scholarly journals Sepsis in children: Initial assessment and treatment

2017 ◽  
Vol 64 (1) ◽  
pp. 49-53
Author(s):  
Izabella Fabri ◽  
Goran Rakic ◽  
Danica Stanic ◽  
Biljana Draskovic
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Clinical Symptoms ◽  
Cost Effective ◽  
Initial Assessment ◽  
Hemodynamic Stability ◽  
Early Administration ◽  
Early Management ◽  
Assessment And Treatment ◽  
Vasoactive Medications

Severe sepsis is the leading cause of mortality among children aged under the age of 5 years. The four main causes of sepsis in children are pneumonia, malaria, measles and diarrhoea. Preventing sepsis is extremely important and immunization of children and regular hand hygiene proved to be very efficient and cost effective in avoiding the development of diseases that may lead to sepsis. Clinical symptoms of all stadiums of sepsis in children are often non specific, but early diagnosis is extremely important. The initial treatment of sepsis in children has to be adjusted to the developmental stadium, age, the capacity of its immune system and the likely cause of infection. In studies on children early administration of antimicrobial therapy proved to be efficient. Early management of septic shock should consist of rapid boluses of crystalloids and 5% albumin solutions and administration of vasoactive medications until hemodynamic stability is achieved.

scholarly journals Importance of haemodynamic stability and adjuvant therapy in the treatment of patients with sepsis and septic shock

2020 ◽  
Vol 45 (4) ◽  
pp. 153-158
Author(s):  
Vesna Marjanović ◽  
Ivana Budić ◽  
Saša Ignjatijević ◽  
Marija Stević ◽  
Dušica Simić
Keyword(s):  
Septic Shock ◽  
Adjuvant Therapy ◽  
Isotonic Saline ◽  
Fluid Replacement ◽  
Initial Assessment ◽  
Hemodynamic Stability ◽  
Threatening Condition ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Vasoactive Medications

Sepsis represents a life-threatening condition that requires prompt recognition, detailed initial assessment and energetic administration of therapy. Guidelines published in 2016 emphasized the importance of early fluids replacement and infection control together with assessment based on laboratory parameters and precise monitoring of hemodynamic status of septic patients within the first 3-6 hours after diagnosis. Revision that followed in 2018 stressed that all therapeutic actions should be initiated within the first hour after diagnosis. Urgent administration of isotonic saline and balanced crystalloids in a dose of 30ml/kg should provide adequate hemodynamic stability of septic patients. If the fluid replacement fails to achieve hemodynamic stability and mean arterial pressure >65 mmHg, addition of vasopressors is mandatory. The vasopressor of choice for septic patients is norepinephrine. It may be used alone or in combination with other vasopressors such as epinephrine, vasopressin, terlipresine or phenylephrine. Septic patients with inadequate cardiac output after fluid replacement, and cardiomyopathy induced by sepsis or those with combined shock may need treatment with inotropic medication such as epinephrine or dobutamine. Adjuvant therapy with steroids, immunoglobulins, anticoagulants, statins, vitamin C and Bl, may be useful, but no benefit regarding the overall outcome was observed. In conclusion, early detection of sepsis and septic shock within the first hour and immediate adequate fluid administration with vasoactive medications to maintain hemodynamic stability, are crucial for achievement of better outcome of these patients.

scholarly journals State-level hospital compliance with and performance in the Centers for Medicaid & Medicare Services’ Early Management Severe Sepsis and Septic Shock Bundle

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Jordan A. Kempker ◽  
Michael R. Kramer ◽  
Lance A. Waller ◽  
Henry E. Wang ◽  
Greg S. Martin
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
State Level ◽  
Early Management ◽  
And Performance ◽  
Sepsis And Septic Shock ◽  
Level Hospital

Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality*

2007 ◽  
Vol 35 (4) ◽  
pp. 1105-1112 ◽  
Author(s):  
H Bryant Nguyen ◽  
Stephen W. Corbett ◽  
Robert Steele ◽  
Jim Banta ◽  
Robin T. Clark ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Quality Indicators ◽  
Early Management ◽  
Sepsis And Septic Shock

scholarly journals Infectious Diseases Team for the Early Management of Severe Sepsis and Septic Shock in the Emergency Department

2017 ◽  
Vol 65 (8) ◽  
pp. 1253-1259 ◽  
Author(s):  
Pierluigi Viale ◽  
Sara Tedeschi ◽  
Luigia Scudeller ◽  
Luciano Attard ◽  
Lorenzo Badia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Infectious Diseases ◽  
Early Management ◽  
Sepsis And Septic Shock

scholarly journals Hospitals That Report Severe Sepsis and Septic Shock Bundle (SEP-1) Compliance Have More Structured Sepsis Performance Improvement

2021 ◽  
Author(s):  
Ty B. Bolte ◽  
Morgan B. Swanson ◽  
Anna Kaldjian ◽  
Nicholas M. Mohr ◽  
Jennifer McDanel ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Performance Improvement ◽  
Administrative Claims ◽  
Case Review ◽  
Sepsis Mortality ◽  
Early Management ◽  
Care Plans ◽  
Sepsis And Septic Shock ◽  
Sepsis Care

Objective: Sepsis is a common cause of death in hospitalized patients. The Centers for Medicare & Medicaid Service (CMS) Severe Sepsis and Septic Shock Bundle (SEP-1) is an evidence-based early management bundle focused on improving sepsis outcomes. It is unknown which quality improvement (QI) practices are associated with SEP-1 compliance and if those practices reduce sepsis mortality. The objectives of this study were to compare sepsis QI practices in SEP-1 reporting and non-reporting hospitals and to measure the association between specific elements of sepsis QI processes and SEP-1 performance and hospital-specific risk-adjusted sepsis mortality. Design, Setting, and Patients: This mixed methods study linked telephone survey data on QI practices from Iowa hospitals to SEP-1 performance data and risk-adjusted mortality from statewide all-payer administrative claims database. The survey assessed sepsis QI practices in eight categories. Characteristics of hospitals and sepsis QI practices were compared by SEP-1 reporting status. Univariable and multivariable logistic and linear regression estimated the association of QI practices with hospital SEP-1 performance and observed-to-expected sepsis mortality ratios. Interventions: None Measurements and Main Results: All 118 Iowa hospitals completed the survey (100% response rate). SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% vs. 38%, p = 0.026) and using the case review process to develop sepsis care plans (87% vs. 64%, p = 0.013). Sepsis QI practices were not associated with increased SEP-1 scores. Two were associated with reduced mortality: having a sepsis committee B= -0.11, p = 0.036) and using case review results for sepsis care plans (B= -0.10, p = 0.049). Conclusions: Hospitals reporting SEP-1 compliance to CMS conduct more sepsis QI practices. Most QI practices are not associated with increased SEP-1 performance or decreased sepsis mortality. Future work could explore how to implement these performance improvement practices in hospitals not reporting SEP-1 compliance.

scholarly journals 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

2020 ◽  
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.

scholarly journals Is Albumin-based Resuscitation in Severe Sepsis and Septic Shock Justifiable? An Evidence from a Cost-effectiveness Evaluation

1970 ◽  
Vol 29 (1) ◽  
Author(s):  
Bereket Tigabu ◽  
Majid Davari ◽  
Abbas Kebriaeezadeh ◽  
Mojtaba Mojtahedzadeh ◽  
Kourosh Sadeghi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Tree Age ◽  
Gdp Per Capita ◽  
Life Years ◽  
Per Capita ◽  
Sepsis And Septic Shock ◽  
The Cost

BACKGROUND: Fluid and antimicrobial therapy are the essential parts of sepsis management. The type of fluid to resuscitate with is an unsettled issue in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate the cost effectiveness of albumin-based resuscitation over crystalloids.METHODS: A cost-effectiveness analysis was conducted by extracting data from a database of Sina Hospital, Islamic Republic of Iran. A decision tree was constructed by using Tree Age Pro2011. The patients were grouped based on the types of fluids used for resuscitation into crystalloid alone or crystalloid + albumin groups at the initial decision node. The patients were followed from the onset of severe sepsis and septic shock upto 28 days. The healthcare payers’ perspective was considered in constructing the model. The cost was measured in US dollars and the effectiveness was measured by life years gained.RESULTS: The addition of albumin during resuscitation of patients with severe sepsis and septic shock has an effectiveness gain of 0.09 life years and cost increment of 495.00 USD. The estimated ICER for this analysis was 5500.00 USD per life year gained. The probability that albumin is cost-effective at one GDP per capita is 49.5%.CONCLUSION: Albumin-based resuscitation is not cost-effective in Iran when a GDP per capita was considered for a life year gain. The cost-effectiveness was insensitive to the cost of standard care. We recomend the caustious use albumin as per the Surviving Sepsis Campaign guideline. 

Sign in / Sign up

Export Citation Format

Share Document