scholarly journals Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock

2010 ◽  
Vol 1 (2) ◽  
pp. 147-157 ◽  
Author(s):  
Joerg C. Schefold ◽  
Jeffrey Bierbrauer ◽  
Steffen Weber-Carstens
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Sepsis And Septic Shock

Evaluation of Meropenem Extended Versus Intermittent Infusion Dosing Protocol in Critically Ill Patients

2018 ◽  
Vol 35 (8) ◽  
pp. 763-771 ◽  
Author(s):  
Nabeela Ahmed ◽  
Shin-Pung Jen ◽  
Diana Altshuler ◽  
John Papadopoulos ◽  
Vinh P. Pham ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Clinical Response ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intermittent Infusion ◽  
Icu Mortality ◽  
Protocol Group

Extended infusion (EI) administration of β-lactams can improve target attainment in critically ill patients with altered pharmacokinetics/pharmacodynamics. To optimize meropenem dosing in patients with severe sepsis/septic shock, our Antimicrobial Stewardship Program implemented a EI meropenem (EIM) protocol in an 18-bed Medical Intensive Care Unit in March 2014. In this retrospective study, we compared intensive care unit (ICU) mortality and clinical response in patients who received meropenem for ≥72 hours administered per EIM protocol of 1 g over 3 hours every 8 hours versus intermittent infusion (IIM) protocol of 500 mg over 30 minutes every 6 hours. Age, weight, comorbidities, severity of illness, and vasopressor use were comparable between groups (EIM protocol n = 52, IIM protocol n = 96). The IIM protocol group had higher rates of renal dose adjustment at meropenem initiation. Among 56 identified gram-negative (GN) pathogens, 94% had meropenem minimal inhibitory concentration ≤0.25 mg/L. The ICU mortality was lower (19 vs 37%; P = .032) and clinical response was higher (83% vs 46%; P < .01) in the EIM protocol versus IIM protocol group. Total vasopressor days were shorter (2 vs 3 days; P = .038), and white blood cell normalization rate was higher (87% vs 51%; P < .01) in the EIM protocol versus IIM protocol group. There was no difference in days of mechanical ventilation, duration of therapy, and ICU stay. The IIM protocol was also identified as an independent risk factor associated with ICU mortality (hazard ratio: 3.653, 95% confidence interval: 1.689-7.981; P = .001) after adjusting for Sequential Organ Failure Assessment score. In this cohort of patients with severe sepsis/septic shock and highly susceptible GN pathogens, there was improved mortality and clinical response in the EIM protocol group.

Sepsis

2020 ◽  
Author(s):  
Steven P LaRosa ◽  
Steven M. Opal
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Organ Dysfunction ◽  
Fluid Resuscitation ◽  
Multiorgan Failure ◽  
Sepsis Management ◽  
The Past ◽  
Sepsis And Septic Shock

Sepsis, along with the multiorgan failure that often accompanies this condition, is a leading cause of mortality in the intensive care unit. Although modest improvements in the prognosis have been made over the past two decades and promising new therapies continue to be investigated, innovations in the management of septic shock are still required. This chapter discusses the definitions, epidemiology, and pathogenesis (including microbial factors, host-derived mediators, and organ dysfunction) relating to sepsis. Management of severe sepsis and septic shock is also described.  This review contains 5 figures, 11 tables, and 99 references. Keywords:Organ dysfunction, sepsis, septic shock, infection, bacteremia, fluid resuscitation, vasopressor

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock

2018 ◽  
pp. 104-108
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Oxygen Demand ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Study Results ◽  
Sepsis And Septic Shock

This case focuses on detecting sepsis through early goal-directed therapies by asking the question: Does aggressive correction of hemodynamic disturbances in the early stages of sepsis improve outcomes? Early goal-directed therapies are aimed at restoring a balance between oxygen delivery and oxygen demand. Patients included in the study were adults presenting to the emergency room with severe sepsis or septic shock. Study results indicated that most patients with severe sepsis or septic shock should be managed with aggressive hemodynamic monitoring and support immediately on presentation in the emergency department (or, if this is not possible, in the intensive care unit) for 6 hours or until there is resolution of hemodynamic disturbances.

scholarly journals Chronically critically ill patients: different behavior in severe sepsis and septic shock?

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
DH Prevedello ◽  
A Rea-Neto ◽  
HA Teive ◽  
LA Tannous ◽  
RAO Deucher ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chronically Critically Ill ◽  
Sepsis And Septic Shock

Absolute eosinophils count as a marker of mortality in patients with severe sepsis and septic shock in an intensive care unit

2012 ◽  
Vol 27 (4) ◽  
pp. 394-399 ◽  
Author(s):  
Carlos Adolfo Merino ◽  
Felipe Tomás Martínez ◽  
Felipe Cardemil ◽  
José Ramón Rodríguez
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Sepsis And Septic Shock

scholarly journals Prognosis Biomarkers of Severe Sepsis and Septic Shock by 1H NMR Urine Metabolomics in the Intensive Care Unit

PLoS ONE ◽  
2015 ◽  
Vol 10 (11) ◽  
pp. e0140993 ◽  
Author(s):  
Monica Garcia-Simon ◽  
Jose M. Morales ◽  
Vicente Modesto-Alapont ◽  
Vannina Gonzalez-Marrachelli ◽  
Rosa Vento-Rehues ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
1H Nmr ◽  
Sepsis And Septic Shock ◽  
Urine Metabolomics

scholarly journals Population Pharmacokinetics and Monte Carlo Dosing Simulations of Meropenem during the Early Phase of Severe Sepsis and Septic Shock in Critically Ill Patients in Intensive Care Units

2015 ◽  
Vol 59 (6) ◽  
pp. 2995-3001 ◽  
Author(s):  
Sutep Jaruratanasirikul ◽  
Suriyan Thengyai ◽  
Wibul Wongpoowarak ◽  
Thitima Wattanavijitkul ◽  
Kanyawisa Tangkitwanitjaroen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Monte Carlo ◽  
Severe Sepsis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Phase ◽  
Volume Of Distribution ◽  
Therapeutic Success ◽  
Altered Pharmacokinetic ◽  
Sepsis And Septic Shock

ABSTRACTPathophysiological changes during the early phase of severe sepsis and septic shock in critically ill patients, resulting in altered pharmacokinetic (PK) patterns for antibiotics, are important factors influencing therapeutic success. The aims of this study were (i) to reveal the population PK parameters and (ii) to assess the probability of target attainment (PTA) for meropenem. The PK studies were carried out following administration of 1 g of meropenem every 8 h during the first 24 h of severe sepsis and septic shock in nine patients, and a Monte Carlo simulation was performed to determine the PTA of achieving 40% exposure time during which the free plasma drug concentration remains above the MIC (fT>MIC) and 80%fT>MIC. The volume of distribution (V) and total clearance (CL) of meropenem in these patients were 23.7 liters and 7.82 liters/h, respectively. For pathogens with MICs of 4 μg/ml, the PTAs of 40%fT>MICfollowing administration of meropenem as a 1-h infusion of 1 g every 8 h and a 4-h infusion of 0.5 g every 8 h were 92.52% and 90.29%, respectively. For pathogens with MICs of 2 μg/ml in immunocompromised hosts, the PTAs of 80%fT>MICfollowing administration of 1-h and 4-h infusions of 2 g of meropenem every 8 h were 84.32% and 94.72%, respectively. These findings indicated that theVof meropenem was greater and the CL of meropenem was lower than the values obtained in a previous study with healthy subjects. The maximum recommended dose, i.e., 2 g of meropenem every 8 h, may be required for treatment of life-threatening infections in this patient population.

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