Necrotizing Soft-Tissue Infections

New England Journal of Medicine, Journal Year: 2017, Volume and Issue: 377(23), P. 2253 - 2265

Published: Dec. 6, 2017

The hallmarks of necrotizing fasciitis are friable superficial fascia, gray exudate without pus, and widespread tissue destruction. infection is either polymicrobial or monomicrobial. Early surgical débridement appropriate antibiotics crucial for recovery.

Language: Английский

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The Pathogenesis of Sepsis and Potential Therapeutic Targets

International Journal of Molecular Sciences, Journal Year: 2019, Volume and Issue: 20(21), P. 5376 - 5376

Published: Oct. 29, 2019

Sepsis is defined as "a life-threatening organ dysfunction caused by a host's dysfunctional response to infection". Although the treatment of sepsis has developed rapidly in past few years, incidence and mortality clinical still climbing. Moreover, because diverse manifestations sepsis, clinicians continue face severe challenges diagnosis, treatment, management patients with sepsis. Here, we review recent development our understanding regarding cellular pathogenesis target diagnosis goal enhancing current The present state research on targeted therapeutic drugs also elaborated upon provide information for

Language: Английский

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European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances

Resuscitation, Journal Year: 2021, Volume and Issue: 161, P. 152 - 219

Published: March 24, 2021

Language: Английский

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The Surviving Sepsis Campaign Bundle: 2018 Update

Critical Care Medicine, Journal Year: 2018, Volume and Issue: 46(6), P. 997 - 1000

Published: May 17, 2018

INTRODUCTION The "sepsis bundle" has been central to the implementation of Surviving Sepsis Campaign (SSC) from first publication its evidence-based guidelines in 2004 through subsequent editions (1–6). Developed separately by SSC, bundles have cornerstone sepsis quality improvement since 2005 (7–11). As noted when they were introduced, bundle elements designed be updated as indicated new evidence and evolved accordingly. In response "Surviving Campaign: International Guidelines for Management Septic Shock: 2016" (12,13), a revised "hour-1 developed is presented below (Fig. 1).Figure 1.: Hour-1 Bundle Care.*The compelling nature literature, which demonstrated an association between compliance with improved survival patients septic shock, led adoption SSC measures National Quality Forum (NQF) subsequently both New York State (NYS) Department Health (14) Centers Medicare Medicaid Services (CMS) (15) USA mandated public reporting. important relationship was confirmed this NYS initiative (16). Paramount management concept that medical emergency. polytrauma, acute myocardial infarction, stroke, early identification appropriate immediate initial hours after development improves outcomes (7–11,14,16–21). state these need urgent assessment treatment, including fluid resuscitation while pursuing source control, obtaining further laboratory results, attaining more precise measurements hemodynamic status. A guiding principle complex detailed then ongoing re-evaluation their treatment. 2018 bundle, intended initiated within hour, are listed Table 1 following. Consistent previous iterations bundles, "time zero" or presentation" defined time triage emergency department or, if referred another care location, earliest chart annotation consistent all (formerly severe sepsis) shock ascertained review. Because based on 2016 publication, themselves should discussion related each element whole.TABLE Elements With Strength Recommendations Under-Pinning Evidence (12 , 13)HOUR-1 BUNDLE most change revision 3-h 6-h combined into single explicit intention beginning immediately. We believe reflects clinical reality at bedside seriously ill shock—that clinicians begin treatment immediately, especially hypotension, rather than waiting extending over longer period. More hour may required completed, but initiation such blood measuring lactate cultures, administration fluids antibiotics, case life-threatening vasopressor therapy, begun It also note there no published studies evaluated efficacy subgroups, burns immunocompromised patients. This knowledge gap needs addressed future specifically targeting subgroups. included taken Guidelines, level support can seen (12, 13). accurate reflection actual care. Measure Lactate Level While serum not direct measure tissue perfusion (22), it serve surrogate, increases represent hypoxia, accelerated aerobic glycolysis driven excess beta-adrenergic stimulation, other causes associated worse (23). Randomized controlled trials significant reduction mortality lactate-guided (24–28). If elevated (> 2mmol/L), remeasured 2−4 h guide normalize levels marker hypoperfusion (24). Obtain Blood Cultures Prior Antibiotics Sterilization cultures occur minutes dose antimicrobial (29,30), so must obtained before antibiotic optimize pathogens improve (31,32). Appropriate include least two sets (aerobic anaerobic). Administration therapy delayed order obtain cultures. Administer Broad-Spectrum Empiric broad-spectrum one intravenous antimicrobials cover likely started immediately (21) presenting shock. narrowed once pathogen sensitivities established, discontinued decision made patient does infection. link antibiotics suspected infection stewardship remains essential aspect high-quality management. proven exist, discontinued. IV Fluid Early effective crucial stabilization sepsis-induced Given emergency, upon recognizing and/or hypotension lactate, completed 3 recognition. recommend comprise minimum 30 mL/kg crystalloid fluid. Although little literature includes data volume, recent interventional described usual practice stages resuscitation, observational supportive (7,8). absence any clear benefit following colloid compared solutions subgroups sepsis, conjunction expense albumin, supports strong recommendation use some indicates sustained positive balance during ICU stay harmful (33–37), beyond requires careful likelihood responsive. Apply Vasopressors Urgent restoration adequate pressure vital organs key part resuscitation. delayed. restored vasopressors commenced achieve mean arterial (MAP) ≥ 65 mm Hg. physiologic effects inotrope/vasopressor selection outlined large number reviews (38–47). SUMMARY Previous introduced means providing education improving bundle," guidelines, department, floor, staff next iteration ever-improving tools we work lessen global burden sepsis. ACKNOWLEDGMENTS authors gratefully acknowledge Deb McBride Lori Harmon invaluable assistance manuscript preparation editing (D.M.) overall (D.M. L.H.).

Language: Английский

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Intubation and Ventilation amid the COVID-19 Outbreak

Anesthesiology, Journal Year: 2020, Volume and Issue: 132(6), P. 1317 - 1332

Published: March 20, 2020

The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released March 4, 2020. Approximately 3.2% of patients with required intubation invasive ventilation at some point disease course. Providing best practices regarding for an overwhelming number amid enhanced risk cross-infection is a daunting undertaking. authors presented experience caring critically ill Wuhan. It extremely important follow strict self-protection precautions. Timely, but not premature, crucial counter progressively enlarging oxygen debt despite high-flow therapy bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, using video laryngoscope are widely used strategies Lung-protective ventilation, prone position adequate sedation analgesia essential components management.

Language: Английский

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