The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China

Clinical Immunology, Journal Year: 2020, Volume and Issue: 214, P. 108393 - 108393

Published: March 25, 2020

Language: Английский

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Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment

Kidney International, Journal Year: 2019, Volume and Issue: 96(5), P. 1083 - 1099

Published: June 8, 2019

Language: Английский

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COVID-19 and Multiorgan Response

Current Problems in Cardiology, Journal Year: 2020, Volume and Issue: 45(8), P. 100618 - 100618

Published: April 28, 2020

Language: Английский

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Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children

Pediatric Critical Care Medicine, Journal Year: 2020, Volume and Issue: 21(2), P. e52 - e106

Published: Feb. 1, 2020

Objectives: To develop evidence-based recommendations for clinicians caring children (including infants, school-aged children, and adolescents) with septic shock other sepsis-associated organ dysfunction. Design: A panel of 49 international experts, representing 12 organizations, as well three methodologists public members was convened. Panel assembled at key meetings (for those attending the conference), a stand-alone meeting held all in November 2018. formal conflict-of-interest policy developed onset process enforced throughout. Teleconferences electronic-based discussion among chairs, co-chairs, methodologists, group heads, within subgroups, served an integral part guideline development process. Methods: The consisted six subgroups: recognition management infection, hemodynamics resuscitation, ventilation, endocrine metabolic therapies, adjunctive research priorities. We conducted systematic review each Population, Intervention, Control, Outcomes question to identify best available evidence, statistically summarized then assessed quality evidence using Grading Recommendations Assessment, Development, Evaluation approach. used evidence-to-decision framework formulate strong or weak, practice statement. In addition, “in our practice” statements were included when inconclusive issue recommendation, but felt that some guidance based on patterns may be appropriate. Results: provided 77 resuscitation Overall, recommendations, 52 weak nine best-practice statements. For 13 questions, no could made; but, 10 these, provided. priorities identified. Conclusions: large cohort experts able achieve consensus regarding many care sepsis, acknowledging most aspects had relatively low resulting frequent issuance recommendations. Despite this challenge, these dysfunction provide foundation consistent improve outcomes inform future research.

Language: Английский

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Adjunctive Glucocorticoid Therapy in Patients with Septic Shock

New England Journal of Medicine, Journal Year: 2018, Volume and Issue: 378(9), P. 797 - 808

Published: Jan. 19, 2018

We randomly assigned patients with septic shock who were undergoing mechanical ventilation to receive hydrocortisone (at a dose of 200 mg per day) or placebo for 7 days until death discharge from the intensive care unit (ICU), whichever came first. The primary outcome was any cause at 90 days.

Language: Английский

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Enhancing Recovery From Sepsis

JAMA, Journal Year: 2018, Volume and Issue: 319(1), P. 62 - 62

Published: Jan. 2, 2018

Importance

Survival from sepsis has improved in recent years, resulting an increasing number of patients who have survived treatment. Current guidelines do not provide guidance on posthospital care or recovery.

Observations

Each year, more than 19 million individuals develop sepsis, defined as a life-threatening acute organ dysfunction secondary to infection. Approximately 14 survive hospital discharge and their prognosis varies. Half recover, one-third die during the following one-sixth severe persistent impairments. Impairments include development average 1 2 new functional limitations (eg, inability bathe dress independently), 3-fold increase prevalence moderate cognitive impairment (from 6.1% before hospitalization 16.7% after hospitalization), high mental health problems, including anxiety (32% survive), depression (29%), posttraumatic stress disorder (44%). About 40% are rehospitalized within 90 days discharge, often for conditions that potentially treatable outpatient setting, such infection (11.9%) exacerbation heart failure (5.5%). Compared with hospitalized other diagnoses, those at increased risk recurrent matched (8.0%) (P < .001), renal (3.3% vs 1.2%,P cardiovascular events (adjusted hazard ratio [HR] range, 1.1-1.4). Reasons deterioration multifactorial accelerated progression preexisting chronic conditions, residual damage, impaired immune function. Characteristics associated complications treatment fully understood but both poorer presepsis status, characteristics septic episode severity infection, host response infection), quality timeliness initial care, avoidance treatment-related harms). Although there is paucity clinical trial evidence support specific postdischarge rehabilitation treatment, experts recommend referral physical therapy improve exercise capacity, strength, independent completion activities daily living. This recommendation supported by observational study involving 30 000 survivors found was lower 10-year mortality compared propensity-matched controls HR, 0.94; 95% CI, 0.92-0.97,P .001).

Conclusions Relevance

In months management should focus (1) identifying physical, mental, problems referring appropriate (2) reviewing adjusting long-term medications, (3) evaluating commonly result hospitalization, failure, aspiration. For poor declining prior experience further it may be palliation symptoms.

Language: Английский

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Hydrocortisone plus Fludrocortisone for Adults with Septic Shock

New England Journal of Medicine, Journal Year: 2018, Volume and Issue: 378(9), P. 809 - 818

Published: Feb. 28, 2018

Septic shock is characterized by dysregulation of the host response to infection, with circulatory, cellular, and metabolic abnormalities. We hypothesized that therapy hydrocortisone plus fludrocortisone or drotrecogin alfa (activated), which can modulate response, would improve clinical outcomes patients septic shock.

Language: Английский

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Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

Journal of Diabetes Science and Technology, Journal Year: 2020, Volume and Issue: 14(4), P. 813 - 821

Published: May 9, 2020

Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes acute hyperglycemia.This retrospective observational study laboratory-confirmed adults evaluated clinical outcomes in without and/or acutely uncontrolled hyperglycemia March 1 to April 6, 2020. was defined A1C ≥6.5%. Uncontrolled ≥2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted Glytec's data warehouse.Among 1122 88 U.S. hospitals, 451 spent 37.8% patient days having mean BG mg/dL. Among 570 who died or discharged, the mortality rate 28.8% 184 patients, compared 6.2% 386 (P < .001). 40 96 (41.7%) 13 (14.8%, P 493 discharged survivors, median length stay (LOS) longer (5.7 vs 4.3 days, .001).Among COVID-19, occurred frequently. These had LOS markedly higher than hyperglycemia. Patients particularly high rate. We recommend health systems which ensure that inpatient safely effectively treated.

Language: Английский

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Antimicrobial therapeutic drug monitoring in critically ill adult patients: a Position Paper#

Intensive Care Medicine, Journal Year: 2020, Volume and Issue: 46(6), P. 1127 - 1153

Published: May 7, 2020

Language: Английский

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The SOFA score—development, utility and challenges of accurate assessment in clinical trials

Critical Care, Journal Year: 2019, Volume and Issue: 23(1)

Published: Nov. 27, 2019

The Sequential Organ Failure Assessment or SOFA score was developed to assess the acute morbidity of critical illness at a population level and has been widely validated as tool for this purpose across range healthcare settings environments.In recent years, become extensively used in other applications. A change 2 more is now defining characteristic sepsis syndrome, European Medicines Agency accepted that an acceptable surrogate marker efficacy exploratory trials novel therapeutic agents sepsis. requirement detect modest serial changes patients' therefore means increased clarity on how should be assessed different circumstances required.This review explores development score, its applications challenges associated with measurement. In addition, it proposes guidance designed facilitate consistent valid assessment multicentre involving interventions.ConclusionThe increasingly important both clinical condition individual patient response therapies context trials. Standardisation between assessors widespread centres key detecting treatment if outcome

Language: Английский

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