Crit Care Resusc
-
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.
-
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.
-
Comparative Study
The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand.
Early goal-directed therapy might benefit patients with sepsis and septic shock in Australia and New Zealand. However, the current treatment and outcome of these patients is unknown. ⋯ The reported incidence of sepsis and septic shock in ICU patients presenting to the ED appears to have increased since 1997. In contrast, hospital mortality has decreased. These data require confirmation with a prospective cohort study.
-
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.
-
Comparative Study Biography Historical Article
On the very first, successful, long-term, large-scale use of IPPV. Albert Bower and V Ray Bennett: Los Angeles, 1948-1949.
An "unprecedented respirator patient load at Los Angeles County Hospital [LACH] in 1948 (294 respirator cases)" arose from a seasonal increase in poliomyelitis cases to nearepidemic proportions. A finding by physician Albert Bower and his team that respiratory acidosis was frequent in patients receiving intermittent negative pressure ventilation (INPV), together with their awareness of a previous high mortality rate due to the standard treatment of polio ventilatory failure with Drinker-Collins respirators, led to multiple advances in equipment technology for LACH. Most important was biomedical engineer V Ray Bennett's positive pressure respirator attachment, in use after September 1948, which converted an INPV machine, the Drinker, into one capable of supplying "intratracheal" intermittent positive pressure ventilation (IPPV), supplementary to its NPV. ⋯ A complete system of respiratory care was developed for polio victims at LACH, setting levels of treatment and expertise distinctly higher, by 1950, than was current at other known polio respiration units, and preceding the well known developments in Copenhagen in the early 1950s. Extensive experience was obtained by a consistent medical staff, working as a team, in one hospital. Bower and Bennett deserve greater recognition of their pioneering merit than they currently receive in the written history of intensive care medicine.