scholarly journals Update of Sepsis in the Intensive Care Unit

2017 ◽  
Vol 9 (5) ◽  
pp. 441-455 ◽  
Author(s):  
Kelly Roveran Genga ◽  
James A. Russell
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Early Recognition ◽  
Hospital Readmissions ◽  
Kidney Injury ◽  
Predictive Biomarkers ◽  
Immune Dysfunction ◽  
Long Term Outcomes

Sepsis, the most common cause of admission to an intensive care unit (ICU), has had an increased incidence and prevalence over the last years with a simultaneous decrease in its short-term mortality. Sepsis survivors are more frequently discharged from hospital and often experience long-term outcomes such as late mortality, immune dysfunction, secondary infections, impaired quality of life, and unplanned readmissions. Early recognition and management of sepsis have challenged emergency care and critical care physicians and nurses. New sepsis definitions were produced and the Surviving Sepsis Campaign (SSC) 2016 was updated recently. Although hospital readmissions after sepsis are common, associated risk factors and how to manage patients who survive an episode of sepsis still need clarification. The immune dysfunction caused by sepsis/septic shock is complex, persistent, affects inflammatory and anti-inflammatory systems, and might be associated with long-term outcomes of sepsis. Several randomized controlled trials (RCT) that analyzed new (and old) interventions in sepsis/septic shock are discussed in this review in parallel with the SSC 2016 recommendations and other guidelines when relevant. RCTs addressing incidence, treatment, and prevention of important sepsis-associated organ dysfunction such as the acute respiratory distress syndrome, acute kidney injury, and brain dysfunction are highlighted. Finally, we briefly discuss the need for novel targets, predictive biomarkers, and new designs of RCTs in sepsis.

scholarly journals Basic and Advanced Echocardiographic Evaluation of Myocardial Dysfunction in Sepsis and Septic Shock

2018 ◽  
Vol 46 (1) ◽  
pp. 13-24 ◽  
Author(s):  
S. Vallabhajosyula ◽  
S. Pruthi ◽  
S. Shah ◽  
B. M. Wiley ◽  
S. V. Mankad ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Myocardial Dysfunction ◽  
Long Term Outcomes ◽  
Mortality And Morbidity ◽  
Echocardiographic Evaluation ◽  
Short And Long Term ◽  
Sepsis And Septic Shock

Sepsis continues to be a leading cause of mortality and morbidity in the intensive care unit. Cardiovascular dysfunction in sepsis is associated with worse short- and long-term outcomes. Sepsis-related myocardial dysfunction is noted in 20%–65% of these patients and manifests as isolated or combined left or right ventricular systolic or diastolic dysfunction Echocardiography is the most commonly used modality for the diagnosis of sepsis-related myocardial dysfunction. With the increasing use of ultrasonography in the intensive care unit, there is a renewed interest in sepsis-related myocardial dysfunction. This review summarises the current scope of literature focused on sepsis-related myocardial dysfunction and highlights the use of basic and advanced echocardiographic techniques for the diagnosis of sepsis-related myocardial dysfunction and the management of sepsis and septic shock.

scholarly journals Outcomes of Chronic Hemodialysis Patients in the Intensive Care Unit

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Melanie Chan ◽  
Marlies Ostermann
Keyword(s):  
Intensive Care Unit ◽  
Renal Function ◽  
Intensive Care ◽  
Kidney Injury ◽  
Chronic Hemodialysis ◽  
Current Evidence ◽  
Icu Outcome ◽  
Stage Renal Disease ◽  
End Stage

Patients with end-stage renal disease (ESRD) experience higher rates of hospitalisation, cardiovascular events, and all-cause mortality and are more likely to require admission to the intensive care unit (ICU) than patients with normal renal function. Sepsis and cardiovascular diseases are the most common reasons for ICU admission. ICU mortality rates in patients requiring chronic hemodialysis are significantly higher than for patients without ESRD; however, dialysis patients have a better ICU outcome than those with acute kidney injury (AKI) requiring renal replacement therapy suggesting that factors other than loss of renal function contribute to their prognosis. Current evidence suggests, the longer-term outcomes after discharge from ICU may be favourable and that long-term dependence on dialysis should not prejudice against prompt referral or admission to ICU.

Improving long-term outcomes after discharge from intensive care unit

2012 ◽  
Vol 40 (2) ◽  
pp. 502-509 ◽  
Author(s):  
Dale M. Needham ◽  
Judy Davidson ◽  
Henry Cohen ◽  
Ramona O. Hopkins ◽  
Craig Weinert ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Long Term Outcomes

scholarly journals Intensive care unit exposures for long-term outcomes research: Development and description of exposures for 150 patients with acute lung injury

2007 ◽  
Vol 22 (4) ◽  
pp. 275-284 ◽  
Author(s):  
Dale M. Needham ◽  
Weiwei Wang ◽  
Sanjay V. Desai ◽  
Pedro A. Mendez-Tellez ◽  
Cheryl R. Dennison ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Outcomes Research ◽  
Research Development ◽  
Long Term Outcomes

scholarly journals Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

2018 ◽  
Vol 64 (9) ◽  
pp. 1361-1369 ◽  
Author(s):  
Pietro Caironi ◽  
Roberto Latini ◽  
Joachim Struck ◽  
Oliver Hartmann ◽  
Andreas Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P < 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P < 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine >2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P < 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

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