Articles: sepsis.
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Intensive care medicine · Dec 2024
ReviewCausal inference can lead us to modifiable mechanisms and informative archetypes in sepsis.
Medical progress is reflected in the advance from broad clinical syndromes to mechanistically coherent diagnoses. By this metric, research in sepsis is far behind other areas of medicine-the word itself conflates multiple different disease mechanisms, whilst excluding noninfectious syndromes (e.g., trauma, pancreatitis) with similar pathogenesis. New technologies, both for deep phenotyping and data analysis, offer the capability to define biological states with extreme depth. ⋯ Genetic studies can directly illuminate drug targets, but in addition they create a reservoir of statistical power that can be divided many times among potential patient subgroups to test for mechanistic coherence, accelerating discovery of modifiable mechanisms for testing in trials. Novel approaches, such as subgroup identification in-flight in clinical trials, will improve efficiency. Within the next decade, we expect ongoing large-scale collaborative projects to discover and test therapeutically relevant sepsis archetypes.
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This review provides insight into recent clinical studies involving septic peri-operative patients and highlights gaps in understanding fluid management. The aim is to enhance the understanding of safe fluid resuscitation to optimize peri-operative outcomes and reduce complications. ⋯ Optimization of peri-operative fluid management is crucial for improving surgical outcomes and reducing postoperative complications in patients with sepsis. Individualized and GDFT using BS is the preferred approach for fluid resuscitation in septic peri-operative patients. Future research should evaluate the interaction between clinical anaesthesia and EG, its implications on fluid resuscitation, and the impact of GDFT in septic peri-operative patients.
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Intensive care medicine · Dec 2024
ReviewSepsis: key insights, future directions, and immediate goals. A review and expert opinion.
This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited by available tools. ⋯ Accessible, resource-adapted solutions are particularly crucial in low- and middle-income countries where sepsis-related mortality rates are higher due to limited resources. Future research should focus on developing and validating integrated, multi-parameter tools that combine clinical, biochemical, and microbiological data to improve sepsis outcomes globally. Advancing sepsis care will require both technological innovation and collaborative, globally consistent guidelines to bridge disparities in healthcare delivery.
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Review Meta Analysis Comparative Study
Comparison of early and late norepinephrine administration in patients with septic shock: a systematic review and meta-analysis.
Vasopressor administration at an appropriate time is crucial, but the optimal timing remains controversial. ⋯ Overall mortality did not differ significantly between early and late norepinephrine administration for septic shock. However, early norepinephrine administration seemed to reduce pulmonary edema incidence, and mortality improvement was observed in studies without fluid restriction interventions, favoring early norepinephrine use.