Articles: sepsis.
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Coagulopathy is part of the pathological host response to infection in sepsis. Higher plasma concentrations of both tissue factor (TF) and tissue factor pathway inhibitor (TFPI) are associated with occurrence of disseminated intravascular coagulation (DIC), multi-organ dysfunction and increased mortality in patients with sepsis. Currently no treatment approaches specifically targeting this axis are available. We hypothesize that therapeutic plasma exchange (TPE) might limit this coagulopathy by restoring the balance of plasma proteins. ⋯ Adjunctive TPE in septic shock is associated with a significant removal of both TF and TFPI, which may contribute to the early hemodynamic improvement observed in septic shock patients receiving TPE. Higher baseline TF (and TFPI) plasma concentrations were identified as a putative predictor of treatment response that could be useful for predictive enrichment strategies in future clinical trials.
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Patients who first meet clinical criteria for sepsis while boarding in the emergency department (ED) may not receive optimal sepsis care. ⋯ Sepsis patients experiencing T-0 as a boarder in the ED have a lower likelihood of receiving SEP-1 compliant care compared to patients who experience T-0 while still under ED care.
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Timely recognition of sepsis in emergency department (ED) is challenging. We evaluated the impact of implementing the biomarker monocyte distribution width (MDW) at bedside, on the time to anti-infective administration. ⋯ Implementing POC MDW measurement in the ED protocols enhances the timeliness of anti-infective administration from sepsis onset, meeting current sepsis management guidelines.
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Multicenter Study Observational Study
Mortality of patients with sepsis in intensive care units at tertiary hospitals in Jordan: Prospective cohort study.
The aim of this study was to describe the 30-day mortality rate of adult patients with sepsis and septic shock in 6 intensive care units of 2 tertiary hospitals in Jordan. A prospective cohort design was used. Patients with sepsis and septic shock admitted to the medical and surgical intensive care units at 2 tertiary hospitals were followed up during the period between February 2022 and June 2022 (N = 148). ⋯ Moreover, 43 (29.0%) patients with sepsis and septic shock had positive blood cultures, and 46 (31.0%) had positive urine cultures. Patients with sepsis and septic shock have a notable mortality rate that can be predicted from total Sequential Organ Failure Assessment scores and from the history of having solid tumors. Early assessment and initiation of treatment for sepsis essentially would reduce the likelihood of progression of sepsis to septic shock and would reduce associated patients' mortality.
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Observational Study
Clinical effects of dexmedetomidine on patients with sepsis and myocardial injury.
This study aimed to explore the organ-protective effects of dexmedetomidine in patients with sepsis combined with myocardial injury. From December 2021 to December 2023, 263 sepsis patients with myocardial injury were included based on inclusion and exclusion criteria. They were divided into an experimental group (n = 122), who had previously received dexmedetomidine, and a control group (n = 141), who had received midazolam. ⋯ Hospitalization duration was similar between groups. Dexmedetomidine reduces heart rate and inflammatory markers, protects myocardial cells, and improves cardiac function in patients with sepsis and myocardial injury. It shows potential as a treatment option, with future research needed to assess its long-term efficacy and safety.