Crit Care Resusc
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Sepsis is among the most common reasons for admission to intensive care units throughout the world. In 1991, a new set of terms and definitions was developed to define sepsis more precisely. The concept of the "systemic inflammatory response syndrome" (SIRS) was developed, and its diagnostic criteria were defined. ⋯ We suggest that septic shock is best defined by a systolic blood pressure less than 90 mmHg (or a fall in systolic blood pressure of > 40 mmHg), or a mean arterial pressure less than 65 mmHg after a crystalloid fluid challenge of 30 mL per kg body weight in a patient with severe sepsis. We believe that a vasopressor should be initiated in patients who remain hypotensive after this fluid challenge. The above operational definition of septic shock is important, as it clearly and unambiguously defines in which patients, and when, treatment with a vasopressor should be initiated, and in which patients adjunctive therapy with hydrocortisone and drotrecogin alfa (activated) should be considered.
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Comparative Study
C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a nested case-control study.
To assess the ability of potential clinical predictors and inflammatory markers to predict in-hospital mortality after patient discharge from the intensive care unit. ⋯ A high CRP concentration at ICU discharge is an independent predictor of subsequent in-hospital mortality. Prospective cohort studies in ICUs with different casemix, discharge criteria and post-ICU mortality rates are needed to validate and generalise our findings.
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Review Meta Analysis Comparative Study
Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis.
Loop diuretics are commonly used in critically ill patients with acute renal failure (ARF), but their effect on clinical outcome remains uncertain. We systematically reviewed the literature comparing loop diuretics with control in the management of ARF. ⋯ Loop diuretics were not associated with improved mortality or rate of independence from RRT, but were associated with shorter duration of RRT and increased urine output. However, these findings have limited relevance to critically ill patients. The relative paucity of high-quality data assessing the value of loop diuretics in ARF for the critically ill suggests a need for a suitably powered randomised trial.
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Extracorporeal membrane oxygenation (ECMO) is a controversial means of life support, particularly in adults. Ongoing refinements in circuit technology and widening global experience have led to ECMO being applied to a broader group of conditions than acute respiratory failure and cardiogenic shock. Septicaemia is no longer viewed as a contraindication to ECMO. ⋯ The last indication is generally more applicable in children than adults, because of differences in the cardiovascular response to severe sepsis seen across age groups. ECMO has a role as rescue therapy in patients with severe sepsis who would otherwise die of either hypoxaemia or inadequate cardiac output. This review describes the basic technique and application of ECMO in neonates, older children, and adults with sepsis.