Life-threatening organ dysfunction triggered by infection
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4 episodes with severe sepsis
8 episodes with severe sepsis
3 episodes with severe sepsis
3 episodes with severe sepsis
2 episodes with severe sepsis
2 episodes with severe sepsis
2 episodes with severe sepsis
2 episodes with severe sepsis
4 episodes with severe sepsis
Neste episódio, conversamos sobre Sepse e a importância do antibótico. Salientamos pontos importantes, fatores de risco e dicas para escolha da terapia correta, principalmente no contexto de gram negativos MDR. Este é o terceiro episódio da nossa série especial realizada em parceria com a Pfizer, em que trazemos discussões que conectam ciência e prática clínica para enfrentar desafios no combate às infecções.
In this episode of Critical Matters, Dr. Zanotti discusses the use of intravenous albumin in critical care. He is joined by D. Jeannie Callum, Director of Transfusion Medicine and Professor of Pathology and Molecular Medicine at Queens University in Ontario, Canada. Dr. Callum's research focuses on blood utilization, hemostasis in the bleeding patient, and transfusion-related errors. She has received numerous awards and published extensively. Dr. Callum is the lead author of “Use of Intravenous Albumin: A Guidelines from the International Collaboration for Transfusion Medicine Guidelines,” published earlier this year in CHEST. Additional Resources: Use of Intravenous Albumin. A Guideline from the International Collaboration for Transfusion Medicine Guidelines. CHEST 2024: https://journal.chestnet.org/article/S0012-3692(24)00285-X/fulltext International Collaboration for Transfusion Medicine Guidelines Website: https://www.ictmg.org/ Ten myths about albumin. M Joannidis, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35247060/ A comparison of albumin and saline for fluid resuscitation in the intensive care unit. SAFE Study Investigators. N Engl J Med 2004: https://pubmed.ncbi.nlm.nih.gov/15163774/ Albumin Replacement in Patients with Severe Sepsis or Septic Shock. ALBIOS Study Investigators. N Engl J .Med 2014: https://www.nejm.org/doi/full/10.1056/NEJMoa1305727 Books mentioned in this episode: Ending Medical Reversal: Improving Outcomes, Saving Lives. By Vinayak K. Prasad: https://bit.ly/4dAimRa The Time Machine. By H.G. Wells: https://amzn.to/4eK4apG
Hosts Angela Huttner & Erin McCreary welcome Prof. David Paterson (Singapore) and Prof. Josh Davis (Newcastle, Australia) to discuss the design and results of the BLING-3 trial, which compared continuous infusion of beta-lactam antibiotics to standard intermittent dosing in 7000 critically ill patients across 104 intensive-care units. In unadjusted analyses, the trial did not show a statistically significant mortality benefit with continuous infusion. Yet in prespecified adjusted analyses, there was a statistically significant reduction in mortality, and a meta-analysis of randomized trials published simultaneously with the BLING-3 trial showed the same. As the two ID doctors on the BLING team, Profs. Paterson and Davis offer context and insights into what these results mean and how they might affect your clinical practice. Episode peer-reviewed by Dr. Mia Lidén of Charité – Universitätsmedizin Berlin. LiteratureBLING-1: Dulhunty et al. Continuous infusion of beta-lactam antibiotics in severe sepsis: a multicenter double-blind, randomized controlled trial. Clin Infect Dis. 2013 Jan;56(2):236-44. DOI: 10.1093/cid/cis856BLING-2: Dulhunty et al. A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis. Am J Respir Crit Care Med. 2015 Dec 1;192(11):1298-305. DOI: 10.1164/rccm.201505-0857OCBLING-3: Dulhunty et al. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. JAMA. 2024 Jun 12:e249779.DOI: 10.1001/jama.2024.9779Meta-analysis: Abdul-Aziz et al. Prolonged vs Intermittent Infusions of β-Lactam Antibiotics in Adults With Sepsis or Septic Shock: A Systematic Review and Meta-Analysis. JAMA. 2024 Jun 12:e249803. DOI: 10.1001/jama.2024.9803
Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS SOFA Score: Vincent JL, MOreno R, Takala J, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction / failure. On Behalf of the working group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10 Vincent JL, de Mendonca A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction / failure in intensive care units: results of a multicenter, prospective study. Working group on ‘sepsis-related problems' of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-1800 Ferreira FL, Bota DP, Bross A, Merlot C, Vincent JL. Serial evaluation of the SOFA score to predict outcomes in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8 Cardenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, Nates JL. Cross-validation of a sequential organ failure assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012 Dec;27(6):673-80 qSOFA score Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762-774 Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and SEptic Shock (Sepsis-3). JAMA. 2016;315(8):775-787 Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 Criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. 2017;317(3):301-308 Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290-300 Comparing Prognostic scores Henning DJ, Puskarich MA, Self WH, Howell MD, Donnino MW, Yealy DM, Jones AE, Shapiro NI. An Emergency Department validation of the SEP-3 Sepsis and Septic Shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017 Oct;70(4):544-552 IDSA concern Rhee C, Chiotos K, Cosgrove SE, Heil EL, Kadri SS, Kalil AC, Gilbert DN, Masur H, Septimus EJ, Sweeney DA, Strich JR, Winslow DL, Klompas M. Infectious diseases society of america position paper: Recommended revisions to the National Severe Sepsis and Septic Shock early management bundle (SEP-1) Sepsis Quality Measure. Clin Infect Dis. 2021 Feb 16;72(4):541-552 About Barcelona Declaration Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care. 2003;7:1-2 1- hour surviving sepsis bundle guidance Freund Y, Khoury A, Mockel M, et al. European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern. Eur J Emerg Med. 2019 Aug;26(4):232-233 Early Goal Directed Therapy Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM. 2001 Nov 8;345(19):1368-77 SEP - 1 Quality Measure National Quality Forum Measure submission and evaluation worksheet 5.0 for NQF #0500 Severe Sepsis and Septic Shock: Management Bundle, last updated Date: Oct 05, 2012. Website link Accessed 01-31-2024: https://www.qualityforum.org/Projects/i-m/Infectious_Disease_Endorsement_Maintenance_2012/0500.aspx National Quality Forum: NQF Revises Sepsis Measure. Website link accessed 01-31-2024: https://www.qualityforum.org/NQF_Revises_Sepsis_Measure.aspx Faust JS, Weingart SD. The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1 - the early management bundle for severe sepsis / septic shock. Emerg Med Clin N Am. 2017; 35:219-231 Affordable care act Patient Protection and Affordable Care Act, Public Law 148, U.S. Statutes at Large 124 (2010):119-1024. Website link accessed 01-31-2024: https://www.govinfo.gov/app/details/STATUTE-124/STATUTE-124-Pg119/summary. Fluids for sepsis in concerning populations Pence M, Tran QK, Shesser R, Payette C, Pourmand A. Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis. Am J Emerg Med. 2022 May:55:157-166 Zadeh AV, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis. Am J Emerg Med. 2023 Nov:73:34-39 WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs
Episode 17! In this episode we talk about "Aggressive of Moderate Fluid Resuscitation in Acute Pancreatitis" published September 2022 by de-Madaria et al in the New England Journal of Medicine and then talk about the landmark study "Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock" by Rivers et al also NEJM but November 2001WATERFALL: https://pubmed.ncbi.nlm.nih.gov/36103415/EGDT: https://pubmed.ncbi.nlm.nih.gov/11794169/Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!
In this episode of the podcast, we will discuss Fluid Management for Sepsis through the lens of the recently published CLOVERS clinical trial. Our guest is Dr. Nathan Shapiro, Professor of Emergency Medicine at Harvard Medical School, and an attending physician in the Department of Emergency Medicine at Beth Israel Deaconess Medical Center. Dr. Shapiro is the Vice Chairman of Research for the Emergency Department. Dr. Shapiro is a lead author and investigator for the recently published CLOVERS clinical trial. Additional Resources Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. CLOVERS clinical trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2212663 Restriction of Intravenous Fluids in ICU Patients with Septic Shock. CLASSIC clinical trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2202707 Surviving Sepsis Campaign: Guidelines 2021: https://www.sccm.org/Surviving-Sepsis-Guidelines-2021 Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock: https://www.nejm.org/doi/full/10.1056/nejmoa010307 Early, Goal-Directed Therapy for Septic Shock: Metanalysis of the ARISE, ProCESS, and PriMISe clinical trials: https://www.nejm.org/doi/10.1056/nejmoa1701380 Books Mentioned in this Episode: Extreme Ownership: How Navy SEALs Lead and Win. By Jocko Willink and Leif Babin: https://bit.ly/3Ktadmk
Episode 2! In this episode we again go to a new and old article 1)"Early Active Mobilization during Mechanical Ventilation in the ICU" by the ANZICS group published NEJM 2022 and 2) "Albumin Replacement in Patients with Severe Sepsis or Septic Shock" by Caironi et al published NEJM 2014. Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!
The Filtrate:Joel TopfSwapnil HiremathJennie LinSpecial Guests:Priya Yenebere @PriRenalAKI Transplant nephrologist at Indiana University School of Medicine. She is a current NSMC Intern. J Pedro Teixeira @NephCrit_NM ICU Nephrologist at the University of New Mexico.Editor: Priya YenebereShow Notes:Critical Care Nephrology Critical Care Nephrology: Core Curriculum 2020 by Benjamin R Griffin, Kathleen D Liu, and J Pedro Teixeira.Critical Care Rheumatology Dual-Trained Rheumatologists Take Multidisciplinary Approach to Their PatientsMed-Peds to NephrologyEarly Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock by Emanuel RiversProMISe: Trial of Early, Goal-Directed Resuscitation for Septic Shock ARISE: Goal-Directed Resuscitation for Patients with Early Septic ShockProCESS: A Randomized Trial of Protocol-Based Care for Early Septic ShockThe Filtrate:Rinaldo Bellomo and micro circulatory disorders as cause of AKI in sepsis. Septic acute kidney injury: new conceptsComparison of Two Fluid-Management Strategies in Acute Lung Injury (FACTT) The negative trial we accept as a positive trial because of the secondary outcomes. The prime minister of Finland was caught on the dance floor. This is a bad thing? (NY Times)Deferred Consent: A New Approach for Resuscitation Research on Comatose PatientsLactate conversion MediCalcThe Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parametersCritical Care Reviews Podcast: CLASSIC Trial Results PresentationWhat is the most George Constanza-esque reason you broke up with someone? (reddit)Bonferroni correctionThe Importance of Fluid Management in Acute Lung Injury Secondary to Septic ShockRestrictive versus Liberal Fluid Therapy for Major Abdominal Surgery in the NEJM. RELIEF, NephJC discussionEffect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension: A Randomized Clinical Trial in JAMAFEAST Trial: Mortality after Fluid Bolus in African Children with Severe InfectionRings of Power on Amazon PrimeWhy the Hobbit trilogy suckedIndustry on HBOSandman 2022 on NetflixWhere did Liverpool FC go wrong with the 2021/2022 Premier League? (Quora)CRRT Academy at University of Alabama with 2020 Robert G. Narins Award Recipient: Ashita Tolwani, MD, MS (YouTube)Life as a Nephrologist podcast on CritCare NephrologyContinuous KRT: A Contemporary Review by J. Pedro Teixeira, Javier A. Neyra and Ashita TolwaniUniversity of New Mexico Nephrology Program. Apply to their fellowship.The Pledge Drive is over, but you can always support NephJC. NephJC is a 501(3)c registered non-profit and all donations are tax deductible in the US.
In this episode, we talk all things critical care the one and only, Dr. Jean-Louis Vincent aka. JLV. This episode is a MUST listen. We touch upon the evolution of early goal directed therapy, measures of fluid responsiveness, optimizing oxygen delivery, and the importance of integrating data points versus examining them in isolation when caring for our critically ill and injured patients. This and MUCH MUCH more in arguably one of my favorite episodes to date!!Timestamps00:00 Introduction01:21 What happened to SG catheters and should we use them?04:05 What decreases mortality in critical care patients?05:30 When to transfuse critical care patient? Use your brain! 08:55 Measures of tissue perfusion and fluid responsiveness09:36 JLV breaks down the Rivers trial10:36 Recent EGDT papers 10:54 How to optimize O2 delivery? Late ScVO2, dob challenge, and fluid challenges13:21 Dynamic measures of fluid responsiveness13:46 CVP as a relative value15:14 Passive leg raising (PLR) as a measure of fluid responsiveness21:20 JLV's take on therapeutic nihilism24:45 Don't isolate; integrate!26:46 Navigating the future of critical care – JLV's thoughts on AI in the ICU29:55 Rapid fire hot topics in the ICU – Yes or No -Metabolic cocktail-Corticosteroids for septic shock-Albumin and Lasix or Lasix alonePCT/CRP and sepsis/AbxResources:International Symposium on Intensive Care and Emergency Medicine (ISICEM):https://www.isicem.orgISICEM Chats Platform:https://www.isicem.org/e-chat/index.asp Articles:Passive leg raising:five rules, not a drop of fluid! https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0708-5The fluid challengehttps://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03443-yBlood lactate levels in sepsis: 8 questionsVincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care. 2021 Jun 1;27(3):298-302. doi: 10.1097/MCC.0000000000000824. PMID: 33852499.We should avoid the term "fluid overload"https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2141-7EGDT in the Treatment of Severe Sepsis and Septic Shockhttps://www.nejm.org/doi/full/10.1056/nejmoa010307A Randomized Trial of Protocol-Based Care for Early Septic Shockhttps://www.nejm.org/doi/full/10.1056/nejmoa1401602Support the show
Contributor: Aaron Lessen, MD Educational Pearls: Prior, smaller studies showed intravenous Vitamin C given to patients with sepsis significantly improved patient mortality and additional outcomes. A recently published, randomized control trial with >800 ICU patients who received up to 4 days of IV Vit C or placebo concluded that the end points of death or persistent organ dysfunction at 28 days were unaffected by Vitamin C administration. There were no adverse safety outcomes associated with Vitamin C administration. Based on this trial, it is unlikely that Vitamin C will become a mainstay of treatment for sepsis patients. References Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017;151(6):1229-1238. doi:10.1016/j.chest.2016.11.036 Lamontagne F, Masse MH, Menard J, et al. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. N Engl J Med. 2022;386(25):2387-2398. doi:10.1056/NEJMoa2200644 Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!
***ALL THE TRIGGERS*** Seriously, we discuss the TN House Bill that is attempting to be passed regarding abortion, the terrible neglectful death of Savita Halappanavar caused by Severe Sepsis and miscarriage. Join us in this episode about the heartbreaking death of Savita Halappanavar. She was a beautiful, first time mom. She had her whole life ahead of her. However, due to the exceedingly strict abortion ban in Ireland at the time (2012), she senselessly lost her life. This is a full T-Rex episode and there were tears. Sources: https://www.irishcentral.com/news/savita-halappanavar https://www.bbc.com/news/uk-northern-ireland-20321741 https://www.thejournal.ie/savitas-law-together-for-yes-4038528-May2018/
The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
Show notes at pharmacyjoe.com/episode648. In this episode, I’ll discuss prehospital antibiotics for severe sepsis. The post Episode 648: Prehospital antibiotics for severe sepsis appeared first on Pharmacy Joe.
The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
Show notes at pharmacyjoe.com/episode648. In this episode, I’ll discuss prehospital antibiotics for severe sepsis. The post Episode 648: Prehospital antibiotics for severe sepsis appeared first on Pharmacy Joe.
Listen to this amazing story of God healing a woman from severe sepsis.
The Filtrate:Joel TopfSwapnil HiremathNayan AroraSophie AmbrusoAnd special guests:Jay L Koyner, Professor of Medicine, University of ChicagoSarah Faubel, Professor of Medicine, University of Colorado EditorNayan AroraShow Notes:It was Kidney 360, not Kidney Medicine. Here is the study I was thinking of: https://kidney360.asnjournals.org/content/2/1/33 SNL Five-Timers Club: https://www.youtube.com/watch?v=6bWGoWFMwKE The Fluid and Electrolyte Companion. Download The Whole EnchiladaAbout the Authors from Topf and Faubel's first book, The Microbiology Companion.Ted Post: The Sarah Faubel of The Clinical Physiology of Acid Base and Electrolyte Disorders.Meta analysis of early dialysis in AKI by Victor Seabra: https://pubmed.ncbi.nlm.nih.gov/18562058/ Meta analysis of early dialysis in AKI by Morgan Grimes: https://www.ajkd.org/article/S0272-6386(15)00530-2/abstract H-index: https://en.wikipedia.org/wiki/H-index Mortality in ARDS: ACURASYS study. The hazard ratio for death at 90 days in the cisatracurium group, as compared with the placebo group, was 0.68 https://www.nejm.org/doi/full/10.1056/nejmoa1005372 Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time? A Systematic Review It is commonly stated and assumed that mortality from acute respiratory distress syndrome (ARDS) is decreasing.We found that mortality from ARDS has not decreased substantially since the publication of a consensus definition in 1994. Based on our findings, a baseline mortality risk from ARDS of 40 to 45% for observational studies and 35 to 40% for randomized control trials should be expected. These results highlight the need for future effective therapeutic interventions for this highly lethal syndrome.https://www.atsjournals.org/doi/full/10.1164/rccm.200805-722oc From Up To Date:Numerous studies suggest that survival has improved over time [2,9,10,11]. As an example, an observational study of 2451 patients who had enrolled in ARDSNet randomized trials found a fall in mortality from 35 to 26 percent between 1996 and 2005 [10]. To the extent that mortality may be decreasing with time, several issues should be considered:● It is not known if mortality has decreased among patients who received their care outside of a specialized center or a clinical trial.● The improved mortality may be attributable to patients who have ARDS related to risk factors other than sepsis, such as trauma [9].● To the extent that mortality has decreased, the reasons are uncertain. Likely causes include better supportive care and improved ventilatory strategies, such as low tidal volume ventilation [10,12,13]Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock by Emanuel Rivers https://www.nejm.org/doi/full/10.1056/nejmoa010307 Early Goal Directed Therapy from NephMadness 2015 https://ajkdblog.org/2015/03/01/nephmadness-2015-critical-care-nephrology-region/#Early Counter point by NSMC graduate Kamran Boka https://ajkdblog.org/2015/03/18/nephmadness-2015-process-arise-promise-and-the-promise-of-early-goal-directed-therapy/ Furosemide stress test https://jasn.asnjournals.org/content/26/8/2023 EM Crit looks at the furosemide stress test: https://emcrit.org/pulmcrit/furosemide-stress-test/ ASN Kidney Week Biomarker debate between Faubel and Koyner. https://www.asn-online.org/education/kidneyweek/2020/program-session-details.aspx?sessId=371699&sessPar=371678 NAD therapy Samir Parikh Don Seldin Young Investigator Award winner 2019.Sarah Faubel's Dream RCT https://ukidney.com/nephrology-resources/dream-rct-initiative/dream-rct-entries/item/nephrologist-driven-rrt-usual-late-or-early-start-for-acute-kidney-injury Perry Wilson's DreamRCT https://www.medpagetoday.com/Nephrology/DreamRCT/53876 Steve Coca on “Permissive AKI” with treatment of heart failure https://www.kidney-international.org/article/S0085-2538(19)30708-2/pdf Edward Clark on HIRRT: Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review https://pubmed.ncbi.nlm.nih.gov/31407042/ Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00177-6/fulltext The Handbook of Critical Care Nephrology Amazon | Target (actually not available
Learn about a treatment for one of the most deadly diseases in America and the world. Share this with friends and family.Sepsis common symptoms acronym T.I.M.E.T - Temperature higher or lower than normalI - Infection, have you now or recently had signs of an infection?M - Mental state. Are there any changes in mental status, such as confusion or excessive sleepiness?E - Extreme pain or illness. Do you have a "feeling you may die?"Vitamin C, Hydrocortisone and Thiamine (B1) For the Treatment of Severe Sepsis and Sepsis Shockhttps://journal.chestnet.org/article/S0012-3692(16)62564-3/fulltexthttps://articles.mercola.com/sites/articles/archive/2017/04/05/vitamin-c-b1-hydrocortisone-reduce-sepsis-mortality.aspxDr. MercolaDr. Paul Marik
Four definitions you must know: SIRS – Must have at least 2 of 4 SIRS criteria (listed below): Fever (>38C) or Hypothermia (12k or 10% Tachycardia > 90 Tachypnea > 20 SEPSIS – Must have SIRS + have a suspected infectious source (eg pulmonary, urinary, intra-abdominal, etc) SEVERE SEPSIS […]
Four definitions you must know: SIRS – Must have at least 2 of 4 SIRS criteria (listed below): Fever (>38C) or Hypothermia (12k or 10% Tachycardia > 90 Tachypnea > 20 SEPSIS – Must have SIRS + have a suspected infectious source (eg pulmonary, urinary, intra-abdominal, etc) SEVERE SEPSIS […]
In this episode, we discuss the role of hydrocortisone, ascorbic acid (Vitamin C) and thiamine (HAT therapy) in the treatment of patients with septic shock. We discuss biological plausibility and comprehensively review the latest evidence. Our guest is Dr. Jonathan Charnin. Dr. Charnin is an assistant professor of anesthesiology in the Divisions of Multi-specialty Anesthesia and Critical Care Medicine at the Mayo Clinic Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com. Thanks for listening! If you enjoy our content, please rate us on iTunes and share our podcast with your colleagues. Music by Stephen Campbell, MD. -- References Fujii T, Luethi N, Young PJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020;323(5):423–431. doi:10.1001/jama.2019.22176 Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017 Jun;151(6):1229-1238. doi: 10.1016/j.chest.2016.11.036. Epub 2016 Dec 6. PMID: 27940189. Englard S, Seifter S. The biochemical functions of ascorbic acid. Annu Rev Nutr. 1986;6:365-406. doi: 10.1146/annurev.nu.06.070186.002053. PMID: 3015170. Fowler AA 3rd, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A, Fisher B, Thacker LR 2nd, Natarajan R, Brophy DF, Sculthorpe R, Nanchal R, Syed A, Sturgill J, Martin GS, Sevransky J, Kashiouris M, Hamman S, Egan KF, Hastings A, Spencer W, Tench S, Mehkri O, Bindas J, Duggal A, Graf J, Zellner S, Yanny L, McPolin C, Hollrith T, Kramer D, Ojielo C, Damm T, Cassity E, Wieliczko A, Halquist M. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA. 2019 Oct 1;322(13):1261-1270. doi: 10.1001/jama.2019.11825. Erratum in: JAMA. 2020 Jan 28;323(4):379. PMID: 31573637; PMCID: PMC6777268. Donnino MW, Andersen LW, Chase M, Berg KM, Tidswell M, Giberson T, Wolfe R, Moskowitz A, Smithline H, Ngo L, Cocchi MN; Center for Resuscitation Science Research Group. Randomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot Study. Crit Care Med. 2016 Feb;44(2):360-7. doi: 10.1097/CCM.0000000000001572. PMID: 26771781; PMCID: PMC4754670. Woolum JA, Abner EL, Kelly A, Thompson Bastin ML, Morris PE, Flannery AH. Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock. Crit Care Med. 2018 Nov;46(11):1747-1752. doi: 10.1097/CCM.0000000000003311. PMID: 30028362.
The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
Show notes at pharmacyjoe.com/episode520. In this episode, I ll discuss whether immediate vs early antibiotic administration improves outcomes in severe sepsis. The post 520: Does immediate vs early antibiotic administration improve outcomes in severe sepsis? appeared first on Pharmacy Joe.
Author: Aaron Lessen, MD Educational Pearls: Previously, trials had shown promising evidence that vitamin C may improve mortality rates in patients with sepsis or septic shock. A 2017 retrospective before-after study gave a “cocktail” of hydrocortisone, vitamin C, and thiamine to patients with severe sepsis or in septic shock and reported a decrease in mortality from 40% to 8%. A 2020 randomized controlled trial demonstrated that giving patients hydrocortisone, vitamin C, and thiamine showed no benefits in improving sepsis outcomes. Currently use of Vitamin C in sepsis and septic shock remains controversial due to lack of sufficient data References 1) Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017;151(6):1229. Epub 2016 Dec 6. 2) Fujii T, Luethi N, Young PJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020;323(5):423–431. doi:10.1001/jama.2019.22176 Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD
In this episode, we discuss treatment recommendations found in recent literature, in regards to fluid administration in septic shock. We also discuss the updates to the definition of sepsis, and the criteria for diagnosing a patient with sepsis. In this episode, we discuss SOFA, and QSOFA, as well as the elimination of SIRS and "Severe Sepsis" from the sepsis spectrum. Join us as we dive in to the pathophysiology of septic shock, and how fluid administration is still considered a staple treatment. We discuss how third spacing occurs secondary to overzealous fluid administration, resulting in potential worsening of hypoperfused tissues and organs. In this episode, we also discuss the ProMISe, ARISE, and CENSER trials, and discuss the suggestions of early vasopressor therapy using norepinephrine has proven to be beneficial. We also briefly discuss the potential benefits of pre-hospital administration of broad spectrum antibiotics, and the Phantasy trial, and propose to revisit a similar study with more objective methods. Please like, subscribe, follow, and share, and look for Episode 10!|www.medicclasscitizen.com| "Subscribe" to receive email updates on the status of the store, and exciting things to come. Facebook: @medicclasscitizenInstagram: @medic_class_citizenTwitter: @medic_citizen
In this episode of Critical Matters, we will discuss the recently published CITRIS-ALI clinical trial evaluating the role of high dose Vitamin C in severe sepsis and ARDS. Our guest is Dr. Emily Brant. Dr. Brant is a practicing intensivist and faculty at the University of Pittsburgh Medical Center. She was the lead author in the JAMA editorial entitled “Is High-Dose Vitamin C Beneficial for Patients with Sepsis?” which was published alongside the CITRIS-ALI Clinical Trial. Additional Resources: Is High-Dose Vitamin C Beneficial for Patients with Sepsis?: http://bit.ly/2nWKoDp Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial: http://bit.ly/31s0QcD Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study: http://bit.ly/2pBs433 Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis: http://bit.ly/2Bl523c Books Mentioned in this Episode: Becoming by Michelle Obama: https://amzn.to/2MvHRd3
Ensuring patients get the right treatment at the right time is a core ambition of a modern healthcare system, and there is no better example of this than the early administration of antibiotics in patients with severe sepsis. Daniel Cudini is an Intensive Care Paramedic and Clinical Support Officer with Ambulance Victoria, and is a noted prehospital researcher. He joins Todd on the podcast to chat about the PASS study - Paramedic Antibiotic administration in Severe Sepsis.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
In this 104th episode I welcome Dr. Pam Lipsett to the show to discuss the diagnosis and treatment of sepsis. References: Sepsis-3 guidelines from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2492881 Marik Sepsis cocktail: Marik PE et al. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock. 2017: 151(6);1229–1238. ADRENAL trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1705835 APROCCHSS Trial: https://www.nejm.org/doi/10.1056/NEJMoa1705716 SEPSISPAM Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1312173
So the three of us are back together and going to take on Sepsis! It's vital to have a sound understanding of sepsis. It has a huge morbidity and mortality but importantly there is so much that we can do both prehospital and in hospital to improve patient outcomes. In the podcast we cover the following; Definitions Scale of problem Different bodies; NICE/Sepsis Trust/3rd international consensus definition including qSOFA Handover and pre alerts Treatment; Sepsis 6 The evidence base behind treatment Contentious areas Prehospital abx Fever control Steroids ETCO2 We hope the podcast helps refresh your knowledge on the topic and brings about some clarity on some contentious points. As always don't just take our word for it, go and have a look at the primary literature referenced below. Enjoy! Simon, Rob & James References & Further Reading Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Kumar. Critical Care Medicine. 2006 Prognostic value of timing of antibiotic administration in patientswith septic shock treated with early quantitative resuscitation. Ryoo SM. Am J Med Sci. 2015 The association between time to antibiotics and relevant clinicaloutcomes in emergency department patients with various stages of sepsis: a prospective multi-center study. de Groot B. Crit Care. 2015 Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Puskarich MA. Crit Care Med. 2011 Early goal-directed therapy in the treatment of severe sepsis and septic shock. Rivers E. N Engl J Med. 2001 Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Nguyen HB. Crit Care Med. 2004 The prognostic value of blood lactate levels relative to that of vitalsigns in the pre-hospital setting: a pilot study. Jansen TC Crit Care. 2008 Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. Jones AE. JAMA. 2010 Lower versus higher hemoglobin threshold for transfusion in septic shock. Holst LB. N Engl J Med. 2014 A randomized trial of protocol-based care for early septic shock. ProCESS Investigators. N Engl J Med. 2014 Trial of early, goal-directed resuscitation for septic shock. Mouncey PR. N Engl J Med. 2015 Goal-directed resuscitation for patients with early septic shock. ARISE Investigators. N Engl J Med. 2014 Acetaminophen for Fever in Critically Ill Patients with SuspectedInfection. Young P. N Engl J Med. 2015 NICE; Sepsis: recognition, diagnosis and early management The Sepsis Trust The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Singer M. JAMA. 2016 NHS E; Improving outcomes for patients with sepsis. A cross-system action plan Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Alam N. Lancet Respir Med. 2018 Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Venkatesh B. N Engl J Med. 2018 PHEMCAST; End Tidal Carbon Dioxide Current clinical controversies in the management of sepsis. Cohen J. J R Coll Physicians Edinb. 2016 St Emlyns; qSOFA RCEM; Severe Sepsis and Septic Shock Clinical Audit 2016/2017 National report RCEM & UK Sepsis Trust; Toolkit: Emergency Department management of Sepsis in adults and young people over 12 years- 2016
This edition of the Emergency Medicine Clinics podcast features discussion on the February 2017 issue on Severe Sepsis Care in the Emergency Department. Guest editor, Dr. Michael Winters, from the University of Maryland, dissects the articles and offer key points and issue highlights.
Margaret Parker, MD, MCCM, speaks with Scott L. Weiss, MD, MSCE, about the article, The Epidemiology of Hospital Death Following Pediatric Severe Sepsis: When, Why, and How Children With Sepsis Die, published in the September 2017 issue of Pediatric Critical Care Medicine.
Margaret Parker, MD, MCCM, speaks with Scott L. Weiss, MD, MSCE, about the article, The Epidemiology of Hospital Death Following Pediatric Severe Sepsis: When, Why, and How Children With Sepsis Die, published in the September 2017 issue of Pediatric Critical Care Medicine.
Hello PEC Podcast Listeners First, we'd like to send the city of Houston and its citizens our most heartfelt condolences and wish all of you a safe and quick recovery. We support all of you! Second, we'd like to thank our EMS, First Responders, and the many disaster teams for aiding in the Response and Recovery of our beloved city and tough citizens of Houston. Be safe all of you and thank you from the bottom of all our hearts! Third, we'd like to announce our very special PEC Podcast Journal club on September 12, 2017 at 3 PM CST, where we will have a live video interview with Dr. Mark Faul and his manuscript: Multiple Naloxone Administrations Among Emergency Medical Service Providers is Increasing There will be guests as well including Dr. Brent Myers and Dr. Ritu Sahni along with the PEC Podcast crew. So stay tuned and we'll provide you with how to watch and ask questions LIVE on September 12, 2017 at 3 PM CST. While many of our colleagues and PEC podcast listeners are helping out in Houston, we have our brand new episode of the PEC podcast for all of you. We hope you'll enjoy this episode and thanks for listening. Right click here to download today! In this episode, we highlight the following articles with interviews! An Analysis of EMS and ED Detection of Stroke Dr. Ian Medoro Prospective Prehospital Evaluation of the Cincinnati Stroke Triage Assessment Tool Dr. Jason McMullan qSOFA Has Poor Sensitivity for Prehospital Identification of Severe Sepsis and Septic Shock Dr. Maia Dorsett We also have exciting discussions about the following articles: Occupational Injuries and Exposures among Emergency Medical Services Workers Effectiveness of Prehospital Epinephrine Administration in Improving Long-term Outcomes of Witnessed Out-of-hospital Cardiac Arrest Patients with Initial Non-shockable Rhythms Basic Life Support Access to Injectable Epinephrine across the United States Effect of the 2011 Revisions to the Field Triage Guidelines on Under- and Over-Triage Rates for Pediatric Trauma Patients Does Prehospital Time Influence Clinical Outcomes in Severe Trauma Patients?: A Cross Sectional Study Association between EMS Question Bank Completion and Passing Rates on the EMS Certification Examination Modeling to Optimize Hospital Evacuation Planning in EMS Systems 9-1-1 Triage of Non-Traumatic Chest Pain: Association with Hospital Diagnosis Don't forget to check out NAEMSP's blog, at http://www.naemsp-blog/com covering everything from Evidence based PREHOSPITAL medicine, words of advice from our godfathers and godmothers of EMS, and comments about controversial EMS topics from providers and leaders like you! Check out our most recent posts covering: Are Emergency Physicians The EMS Experts That Many Think They Are? Book Club Sessions: Evicted, Poverty And Profit In the American City We hope you enjoy this podcast episode, thank you all for listening, and stay tuned for our Special September Podcast Journal club with Dr. Mark Faul on September 12, 2017 at 3 PM CST! Hawnwan Philip Moy MD Scott Goldberg MD, MPH Jeremiah Escajeda MD, MPH Joelle Donofrio DO
Jag har ägnat en del tid åt att fundera på den här studien av Marik mfl: Marik, P. E., Khangoora, V., Rivera, R., Hooper, M. H., & Catravas, J. (2016). Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. https://doi.org/10.1016/j.chest.2016.11.036 I dagens avsnitt ger jag […]
With special guest Connie Chappelle, RN, MN, CLNC, risk management coordinator for Kansas University Medical Center in Kansas City, and Allen Frady, RN, BSN, CCDS, CCS, CDI Education Specialist at HCPro and the Association of Clinical Documentation Improvement Specialists (ACDIS).
Ludwig Lin, MD, speaks with Sachin Yende, MD, MS, about his article, "Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials," published in Critical Care Medicine.
Ludwig Lin, MD, speaks with Sachin Yende, MD, MS, about his article, "Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials," published in Critical Care Medicine.
This week Dr. Christian Jones and Dr. Matthew Exline take us step by step on the current management of sepsis 15 years after the publication of the most influential article on sepsis ever published: Rivers et al. "Early Goal Directed Therapy In The Treatment of Severe Sepsis and Septic Shock" Dr. Christian Jones is a trauma and acute care surgeon at Johns Hopkins. Connect with him on twitter @jonessurgery Dr. Matthew Exline is a critical care physician at Ohio State University Check out the Ultrasound App from Ohio State https://itunes.apple.com/us/app/poc-ultrasound-guide/id590234691?mt=8 Please go on iTunes and give us a rating!
We bring you breaking news on the updated sepsis definition from the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine. SIRS and Severe Sepsis? Out. qSOFA (HAT - Hypotension, AMS, Tachypnea)? In. Septic Shock? Sepsis + Vasopressors needed to maintain MAP >65 mmHg + Lactate >2 mmol/L (*after adequate fluids)
This episode covers Chapter 6 of Rosen's Emergency Medicine. Episode Overview: List, define and explain the 5 causes of shock What is the utility of lactate and base deficit in the management of shock? Define: SIRS, Sepsis, Severe Sepsis, and Septic Shock List 5 empirical criteria for the diagnosis of circulatory shock Describe Early Goal Directed Therapy Describe the management goals in cardiogenic shock Wisecracks: A stepwise approach to cardiogenic shock
This episode covers Chapter 6 of Rosen's Emergency Medicine. Episode Overview: List, define and explain the 5 causes of shock What is the utility of lactate and base deficit in the management of shock? Define: SIRS, Sepsis, Severe Sepsis, and Septic Shock List 5 empirical criteria for the diagnosis of circulatory shock Describe Early Goal Directed Therapy Describe the management goals in cardiogenic shock Wisecracks: A stepwise approach to cardiogenic shock
Margaret Parker, MD, MCCM, speaks with Mirjana Cvetkovic, FRCA. Dr. Cvetkovic works as a Clinical Fellow at the Children's Acute Transport Service at Great Ormond Street Hospital in London and a Consultant Intensivist in Anesthesia at Leicester Hospital.
Margaret Parker, MD, MCCM, speaks with Mirjana Cvetkovic, FRCA. Dr. Cvetkovic works as a Clinical Fellow at the Children's Acute Transport Service at Great Ormond Street Hospital in London and a Consultant Intensivist in Anesthesia at Leicester Hospital.
Margaret Parker, MD, MCCM, speaks with Fran Balamuth, MD, PhD
Margaret Parker, MD, MCCM, speaks with Fran Balamuth, MD, PhD
the Arise Study (Australasian Resuscitation In Sepsis Evaluation) and Severe Sepsis Care in 2014
Margaret Parker, MD, FCCM, speaks with Mary Hartman MD, MPH, about her article published in the September Pediatric Critical Care Medicine.
Margaret Parker, MD, FCCM, speaks with Mary Hartman MD, MPH, about her article published in the September Pediatric Critical Care Medicine.
From day 2 of the Advances in Acute Medicine conference (4-5 February 2013) by Dr Rebecca Appelboam, Consultant Intensivist, Derriford Hospital, Plymouth, UK
Michael Weinstein, MD, FACS, FCCP, speaks with David F. Gaieski, MD.
Michael Weinstein, MD, FACS, FCCP, speaks with David F. Gaieski, MD.
Article discussion from December 15, 2012
Part III of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis, Septic Shock, and early goal directed therapy.
Part II of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis.
Part I of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis.
H. Bryant Nguyen, MD, associate professor of emergency medicine at Loma Linda University in California, discusses an article published in the April 2007 edition of Critical Care Medicine, Implementation of a Bundle of Quality Indicators for the Early Management of Severe Sepsis and Septic Shock is Associated with Decreased Mortality.(Crit Care Med. 2007;35(4):1105)
Mitchell Levy, MD, FCCM, and Jean-Louis Vincent, MD, PhD, FCCM, discuss their article in the October issue of Critical Care Medicine. The article, "Early Changes in Organ Function Predict Eventual Survival in Severe Sepsis," can help clinicians identify variables associated with good outcomes in sepsis. The authors explain that if patients with sepsis are not getting better at the end of 24 hours, they may be getting worse. (Critical Care Medicine, Volume 33(issue 10) October 2005 pp 2194-2201).
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