scholarly journals The importance of early detection of endotoxemia

2016 ◽  
Vol 22 (7) ◽  
pp. 503-509 ◽  
Author(s):  
Barbara Adamik ◽  
Jakub Smiechowicz ◽  
Andrzej Kübler
Keyword(s):  
Septic Shock ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Clinical Challenge ◽  
Endotoxin Activity ◽  
Sepsis And Septic Shock ◽  
Clinical Conditions ◽  
Endotoxin Elimination ◽  
Selection Of Patients ◽  
Selection Of

Endotoxin is considered a key signaling molecule in the pathogenesis of sepsis and septic shock. Anti-endotoxin therapies may result in the improvement of a patient’s clinical condition and lower mortality. The pressing clinical challenge is to identify patients for whom endotoxin elimination would be the most beneficial. An endotoxin activity assay (EAA) has been available for detection of endotoxins, allowing selection of patients at high risk of endotoxemia in intensive care units (ICUs). We studied a cohort of 172 consecutive patients who had septic shock on admission to the ICU. Endotoxin activity (EA) was measured with a rapid chemiluminescent EAA, regarded as point-of-care testing. Endotoxemia with a mean EA of 0.59 ± 0.14 EAU was present in 104 patients (60%) and absent in 68 patients (EA = 0.25 ± 0.11 EAU). The risk of endotoxemia increased with the presence of a Gram-negative infection [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6–5.9; P = 0.001] and bacteremia (OR 3.8, 95% CI 1.6–8.9; P = 0.02) but did not change with a diagnosis of peritonitis (OR 1.03, 95% CI 0.54–1.97; P = 0.90). These findings indicate that anti-endotoxin interventions should be tailored to individual patients based on both clinical conditions and measured endotoxin levels.

Impact of Hyperoncotic Albumin on Duration of Vasopressor Support inSeptic Shock: A PropensityScore–Matched Analysis

2020 ◽  
pp. 106002802096364
Author(s):  
Alexander H. Flannery ◽  
Gary D. Owen ◽  
Angel Coz ◽  
Melissa L. Thompson Bastin ◽  
Kripa Patel
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Large Trial ◽  
Matched Cohort ◽  
Albumin Administration ◽  
Sepsis And Septic Shock ◽  
Vasopressor Use ◽  
The Impact ◽  
Selection Of Patients ◽  
Selection Of

Background While albumin has not been shown to reduce mortality in sepsis and septic shock, a tertiary analysis of a large trial suggested that it may reduce the duration of vasopressor use in septic shock. Objective We sought to test if 25% albumin administration was associated with reduced cumulative vasopressor use in septic shock in a real-world setting. Methods This was a retrospective, propensity score–matched cohort study of septic shock in which patients receiving albumin were compared with a matched cohort of those not receiving albumin. The primary outcome was days alive and free of vasopressors. Results The matched cohort included 335 patients who received albumin and 335 who did not. The days alive and free of vasopressors were similar between the albumin and no albumin groups: 17.4 (0-24.8) versus 19.4 (0-25.3); P = 0.160. Similarly, in-hospital mortality was no different between groups (46.9% vs 44.8%; P = 0.587). Receipt of albumin was associated with fewer ventilator-free and intensive care unit (ICU)-free days: 0 (0-19) versus 11 (0-23), P = 0.007, and 0 (0-18) versus 10.6 (0-22.1), P = 0.002, respectively. Conclusion and Relevance Albumin use in septic shock was not associated with additional days alive and free of vasopressors or in-hospital mortality. The finding of fewer ventilator- and ICU-free days may reflect selection of patients who were critically ill for longer periods of time before or after albumin administration. Additional study is needed to clarify the impact that timing may have on the effectiveness of albumin in septic shock.

scholarly journals Electrochemical Biosensors Based on S-Layer Proteins

Sensors ◽  
2020 ◽  
Vol 20 (6) ◽  
pp. 1721 ◽  
Author(s):  
Samar Damiati ◽  
Bernhard Schuster
Keyword(s):  
Lipid Membranes ◽  
Point Of Care ◽  
Electrochemical Techniques ◽  
Critical Issue ◽  
Electrochemical Biosensors ◽  
Point Of Care Testing ◽  
Bacterial Surface ◽  
Surfaces And Interfaces ◽  
Small Biomolecules ◽  
Selection Of

Designing and development of electrochemical biosensors enable molecule sensing and quantification of biochemical compositions with multitudinous benefits such as monitoring, detection, and feedback for medical and biotechnological applications. Integrating bioinspired materials and electrochemical techniques promote specific, rapid, sensitive, and inexpensive biosensing platforms for (e.g., point-of-care testing). The selection of biomaterials to decorate a biosensor surface is a critical issue as it strongly affects selectivity and sensitivity. In this context, smart biomaterials with the intrinsic self-assemble capability like bacterial surface (S-) layer proteins are of paramount importance. Indeed, by forming a crystalline two-dimensional protein lattice on many sensors surfaces and interfaces, the S-layer lattice constitutes an immobilization matrix for small biomolecules and lipid membranes and a patterning structure with unsurpassed spatial distribution for sensing elements and bioreceptors. This review aims to highlight on exploiting S-layer proteins in biosensor technology for various applications ranging from detection of metal ions over small organic compounds to cells. Furthermore, enzymes immobilized on the S-layer proteins allow specific detection of several vital biomolecules. The special features of the S-layer protein lattice as part of the sensor architecture enhances surface functionalization and thus may feature an innovative class of electrochemical biosensors.

Integrated Multiorgan Bedside Ultrasound for the Diagnosis and Management of Sepsis and Septic Shock

2021 ◽  
Vol 42 (05) ◽  
pp. 641-649
Author(s):  
Daniel A. Sweeney ◽  
Brandon M. Wiley
Keyword(s):  
Septic Shock ◽  
Point Of Care ◽  
Bedside Ultrasound ◽  
Multiple Point ◽  
Point Of Care Ultrasound ◽  
Suspected Sepsis ◽  
Source Of Infection ◽  
Organ Systems ◽  
Sepsis And Septic Shock ◽  
Delays In Diagnosis

AbstractDespite decades of research, the mortality rate of sepsis and septic shock remains unacceptably high. Delays in diagnosis, identification of an infectious source, and the challenge of providing patient-tailored resuscitation measures routinely result in suboptimal patient outcomes. Bedside ultrasound improves a clinician's ability to both diagnose and manage the patient with sepsis. Indeed, multiple point-of-care ultrasound (POCUS) protocols have been developed to evaluate and treat various subsets of critically ill patients. These protocols mostly target patients with undifferentiated shock and have been shown to improve clinical outcomes. Other studies have shown that POCUS can improve a clinician's ability to identify a source of infection. Once a diagnosis of septic shock has been made, serial POCUS exams can be used to continuously guide resuscitative efforts. In this review, we advocate that the patient with suspected sepsis or septic shock undergo a comprehensive POCUS exam in which sonographic information across organ systems is synthesized and used in conjunction with traditional data gleaned from the patient's history, physical exam, and laboratory studies. This harmonization of information will hasten an accurate diagnosis and assist with hemodynamic management.

scholarly journals Presepsin (Soluble CD14 Subtype) as an Early Marker of Neonatal Sepsis and Septic Shock: A Prospective Diagnostic Trial

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 580
Author(s):  
Carlo Pietrasanta ◽  
Andrea Ronchi ◽  
Claudia Vener ◽  
Chiara Poggi ◽  
Claudia Ballerini ◽  
...  
Keyword(s):  
Septic Shock ◽  
Blood Culture ◽  
Neonatal Sepsis ◽  
Clinical Severity ◽  
Youden Index ◽  
Reactive Protein ◽  
Sepsis And Septic Shock ◽  
Sensitivity Specificity ◽  
Clinical Conditions ◽  
Diagnostic Trial

In the context of suspected neonatal sepsis, early diagnosis and stratification of patients according to clinical severity is not yet effectively achieved. In this diagnostic trial, we aimed to assess the accuracy of presepsin (PSEP) for the diagnosis and early stratification of supposedly septic neonates. PSEP, C-reactive protein (CRP), and procalcitonin (PCT) were assessed at the onset of sepsis suspicion (T0), every 12–24 h for the first 48 h (T1–T4), and at the end of antibiotic therapy (T5). Enrolled neonates were stratified into three groups (infection, sepsis, septic shock) according to Wynn and Wong’s definitions. Sensitivity, specificity, and area under the ROC curve (AUC) according to the severity of clinical conditions were assessed. We enrolled 58 neonates with infection, 77 with sepsis, and 24 with septic shock. PSEP levels were higher in neonates with septic shock (median 1557.5 pg/mL) and sepsis (median 1361 pg/mL) compared to those with infection (median 977.5 pg/mL) at T0 (p < 0.01). Neither CRP nor PCT could distinguish the three groups at T0. PSEP’s AUC was 0.90 (95% CI: 0.854–0.943) for sepsis and 0.94 (95% CI: 0.885–0.988) for septic shock. Maximum Youden index was 1013 pg/mL (84.4% sensitivity, 88% specificity) for sepsis, and 971.5 pg/mL for septic shock (92% sensitivity, 86% specificity). However, differences in PSEP between neonates with positive and negative blood culture were limited. Thus, PSEP was an early biomarker of neonatal sepsis severity, but did not support the early identification of neonates with positive blood culture.

Viscoelastic and aggregometric point-of-care testing in patients with septic shock - cross-links between inflammation and haemostasis

2012 ◽  
Vol 56 (10) ◽  
pp. 1277-1290 ◽  
Author(s):  
T. BRENNER ◽  
K. SCHMIDT ◽  
M. DELANG ◽  
A. MEHRABI ◽  
T. BRUCKNER ◽  
...  
Keyword(s):  
Septic Shock ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Cross Links

scholarly journals Application guide: training of professional users of devices for near-patient testing

2017 ◽  
Vol 41 (5) ◽  
Author(s):  
Nicola Barabas ◽  
Andreas Bietenbeck
Keyword(s):  
Point Of Care ◽  
Point Of Care Testing ◽  
Operator Training ◽  
Train The Trainer ◽  
Root Cause ◽  
Learning Path ◽  
E Learning ◽  
Near Patient Testing ◽  
Selection Of

AbstractInsufficient operator training has been identified as an underlying root cause for many errors of point-of-care testing. However, while the need for operator training is beyond doubt, the practical solutions on how to train operators remain challenging. Therefore a multidisciplinary team of experts created the application guide VDE-AR-E 2411-2-101 “Schulung professioneller Anwender von patientennahen Tests” (Training of professional users of devices for near-patient testing). This work is based on the talk of Nicola Barabas during the POCT-Symposium in Munich 2017 and presents selected aspects of the application guide such as the role of the manufacturer, the learning path, the selection of training topics, the train-the-trainer concept and e-learning.

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