Use of CytoSorb in the emergency department-high dependency unit: A case report and a mini review

Circulating inflammatory mediators and cytokines play a pivotal role in the progression of sepsis, leading in turn to septic shock, organ failure and resistance to standard therapy. Blood purification therapies may be adjuvant treatment for severe sepsis, but results have been shown to be so far controversial. Recently, CytoSorb has achieved promising outcomes on reduction of cytokine blood levels, improvement of clinical parameters and mortality in sepsis, as well as in other acute conditions. It is mostly used in Intensive Care Unit (ICU), in isolated hemoperfusion, or inserted in other circuits in addition to Continuous Renal Replacement Therapy (CRRT), heart-lung machines and extracorporeal membrane oxygenation. We report a case of septic shock occurred in our Emergency Department-High Dependency Unit (ED-HDU), resistant to standard therapy and improved after CytoSorb, so avoiding ICU hospitalization.

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Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0020 ◽

2018 ◽

pp. 104-108

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Oxygen Demand ◽

Goal Directed Therapy ◽

Early Goal Directed Therapy ◽

Study Results ◽

Sepsis And Septic Shock

This case focuses on detecting sepsis through early goal-directed therapies by asking the question: Does aggressive correction of hemodynamic disturbances in the early stages of sepsis improve outcomes? Early goal-directed therapies are aimed at restoring a balance between oxygen delivery and oxygen demand. Patients included in the study were adults presenting to the emergency room with severe sepsis or septic shock. Study results indicated that most patients with severe sepsis or septic shock should be managed with aggressive hemodynamic monitoring and support immediately on presentation in the emergency department (or, if this is not possible, in the intensive care unit) for 6 hours or until there is resolution of hemodynamic disturbances.

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Plasma-Calprotectin as an Indicator for Immediate Need of Intensive Care Treatment in Suspected Sepsis

10.21203/rs.3.rs-213752/v1 ◽

2021 ◽

Author(s):

Asa Emilia Parke ◽

Christian Unge ◽

David Yu ◽

Jonas Sunden-Cullberg ◽

Kristoffer Stralin

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Intensive Care Treatment ◽

High Dependency Unit ◽

Suspected Sepsis ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein ◽

Promising Tool ◽

High Dependency

Abstract Introduction: Decisions regarding need of transfer to intensive care of patients with sepsis in the emergency department is challenging. We hypothesised that the new biomarker plasma-calprotectin could be used to help select patients who need intensive care, since it already has shown to be a promising tool in the intensive care unit. Methods: This prospective study was performed on consecutive sepsis alert patients. The alert summons a multidisciplinary team of physicians from the emergency department, the Department of Infectious Diseases, and the intensive care unit, who evaluate patients for possible infection and decide where to transfer the patient. Blood sampling was performed on consecutive sepsis alert patients. C-reactive protein, procalcitonin, neutrophils, and lymphocytes were routinely analysed, p-calprotectin was analysed from frozen plasma samples using a specific turbidimetric assay. Results: Among 367 sepsis alert patients, 335 had an infection of whom 66 were immediately transferred to the intensive care unit or high dependency unit. 269 patients were transferred to ordinary wards. Median p-calprotectin for all infected patients was 2.2 (IQR 1.2–3.9), 3.3 (IQR 1.6–5.2) among those transferred immediately to intensive care unit/ high dependency unit and 2.1 (IQR 1.1–3.5) among those transferred to wards (p = 0.0001). Analysis of area under the receiver-operating characteristic (ROC) curve for transferral to higher care level showed superiority for p-calprotectin compared to procalcitonin and neutrophil-lymphocyte-ratio, both regarding all sepsis alert cases and regarding the patients with infection (p < 0.001 for all comparisons)). The best p-calprotectin cut-off 4.0 mg/L showed sensitivity 42.5% and specificity 83% for transferral to ICU/HDU among patients with infection. Conclusion: In sepsis alert patients, p-calprotectin was significantly elevated in patients transferred immediately to intensive care. P-calprotectin was superior to traditional biomarkers as a predictor of need for intensive care. Trial registration: Not registered, as the sepsis alert was developed as a clinical supportive tool.

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Understanding of Severe Sepsis and Septic Shock Among Emergency Department and Intensive Care Unit Medical Officers in a Developing Country Nepal: A Survey Study

Birat Journal of Health Sciences ◽

10.3126/bjhs.v1i1.17096 ◽

2017 ◽

Vol 1 (1) ◽

pp. 47-50

Author(s):

G.S. Shrestha ◽

B.P. Parajuli ◽

S.P. Acharya ◽

A. Banstola ◽

B. Upadhyay ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Survey Study ◽

Effective Management ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Sepsis And Septic Shock

Introduction Severe sepsis and septic shock is a major cause of morbidity and mortality. The burden is higher and the outcome is dismal in the low and middle income countries.Objective This study aims to evaluate the knowledge about severe sepsis and septic shock among the medical officers of emergency department and intensive care unit in Nepal. It is a cross-sectional survey study.Methodology The medical officers working in emergency department and intensive care unit were asked to fill up the survey questionnaire, which contained the questions related to the demographics of the participant, about the knowledge of sepsis and the hindrances behind the effective management of septic patients. The percentage of correct answers for each question and average correct response for all the questions were analyzed.Results Seventy medical officers from twenty-four hospitals across the country were enrolled in the study. Among them, 39 were working in the emergency department and 31 were working in the intensive care unit. For the individual questions, the percentage of correct answers varied from 8.57% to 82.86% (average 48.16%). As per the response of the participants, lack of knowledge about sepsis and management guidelines, lack of experience for management of sepsis and lack of investigation facilities were considered to be the major barriers for effective management of septic patients.Conclusions Knowledge and understanding about severe sepsis and septic shock among the medical officers of emergency department and intensive care unit in Nepal is sub-optimal. To improve the outcome of septic patients, efforts should be made to increase the understanding among these first-line health care workers by implementing regular and mandatory training programs.Birat Journal of Health Sciences 2016 1(1): 47-50

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Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.

Acta Médica Portuguesa ◽

10.20344/amp.6998 ◽

2016 ◽

Vol 29 (2) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Joao Miguel Carvas ◽

Cátia Canelas ◽

Gustavo Montanha ◽

Carlos Silva ◽

Francisco Esteves

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Venous Pressure ◽

Blood Cultures ◽

Surviving Sepsis Campaign ◽

Central Venous ◽

Resuscitation Bundle

Introduction: Severe sepsis and septic shock are common conditions with high levels of morbi-mortality surpassing those of coronary heart disease or stroke. The reality of hospital treated sepsis is largely unknown outside of the intensive care unit. We therefore aimed to evaluate the level of compliance with the Surviving Sepsis Campaign 6-hour bundle in a Portuguese emergency department and to relate it to the patient clinical outcomes. Material and Methods: We conducted a retrospective, observational cohort study with 178 severe sepsis/septic shock patients admitted to the intensive and intermediate care unit between January 1st 2012 and December 31st 2012.Results: In the study, period septic shock was diagnosed in 100 patients (56.2%) and severe sepsis in 78 patients (43.8%). Compliance with the sepsis bundle was: (1) 62.9% for lactate measurement; (2) 62.9% for blood cultures before antibiotics; (3) 41.6% for antibiotics in the first 3 hours; (4) 76.4% for fluid administration; (5) 25% for vasopressor administration; (6) 37% for central venous pressure measurement and (7) 39% for central venous oxygen saturation measurement. Full compliance was observed in 22% of the patients. The individual bundle measure - Blood cultures before antibiotics - was significantly associated with a decreased risk of both intensive care unit mortality and 28-day mortality. There was also a trend for an inverse correlation between increased compliance with the full bundle and the intensive care unit and 28-days hospital mortality.Discussion: There was a low compliance with the Surviving Sepsis Campaign 6-hour bundle, a result that replicates the findings in similar international studies. The explanation is complex but it may include the lack of institutional quality monitoring in the emergency department. Conclusions: The compliance with a sepsis resuscitation bundle starting in the emergency department was positively associated with the outcomes of the septic patients. Nonetheless the bundle was unreliably performed.

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Effect of an emergency department sepsis protocol on the care of septic patients admitted to the intensive care unit

CJEM ◽

10.1017/s1481803500012562 ◽

2010 ◽

Vol 12 (05) ◽

pp. 414-420 ◽

Cited By ~ 3

Author(s):

David D. Sweet ◽

Dharmvir Jaswal ◽

Winnie Fu ◽

Matt Bouchard ◽

Praveena Sivapalan ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length Of Stay ◽

Arterial Line ◽

Central Venous ◽

Line Placement

ABSTRACT Objective: We sought to determine whether the implementation of a sepsis protocol in a Canadian emergency department (ED) improves care for the subset of patients admitted to the intensive care unit (ICU). Methods: After implementing a sepsis protocol in our ED we used an ICU database and chart review to compare various time-dependent end points and outcomes between a historical control year and the first year after implementation. We reviewed the charts of all patients admitted to the ICU within 24 hours of ED admission with a primary or other diagnosis of sepsis, severe sepsis or septic shock, who met criteria for early goal-directed therapy within the first 6 hours of their ED stay. Results: We compared 29 patients from the control year with 30 patients from the year after implementation of our sepsis protocol. We found that patients treated during the postintervention year had improvements in time to antibiotics (4.2 v. 1.0 h, difference = –3.2 h, 95% CI –4.8 to –2.0), time to central line placement (above the diaphragm) (11.6 v. 3.2 h, difference = –8.4 h, 95% CI –12.1 to –4.7), time to arterial line placement (7.5 v. 2.3 h, difference = –5.2 h, 95% CI –7.4 to –3.0), and achievement of central venous pressure and central venous oxygen saturation goals (11.1 v. 5.1 h, difference = –6.0 h, 95% CI –11.03 to –1.71, and 13.1 v. 5.5 h, difference = –7.6 h, 95% CI –11.97 to –3.16, respectively). There were no statistically significant differences in ICU length of stay, hospital length of stay or mortality (31.0% v. 20.0%, difference = –11.0%, 95% CI –33.1% to 11.1%). Conclusion: Implementation of an ED sepsis protocol improves care for patients with severe sepsis and septic shock.

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