Articles: sepsis.
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Multicenter Study
Resuscitating patients with early severe sepsis: a Canadian multicentre observational study.
Fluid resuscitation is a key factor in restoring hemodynamic stability and tissue perfusion in patients with severe sepsis. We sought to examine associations of the quantity and type of fluid administered in the first six hours after identification of severe sepsis and hospital mortality, intensive care unit (ICU) mortality, and organ failure. ⋯ An association between hospital mortality and quantity or type of fluid administered in the first six hours after the diagnosis of severe sepsis was not identifiable. These findings should be considered as hypothesis-generating and warrant confirmation or refutation by randomized controlled trials.
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Multicenter Study Comparative Study
[Cost differences in the treatment of severe sepsis between survivors and non-survivors on the first day of intensive care admission].
Patients admitted to intensive care unit with severe sepsis have high mortality and use significant resources. ⋯ The mortality of severe sepsis is high and the cost of sepsis treatment is low in Hungary compared to international data. Non-survivors cost almost twice as much even on day 1, this warrants the need for early diagnosis and adequate treatment.
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Am. J. Respir. Crit. Care Med. · Sep 2007
Randomized Controlled Trial Multicenter StudyProphylactic heparin in patients with severe sepsis treated with drotrecogin alfa (activated).
Patients with severe sepsis frequently receive prophylactic heparin during drotrecogin alfa (activated) (DrotAA) treatment due to risk of venous thromboembolic events (VTEs). Biological plausibility exists for heparin to reduce DrotAA efficacy and/or increase bleeding. ⋯ Compared with placebo, concomitant prophylactic heparin was not equivalent, did not increase 28-day mortality, and had an acceptable safety profile in patients with severe sepsis receiving DrotAA. Heparin discontinuation should be carefully weighed in patients considered for DrotAA treatment. XPRESS clinical trial registered with www.clinicaltrials.gov (NCT 00049777). The study ID numbers are 6743; F1K-MC-EVBR.
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Journal of critical care · Sep 2007
Multicenter Study Comparative StudyThe COASST study: cost-effectiveness of albumin in severe sepsis and septic shock.
The cost-effectiveness of albumin-based fluid support in patients with severe sepsis is not known. ⋯ The application of the SAFE Study results to CUB-Réa data shows that albumin infusion is cost-effective in severe sepsis.
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Multicenter Study
Understanding the inflammatory cytokine response in pneumonia and sepsis: results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study.
Severe sepsis is common and frequently fatal, and community-acquired pneumonia (CAP) is the leading cause. Although severe sepsis is often attributed to uncontrolled and unbalanced inflammation, evidence from humans with infection syndromes across the breadth of disease is lacking. In this study we describe the systemic cytokine response to pneumonia and determine if specific patterns, including the balance of proinflammatory and anti-inflammatory markers, are associated with severe sepsis and death. ⋯ The circulating cytokine response to pneumonia is heterogeneous and continues for more than a week after presentation, with considerable overlap between those who do and do not develop severe sepsis. Unbalanced activation is uncommon, and mortality is highest when both proinflammatory and anti-inflammatory cytokine levels are high.