scholarly journals Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

2016 ◽  
Vol 42 (12) ◽  
pp. 1948-1957 ◽  
Author(s):  
Luc Morin ◽  
◽  
Samiran Ray ◽  
Clare Wilson ◽  
Solenn Remy ◽  
...  
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
European Society ◽  
Neonatal Intensive Care ◽  
Refractory Septic Shock

scholarly journals Validation of the pediatric refractory septic shock definition: post hoc analysis of a controlled trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Luc Morin ◽  
Karthik Narayanan Ramaswamy ◽  
Muralidharan Jayashree ◽  
Arun Bansal ◽  
Karthi Nallasamy ◽  
...  
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Receiver Operating Curve ◽  
Double Blind ◽  
Post Hoc Analysis ◽  
Prognostic Accuracy ◽  
Refractory Septic Shock ◽  
Post Hoc

Abstract Background The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) developed and validated a definition of pediatric refractory septic shock (RSS), based on two septic shock scores (SSS). Both bedside SSS (bSSS) and computed SSS (cSSS) were found to be strongly associated with mortality. We aimed at assessing the accuracy of the RSS definition on a prospective cohort from India. Methods Post hoc analysis of a cohort issued from a double-blind randomized trial that compared first-line vasoactive drugs in children with septic shock. Sequential bSSS and cSSS from 60 children (single-center study, 53% mortality) were analyzed. The prognostic value of the ESPNIC RSS definition was tested for 28-day all-cause mortality. Results In this septic shock cohort, RSS was diagnosed in 35 patients (58.3%) during the first 24 h. Death occurred in 30 RSS patients (85.7% mortality) and in 2 non-RSS patients (8% mortality), OR = 60.9 [95% CI: 10.5–676.2], p < 0.001 with a median delay from sepsis onset of 3 days [1.0–6.7]. Among patients diagnosed with RSS, the mortality was not significantly different according to vasopressors randomization. Diagnosis of RSS with bSSS and cSSS had a high discrimination for death with an area under the receiver operating curve of 0.916 [95% CI: 0.843–0.990] and 0.925 [95% CI: 0.845–1.000], respectively. High prognostic accuracy of the bSSS was found in the first hours following intensive care admission. The best interval of prognostication occurs after the 12th hour following treatment initiation (AUC 0.973 [95% CI: 0.925–1.000]). Conclusions The ESPNIC refractory septic shock definition accurately identifies, within the first 6 h of septic shock management, children with lethal outcome.

scholarly journals Impacts of Multidrug-Resistant Pathogens and Inappropriate Initial Antibiotic Therapy on the Outcomes of Neonates with Ventilator-Associated Pneumonia

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 760
Author(s):  
Hsiao-Chin Wang ◽  
Chen-Chu Liao ◽  
Shih-Ming Chu ◽  
Mei-Yin Lai ◽  
Hsuan-Rong Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Treatment Failure ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Ventilator Associated Pneumonia ◽  
Neurological Sequelae ◽  
Independent Risk Factors

It is unknown whether neonatal ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) pathogens and inappropriate initial antibiotic treatment is associated with poor outcomes after adjusting for confounders. Methods: We prospectively observed all neonates with a definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and March 2020. All clinical features, therapeutic interventions, and outcomes were compared between the MDR–VAP and non-MDR–VAP groups. Multivariate regression analyses were used to investigate independent risk factors for treatment failure. Results: Of 720 neonates who were intubated for more than 2 days, 184 had a total of 245 VAP episodes. The incidence rate of neonatal VAP was 10.1 episodes/per 1000 ventilator days. Ninety-six cases (39.2%) were caused by MDR pathogens. Neonates with MDR–VAP were more likely to receive inadequate initial antibiotic therapy (51.0% versus 4.7%; p < 0.001) and had delayed resolution of clinical symptoms (38.5% versus 25.5%; p = 0.034), although final treatment outcomes were comparable with the non-MDR–VAP group. Inappropriate initial antibiotic treatment was not significantly associated with worse outcomes. The VAP-attributable mortality rate and overall mortality rate of this cohort were 3.7% and 12.0%, respectively. Independent risk factors for treatment failure included presence of concurrent bacteremia (OR 4.83; 95% CI 2.03–11.51; p < 0.001), septic shock (OR 3.06; 95% CI 1.07–8.72; p = 0.037), neonates on high-frequency oscillatory ventilator (OR 4.10; 95% CI 1.70–9.88; p = 0.002), and underlying neurological sequelae (OR 3.35; 95% CI 1.47–7.67; p = 0.004). Conclusions: MDR–VAP accounted for 39.2% of all neonatal VAP in the neonatal intensive care unit (NICU), but neither inappropriate initial antibiotics nor MDR pathogens were associated with treatment failure. Neonatal VAP with concurrent bacteremia, septic shock, and underlying neurological sequelae were independently associated with final worse outcomes.

scholarly journals Recommendations for hemodynamic Monitoring for Critically Ill Children – Expert Consensus Statement issued by the Cardiovascular Dynamics Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

2020 ◽  
Author(s):  
Yogen Singh ◽  
Javier Urbano Villaescusa ◽  
Eduardo M. da Cruz ◽  
Shane M Tibby ◽  
Gabriella Bottari ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Hemodynamic Monitoring ◽  
European Society ◽  
Neonatal Intensive Care ◽  
Expert Consensus ◽  
Critically Ill Children ◽  
Evidence Based ◽  
Cardiovascular Dynamics ◽  
Hemodynamic Assessment

Abstract Background: Cardiovascular instability is common in critically-ill children. There is scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children.Methods: Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature - a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document.Results: Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement”, 20 “weak agreement” and 2 had “no agreement”. Six statements were considered as redundant after rephrasing of statements following first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus.Conclusions: These expert consensus-based recommendation may be used to guide clinical practice for hemodynamic monitoring in critically-ill children and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.

scholarly journals Recommendations for hemodynamic monitoring for critically ill children—expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Yogen Singh ◽  
Javier Urbano Villaescusa ◽  
Eduardo M. da Cruz ◽  
Shane M. Tibby ◽  
Gabriella Bottari ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Hemodynamic Monitoring ◽  
European Society ◽  
Neonatal Intensive Care ◽  
Expert Consensus ◽  
Critically Ill Children ◽  
Evidence Based ◽  
Cardiovascular Dynamics ◽  
Hemodynamic Assessment

Abstract Background Cardiovascular instability is common in critically ill children. There is a scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. Methods Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature—a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. Results Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement,” 20 “weak agreement,” and 2 had “no agreement.” Six statements were considered as redundant after rephrasing of statements following the first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to a lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. Conclusions These expert consensus-based recommendations may be used to guide clinical practice for hemodynamic monitoring in critically ill children, and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.

scholarly journals Refractory septic shock (Part 1)

2021 ◽  
Vol 18 (2) ◽  
pp. 77-83
Author(s):  
L. L. Plotkin
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Adjuvant Therapy ◽  
Intensive Therapy ◽  
Underlying Disease ◽  
Shock Treatment ◽  
Short Term ◽  
Refractory Septic Shock ◽  
Liquid Bolus

Refractory septic shock develops in 6–7% of sepsis patients with short-term lethality rate of more than 50%. It is necessary to assess the effectiveness of intensive therapy methods used in this case.The objective of the review: to analyze publications on the intensive care of refractory septic shock.Results. 56 studies published in the period from January 1, 1990 to September 1, 2020 were analysed, they reflect the effectiveness of some methods used for management of refractory septic shock (treatment of the underlying disease, liquid bolus, the use of norepinephrine, adjuvant therapy, management of metabolic acidosis). The second part of this article will reflect the evaluation of the effectiveness of other approaches to the treatment of this complication.

scholarly journals Refractory Septic Shock (Part 2)

2021 ◽  
Vol 18 (3) ◽  
pp. 79-86
Author(s):  
L. L. Plotkin
Keyword(s):  
Septic Shock ◽  
Methylene Blue ◽  
Intensive Care ◽  
Intensive Therapy ◽  
Vitamin B ◽  
Vasopressor Therapy ◽  
Short Term ◽  
Refractory Shock ◽  
Short Term Mortality ◽  
Refractory Septic Shock

Refractory shock is the shock that does not respond to vasopressor therapy. Refractory shock with a short-term mortality rate of more than 50% is diagnosed in 6-7% of critically ill patients. There is an objective need to Investigate methods of intensive therapy for refractory septic shock.The objective of the study: to analyze literature data on the intensive care of refractory septic shock.Results. The second part of the article analyzes 37 studies, both Russian and foreign ones devoted to the intensive care of refractory shock. At present, based on the analysis of the publication, it is impossible to draw reasonable conclusions about the advantage of one or another method of intensive therapy for refractory shock (veno-venous hemofiltration, the use of angiotensin II and vasopressin, as well as methylene blue, vitamin B12, ECMO) over basic therapy.

scholarly journals Update on Changing Terminologies in Sepsis

2016 ◽  
Vol 36 (2) ◽  
pp. 178-183
Author(s):  
Ashish Kumar Simalti ◽  
Ranjit Ghuliani ◽  
Bindu T. Nair
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
European Society ◽  
Task Force ◽  
Critical Care Medicine ◽  
International Consensus ◽  
The Third ◽  
Sepsis And Septic Shock

Definitions of sepsis and septic shock were last revised in 2001. Since then there have been considerable advances in our understanding of pathophysiology, management, and epidemiology of sepsis, suggesting the need for reexamination. The European Society of Intensive Care Medicine and the Society of Critical Care Medicine convened a task force in January 2014 with objective to evaluate and, as needed, update definitions for sepsis and septic shock. Recommendations of this task force were published recently as “The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)”. The aim of this article is to generate awareness and discussion regarding this new important development.  

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