Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis DOI Open Access
Giacomo Monti, Nikola Bradić,

Matteo Marzaroli

et al.

JAMA, Journal Year: 2023, Volume and Issue: 330(2), P. 141 - 141

Published: June 16, 2023

Meropenem is a widely prescribed β-lactam antibiotic. exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, administration of meropenem may improve clinical outcomes.To determine whether reduces composite mortality and emergence pandrug-resistant or extensively drug-resistant bacteria compared in critically ill patients sepsis.A double-blind, randomized trial enrolling sepsis septic shock who had been their treating clinicians at 31 intensive care units 26 hospitals 4 countries (Croatia, Italy, Kazakhstan, Russia). Patients were enrolled between June 5, 2018, August 9, 2022, final 90-day follow-up was completed November 2022.Patients receive an equal dose antibiotic either (n = 303) 304).The primary outcome all-cause day 28. There secondary outcomes, including days alive free from antibiotics 28, unit 90. Seizures, allergic reactions, recorded as adverse events.All 607 (mean age, 64 [SD, 15] years; 203 women [33%]) included measurement 28-day follow-up. The majority (369 patients, 61%) shock. median time hospital admission randomization 9 (IQR, 3-17 days) duration therapy 11 6-17 days). Only 1 crossover event recorded. occurred 142 (47%) group 149 (49%) (relative risk, 0.96 [95% CI, 0.81-1.13], P .60). Of none statistically significant. No events seizures reactions related study reported. At 90 days, 42% both (127 303 patients) 304 patients).In sepsis, did not 28.ClinicalTrials.gov Identifier: NCT03452839.

Language: Английский

The immunology of sepsis DOI Creative Commons
Tom van der Poll, Manu Shankar‐Hari, W. Joost Wiersinga

et al.

Immunity, Journal Year: 2021, Volume and Issue: 54(11), P. 2450 - 2464

Published: Nov. 1, 2021

Language: Английский

Citations

549
Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue DOI
Laura Connelly‐Smith, Caroline R. Alquist,

Nicole A. Aqui

et al.

Journal of Clinical Apheresis, Journal Year: 2023, Volume and Issue: 38(2), P. 77 - 278

Published: April 1, 2023

The American Society for Apheresis (ASFA) Journal of Clinical (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications the evidence-based use therapeutic apheresis (TA) in human disease. In Ninth Edition, JCA has incorporated systematic review approaches grading evidence categorization to make recommendations on a wide variety diseases conditions. This edition largely maintained general layout concept fact sheet introduced Fourth Edition (2007). Each succinctly summarizes TA specific disease or medical condition. comprises 91 sheets 166 graded categorized indications. includes seven new sheets, nine existing eight changes category seeks continue serve as key resource that guides utilization treatment

Language: Английский

Citations

284
Restriction of Intravenous Fluid in ICU Patients with Septic Shock DOI Open Access
Tine Sylvest Meyhoff, Peter Buhl Hjortrup, Jørn Wetterslev

et al.

New England Journal of Medicine, Journal Year: 2022, Volume and Issue: 386(26), P. 2459 - 2470

Published: June 17, 2022

Intravenous fluids are recommended for the treatment of patients who in septic shock, but higher fluid volumes have been associated with harm intensive care unit (ICU).In this international, randomized trial, we assigned shock ICU had received at least 1 liter intravenous to receive restricted or standard therapy; were included if onset within 12 hours before screening. The primary outcome was death from any cause 90 days after randomization.We enrolled 1554 patients; 770 restrictive-fluid group and 784 standard-fluid group. Primary data available 1545 (99.4%). In ICU, a median 1798 ml (interquartile range, 500 4366); 3811 1861 6762). At days, occurred 323 764 (42.3%) group, as compared 329 781 (42.1%) (adjusted absolute difference, 0.1 percentage points; 95% confidence interval [CI], -4.7 4.9; P = 0.96). serious adverse events once 221 751 (29.4%) 238 772 (30.8%) -1.7 99% CI, -7.7 4.3). randomization, numbers alive without life support out hospital similar two groups.Among adult restriction did not result fewer deaths than therapy. (Funded by Novo Nordisk Foundation others; CLASSIC ClinicalTrials.gov number, NCT03668236.).

Language: Английский

Citations

251
How to use biomarkers of infection or sepsis at the bedside: guide to clinicians DOI Open Access
Pedro Póvoa, Luís Coelho, Felipe Dal‐Pizzol

et al.

Intensive Care Medicine, Journal Year: 2023, Volume and Issue: 49(2), P. 142 - 153

Published: Jan. 2, 2023

Language: Английский

Citations

163
Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study DOI Open Access
Alexis Tabah, Niccolò Buetti,

Quentin Staiquly

et al.

Intensive Care Medicine, Journal Year: 2023, Volume and Issue: 49(2), P. 178 - 190

Published: Feb. 1, 2023

Language: Английский

Citations

146
2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department DOI Open Access
Matteo Guarino, Benedetta Perna,

Alice Eleonora Cesaro

et al.

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(9), P. 3188 - 3188

Published: April 28, 2023

Sepsis/septic shock is a life-threatening and time-dependent condition that requires timely management to reduce mortality. This review aims update physicians with regard the main pillars of treatment for this insidious condition.PubMed, Scopus, EMBASE were searched from inception special attention paid November 2021-January 2023.The sepsis/septic challenging involves different pathophysiological aspects, encompassing empirical antimicrobial (which promptly administered after microbial tests), fluid (crystalloids) replacement (to be established according tolerance responsiveness), vasoactive agents (e.g., norepinephrine (NE)), which are employed maintain mean arterial pressure above 65 mmHg risk overload. In cases refractory shock, vasopressin (rather than epinephrine) should combined NE reach an acceptable level control. If mechanical ventilation indicated, tidal volume reduced 10 6 mL/kg. Heparin prevent venous thromboembolism, glycemic control recommended. The efficacy other treatments proton-pump inhibitors, sodium bicarbonate, etc.) largely debated, such might used on case-to-case basis.The has significantly progressed in last few years. Improving knowledge therapeutic cornerstones crucial achieve better patient outcomes.

Language: Английский

Citations

123
Immunopathophysiology of human sepsis DOI Creative Commons
W. Joost Wiersinga, Tom van der Poll

EBioMedicine, Journal Year: 2022, Volume and Issue: 86, P. 104363 - 104363

Published: Dec. 1, 2022

Language: Английский

Citations

122
Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial DOI Creative Commons
Stefan Hagel,

Friedhelm Bach,

Thorsten Brenner

et al.

Intensive Care Medicine, Journal Year: 2022, Volume and Issue: 48(3), P. 311 - 321

Published: Feb. 1, 2022

Insufficient antimicrobial exposure is associated with worse outcomes in sepsis. We evaluated whether therapeutic drug monitoring (TDM)-guided antibiotic therapy improves outcomes. Randomized, multicenter, controlled trial from January 2017 to December 2019. Adult patients (n = 254) sepsis or septic shock were randomly assigned 1:1 receive continuous infusion of piperacillin/tazobactam dosing guided by daily TDM piperacillin a fixed dose (13.5 g/24 h if eGFR ≥ 20 mL/min). Target plasma concentration was four times the minimal inhibitory (range ± 20%) underlying pathogen, respectively, Pseudomonas aeruginosa empiric situation. Primary outcome mean total Sequential Organ Failure Assessment (SOFA) score up day 10. Among 249 evaluable (66.3 13.7 years; female, 30.9%), there no significant difference SOFA between (7.9 points; 95% CI 7.1–8.7) and without (8.2 7.5–9.0) (p 0.39). Patients TDM-guided showed lower 28-day mortality (21.6% vs. 25.8%, RR 0.8, 0.5–1.3, p 0.44) higher rate clinical (OR 1.9; 0.5–6.2, 0.30) microbiological cure 2.4; 0.7–7.4, 0.12), but these differences did not reach statistical significance. Attainment target more common (37.3% 14.6%, OR 4.5, 95%, 2.9–6.9, < 0.001). beneficial effect regard score. Larger studies strategies ensure optimization are needed definitively answer question.

Language: Английский

Citations

119
How can assessing hemodynamics help to assess volume status? DOI Open Access
Daniel De Backer, Nadia Aïssaoui, Maurizio Cecconi

et al.

Intensive Care Medicine, Journal Year: 2022, Volume and Issue: 48(10), P. 1482 - 1494

Published: Aug. 10, 2022

Language: Английский

Citations

112
The Sequential Organ Failure Assessment (SOFA) Score: has the time come for an update? DOI Creative Commons
Rui P. Moreno, Andrew Rhodes, Lise Piquilloud

et al.

Critical Care, Journal Year: 2023, Volume and Issue: 27(1)

Published: Jan. 13, 2023

Abstract The Sequential Organ Failure Assessment (SOFA) score was developed more than 25 years ago to provide a simple method of assessing and monitoring organ dysfunction in critically ill patients. Changes clinical practice over the last few decades, with new interventions greater focus on non-invasive systems, mean it is time update SOFA score. As first step this process, we propose some possible variables that could be included 2.0. By so doing, hope stimulate debate discussion move toward new, properly validated will fit for modern practice.

Language: Английский

Citations

106