Maternal Sepsis: A Review of National and International Guidelines

2021 ◽  
Author(s):  
Angela J. Stephens ◽  
Suneet P. Chauhan ◽  
John R. Barton ◽  
Baha M. Sibai
Keyword(s):  
Septic Shock ◽  
New Zealand ◽  
Royal College ◽  
English Language ◽  
World Health ◽  
International Consensus ◽  
International Guidelines ◽  
Obstetric Medicine ◽  
Maternal Sepsis ◽  
Sepsis And Septic Shock

Objective Sepsis is a life-threatening syndrome caused by the body's response to infection. The Global Maternal Sepsis Study (GLOSS) suggests sepsis plays a larger role in maternal morbidity and mortality than previously thought. We therefore sought to compare national and international guidelines for maternal sepsis to determine their consistency with each other and the Third International Consensus for Sepsis and Septic Shock (SEPSIS-3). Study Design Using Cochrane Database of Systematic Reviews, PubMed, Google Scholar, and organization Web sites, we identified seven guidelines on maternal sepsis in the English language—The American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Society of Obstetric Medicine of Australia and New Zealand, Royal College of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland Institute of Obstetricians and Gynaecologists, and World Health Organization. Guidelines were reviewed to ascertain the commonality and variation, if any, in definitions of maternal sepsis, tools and criteria utilized for diagnosis, obstetric warning systems used, as well as evaluation and management of maternal sepsis. These variables were also compared with SEPSIS-3. Results All guidelines provided definitions consistent with a version of the SEPSIS, although the specific version utilized were varied. Clinical variables and tools employed for diagnosis of maternal sepsis were also varied. Evaluation and management of maternal sepsis and septic shock were similar. Conclusion In conclusion, national and international maternal sepsis guidelines were incongruent with each other and SEPSIS-3 in diagnostic criteria and tools but similar in evaluation and management recommendations. Key Points

scholarly journals Is Presepsin a Reliable Marker of Sepsis Diagnosis in Pediatric Intensive Care Unit?

2020 ◽  
Vol 8 (B) ◽  
pp. 66-70
Author(s):  
Hebat-Allah Algebaly ◽  
Hala M. Fouad ◽  
Maha M. Elkholy ◽  
Sally K. Ibrahim ◽  
Nermin M. Riad
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Consensus Conference ◽  
University Teaching ◽  
Control Group ◽  
Healthy Children ◽  
International Consensus ◽  
Critical Patients ◽  
Sepsis And Septic Shock

BACKGROUND: Sepsis is a major challenge in emergency departments and intensive care units (ICUs). Sepsis also mimics or interacts with many other disorders causing high mortality and morbidity. There is no accurate biomarker or test to diagnose or predict sepsis. The treatment of sepsis is often based on the clinician’s experience. AIM: We conducted this study to analyze the serum level of presepsin in pediatric critical patients with SIRS, sepsis, severe sepsis, and septic shock. METHODS: The study included 58 children, 32 septic pediatric patients admitted to the Pediatric ICU (PICU) of Cairo University Teaching Hospital and 26 healthy children who served as a control group. The aim was to estimate the diagnostic accuracy of presepsin in predicting sepsis in PICU. We classified the patients into systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock according to the international consensus conference criteria. RESULTS: In our study, we detected a positive correlation between C-reactive protein and presepsin levels at day 1 and day 3 of admission and a negative correlation between hemoglobin and presepsin levels at day 1. However, we found no difference in the serum presepsin between the children who had sepsis and the healthy ones (at day 1 [p = 0.430) and at day 3 [p = 0.845]). We also found that serum levels of presepsin were not significantly increased with the increasing severity of sepsis despite the higher median values with increasing sepsis severity. CONCLUSIONS: It was noted that presepsin levels increased in anemic critical patients, whereas presepsin had no role in differentiating the septic critical patients from healthy children. However, its level increased with increasing severity of sepsis grade.

scholarly journals Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

2017 ◽  
Vol 43 (3) ◽  
pp. 304-377 ◽  
Author(s):  
Andrew Rhodes ◽  
Laura E. Evans ◽  
Waleed Alhazzani ◽  
Mitchell M. Levy ◽  
Massimo Antonelli ◽  
...  
Keyword(s):  
Septic Shock ◽  
Surviving Sepsis Campaign ◽  
International Guidelines ◽  
Sepsis And Septic Shock

Maternal Sepsis and Septic Shock

2016 ◽  
Vol 32 (1) ◽  
pp. 119-135 ◽  
Author(s):  
Ahmad Chebbo ◽  
Susanna Tan ◽  
Christelle Kassis ◽  
Leslie Tamura ◽  
Richard W. Carlson
Keyword(s):  
Septic Shock ◽  
Maternal Sepsis ◽  
Sepsis And Septic Shock

scholarly journals Hydrocortisone Compared with Placebo in Patients with Septic Shock Satisfying the Sepsis-3 Diagnostic Criteria and APROCCHSS Study Inclusion Criteria

2019 ◽  
Vol 131 (6) ◽  
pp. 1292-1300 ◽  
Author(s):  
Balasubramanian Venkatesh ◽  
Simon Finfer ◽  
Jeremy Cohen ◽  
Dorrilyn Rajbhandari ◽  
Yaseen Arabi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Diagnostic Criteria ◽  
Odds Ratio ◽  
Hazard Ratio ◽  
Sensitivity Analyses ◽  
Inclusion Criteria ◽  
International Consensus ◽  
Significant Difference ◽  
Sepsis And Septic Shock ◽  
Post Hoc

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Two recent randomized controlled trials (Adjunctive Glucocorticoid Therapy in Patients with Septic Shock [ADRENAL] and Activated Protein C and Corticosteroids for Human Septic Shock [APROCCHSS]) of corticosteroids in patients with septic shock reported different treatment effects on 90-day mortality. Both trials enrolled patients who met the criteria for septic shock using the second international consensus definitions for sepsis and septic shock (Sepsis-2), but the APROCCHSS trial mandated a greater severity of shock as an inclusion criterion. Methods The authors conducted post hoc sensitivity analyses of the ADRENAL trial to determine the effects of hydrocortisone versus placebo in subgroups selected using third international consensus definitions for sepsis and septic shock (Sepsis-3) diagnostic criteria or APROCCHSS inclusion criteria. Results There were 1,950 subjects (973 hydrocortisone and 977 placebo) who met the Sepsis-3 criteria (ADRENAL–Sepsis-3 cohort) and 905 patients (455 hydrocortisone and 450 placebo) who met the APROCCHSS criteria (ADRENAL–APROCCHSS cohort). At 90 days after randomization, in the ADRENAL–Sepsis-3 cohort, 312 of 963 (32.4%) and 337 of 958 (35.2%) patients assigned to hydrocortisone and placebo, respectively, had died (odds ratio, 0.86; 95% CI, 0.70 to 1.06; P = 0.166). The corresponding figures for the ADRENAL–APROCCHSS cohorts were 187 of 453 (41.3%) and 200 of 445 (44.9%), respectively (odds ratio, 0.84; 95% CI, 0.60 to 1.17; P = 0.303). There was no statistically significant difference in the time to death between the groups during the 90 days after randomization (hazard ratio = 0.87; 95% CI, 0.75 to 1.02; P = 0.082 for ADRENAL–Sepsis-3; and hazard ratio = 0.86; 95% CI, 0.71 to 1.06; P = 0.156 for ADRENAL–APROCCHSS cohorts). In both cohorts, patients assigned to hydrocortisone had faster resolution of shock. In the ADRENAL–Sepsis-3 cohort, patients assigned to hydrocortisone had an increase in the number of days alive and free of mechanical ventilation (57.0 ± 37.2 vs. 53.7 ± 38.2 days; 95% CI, 0.40 to 7.04; P = 0.028) and the number of days alive and free of the intensive care unit (54.3 ± 36.0 vs. 51.0 ± 37.1; 95% CI, 0.82 to 7.24; P = 0.014). Conclusions In a post hoc analysis of the ADRENAL trial participants who fulfilled either the Sepsis-3 or the APROCCHSS inclusion criteria, a continuous infusion of hydrocortisone did not result in a lower 90-day mortality than placebo in septic shock.

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