Tag Archives: Sepsis

Registration Open for Webcast on New Sepsis Definitions

Register today for the upcoming webcast, “Sepsis Redefined,” from the Society of Critical Care Medicine (SCCM). Moderated by Craig M. Coopersmith, MD, FACS, FCCM, this webcast will feature leading sepsis experts who will discuss the recently published The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) and a related response that has been provided by the Surviving Sepsis Campaign (SSC). Preparation for this webcast may include review of the primary Sepsis-3 manuscript available from the Journal of the American Medical Association and the SSC statement responding to Sepsis-3.

Clifford S. Deutschman, MS, MD, FCCM, and Mitchell M. Levy, MD, MCCM, FCCP, will explore such topics as the rationale for the new definitions of sepsis and septic shock, the quick Sepsis-Related Organ Failure Assessment (qSOFA) and how this definition might apply to bedside sepsis screening.

Learning Objectives

  • Understand The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) and related clinical assessment tools
  • Recognize the rationale behind the new definitions for sepsis and septic shock
  • Understand the relationship of the new sepsis definitions to bedside screening and treatment of sepsis patients

This 90-minute webcast will take place Tuesday, March 29, 2016, at 9:00 a.m. Central Time.

Register online today using your Customer ID and password. Registration is complimentary. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

Keep the discussion going on Twitter by using #SepsisRedefined. Join the #SepsisRedefined conversation group for updates on upcoming Twitter Chats on this topic.

This webcast is supported by the Gordon and Betty Moore Foundation.

VTE Incidence in Patients with Severe Sepsis and Septic Shock

Prospective studies on the incidence of venous thromboembolism (VTE) during severe sepsis and septic shock remain absent, hindering efficacy assessments regarding VTE prevention strategies in sepsis. Kaplan et al prospectively evaluated the incidence of VTE in 113 patients from three different academic medical center intensive care units (ICUs) admitted with severe sepsis or septic shock.

They identified a high incidence of VTE in patients with severe sepsis and septic shock, despite the use of universal, guideline-recommended thromboprophylaxis.

Read the full Concise Critical Appraisal by logging in to the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Can Changes in Plasma Glycoproteins Predict Mortality in Severe Sepsis?

Sepsis remains a major cause of mortality in the intensive care unit. Numerous studies have attempted to elucidate the exact pathophysiology of sepsis at the cellular level, including identifying specific proteins in common pathways associated with survival. Although prior studies have had promising but limited success, the recent development and utilization of advanced genomic and proteomic databases have yielded intriguing findings that may link particular proteins and mechanisms to sepsis mortality. DeCoux et al used glycoprotein analysis to determine whether changes in plasma glycoproteins may predict mortality in severe sepsis.

This study ultimately identified proteins linked to patient outcomes and provided insight into unexplored mechanisms that can be investigated for the identification of novel therapeutic targets.

Read the full Concise Critical Appraisal by logging in to the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Comparing Utility of First-Line Vasoactive Drugs in Pediatric Septic Shock

There have been many international consensus statements on the diagnosis and management of pediatric sepsis and septic shock during the past few decades. However, because of the complexity and variability in the presentation and natural course of the disease, specific recommendations regarding the ideal vasoactive agent remain controversial. Ventura et al used clinical and laboratory parameters to determine whether children with fluid-refractory septic shock would benefit more from a potent inotrope (i.e., epinephrine) than from dopamine.

Overall, the study suggested a significant benefit to using epinephrine as a first-line agent (compared to dopamine).

Read the full Concise Critical Appraisal by logging in to the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Participate in Twitter Chat Centered on Sepsis

The Society of Critical Care Medicine (SCCM) is partnering with the U.S. Centers for Disease Control and Prevention (CDC) to hold a Twitter chat aimed at raising awareness about sepsis. The chat will take place from 1:00 p.m. to 2:00 p.m. Central Time on Thursday, September 10, 2015. This is a great opportunity to learn about best practices for detecting and treating sepsis. It is also a great opportunity to learn about pertinent sepsis-related resources. SCCM President Craig M. Coopersmith, MD, FCCM, will be fielding questions from participants throughout, so come prepared with any relevant questions you may have and make sure to use #SepsisChat in your tweets.

This Twitter chat is part of Sepsis Awareness Month, which was created to spread the word about this life-threatening condition.

GCR Expression in Critically Ill Children with Cardiovascular Dysfunction

Various efforts have been made to better understand the interplay of glucocorticoid receptor (GCR) expression and critical illness, but many unknowns remain. Shibata et al hypothesized that a subset of critically ill children with cardiovascular (CV) collapse would demonstrate decreased expression of GCR and would have more severe illness (based on Pediatric Risk of Mortality [PRISM] III measurements) and more organ failure than critically ill children with no CV collapse.

In a comparison of these two groups, the investigators discovered a statistically significant decrease in GCR expression in CD4+ and CD8+ cells in critically ill children with CV failure. They also discovered that this diminished expression could be found in patients with higher PRISM III scores and those with greater organ failure burden. Ultimately, this study’s findings suggest that the lack of GCR expression in critically ill patients could serve as a risk factor for worsening severity of illness and CV failure.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Diastolic Dysfunction in Children with Fluid Refractory Septic Shock

The presence of cardiac dysfunction in patients with septic shock has been described for decades. However, the true prevalence or ultimate effect of diastolic dysfunction has only been described in septic children in limited fashion. Sankar et al analyzed 56 children (all between three months and 17 years of age) with fluid refractory septic shock, before inotropes or mechanical ventilation were initiated. The primary objectives of this study were to determine the prevalence of diastolic dysfunction in children with fluid refractory septic shock and to determine if there was an association between diastolic dysfunction and mortality.

The authors demonstrated that diastolic dysfunction in children with fluid refractory septic shock is relatively common, similar to some adult findings. Interestingly, children with diastolic dysfunction and those with no cardiac dysfunction had higher mortality rates than those with systolic dysfunction (43%, 37% and 15%, respectively), though these differences were not statistically significant. In the wake of this study, questions still linger about the true prevalence of diastolic dysfunction in children with fluid refractory septic shock. Further studies are needed to confirm these findings.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Is the Sun Setting on Goal-Directed Resuscitation for Septic Shock?

Since the landmark 2001 trial by Rivers et al, early goal-directed therapy (EGDT) for septic shock has been endorsed as the standard of care. The multicenter Australasian Resuscitation in Sepsis Evaluation (ARISE) trial was designed to test the hypothesis that EGDT, as compared with usual care, would reduce all-cause mortality at 90 days among patients presenting to the emergency department with early septic shock. The study was a prospective, randomized, parallel-group trial hosted in 51 tertiary care and nontertiary care hospitals in Australia, New Zealand, Finland, Hong Kong, and Ireland.

The authors concluded that EGDT does not offer a survival advantage in patients presenting to the emergency department with early septic shock. This work represents the second published study in a triad of trials. The Protocolised Management in Sepsis (ProMISe) trial has yet to be published; the results of the Protocolized Care for Early Septic Shock (ProCESS) trial were published earlier this year. Strengths of the ARISE trial include an appropriate sample size, the multicenter nature of the study and high compliance with the intervention. However, early resuscitation and antibiotic administration likely are now regarded as “usual care,” and this may have had a significant impact before randomization. A meta-analysis of all three trials is planned when the ProMISe trial is completed. This meta-analysis — which could have greater power than any individual study — may demonstrate benefits of EGDT in certain patient populations.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

The Surviving Sepsis Campaign recently released an updated statement regarding hemodynamic and oximetric monitoring. This statement is in response to the ProCESS and ARISE trials. The statement highlights recently released data from the Surviving Sepsis Campaign, which confirms that “adherence to quality improvement measures in severe sepsis and septic shock is associated with mortality decline.”

Mitochondrial Defects in PBMCs of Children with Sepsis

Mitochondrial dysfunction has been implicated in the pathogenesis of organ injury related to the sepsis syndrome. This can be seen in the condition known as cytopathic hypoxia, wherein oxygen delivery is maintained, but the mitochondria are unable to efficiently convert this delivered oxygen to adenosine triphosphate (ATP) production. An energy deficit consequently arises. In adults, this diminished ability to produce adequate ATP has been demonstrated in peripheral blood mononuclear cells (PBMCs) of septic patients. Mitochondrial defects in PBMCs of septic children have not been previously described. Weiss et al sought to correlate defects in mitochondrial oxygen consumption and mitochondrial membrane potential in the PBMCs of children with septic shock of clinical severity. Twenty-eight children with septic shock were approached for consent. Ultimately, data from 13 patients were compared to those of 11 control subjects.

The authors found that mitochondrial dysfunction occurs in PBMCs from critically ill children with septic shock and multiple organ dysfunction syndrome. While this study has limitations related to the choice of cells studied, the timing of sampling and the numbers of patients, mitochondrial dysfunction in these patients is a significant finding that warrants further research.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

SSC Releases Updated Statement in Response to ProCESS and ARISE Trials

The Surviving Sepsis Campaign (SSC) released an updated statement regarding hemodynamic and oximetric monitoring. The statement is in response to the Protocolized Care for Early Septic Shock (ProCESS) and the Australasian Resuscitation in Sepsis Evaluation (ARISE) trials.

The statement highlights recently released data from the Surviving Sepsis Campaign, which confirms that “adherence to quality improvement measures in severe sepsis and septic shock is associated with mortality decline.” The research has been published online ahead of print in Critical Care Medicine and in Intensive Care Medicine. The final print version is scheduled to appear in the January 2015 edition of Critical Care Medicine.

Mitchell Levy Featured in CDC Expert Commentary Series Discussing Sepsis

Mitchell Levy, MD, FCCP, FCCM, 2012 co-chair of the Surviving Sepsis Campaign Guidelines Committee, recently recorded a video for the U.S. Centers for Disease Control and Prevention (CDC) in which he discusses the latest Surviving Sepsis Campaign (SSC) guidelines and associated care bundles.

Recorded as part of the CDC Expert Commentary series — a joint collaboration of the CDC and Medscape — the video features Dr. Levy describing the efficacy of evidence-based care bundles. He also details SSC resources designed to aid guideline implementation efforts.

To learn more about these resources and the Campaign’s overall mission, visit www.survivingsepsis.org.

Also, a new CDC website has been created to increase sepsis awareness and improve early recognition, diagnosis and treatment. The site puts a spotlight on the many resources made available by the Campaign.

Hospitals Report Results of SSC Implementation

Four hospitals in Detroit reported their success in implementing the Surviving Sepsis Campaign (SSC), demonstrating improved frequency of blood culture testing before antibiotic administration and significant improvement in the time to antibiotic treatment — from a mean of approximately 182 minutes to 92 minutes. The four hospitals participated in a study published in the Journal for Healthcare Quality.

“While guidelines provide a roadmap for patient care, successful implementation relies on consistent patterns of clinician practice to achieve optimal outcomes,” said lead author of the study and Society of Critical Care Medicine (SCCM) member Maria Teresa Palleschi, CCRN, DNP, ACNP, of Detroit Medical Center. “Educating staff is essential to the process of improving patient outcomes, and the results of our study showed the relationship between education and sampling of lactate and blood cultures, as well as timeliness of antibiotic administration.”

Learn more about the tools needed to implement the SSC at www.survivingsepsis.org and get involved in the community at www.facebook.com/survivingsepsis.

Early Antibiotic Administration in Severe Sepsis and Septic Shock

Several retrospective studies have demonstrated improved survival when antibiotics are administered early in septic shock and severe sepsis. However, the results of the recent Protocolized Care for Early Septic Shock (ProCESS) trial have prompted intense debate in the critical care community regarding which elements of sepsis resuscitation bundles are most beneficial. Ferrer and colleagues sought to analyze the association between timing of antibiotic administration and mortality. The authors also evaluated whether an optimal time window for empiric antibiotic administration can be determined.

Using the database compiled for the Surviving Sepsis Campaign (SSC), the authors examined data entered between January 2005 and February 2010. Specifically, they analyzed data from 17,990 of 28,150 patients in the SSC database with severe sepsis and septic shock. They found that delay in antibiotic administration was associated with increased in-hospital mortality. As with any retrospective study, there is potential for residual confounding. In addition, appropriateness of antibiotics was not captured in this work. Despite these limitations, the strength of association demonstrated in this study appears to support current SSC guidelines.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

In the most recent issue of Critical Connections, SCCM President J. Christopher Farmer, MD, FCCM, also touches on the debate and controversy of the ProCESS trial.

New Surviving Sepsis Campaign Facebook Page

The Surviving Sepsis Campaign (SSC), a joint collaboration of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine, just launched its own Facebook page.

The new page will feature regular updates on the Campaign and provide pertinent information related to the 2012 SSC guidelines and the recommendations contained therein. It will also provide a forum for interested parties to connect and exchange meaningful ideas about the management of sepsis in critically ill patients.

Check Out New Surviving Sepsis Campaign Presentations

The Surviving Sepsis Campaign, a joint collaboration of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine, recently made available 12 individual presentations that provide background on the recommendations and suggestions incorporated in the 2012 Surviving Sepsis Campaign guidelines. In addition, a presentation inclusive of all the slides is available.

Developed by the authors of the guidelines, these slides may be used for educational purposes to improve knowledge and team performance.

Visit the Surviving Sepsis Campaign website to download these offerings:

  • 01_SSC_Grading_06_03_14
  • 02_SSC_Initial_Resuscitation_Hemodynamic_Support_06_13_14
  • 03_SSC_Infection_Related_Issues_06_03_14
  • 04_SSC_Adjunctive_Therapy_06_03_14
  • 05_SSC_Mechanical_Ventilation_of_Acute_Respiratory_Distress_Syndrome_06_03_14
  • 06_SSC_Glucose_Control_06_03_14
  • 07_SSC_Nutrition_06_03_14
  • 08_SSC_Renal_Replacement_Therapy_06_03_14
  • 09_SSC_Prophylaxis_for_Venous_Thromboembolism_06_03_14
  • 10_SSC_Stress_Ulcer_Prophylaxis_06_03_14
  • 11_SSC_Setting_Goals_of_Care_06_03_14
  • 12_SSC_Pediatric_Considerations_06_03_14
  • SSC_All_Slides_2014