Critical care nursing quarterly
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Comparative Study Observational Study
Anesthetic choices and breast cancer recurrence: a retrospective pilot study of patient, disease, and treatment factors.
The purpose of this work was to investigate differences in patient, disease, and treatment factors between women who received outpatient surgical treatment of breast cancer with paravertebral and general anesthesia compared with women who received general anesthesia alone. A total of 358 patients with stage 0-III disease received a partial or total mastectomy without axillary node dissection at a large academic cancer center. Study median follow-up time was 28.8 months. ⋯ Overall, no association between anesthesia type and recurrence was detected (P = .53), with an unadjusted estimated hazard ratio of 1.84 (95% confidence interval, 0.34-10.08). The overall rate of recurrence was very small in this population. A larger study is needed to detect significant differences in rates of recurrence attributable to type of anesthesia.
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The management of sepsis and septic shock in the intensive care environment is a complex task requiring the cooperation of a multidisciplinary team. The Surviving Sepsis Campaign provides systematic guidelines for the recognition, early intervention, and supportive management of sepsis. ⋯ This article discusses the pathophysiologic processes in severe sepsis and septic shock and discusses the appropriate interventions as recommended by the Surviving Sepsis Campaign. Recommended early treatments are reviewed along with interventions related to hemodynamics, perfusion, and supportive care in the critical care environment.
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Sepsis and septic shock are a continuum of disease resulting from a complex host response to infection. They are major health issues in the United States, causing significant financial burden to the health care system in addition to multisystem morbidity and high rates of mortality. In recent decades, landmark trials in sepsis management have demonstrated improved mortality. Although the value of protocol-driven care is currently under question, it is clear that early recognition, prompt resuscitation, and timely use of antibiotics are of utmost importance.
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Treatment of sepsis involves prompt recognition and treatment to optimize outcome. Several medication considerations are pertinent to patients with sepsis, severe sepsis, and septic shock. ⋯ Ongoing research will continue to focus on this disease process and will continue to shape treatment in the future. The use of medication therapies directed at treatment of sepsis will be reviewed in this article.
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Sepsis is a potentially fatal response to infection affecting patients across the life span. Sepsis can progress from systemic inflammatory response to severe sepsis and septic shock if not recognized promptly and managed effectively. ⋯ Sepsis awareness is essential and includes identification of population-focused risk factors, recognition of clinical signs and symptoms, and timely implementation of interventions. The purpose of this article was to examine sepsis in older adults, including prevalence, atypical presentation of the condition, and considerations for sepsis management in the elderly population.