Guidelines For Management Of Sepsis Research Articles

Clinical impact of the implementation of monocyte distribution width (MDW) measurement on time to anti-infective administration in sepsis patients in the emergency department: a before/after cohort study

BackgroundTimely recognition of sepsis in emergency department (ED) is challenging. We evaluated the impact of implementing the biomarker monocyte distribution width (MDW) at bedside, on the time to anti-infective administration.MethodsWe conducted a before-and-after cohort study in the ED of an academic hospital in Paris, to compare sepsis patients care and outcomes, before and after the implementation of point of care (POC) MDW measurement in the ED. During post-implementation period (period-2), MDW was measured with complete blood count by ED nurses with results given in 2 min: if above 21.5 units, ED physicians were asked to consider sepsis and to start an anti-infectious as soon as possible. Primary endpoint was time to anti-infectious administration (TTA) from ED arrival, and secondary endpoints were TTA from sepsis onset (TTAS), length of stay, mortality, and hospitalization rates.ResultsIn total, 255 patients (period-1) and 180 patients (period-2) with sepsis were included. The TTA was 5.4 h (3.5–7.7) period-1 and 4.9 h (IQR 2.5–7.1) in period-2 (p = 0.06). MDW implementation significantly reduced the median TTAS from to 3.7 h (IQR 1.5–5.8) in period-1, to 2.2 h (IQR 0.5–4.5) in period-2 (p < 0.001). Mortality rates remained similar between the two periods (18% vs. 16% respectively, p = 0.4), as did hospitalization rates (93% vs. 91%, p = 0.4) and ED length of stay (7.2 h (5.3–9.8) vs 7.0 (5.4–9.4), p = 0.7).ConclusionImplementing POC MDW measurement in the ED protocols enhances the timeliness of anti-infective administration from sepsis onset, meeting current sepsis management guidelines.

Performance of a Large Language Model in Screening Citations

Large language models (LLMs) are promising as tools for citation screening in systematic reviews. However, their applicability has not yet been determined. To evaluate the accuracy and efficiency of an LLM in title and abstract literature screening. This prospective diagnostic study used the data from the title and abstract screening process for 5 clinical questions (CQs) in the development of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock. The LLM decided to include or exclude citations based on the inclusion and exclusion criteria in terms of patient, population, problem; intervention; comparison; and study design of the selected CQ and was compared with the conventional method for title and abstract screening. This study was conducted from January 7 to 15, 2024. LLM (GPT-4 Turbo)-assisted citation screening or the conventional method. The sensitivity and specificity of the LLM-assisted screening process was calculated, and the full-text screening result using the conventional method was set as the reference standard in the primary analysis. Pooled sensitivity and specificity were also estimated, and screening times of the 2 methods were compared. In the conventional citation screening process, 8 of 5634 publications in CQ 1, 4 of 3418 in CQ 2, 4 of 1038 in CQ 3, 17 of 4326 in CQ 4, and 8 of 2253 in CQ 5 were selected. In the primary analysis of 5 CQs, LLM-assisted citation screening demonstrated an integrated sensitivity of 0.75 (95% CI, 0.43 to 0.92) and specificity of 0.99 (95% CI, 0.99 to 0.99). Post hoc modifications to the command prompt improved the integrated sensitivity to 0.91 (95% CI, 0.77 to 0.97) without substantially compromising specificity (0.98 [95% CI, 0.96 to 0.99]). Additionally, LLM-assisted screening was associated with reduced time for processing 100 studies (1.3 minutes vs 17.2 minutes for conventional screening methods; mean difference, -15.25 minutes [95% CI, -17.70 to -12.79 minutes]). In this prospective diagnostic study investigating the performance of LLM-assisted citation screening, the model demonstrated acceptable sensitivity and reasonably high specificity with reduced processing time. This novel method could potentially enhance efficiency and reduce workload in systematic reviews.

Medical Emergency Team call within 24 h of medical admission with a focus on sepsis: a retrospective review.

Clinical deterioration within the first 24 h of patient admission triggering a Medical Emergency Team (MET) call is a common occurrence. A greater understanding of these events, with a focus on the recognition and management of sepsis, could lead to quality improvement interventions. A retrospective observational review of general and subspecialty medical admissions triggering a MET call within 24 h of admission at a quaternary Australian hospital. 2648 MET calls occurred (47.9/1000 admissions), 527 (20% of total MET events, 9.5/1000 admissions) within 24 h of admission, with the trigger more likely to be hypotension (odds ratio: 1.5, P = 0.0013). There were 263 MET calls to 217 individual medical patients within 24 h of admission, of which 84 (38.7%) were admitted with suspected infection, 69% of which fulfilled sepsis criteria. Of these, 36.2% received antimicrobial therapy within the recommended timeframe and 39.6% received antibiotics in line with hospital guidelines. Sepsis was initially missed in 11% of patients. Afferent limb failure occurred in 29% of patients with 40.5% experiencing a failure of the ward-based response to deterioration prior to MET call. Median hospital length of stay was increased in patients admitted with suspected infection (7 vs 5 days, P = 0.015) and in those with sepsis not receiving antimicrobial therapy within guideline timeframes (9 vs 4 days, P = 0.017). There is a significant opportunity to improve care for patients who trigger a MET within 24 h of admission. This study supports the implementation of a hospital sepsis management guideline.

AB178. SOH24AB_224. A closed-loop audit of adherence to the sepsis management guidelines among adult patients suspected of sepsis presenting to the emergency department at Cork University Hospital

AB178. SOH24AB_224. A closed-loop audit of adherence to the sepsis management guidelines among adult patients suspected of sepsis presenting to the emergency department at Cork University Hospital

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024

Patient diversity and author representation in clinical studies supporting the Surviving Sepsis Campaign guidelines for management of sepsis and septic shock 2021: a systematic review of citations

BackgroundThe generalizability of the Surviving Sepsis Campaign (SSC) guidelines to various patient populations and hospital settings has been debated. A quantitative assessment of the diversity and representation in the clinical evidence supporting the guidelines would help evaluate the generalizability of the recommendations and identify strategic research goals and priorities. In this study, we evaluated the diversity of patients in the original studies, in terms of sex, race/ethnicity, and geographical location. We also assessed diversity in sex and geographical representation among study first and last authors.MethodsAll clinical studies cited in support of the 2021 SSC adult guideline recommendations were identified. Original clinical studies were included, while editorials, reviews, non-clinical studies, and meta-analyses were excluded. For eligible studies, we recorded the proportion of male patients, percentage of each represented racial/ethnic subgroup (when available), and countries in which they were conducted. We also recorded the sex and location of the first and last authors. The World Bank classification was used to categorize countries.ResultsThe SSC guidelines included six sections, with 85 recommendations based on 351 clinical studies. The proportion of male patients ranged from 47 to 62%. Most studies did not report the racial/ ethnic distribution of the included patients; when they did so, most were White patients (68–77%). Most studies were conducted in high-income countries (77–99%), which included Europe/Central Asia (33–66%) and North America (36–55%). Moreover, most first/last authors were males (55–93%) and from high-income countries (77–99%).ConclusionsTo enhance the generalizability of the SCC guidelines, stakeholders should define strategies to enhance the diversity and representation in clinical studies. Though there was reasonable representation in sex among patients included in clinical studies, the evidence did not reflect diversity in the race/ethnicity and geographical locations. There was also lack of diversity among the first and last authors contributing to the evidence.

613 The Use of an Online Sepsis Screening Tool to Improve the Initial Management of Sepsis

Abstract Aim The aim of the project was to improve the adherence to sepsis management guidelines in Trauma and Orthopaedic patients through the use of an online Sepsis Screening Tool (SST). This was created to increase recognition of the early signs of sepsis to guide time critical interventions thus improving patient care. Method A retrospective audit of adult Trauma and Orthopaedic inpatients with a NEWS2 score of over 5, or 3 in one parameter, or a new suspected infection within a seven-day period was conducted in July 2020, March 2021 and August 2021 for each audit cycle respectively. We then assessed whether the SST and time critical interventions had been completed. Results After the initial audit in July 2020 showed the use of the SST and achievement of time critical interventions was poor, we introduced several interventions including information posters, and sepsis teaching for junior doctors. Further interventions were implemented after repeat audit cycles, including the incorporation of the SST within daily nursing safety huddles. By August 2021 the use of the SST had increased from 10% to 54%. This was associated with improved adherence to the sepsis management guidelines including correct observation frequency and medical review within 1 hour. Communication of a sepsis diagnosis to patients and family members also improved. Conclusions The completion of the SST increased adherence to sepsis management guidelines in our patients. We therefore recommend the use of Sepsis Screening Tools to identify patients at risk of sepsis and to improve their initial management.

Improving the management of medical emergency team calls due to suspected infections: A before–after study

ObjectiveTo introduce a management guideline for sepsis-related MET calls to increase lactate and blood culture acquisition, as well as prescription of appropriate antibiotics. DesignProspective before (Jun–Aug 2018) and after (Oct–Dec 2018) study was designed. SettingA public university linked hospital in Melbourne, Australia. ParticipantsAdult patients with MET calls related to sepsis/infection were included. Main outcome measuresThe primary outcome measure was the proportion of MET calls during which both a blood culture and lactate level were ordered. Secondary outcomes included the frequency with which new antimicrobials were commenced by the MET, and the presence and class of administered antimicrobials. ResultsThere were 985 and 955 MET calls in the baseline and after periods, respectively. Patient features, MET triggers, limitations of treatment and disposition after the MET call were similar in both groups. Compliance with the acquisition of lactates (p = 0.101), respectively. There was a slight reduction in compliance with lactate acquisition in the after period (97% vs 99%; p = 0.06). In contrast, there was a significant increase in acquisition of blood cultures in the after period (69% vs 78%; p = 0.035). ConclusionsIntroducing a sepsis management guideline and enhanced linkage with an AMS program increased blood culture acquisition and decreased broad spectrum antimicrobial use but didn't change in-hospital mortality.

Clinical ground truth in machine learning for early sepsis diagnosis

Clinical ground truth in machine learning for early sepsis diagnosis

Surviving Sepsis Campaign 2021 Updates for Management of Sepsis and Septic Shock

Article| January 2023 Surviving Sepsis Campaign 2021 Updates for Management of Sepsis and Septic Shock Ana Maria Crawford, MD, MSc, FASA Ana Maria Crawford, MD, MSc, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2023, Vol. 87, 30. https://doi.org/10.1097/01.ASM.0000911800.69781.4b Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Ana Maria Crawford; Surviving Sepsis Campaign 2021 Updates for Management of Sepsis and Septic Shock. ASA Monitor 2023; 87:30 doi: https://doi.org/10.1097/01.ASM.0000911800.69781.4b Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: sepsis, septic shock, surviving sepsis campaign Millions of people die each year from sepsis and septic shock. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection (JAMA 2016;315:801-10). The Surviving Sepsis Campaign (SSC) formed in 2002 as a joint collaboration of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). The campaign's mission is the reduction of morbidity and mortality from sepsis and septic shock worldwide. In October 2021, the SSC released their 5th edition of International Guidelines for Management of Sepsis and Septic Shock (Crit Care Med 2021;49:e1063-1143).Previous versions were released in 2004, 2008, 2012, and 2016 (Crit Care Med 2021;49:1974-82). Overall, there are 93 statements in the updated guidelines. Fifteen of the statements are strong recommendations, 54 are weak recommendations, 15 are best practice statements, and nine statements make no recommendation regarding a specific intervention... You do not currently have access to this content.

ビタミンCの投与に関する推奨の変更：日本版敗血症診療ガイドライン2020(The revised recommendation for the administration of vitamin C in septic patients: The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020)

日本版敗血症診療ガイドライン2020 （J–SSCG2020）特別委員会（本委員会）は，作成当時に入手可能であったエビデンスを基に，敗血症患者に対して急性期にビタミンCの投与を行うことを弱く推奨した 1, 2。その後，2022年にLamontagneらが872名の昇圧薬投与を必要とする敗血症患者を対象にした大規模多施設ランダム化比較試験（RCT）を発表した 3。このRCTでは，28日死亡，持続する臓器障害のそれぞれでは有意差がなかったものの，両者の複合アウトカムにおける発生割合は，ビタミンCの投与を⾏うことによって有意に増加した。本委員会は，この結果を受けて，“Patients（P）”，“Intervention（I）”，“Control（C）”，“Outcome（O）”と検索式はJ–SSCG2020と同じものを用いた追加のシステマティックレビューを行い，新たに12のRCTを追加し，計23のRCTのメタアナリシスを基に推奨の再検討を行った（表1，補足図1）。 バイアス のリスク その他の検討 相対指標(95% CI) 絶対指標(95% CI) RR 1.11 (1.02 to 1.22) 1,000人あたり42人多い (8人多い～ 83人多い) ⊕⊕⊕◯ 中 RR 0.89 (0.77 to 1.04) 1,000人あたり34人少ない (70人少ない～ 12人多い) ⊕◯◯◯ 非常に低 RR 0.94 (0.76 to 1.16) 1,000人あたり20人少ない (from 80人少ない ～53人多い) ⊕◯◯◯ 非常に低 平均0.25日短い (0.72 日短い～ 0.22日長い) ⊕◯◯◯ 非常に低 平均0.24 日長い (0.97 日短い～ 1.45日長い) ⊕◯◯◯ 非常に低 RR 1.02 (0.93 to 1.13) 1,000人あたり6人多い (20人少ない～ 38人多い) ⊕⊕◯◯ 低 望ましい効果であるICU滞在日数に関する効果推定値は，平均差（mean difference: MD）0.25日短い［95%信頼区間（CI）：0.72日短い～0.22日長い］（16RCT，3,534名）であり，望ましい効果は「わずか」と判断した。一方，望ましくない効果である死亡に関する効果推定値は，エビデンスの確実性の最も高い長期死亡がリスク差（risk difference: RD）42人多い/ 1,000人（95%CI：8人多い～83人多い）（6RCT，2,881名），急性腎障害に関する効果推定値がRD 6人多い/ 1,000人（95%CI：20人少ない～38人多い）（9RCT，2,230名），入院期間に関する効果推定値がMD 0.24日長い（95%CI：0.97日短い～1.45日長い）（12RCT，3,407名）であり，望ましくない効果は「中」と判断した。これらより，効果のバランスはプラセボ群でおそらく優位で，各アウトカムが異なる方向性を示しており，エビデンスの確実性は「非常に低」と判断した。価値観，容認性，実行可能性の判断に変更はなく，以上から本委員会は，「敗血症患者にビタミンCの投与を行わないことを弱く推奨する（Grade 2D：エビデンスの確実性＝「非常に低」）」に推奨を変更することとした。 なお，本委員会報告は，日本集中治療医学会雑誌，日本救急医学会雑誌に同じ内容で掲載される。 本論文の記述内容に関して，著者全員に利益相反（COI）はない。J–SSCG2020作成に関する全メンバーのCOIはJ–SSCG2020本編の巻末に示した。 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The revised recommendation for the administration of vitamin C in septic patients: The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020

The revised recommendation for the administration of vitamin C in septic patients: The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020

日本版敗血症診療ガイドライン2020の使用状況と認知度に関するアンケート調査

日本版敗血症診療ガイドライン2020の使用状況と認知度に関するアンケート調査

日本版敗血症診療ガイドライン2020の使用状況と認知度に関するアンケート調査(Questionnaire survey on usage and awareness of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020)

要旨日本版敗血症診療ガイドライン（The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock: J–SSCG）2020特別委員会は，J–SSCG2020の使用状況と認知度，および，今後の改善点を検討するために，オンラインアンケートを実施した。J–SSCG2020を合同作成した日本集中治療医学会と日本救急医学会の2学会の会員には使用状況を調査するために最大22項目，J–SSCG2020を後援いただいた16学会の会員には認知度を調査するために最大10項目の質問を実施した。2学会会員を対象としたアンケートは450名より回答を得た。敗血症診療にJ–SSCG2020を参考にするとの回答は88%であった。敗血症患者の何%くらいでJ–SSCG2020に準じた診療が行われているかという質問には，75%程度であるとの回答が最多（54%）であった。J–SSCG2020で取り上げた22項目のうち特に遵守している項目に対する回答者数の割合は，3～62%と項目ごとに大きなばらつきがみられた。また，日本の敗血症診療におけるJ–SSCG2020の役割について，診療の標準化（87%），教育の向上（64%）の点で特に評価されていた。J–SSCG2016アンケート結果との比較では，J–SSCG2020の方がより広く敗血症診療に利用されていた。16学会会員対象のアンケートは764名より回答を得た。J–SSCG2020の認知度は72%であった。認知している回答者のうち81%が敗血症診療に利用し，うち95%は役に立つとの回答であった。一方，J–SSCG2020の問題点としては，内容が多すぎるという意見が最多であった。日本医療機能評価機構EBM普及推進事業（Minds）によるThe Appraisal of Guidelines for Research and Evaluation（AGREE II）を用いた評価では，J–SSCG2020の全体評価は88%であった。以上から，集中治療医や救急医のみならず，一般臨床家を対象として幅広く敗血症診療を支援するというJ–SSCG2020の主要な目的はある程度達成されていることが示唆された。一方，領域や臨床疑問（clinical question: CQ）数の見直しなど今後の改訂に向けた課題も明らかになった。

Challenges With Using a Weight-Based Approach to Bolus Fluid Dosing in Obese Critically Ill Patients.

At least 30 mL/kg of crystalloid fluid administration within the first 3 hours of resuscitation is suggested by the current Surviving Sepsis Campaign guidelines for management of sepsis and septic shock. This commentary discusses the challenges with using a weight-based approach to bolus fluid dosing during the early phase of resuscitation of adult, obese patients. Based on the available literature, arguments can be made for the use of either ideal or adjusted body weight for weight-based fluid dosing, but there are concerns with fluid overload if using actual body weight to dose patients with more severe forms of obesity.

Facilitating high quality acute care in resource-constrained environments: Perspectives of patients recovering from sepsis, their caregivers and healthcare workers in Uganda and Malawi.

Sepsis is a major global health problem, especially in sub-Saharan Africa. Improving patient care requires that healthcare providers understand patients' priorities and provide quality care within the confines of the context they work. We report the perspectives of patients, caregivers and healthcare workers regarding care quality for patients admitted for sepsis to public hospitals in Uganda and Malawi. This qualitative descriptive study in two hospitals included face-to face semi-structured interviews with purposively selected patients recovering from sepsis, their caregivers and healthcare workers. In both Malawi and Uganda, sepsis care often occurred in resource-constrained environments which undermined healthcare workers' capacity to deliver safe, consistent and accessible care. Constraints included limited space, strained; water, sanitation and hygiene (WASH) amenities and practices, inadequate human and material resources and inadequate provision for basic needs including nutrition. Heavy workloads for healthcare workers strained relationships, led to poor communication and reduced engagement with patients and caregivers. These consequences were exacerbated by understaffing which affected handover and continuity of care. All groups (healthcare workers, patients and caregivers) reported delays in care due to long queues and lack of compliance with procedures for triage, treatment, stabilization and monitoring due to a lack of expertise, supervision and context-specific sepsis management guidelines. Quality sepsis care relies on effective severity-based triaging, rapid treatment of emergencies and individualised testing to confirm diagnosis and monitoring. Hospitals in resource-constrained systems contend with limitations in key resources, including for space, staff, expertise, equipment and medicines, in turn contributing to gaps in areas such as WASH and effective care delivery, as well as communication and other relational aspects of care. These limitations are the predominant challenges to achieving high quality care.

Nursing Implications of the Updated 2021 Surviving Sepsis Campaign Guidelines.

Sepsis is a life-threatening illness that affects millions of people worldwide. Early recognition and timely treatment are essential for decreasing mortality from sepsis. The Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021, the fifth iteration of the guidelines, was released in October 2021 and includes 93 recommendations for the management of sepsis. The evidence-based guidelines include recommendations and rationales for screening and early treatment, initial resuscitation, mean arterial pressure targets, admission to intensive care, management of infection, hemodynamic monitoring, ventilation, and additional therapies. A new section addresses long-term outcomes and goals of care. This article presents several recommendations, changes, and updates in the 2021 guidelines and highlights the important contributions nurses have in delivering timely and evidence-based care to patients with sepsis. Recommendations may be for or against an intervention, according to the evidence. Although many recommendations are unchanged, several new recommendations directly affect nursing care and may require specialized training (eg, venovenous extracorporeal membrane oxygenation). The newest section, long-term outcomes and goals of care, is aimed at using available resources to provide care that is aligned with the patient and the patient's family through goals-of-care discussions and shared decision-making. Interventions aimed at improving recovery across the continuum of care should include attention to long-term outcomes. Nurses are essential in identifying patients with sepsis, administering and assessing response to treatment, supporting the patient and family, and limiting sequelae from sepsis. This article highlights the 2021 recommendations that influence nursing care for patients with sepsis.

Identifying factors associated with intravenous fluid administration in patients with sepsis presenting to the emergency department: a retrospective cohort study

BackgroundAppropriate and timely administration of intravenous fluids to patients with sepsis-induced hypotension is one of the mainstays of sepsis management in the emergency department (ED), however, fluid resuscitation remains an ongoing challenge in ED. Our study has been undertaken with two specific aims: firstly, for patients with sepsis, to identify factors associated with receiving intravenous fluids while in the ED; and, secondly to identify determinants associated with the actual time to fluid administration.MethodsWe conducted a retrospective multicentre cohort study of adult ED presentations between October 2018 and May 2019 in four metropolitan hospitals in Western Sydney, Australia. Patients meeting pre-specified criteria for sepsis and septic shock and treated with antibiotics within the first 24 h of presentation were included. Multivariable models were used to identify factors associated with fluid administration in sepsis.ResultsFour thousand one hundred forty-six patients met the inclusion criteria, among these 2,300 (55.5%) patients with sepsis received intravenous fluids in ED. The median time to fluid administration from the time of diagnosis of sepsis was 1.6 h (Interquartile Range (IQR) 0.5 to 3.8), and the median volume of fluids administered was 1,100 mL (IQR 750 to 2058). Factors associated with patients receiving fluids were younger age (Odds Ratio (OR) 1.05, 95% Confidence Interval (CI (1.03 to 1.07), p < 0.001); lower systolic blood pressure (OR 1.11, 95% CI (1.08 to 1.13), p < 0.001); presenting to smaller hospital (OR 1.48, 95% CI (1.25 to 1.75, p < 0.001) and a Clinical Rapid Response alert activated (OR 1.64, 95% CI (1.28 to 2.11), p < 0.001). Patients with Triage Category 1 received fluids 101.22 min earlier (95% CI (59.3 to131.2), p < 0.001) and those with Category 2 received fluids 43.58 min earlier (95% CI (9.6 to 63.1), p < 0.001) compared to patients with Triage Category 3–5. Other factors associated with receiving fluids earlier included septic shock (-49.37 min (95% CI (-86.4 to -12.4), p < 0.001)); each mmol/L increase in serum lactate levels (-9.0 min, 95% CI (-15.7 to -2.3), p < 0.001) and presenting to smaller hospitals (-74.61 min, 95% CI (-94.0 to -55.3), p < 0.001).ConclusionsYounger age, greater severity of sepsis, and presenting to a smaller hospital increased the probability of receiving fluids and receiving it earlier. Recognition of these factors may assist in effective implementation of sepsis management guidelines which should translate into better patient outcomes. Future studies are needed to identify other associated factors that we have not explored.

Surviving sepsis campaign: International guidelines for management of sepsis and septic shock in adults 2021 - endorsement by the Scandinavian society of anaesthesiology and intensive care medicine.

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. The guideline serves as a useful bedside decision aid for clinicians managing adults with suspected and confirmed septic shock and sepsis‐associated organ dysfunction.

Реамберин у комплексі оптимізації та диференціації стратегії інтенсивної терапії вторинних гнійних менінгоенцефалітів

Стаття присвячена питанням покращання діагностики, застосування методик оцінки тяжкості стану хворих при надходженні у відділення інтенсивної терапії, у динаміці спостереження за ними, оптимізації інтенсивної терапії (ІТ) вторинного гнійного менінгоенцефаліту (ВГМЕ). Загальна схема відбору пацієнтів, їх рандомізації, включення в дослідження й аналіз можуть бути подані в такий спосіб. Пацієнти з підтвердженим ВГМЕ методом рандомізації з урахуванням тяжкості стану та варіанту ІТ були розподілені на 2 групи. У I групу увійшли 22 пацієнти, котрим проводилася базисна ІТ із позицій доказової медицини відповідно до міжнародних рекомендацій Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septiс shock 2012, що доповнювалася включенням дексаметазону. У II групу увійшов 21 пацієнт, у яких ІТ, що проводилась у I групі, доповнювалась в/в введенням розчину реамберин. На початку дослідження не виявлено вірогідних відмінностей між групами за статтю, віком, локалізацією септичного вогнища, частотою реєстрації 4 ознак синдрому системної запальної відповіді, позитивних результатів бактеріологічних посівів ліквору та матеріалів із первинного вогнища, тобто вибірки були порівняними за цими ознаками. У цей же час серед пацієнтів II групи було в 2,8 раза більше хворих із рівнем свідомості «сопор» або «кома I ступеня» (76,2 % проти 27,2 %; р &lt; 0,001). Несприятливий прогноз (центральний перфузійний тиск &lt; 50 мм рт.ст.) при надходженні до стаціонару мали 22,7 % хворих із I групи і 28,6 % — із II (р &gt; 0,60). Незважаючи на початково більш тяжкий стан хворих із ВГМЕ в II групі, додавання до базисної терапії в/в введення розчину реамберин сприяло тому, що санація ліквору в II групі проходила більш плавно, без вторинного сплеску цитозу, характерного для I групи на 5-ту добу дослідження. Установлено, що в I групі С-реактивний білок у лікворі зникав до 3-ї доби дослідження, з’являвся на 5-ту добу і був відсутнім до 7-ї доби дослідження. У II групі наявність С-реактивного білка було зафіксовано лише на початку і 1-шу добу дослідження, що свідчить про більш стійкий характер відновлення функціонального стану гематоенцефалічного бар’єра в II групі, без вторинного (повторного) його прориву. Оцінка ефективності ІТ на 28-му добу дослідження показала, що відмічалось зменшення когнітивних дисфункцій у I групі на 28,4 %, у II — на 37,7 %; органних дисфункцій у I групі — з 76,3 до 43,8 %; у II — з 88,7 до 36,9 %. Показники істинної летальності становили 27,27 і 23,81 % (р &gt; 0,90) відповідно. Зниження прогнозованої летальності в I групі становило 4,73 %, у II — 16,19 %.