World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)

International Journal of Surgery, Год журнала: 2020, Номер 76, С. 71 - 76

Опубликована: Фев. 26, 2020

Язык: Английский

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Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Intensive Care Medicine, Год журнала: 2021, Номер 47(11), С. 1181 - 1247

Опубликована: Окт. 2, 2021

Язык: Английский

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High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study

Intensive Care Medicine, Год журнала: 2020, Номер 46(6), С. 1089 - 1098

Опубликована: Май 4, 2020

Язык: Английский

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Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

American Journal of Respiratory and Critical Care Medicine, Год журнала: 2019, Номер 200(7), С. e45 - e67

Опубликована: Окт. 1, 2019

Section:ChooseTop of pageAbstract <

Язык: Английский

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ESPEN guideline on clinical nutrition in the intensive care unit

Clinical Nutrition, Год журнала: 2018, Номер 38(1), С. 48 - 79

Опубликована: Сен. 29, 2018

Язык: Английский

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Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

Intensive Care Medicine, Год журнала: 2020, Номер 46(5), С. 854 - 887

Опубликована: Март 28, 2020

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands people around world. Urgent guidance for clinicians caring sickest these patients needed. We formed panel 36 experts from 12 countries. All members completed World Health Organization conflict interest disclosure form. proposed 53 questions that are relevant to management COVID-19 in ICU. searched literature direct and indirect evidence on critically ill identified recent systematic reviews most relating supportive care. assessed certainty using Grading Recommendations, Assessment, Development Evaluation (GRADE) approach, then generated recommendations based balance between benefit harm, resource cost implications, equity, feasibility. Recommendations were either strong or weak, form best practice recommendations. Surviving Sepsis Campaign issued 54 statements, which 4 9 recommendations, 35 weak No recommendation was provided 6 questions. topics were: (1) infection control, (2) laboratory diagnosis specimens, (3) hemodynamic support, (4) ventilatory (5) therapy. several help support healthcare workers ICU with COVID-19. When available, we will provide new further releases guidelines.

Язык: Английский

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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Critical Care Medicine, Год журнала: 2021, Номер 49(11), С. e1063 - e1143

Опубликована: Окт. 4, 2021

INTRODUCTION Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (1). and septic shock are major healthcare problems, impacting millions of people around the world each year killing between one in three six those it affects (2–4). Early identification appropriate management initial hours after development sepsis improve outcomes. The recommendations this document intended provide guidance for clinician caring adult patients with or hospital setting. Recommendations from these guidelines cannot replace clinician's decision-making capability when presented unique patient's clinical variables. These reflect best practice (Table 1). TABLE 1. - Table Current Changes From Previous 2016 2021 Recommendation Strength Quality Evidence For hospitals health systems, we recommend using performance improvement program sepsis, including screening acutely ill, high-risk standard operating procedures treatment. Strong , moderate-quality evidence (for screening) Changed Best statement "We that systems have patients." very low-quality procedures) 2. We against qSOFA compared SIRS, NEWS, MEWS as single-screening tool shock. NEW 3. adults suspected having suggest measuring blood lactate. Weak low quality INITIAL RESUSCITATION 4. medical emergencies, treatment resuscitation begin immediately. 5. induced hypoperfusion at least 30 mL/kg IV crystalloid fluid should be given within first 3 hr resuscitation. Weak, DOWNGRADE sepsis-induced hypoperfusion, hr" 6. shock, dynamic measures guide resuscitation, over physical examination, static parameters alone. 7. guiding decrease serum lactate elevated level, not 8. capillary refill time an adjunct other perfusion. MEAN ARTERIAL PRESSURE 9. on vasopressors, target mean arterial pressure (MAP) 65 mm Hg higher MAP targets. ADMISSION TO INTENSIVE CARE 10. who require ICU admission, admitting 6 hr. INFECTION 11. but unconfirmed infection, continuously re-evaluating searching alternative diagnoses discontinuing empiric antimicrobials if cause illness demonstrated strongly suspected. 12. possible high likelihood administering immediately, ideally 1 recognition. (Septic shock) CHANGED previous: administration intravenous initiated soon recognition hour both a) b) without shock" (Sepsis strong recommendation moderate 13. rapid assessment infectious versus noninfectious causes acute illness. 14. time-limited course investigation concern persists, was recognized. 15. deferring while continuing closely monitor patient. 16. procalcitonin plus evaluation decide start antimicrobials, 17. risk MRSA, MRSA coverage coverage. broad-spectrum therapy more presenting cover all likely pathogens (including bacterial potentially fungal viral coverage." 18. coverage, 19. multidrug resistant (MDR) organisms, two gram-negative agent. 20. agents treatment, 21. double once causative pathogen susceptibilities known. 22. antifungal no therapy. 23. use " 24. make antiviral agents. No 25. prolonged infusion beta-lactams maintenance (after bolus) conventional bolus infusion. 26. optimising dosing strategies based accepted pharmacokinetic/pharmacodynamic (PK/PD) principles specific drug properties. 27. rapidly identifying excluding anatomical diagnosis requires emergent source control implementing any required intervention medically logistically practical. 28. prompt removal intravascular access devices vascular has been established. 29. daily de-escalation fixed durations reassessment de-escalation. 30. adequate control, shorter longer duration antimicrobial 31. where optimal unclear, AND discontinue HEMODYNAMIC MANAGEMENT 32. crystalloids first-line 33. balanced instead normal saline weak evidence. either 34. albumin received large volumes crystalloids. 35. starches high-quality 36. gelatin UPGRADE gelatins resuscitating shock." 37. norepinephrine agent vasopressors. Dopamine. High-quality Vasopressin. Moderate-quality Epinephrine. Low Selepressin. Angiotensin II. Very 38. inadequate levels, adding vasopressin escalating dose norepinephrine. 39. levels despite vasopressin, epinephrine. 40. terlipressin. 41. cardiac persistent volume status pressure, dobutamine epinephrine 42. levosimendan. 43. invasive monitoring noninvasive monitoring, practical resources available. 44. starting vasopressors peripherally restore rather than delaying initiation until central venous secured. 45. There insufficient restrictive liberal 24 still signs depletion VENTILATION 46.There conservative oxygen targets hypoxemic respiratory failure. 47. failure, flow nasal ventilation. 48. ventilation comparison 49. ARDS, tidal strategy (6 mL/kg), (> 10 mL/kg). 50. severe upper limit goal plateau pressures cm H2O, pressures. 51. PEEP lower PEEP. 52. failure (without ARDS), 53. moderate-severe traditional recruitment maneuvers. 54. When maneuvers, incremental titration/strategy. 55. prone greater 12 daily. 56. intermittent NMBA boluses, continuous 57. Veno-venous (VV) ECMO mechanical fails experienced centers infrastructure place support its use. ADDITIONAL THERAPIES 58. ongoing requirement vasopressor corticosteroids. hydrocortisone treat able hemodynamic stability (see goals Initial Resuscitation). If achievable, 200 mg/day." 59. polymyxin B hemoperfusion. regarding purification techniques" 60. techniques. 61. (over liberal) transfusion strategy. 62. immunoglobulins. 63. factors gastrointestinal (GI) bleeding, stress ulcer prophylaxis. 64. pharmacologic thromboembolism (VTE) prophylaxis unless contraindication such exists. 65. molecular weight heparin unfractionated VTE 66. prophylaxis, addition pharmacological 67. In AKI, renal replacement 68. definitive indications therapy, 69. initiating insulin glucose level ≥ 180mg/dL (10 mmol/L). 70. vitamin C. 71. hypoperfusion-induced lactic acidemia, sodium bicarbonate hemodynamics reduce requirements. 72. metabolic acidemia (pH ≤ 7.2) kidney injury (AKIN score 2 3), 73. can fed enterally, early (within 72 hr) enteral nutrition. LONG-TERM OUTCOMES GOALS OF 74. discussing care prognosis families discussion. 75. addressing late (72 later). 76. there standardized criterion trigger 77. palliative (which may include consultation judgement) integrated into plan, appropriate, address patient family symptoms suffering. 78. routine formal judgement. 79. survivors their families, referral peer groups referral. 80. handoff process critically important information transitions process. 81. structured usual processes. 82. economic social housing, nutritional, financial, spiritual support), referrals available meet needs. 83. offering written verbal education (diagnosis, post-ICU/post-sepsis syndrome) prior discharge follow-up 84. team opportunity participate shared decision making post-ICU planning ensure plans acceptable feasible. 85. critical transition program, care, upon transfer floor. 86. reconciling medications discharge. 87. about stay, related diagnoses, treatments, common impairments summary. 88. developed new impairments, clinicians manage long-term sequelae. 89. post-hospital follow-up. 90. cognitive 91. physical, cognitive, emotional problems 92. post-critical 93. receiving > 48hr stay hr, rehabilitation program. (References 5–24 referred Methodology section which accessed Supplemental Digital Content: Methodology.) SCREENING EARLY TREATMENT Screening Patients With Septic Shock recommendation, screening. procedures. Rationale programs generally consist screening, education, measurement bundle performance, outcomes, actions identified opportunities (25,26). Despite some inconsistency, meta-analysis 50 observational studies effect showed were associated better adherence bundles along reduction mortality (OR, 0.66; 95% CI, 0.61–0.72) (27). components did appear presence included metrics. tools designed promote manual methods automated electronic record (EHR). wide variation diagnostic accuracy most poor predictive values, although improvements processes (28–31). A variety variables used systemic inflammatory syndrome (SIRS) criteria, vital signs, quick Sequential Organ Failure Score (qSOFA) Assessment (SOFA) National Warning (NEWS), Modified (MEWS) (26,32). Machine learning tools, 42,623 seven predicting acquired pooled area under curve (SAUROC) (0.89; 0.86−0.92); sensitivity (81%; 80−81), specificity (72%; 72−72) machine SAUROC SIRS (0.70), (0.50), SOFA (0.78) (32). various locations, in-patient wards, emergency departments, ICUs (28–30,32). analysis RCTs demonstrate benefit active (RR, 0.90; 0.51−1.58) (33–35). However, they component timely intervention. Standard set practices specify preferred circumstances (36). procedures, initially specified Goal Directed Therapy evolved "usual care" includes approach bundle, identification, lactate, cultures, antibiotics, fluids (37). study examined association implementation state-mandated protocols, compliance, mortality. retrospective cohort 1,012,410 admissions 509 United States before (27 months) (30 New York state regulations, concurrent population four states (38). comparative interrupted series, compliance achieving successfully. Lower resource countries experience different effect. Sub-Saharan Africa found 1.26; 1.00−1.58) decreased (adjusted hazard ratio [HR]; 0.55−0.98) (39). single uses predict death known sepsis: Glasgow Coma < 15, rate 22 breaths/min systolic 100 Hg. present simultaneously, considered positive. Data Third International Consensus Conference Definitions predictor outcome performed (5). Since numerous investigated potential (40–42). results contradictory usefulness. Studies shown less sensitive criteria (40–43). Neither nor ideal bedside needs understand limitations each. original derivation study, authors only 24% infected had 3, accounted 70% outcomes Similar findings also comparing warning (NEWS) (44). Although positive alert possibility settings; qSOFA, panel issued tool.

Язык: Английский

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Time to Treatment and Mortality during Mandated Emergency Care for Sepsis

New England Journal of Medicine, Год журнала: 2017, Номер 376(23), С. 2235 - 2244

Опубликована: Май 21, 2017

In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid sepsis improves outcomes in patients.

Язык: Английский

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Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)

Critical Care Medicine, Год журнала: 2020, Номер 48(6), С. e440 - e469

Опубликована: Март 25, 2020

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands people around world. Urgent guidance for clinicians caring sickest these patients needed. Methods: We formed panel 36 experts from 12 countries. All members completed World Health Organization conflict interest disclosure form. proposed 53 questions that are relevant to management COVID-19 in ICU. searched literature direct and indirect evidence on critically ill identified recent systematic reviews most relating supportive care. assessed certainty using Grading Recommendations, Assessment, Development Evaluation (GRADE) approach, then generated recommendations based balance between benefit harm, resource cost implications, equity, feasibility. Recommendations were either strong or weak, form best practice recommendations. Results: Surviving Sepsis Campaign issued 54 statements, which four nine recommendations, 35 weak No recommendation was provided six questions. topics were: 1) infection control, 2) laboratory diagnosis specimens, 3) hemodynamic support, 4) ventilatory 5) therapy. Conclusion: several help support healthcare workers ICU with COVID-19. When available, we will provide new further releases guidelines.

Язык: Английский

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The Surviving Sepsis Campaign Bundle: 2018 update

Intensive Care Medicine, Год журнала: 2018, Номер 44(6), С. 925 - 928

Опубликована: Апрель 19, 2018

Язык: Английский

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