Articles: sepsis.
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Critical care medicine · Apr 2010
Multicenter StudyA prospective multicenter cohort study of the association between global tissue hypoxia and coagulation abnormalities during early sepsis resuscitation.
Coagulation activation is an integral part of sepsis pathogenesis. Experimental data suggest that endothelial exposure to hypoxia activates coagulation. We aimed to test the hypothesis that the quantity of exposure to global tissue hypoxia is associated with the degree of coagulation activation during early sepsis resuscitation. ⋯ In this sample of patients undergoing quantitative resuscitation for sepsis, we found that exposure to global tissue hypoxia (as quantified by low central venous oxygen saturation) was not associated with major coagulation activation. Further investigation to elucidate the clinical factors that trigger or intensify the procoagulant response to sepsis is warranted.
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Intensive care medicine · Apr 2010
Multicenter StudyAre small hospitals with small intensive care units able to treat patients with severe sepsis?
To find out whether mortality from sepsis is influenced by the size of the hospital and of the intensive care unit (ICU). ⋯ Treatment of surgical patients with severe sepsis in small ICUs was associated with increased mortality. Because of the relatively small sample size, further studies are needed to confirm or refute this association.
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Multicenter Study
Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis.
Aggressive diagnosis and treatment of patients presenting to the emergency department (ED) with septic shock has been shown to reduce mortality. To enhance the ability to intervene in patients with lesser illness severity, a better understanding of the natural history of the early progression from simple infection to more severe illness is needed. ⋯ A significant portion of ED patients with less severe sepsis progress to severe sepsis or shock within 72 hours. Additional diagnostic approaches are needed to risk stratify and more effectively treat ED patients with sepsis.
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Critical care medicine · Feb 2010
Multicenter StudyThe Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis.
The Surviving Sepsis Campaign (SSC or "the Campaign") developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations. ⋯ The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.
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Multicenter Study
Standardization of severe sepsis management: a survey of methodologies in academic and community settings.
Evidence-based therapies for severe sepsis include early antibiotics, early goal-directed therapy, corticosteroids, recombinant human activated protein C, glucose control, and lung protective strategies. ⋯ Implementation of a sepsis management protocol incorporating evidence-based therapies can be accomplished in both academic and community hospitals, with minimal additional staffing. The presence of a protocol champion and education program is crucial to success, and may result in improved patient outcome.