Chronically critically ill patients: different behavior in severe 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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Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock

Journal of Cachexia Sarcopenia and Muscle ◽

10.1007/s13539-010-0010-6 ◽

2010 ◽

Vol 1 (2) ◽

pp. 147-157 ◽

Cited By ~ 109

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

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Clinical Usefulness of Procalcitonin and C-Reactive Protein as Outcome Predictors in Critically Ill Patients with Severe Sepsis and Septic Shock

PLoS ONE ◽

10.1371/journal.pone.0138150 ◽

2015 ◽

Vol 10 (9) ◽

pp. e0138150 ◽

Cited By ~ 38

Author(s):

Jeong-Am Ryu ◽

Jeong Hoon Yang ◽

Daesang Lee ◽

Chi-Min Park ◽

Gee Young Suh ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Usefulness ◽

Outcome Predictors ◽

C Reactive Protein ◽

Reactive Protein ◽

Sepsis And Septic Shock

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Dynamics of brain natriuretic peptide in critically ill patients with severe sepsis and septic shock

Saudi Journal of Anaesthesia ◽

10.4103/1658-354x.115347 ◽

2013 ◽

Vol 7 (3) ◽

pp. 270 ◽

Cited By ~ 5

Author(s):

AmrS Omar ◽

Masood ur Rahman ◽

GurdeepS Dhatt ◽

GubrilO Salami ◽

Said Abuhasna

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Brain Natriuretic Peptide ◽

Critically Ill ◽

Natriuretic Peptide ◽

Critically Ill Patients ◽

Sepsis And Septic Shock

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Alkalosis in Critically Ill Patients with Severe Sepsis and Septic Shock

PLoS ONE ◽

10.1371/journal.pone.0168563 ◽

2017 ◽

Vol 12 (1) ◽

pp. e0168563 ◽

Cited By ~ 5

Author(s):

Simon Kreü ◽

Allan Jazrawi ◽

Jan Miller ◽

Amir Baigi ◽

Michelle Chew

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Sepsis And Septic Shock

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Treatment of severe sepsis and septic shock in critically ill patients

Heart & Lung ◽

10.1016/j.hrtlng.2012.03.004 ◽

2012 ◽

Vol 41 (4) ◽

pp. 408-409

Author(s):

Silvio A. Ñamendys-Silva ◽

Marisol Hernández-Garay

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Sepsis And Septic Shock

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Reliability of Procalcitonin as a Severity Marker in Critically Ill Patients with Inflammatory Response

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000605 ◽

2002 ◽

Vol 30 (6) ◽

pp. 747-754 ◽

Cited By ~ 26

Author(s):

S. Tugrul ◽

F. Esen ◽

S. Celebi ◽

P. E. Ozcan ◽

O. Akinci ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Inflammatory Response ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Laboratory ◽

Systemic Inflammatory Response ◽

Reactive Protein ◽

Reliable Marker ◽

Sepsis And Septic Shock

Procalcitonin (PCT) is increasingly recognised as an important diagnostic parameter in clinical evaluation of the critically ill. This prospective study was designed to investigate PCT as a diagnostic marker of infection in critically ill patients with sepsis. Eighty-five adult ICU patients were studied. Four groups were defined on the basis of clinical, laboratory and bacteriologic findings as systemic inflammatory response syndrome (SIRS) (n=10), sepsis (n=16), severe sepsis (n=18) and septic shock (n=41). Data were collected including C-reactive protein (CRP), PCT levels and Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores on each ICU day. PCT levels were significantly higher in patients with severe sepsis and septic shock (19.25±43.08 and 37.15± 61.39 ng/ml) than patients with SIRS (0.73±1.37 ng/ml) (P<0.05 for each comparison). As compared with SIRS patients, plasma PCT levels were significantly higher in infected patients (21.9±47.8 ng/ml), regardless of the degree of sepsis (P<0.001). PCT showed a higher sensitivity (73% versus 35%) and specificity (83% versus 42%) compared to CRP in identifying infection as a cause of the inflammatory response. Best cut-off levels were 1.31 ng/ml for PCT and 13.9 mg/dl for CRP. We suggest that PCT is a more reliable marker than CRP in defining infection as a cause of systemic inflammatory response.

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