Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Intensive Care Medicine, Год журнала: 2017, Номер 43(3), С. 304 - 377

Опубликована: Янв. 18, 2017

Язык: Английский

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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Critical Care Medicine, Год журнала: 2017, Номер 45(3), С. 486 - 552

Опубликована: Янв. 18, 2017

Objective: To provide an update to “Surviving Sepsis Campaign Guidelines for Management of and Septic Shock: 2012.” Design: A consensus committee 55 international experts representing 25 organizations was convened. Nominal groups were assembled at key meetings (for those members attending the conference). formal conflict-of-interest (COI) policy developed onset process enforced throughout. stand-alone meeting held all panel in December 2015. Teleconferences electronic-based discussion among subgroups entire served as integral part development. Methods: The consisted five sections: hemodynamics, infection, adjunctive therapies, metabolic, ventilation. Population, intervention, comparison, outcomes (PICO) questions reviewed updated needed, evidence profiles generated. Each subgroup generated a list questions, searched best available evidence, then followed principles Grading Recommendations Assessment, Development, Evaluation (GRADE) system assess quality from high very low, formulate recommendations strong or weak, practice statement when applicable. Results: Surviving Guideline provided 93 statements on early management resuscitation patients with sepsis septic shock. Overall, 32 recommendations, 39 weak 18 best-practice statements. No recommendation four questions. Conclusions: Substantial agreement exists large cohort regarding many care sepsis. Although significant number aspects have relatively support, evidence-based acute shock are foundation improved these critically ill mortality.

Язык: Английский

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Delirium in elderly people

The Lancet, Год журнала: 2013, Номер 383(9920), С. 911 - 922

Опубликована: Авг. 28, 2013

Язык: Английский

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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Critical Care Medicine, Год журнала: 2018, Номер 46(9), С. e825 - e873

Опубликована: Авг. 16, 2018

To update and expand the 2013 Clinical Practice Guidelines for Management of Pain, Agitation, Delirium in Adult Patients ICU.Thirty-two international experts, four methodologists, critical illness survivors met virtually at least monthly. All section groups gathered face-to-face annual Society Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict interest policy was developed a priori enforced throughout process. Teleconferences electronic discussions among subgroups whole panel were part guidelines' development. general content review completed by all members January 2017.Content ICU represented each five sections guidelines: Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), Sleep (disruption). Each created Population, Intervention, Comparison, Outcome, nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, patients prioritized importance. For Outcome question, searched best available evidence, determined its quality, formulated recommendations as "strong," "conditional," or "good" practice statements Grading Recommendations Assessment, Development Evaluation principles. In addition, evidence gaps caveats explicitly identified.The Agitation/Sedation, (disruption) issued 37 (three strong 34 conditional), two good statements, 32 ungraded, nonactionable statements. Three from patient-centered question list remained without recommendation.We found substantial agreement large, interdisciplinary cohort experts regarding supporting recommendations, remaining literature assessment, prevention, treatment critically ill adults. Highlighting this research needs will improve management provide foundation improved outcomes science vulnerable population.

Язык: Английский

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Long-Term Cognitive Impairment after Critical Illness

New England Journal of Medicine, Год журнала: 2013, Номер 369(14), С. 1306 - 1316

Опубликована: Окт. 2, 2013

Survivors of critical illness often have a prolonged and disabling form cognitive impairment that remains inadequately characterized.We enrolled adults with respiratory failure or shock in the medical surgical intensive care unit (ICU), evaluated them for in-hospital delirium, assessed global cognition executive function 3 12 months after discharge use Repeatable Battery Assessment Neuropsychological Status (population age-adjusted mean [±SD] score, 100±15, lower values indicating worse cognition) Trail Making Test, Part B age-, sex-, education-adjusted 50±10, scores function). Associations duration delirium sedative analgesic agents outcomes were linear regression, adjustment potential confounders.Of 821 patients enrolled, 6% had at baseline, developed 74% during hospital stay. At months, 40% 1.5 SD below population means (similar to moderate traumatic brain injury), 26% 2 mild Alzheimer's disease). Deficits occurred both older younger persisted, 34% 24% all assessments similar injury disease, respectively. A longer was independently associated (P=0.001 P=0.04, respectively) (P=0.004 P=0.007, respectively). Use medications not consistently months.Patients ICUs are high risk long-term impairment. months. (Funded by National Institutes Health others; BRAIN-ICU ClinicalTrials.gov number, NCT00392795.).

Язык: Английский

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Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Circulation, Год журнала: 2017, Номер 136(16)

Опубликована: Сен. 19, 2017

Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity mortality remain high, there are few evidence-based therapeutic interventions known to clearly improve outcomes. This scientific statement on cardiogenic summarizes the epidemiology, pathophysiology, causes, outcomes shock; reviews contemporary best medical, surgical, mechanical circulatory support, palliative care practices; advocates for development regionalized systems care; outlines future research priorities.

Язык: Английский

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European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

European Journal of Anaesthesiology, Год журнала: 2017, Номер 34(4), С. 192 - 214

Опубликована: Фев. 9, 2017

The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention treatment postoperative delirium. cornerstones are preoperative identification handling patients at risk, adequate intraoperative care, detection delirium management delirious patients. scope not cover ICU Considering that many medical disciplines involved in surgical patients, a team-based approach should be implemented into daily practice. This aimed promote knowledge education preoperative, setting only among anaesthesiologists but also all other healthcare professionals care

Язык: Английский

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Guidelines for Perioperative Care in Cardiac Surgery

JAMA Surgery, Год журнала: 2019, Номер 154(8), С. 755 - 755

Опубликована: Май 6, 2019

Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims present consensus recommendations the optimal management of patients undergoing cardiac surgery. A review meta-analyses, randomized trials, large nonrandomized studies, reviews was conducted each protocol element. The quality evidence graded used form topic. Development these endorsed by Society.

Язык: Английский

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Outcome of delirium in critically ill patients: systematic review and meta-analysis

BMJ, Год журнала: 2015, Номер 350(may19 3), С. h2538 - h2538

Опубликована: Июнь 3, 2015

To determine the relation between delirium in critically ill patients and their outcomes short term (in intensive care unit hospital) after discharge from hospital.Systematic review meta-analysis of published studies.PubMed, Embase, CINAHL, Cochrane Library, PsychINFO, with no language restrictions, up to 1 January 2015.Reports were eligible for inclusion if they prospective observational cohorts or clinical trials adults units who assessed a validated screening rating system, association was measured at least one four endpoints (death during admission, length stay, duration mechanical ventilation, any outcome hospital discharge). Studies excluded primarily enrolled neurological disorder admitted cardiac surgery organ/tissue transplantation, centered on sedation management alcohol substance withdrawal. Data extracted characteristics studies, populations sampled, identification delirium, outcomes. Random effects models meta-regression analyses used pool data individual studies.Delirium identified 5280 16,595 (31.8%) reported 42 studies. When compared control without had significantly higher mortality admission (risk ratio 2.19, 94% confidence interval 1.78 2.70; P<0.001) as well longer durations ventilation lengths stay (standard mean differences 1.79 (95% 0.31 3.27; P<0.001), 1.38 (0.99 1.77; 0.97 (0.61 1.33; respectively). Available studies indicated an cognitive impairment discharge.Nearly third develop these are increased risk dying stays hospital, discharge.

Язык: Английский

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Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock

CHEST Journal, Год журнала: 2016, Номер 151(6), С. 1229 - 1238

Опубликована: Дек. 6, 2016

Язык: Английский

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