2011 to May 2012) were included as controls (n = 358).MethodsCases and controls were identified using the CEMD and UKOSS. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals.Main outcome measuresOdds ratios for socio‐demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived.ResultsFour factors were included in the final regression model. Women who died were more likely to have never received antibiotics [aOR = 22.7, 95% confidence interval (CI) 3.64–141.6], to have medical comorbidities (aOR = 2.53, 95%CI 1.23–5.23) and to be multiparous (aOR = 3.57, 95%CI 1.62–7.89). Anaemia (aOR = 13.5, 95%CI 3.17–57.6) and immunosuppression (aOR = 15.0, 95%CI 1.93–116.9) were the two most important factors driving the association between medical comorbidities and progression to death.ConclusionsThere must be continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis‐related maternal deaths.Tweetable abstractMedical comorbidities, multiparity and antibiotic delays increase the risk of death from maternal sepsis.

show abstract

Section: Resultssupporting

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis

Mohamed-Ahmed

Nair

Acosta

et al. 2015

BJOG

View full text Add to dashboard Cite

show abstract

“…provided precise risk estimates and better information about the hierarchy of target BG ranges for achieving safe and effective glycemic control in critically ill patients, and a BG of 140–180 mg/dL achieved the best outcome in relation to all‐cause mortality and hypoglycemia. Surviving Sepsis Campaign guidelines30 for the management of severe sepsis and septic shock recommended a protocolized approach with a target upper BG of 180 mg/dL rather than 110 mg/dL.…”

Section: Indication For Intensive Protocol In Critically Ill Patientsmentioning

confidence: 99%

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Takesue

Tsuchida

2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

Perioperative hyperglycemia is a risk factor for surgical site infections (SSI). Although the recommended target blood glucose level (BG) is 140–180 mg/dL for critically ill patients, recent studies conducted in patients undergoing surgery showed a significant benefit of intensive insulin therapy for the management of perioperative hyperglycemia. The aim of the present review is to evaluate the benefits of strict glycemic control for reducing SSI in gastroenterological surgery. We carried out a post‐hoc analysis of the previously published data from research on the risk factors for SSI. The highest BG within 24 hours after surgery was evaluated. A total of 1555 patients were enrolled in the study. In multivariate analysis, a dose–response relationship between the level of hyperglycemia and the odds of SSI was demonstrated when compared with the reference group (≤150 mg/dL) (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.14–2.49 for 150–200 mg/dL; and OR = 2.15, 95% CI 1.40–3.29 for >200 mg/dL). Unexpectedly, hyperglycemia was not a significant risk factor for SSI among diabetes patients. By contrast, non‐diabetes patients with a BG of >150 mg/dL were found to have increased odds of SSI. In conclusion, a target BG of ≤150 mg/dL is recommended in patients without diabetes who undergo gastroenterological surgery. Additional study is required to determine an optimal target BG in diabetes patients. Because of the risk of hypoglycemia, a conventional protocol is indicated for patients admitted to the general ward where frequent glucose measurement is not assured.

show abstract

Effect of Heart Rate Control With Esmolol on Hemodynamic and Clinical Outcomes in Patients With Septic Shock

Morelli

Ertmer

Westphal

et al. 2013

JAMA

565

512

View full text Add to dashboard Cite

IMPORTANCE β-Blocker therapy may control heart rate and attenuate the deleterious effects of β-adrenergic receptor stimulation in septic shock. However, β-Blockers are not traditionally used for this condition and may worsen cardiovascular decompensation related through negative inotropic and hypotensive effects.OBJECTIVE To investigate the effect of the short-acting β-blocker esmolol in patients with severe septic shock. DESIGN, SETTING, AND PATIENTSOpen-label, randomized phase 2 study, conducted in a university hospital intensive care unit (ICU) between November 2010 and July 2012, involving patients in septic shock with a heart rate of 95/min or higher requiring high-dose norepinephrine to maintain a mean arterial pressure of 65 mm Hg or higher. INTERVENTIONSWe randomly assigned 77 patients to receive a continuous infusion of esmolol titrated to maintain heart rate between 80/min and 94/min for their ICU stay and 77 patients to standard treatment. MAIN OUTCOMES AND MEASURESOur primary outcome was a reduction in heart rate below the predefined threshold of 95/min and to maintain heart rate between 80/min and 94/min by esmolol treatment over a 96-hour period. Secondary outcomes included hemodynamic and organ function measures; norepinephrine dosages at 24, 48, 72, and 96 hours; and adverse events and mortality occurring within 28 days after randomization. RESULTS Targeted heart rates were achieved in all patients in the esmolol group compared with those in the control group. The median AUC for heart rate during the first 96 hours was −28/min (IQR, −37 to −21) for the esmolol group vs −6/min (95% CI, −14 to 0) for the control group with a mean reduction of 18/min (P < .001). For stroke volume index, the median AUC for esmolol was 4 mL/m 2 (IQR, −1 to 10) vs 1 mL/m 2 for the control group (IQR, −3 to 5; P = .02), whereas the left ventricular stroke work index for esmolol was 3 mL/m 2 (IQR, 0 to 8) vs 1 mL/m 2 for the control group (IQR, −2 to 5; P = .03). For arterial lactatemia, median AUC for esmolol was −0.1 mmol/L (IQR, −0.6 to 0.2) vs 0.1 mmol/L for the control group (IQR, −0.3 for 0.6; P = .007); for norepinephrine, −0.11 μg/kg/min (IQR, −0.46 to 0.02) for the esmolol group vs −0.01 μg/kg/min (IQR, −0.2 to 0.44) for the control group (P = .003). Fluid requirements were reduced in the esmolol group: median AUC was 3975 mL/24 h (IQR, 3663 to 4200) vs 4425 mL/24 h (IQR, 4038 to 4775) for the control group (P < .001). We found no clinically relevant differences between groups in other cardiopulmonary variables nor in rescue therapy requirements. Twenty-eight day mortality was 49.4% in the esmolol group vs 80.5% in the control group (adjusted hazard ratio, 0.39; 95% CI, 0.26 to 0.59; P < .001). CONCLUSIONS AND RELEVANCEFor patients in septic shock, open-label use of esmolol vs standard care was associated with reductions in heart rates to achieve target levels, without increased adverse events. The observed improvement in mortality and other secondary clinical outcomes warrants further investigation.

show abstract

Surviving Sepsis Campaign

Cited by 5,366 publications

References 604 publications

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis

Strict glycemic control to prevent surgical site infections in gastroenterological surgery

Effect of Heart Rate Control With Esmolol on Hemodynamic and Clinical Outcomes in Patients With Septic Shock

Contact Info

Product

Resources

About