scholarly journals ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

2021 ◽  
Vol 8 ◽  
Author(s):  
Raphael Romano Bruno ◽  
Bernhard Wernly ◽  
Behrooz Mamandipoor ◽  
Richard Rezar ◽  
Stephan Binnebössel ◽  
...  
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Length Of Stay ◽  
Research Database ◽  
Icu Mortality ◽  
Icu Patients ◽  
Old Patients ◽  
Very Old ◽  
Sepsis And Septic Shock ◽  
Very Old Patients

Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care.Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted.Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01).Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.

scholarly journals Role of Steroid in Adult Patients of Septic Shock - A Critical Analysis

KYAMC Journal ◽  
2017 ◽  
Vol 4 (2) ◽  
pp. 409-414
Author(s):  
Rajib Hasan ◽  
Humayun Kabir ◽  
Taposh Chandra Roy ◽  
Javed Sharoar Chowdhury ◽  
Farzana Yeasmin
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critical Analysis ◽  
Adult Patients ◽  
Evidence Based ◽  
Icu Patients ◽  
Evidence Based Practices ◽  
Sepsis And Septic Shock

" Sepsis and septic shock is the condition which has been with intensive care units from long before. In fact, it is one of the highly ranked diseases causing mortality in ICU patients. There are currently many evidence based practices in the management of septic shock and use of steroid is one of them. The aim of this article is to critically evaluate the evidences regarding the role of steroids in adult patients of septic shock. This article has also evaluated all the current evidences regarding details of the role of steroids including their formulation, dosage, duration and route of administration in patients of septic shock.KYAMC Journal Vol. 4, No.-2, Jan 2014, Page 409-414

scholarly journals Vitamin C, Hydrocortisone, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Analysis of Real-World Application

2019 ◽  
Vol 8 (4) ◽  
pp. 478 ◽  
Author(s):  
Jane Litwak ◽  
Nam Cho ◽  
H. Nguyen ◽  
Kayvan Moussavi ◽  
Thomas Bushell
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Combination Therapy ◽  
Vitamin C ◽  
Triple Therapy ◽  
Real World ◽  
Standard Care ◽  
Icu Mortality ◽  
Sepsis And Septic Shock

A recent study suggested mortality benefits using vitamin C, hydrocortisone, and thiamine combination therapy (triple therapy) in addition to standard care in patients with severe sepsis and septic shock. In order to further evaluate the effects of triple therapy in real-world clinical practice, we conducted a retrospective observational cohort study at an academic tertiary care hospital. A total of 94 patients (47 in triple therapy group and 47 in standard care group) were included in the analysis. Baseline characteristics in both groups were well-matched. No significant difference in the primary outcome, hospital mortality, was seen between triple therapy and standard care groups (40.4% vs. 40.4%; p = 1.000). In addition, there were no significant differences in secondary outcomes, including intensive care unit (ICU) mortality, requirement for renal replacement therapy for acute kidney injury, ICU length of stay, hospital length of stay, and time to vasopressor independence. When compared to standard care, triple therapy did not improve hospital or ICU mortality in patients with septic shock. A randomized controlled trial evaluating the effects of triple therapy is necessary prior to implementing vitamin C, hydrocortisone, and thiamine combination therapy as a standard of care in patients with septic shock.

scholarly journals The status of intensive care medicine research and a future agenda for very old patients in the ICU

2017 ◽  
Vol 43 (9) ◽  
pp. 1319-1328 ◽  
Author(s):  
H. Flaatten ◽  
D. W. de Lange ◽  
A. Artigas ◽  
D. Bin ◽  
R. Moreno ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Medicine ◽  
Old Patients ◽  
Very Old ◽  
Medicine Research ◽  
The Status ◽  
Very Old Patients

scholarly journals Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis

Critical Care ◽  
2009 ◽  
Vol 13 (2) ◽  
pp. R45 ◽  
Author(s):  
Sean M Bagshaw ◽  
Steve AR Webb ◽  
Anthony Delaney ◽  
Carol George ◽  
David Pilcher ◽  
...  
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Cohort Analysis ◽  
Old Patients ◽  
Very Old ◽  
Very Old Patients

scholarly journals Publisher Correction: Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bernhard Wernly ◽  
Raphael Romano Bruno ◽  
Malte Kelm ◽  
Ariane Boumendil ◽  
Alessandro Morandi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Medicine ◽  
Old Patients ◽  
Very Old ◽  
Specific Outcome ◽  
Very Old Patients

scholarly journals Time to First Antimicrobial Administration After Onset of Sepsis in Critically Ill Children

2015 ◽  
Vol 20 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Nicholas M. Fusco ◽  
Kristine A. Parbuoni ◽  
Jill A. Morgan
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Critically Ill Children ◽  
Sepsis And Septic Shock ◽  
Antimicrobial Administration

OBJECTIVES: Delay of antimicrobial administration in adult patients with severe sepsis and septic shock has been associated with a decrease in survival to hospital discharge. The primary objective of this investigation was to determine the time to first antimicrobial administration after the onset of sepsis in critically ill children. Secondary objectives included appropriateness of empiric antimicrobials and microbiological testing, fluid resuscitation during the first 24 hours after onset of sepsis, intensive care unit and hospital length of stay, and mortality. METHODS: Retrospective, chart review of all subjects less than or equal to 18 years of age admitted to the pediatric intensive care unit (PICU) with a diagnosis of sepsis between January 1, 2011, and December 31, 2012. RESULTS: A total of 72 subjects met the inclusion criteria during the study period. Median time to first antimicrobial administration by a nurse after the onset of sepsis was 2.7 (0.5–5.1) hours. Cultures were drawn prior to administration of antimicrobials in 91.7% of subjects and were repeated within 48 hours in 72.2% of subjects. Empiric antimicrobial regimens were appropriate in 91.7% of cases. The most common empiric antimicrobial regimens included piperacillin/tazobactam plus vancomycin in 19 subjects (26.4%) and ceftriaxone plus vancomycin in 15 subjects (20.8%). Median PICU length of stay was 129 (64.6–370.9) hours, approximately 5 days, and median hospital length of stay was 289 (162.5–597.1) hours, approximately 12 days. There were 4 deaths during the study period. CONCLUSIONS: Time to first antimicrobial administration after onset of sepsis was not optimal and exceeded the recommendations set forth in international guidelines. At our institution, the process for treating pediatric patients with severe sepsis and septic shock should be modified to increase compliance with national guidelines.

scholarly journals A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

2019 ◽  
Vol 52 ◽  
pp. 141-148 ◽  
Author(s):  
Christian Jung ◽  
Bernhard Wernly ◽  
Johanna M. Muessig ◽  
Malte Kelm ◽  
Ariane Boumendil ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elective Surgery ◽  
Old Patients ◽  
Very Old ◽  
Very Old Patients
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