Correction: Is the Current Management of Severe Sepsis and Septic Shock Really Evidence Based?

Postsurgical gastro-intestinal or intestinal-intestinal anastomotic leaks while not frequent, are the most feared complications for any anastomoses performed in the gastrointestinal tract (GIT) by general surgeons. This is particularly important in the upper GIT, such as gastro esophageal anastomosis, where leaks can lead to severe sepsis and septic shock, need for re-operation, or stent placement. For this short review we will address post- operative leaks following esophagectomy and sleeve gastrectomy as the most frequent bariatric procedure today. The factors and causes responsible for Upper Gastro-Intestinal Anastomosis, as they relate to patient, surgeon or technique will be reviewed. Moreover, the diagnosis and current management will be examined.

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Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure

Clinical Infectious Diseases ◽

10.1093/cid/ciaa059 ◽

2020 ◽

Cited By ~ 3

Author(s):

Chanu Rhee ◽

Kathleen Chiotos ◽

Sara E Cosgrove ◽

Emily L Heil ◽

Sameer S Kadri ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Infectious Diseases ◽

Unintended Consequences ◽

Position Paper ◽

Antibiotic Prescribing ◽

Evidence Based ◽

Early Management ◽

Treatment Standard ◽

Sepsis And Septic Shock

Abstract The Centers for Medicare & Medicaid Services’ Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure has appropriately established sepsis as a national priority. However, the Infectious Diseases Society of America (IDSA and five additional endorsing societies) is concerned about SEP-1’s potential to drive antibiotic overuse because it does not account for the high rate of sepsis overdiagnosis and encourages aggressive antibiotics for all patients with possible sepsis, regardless of the certainty of diagnosis or severity of illness. IDSA is also concerned that SEP-1’s complex “time zero” definition is not evidence-based and is prone to inter-observer variation. In this position paper, IDSA outlines several recommendations aimed at reducing the risk of unintended consequences of SEP-1 while maintaining focus on its evidence-based elements. IDSA’s core recommendation is to limit SEP-1 to septic shock, for which the evidence supporting the benefit of immediate antibiotics is greatest. Prompt empiric antibiotics are often appropriate for suspected sepsis without shock, but IDSA believes there is too much heterogeneity and difficulty defining this population, uncertainty about the presence of infection, and insufficient data on the necessity of immediate antibiotics to support a mandatory treatment standard for all patients in this category. IDSA believes guidance on managing possible sepsis without shock is more appropriate for guidelines that can delineate the strengths and limitations of supporting evidence and allow clinicians discretion in applying specific recommendations to individual patients. Removing sepsis without shock from SEP-1 will mitigate the risk of unnecessary antibiotic prescribing for noninfectious syndromes, simplify data abstraction, increase measure reliability, and focus attention on the population most likely to benefit from immediate empiric broad-spectrum antibiotics.

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Antimicrobial therapy for patients with severe sepsis and septic shock: An evidence-based review

Critical Care Medicine ◽

10.1097/01.ccm.0000143118.41100.14 ◽

2004 ◽

Vol 32 (Supplement) ◽

pp. S495-S512 ◽

Cited By ~ 112

Author(s):

Pierre-Yves Bochud ◽

Marc Bonten ◽

Oscar Marchetti ◽

Thierry Calandra

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Antimicrobial Therapy ◽

Evidence Based ◽

Sepsis And Septic Shock

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Fluid resuscitation in severe sepsis and septic shock: An evidence-based review

Critical Care Medicine ◽

10.1097/01.ccm.0000142984.44321.a4 ◽

2004 ◽

Vol 32 (Supplement) ◽

pp. S451-S454 ◽

Cited By ~ 109

Author(s):

Jean-Louis Vincent ◽

Herwig Gerlach

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Fluid Resuscitation ◽

Evidence Based ◽

Sepsis And Septic Shock

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Improving Survival In Patients With Severe Sepsis And Septic Shock: Using Nurse-Physician Dyads, Evidence Based Education And Positive Feedback To Impact Compliance With Early Antibiotics

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a5078 ◽

2012 ◽

Author(s):

Dana Palka ◽

David Portelli ◽

Micelle Gaudreau ◽

Mitchell Levy ◽

Robert Boss ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Positive Feedback ◽

Evidence Based ◽

Sepsis And Septic Shock

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Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽

10.32895/ump.mpr.2.3.27 ◽

2018 ◽

Vol 2 (3) ◽

pp. 27-32

Author(s):

Bien Le ◽

Dai Huynh ◽

Mai Tuan ◽

Minh Phan ◽

Thao Pham ◽

...

Keyword(s):

Blood Pressure ◽

Septic Shock ◽

Severe Sepsis ◽

Fluid Responsiveness ◽

Statistical Significance ◽

Venous Pressure ◽

Fluid Bolus ◽

Low Blood Pressure ◽

Low Central Venous Pressure ◽

Sepsis And Septic Shock

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock. Design: observational study. Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%. Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers). Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

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