Comment on “Surviving sepsis campaign guidelines for the management of severe sepsis and septic shock” by Dellinger et al.

Zandstra, D. F.; Voort, Peter H. J. van der

doi:10.1007/s00134-004-2397-z

Cited by 335 publications

(559 citation statements)

References 6 publications

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“…35,37,38 Surviving sepsis guidelines for children do not recommend high-volume hemofiltration for sepsis. 40 However, high-volume CKRT might be associated with underdosing of essential drugs (eg, antibiotics and antiepileptics) and an exacerbated catabolic state already present in AKI by removing essential nutrients. As with every other aspect of CKRT, optimal delivery of CKRT should be a dynamic and patient-specific therapy, taking into account the potential discrepancy between the prescribed and delivered dose, which could be as high as 20% to 30%.…”

Section: Systemic Prostacyclin 1 (1)mentioning

confidence: 99%

“…More than one-third (39%) of the PICUs used diuretics while the patient was receiving CKRT, and more than half (60%) of the PICUs altered the prescription of nutritional support mainly by changing the amount of protein (48%) and calories (38%) (Table2).In case of insufficient desired toxin clearance, respondents preferred to change the CKRT modality, followed by increasing the effluent rate (eFigure 3B in Supplement 1). The CKRT dose was calculated mainly (72%) using a weight-based formula (mL/kg/h), and the median (IQR) CKRT dose among the PICUs was 35 (30-50) mL/kg/h in neonates and 30(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) mL/kg/h in children aged 1 month to 18 years. Only 30% of PICUs reported ever using a CKRT dose over 40 mL/kg/h, with a median (IQR) dose of 80 (45-120) mL/kg/h.…”

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confidence: 99%

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Continuous Kidney Replacement Therapy Practices in Pediatric Intensive Care Units Across Europe

et al. 2022

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ImportanceContinuous kidney replacement therapy (CKRT) is the preferred method of kidney support for children with critical illness in pediatric intensive care units (PICUs). However, there are no data on the current CKRT management practices in European PICUs.ObjectiveTo describe current CKRT practices across European PICUs.Design, Setting, and ParticipantsThis cross-sectional survey of PICUs in 20 European countries was conducted by the Critical Care Nephrology Section of the European Society of Pediatric and Neonatal Intensive Care from April 1, 2020, to May 31, 2022. Participants included intensivists and nurses working in European PICUs. The survey was developed in English and distributed using SurveyMonkey. One response from each PICU that provided CKRT was included in the analysis. Data were analyzed from June 1 to June 30, 2022.Main Outcome and MeasuresDemographic characteristics of European PICUs along with organizational and delivery aspects of CKRT (including prescription, liberation from CKRT, and training and education) were assessed.ResultsOf 283 survey responses received, 161 were included in the analysis (response rate, 76%). The attending PICU consultant (70%) and the PICU team (77%) were mainly responsible for CKRT prescription, whereas the PICU nurses were responsible for circuit setup (49%) and bedside machine running (67%). Sixty-one percent of permanent nurses received training to use CKRT, with no need for certification or recertification in 36% of PICUs. Continuous venovenous hemodiafiltration was the preferred dialytic modality (51%). Circuit priming was performed with normal saline (67%) and blood priming in children weighing less than 10 kg (56%). Median (IQR) CKRT dose was 35 (30-50) mL/kg/h in neonates and 30 (30-40) mL/kg/h in children aged 1 month to 18 years. Forty-one percent of PICUs used regional unfractionated heparin infusion, whereas 35% used citrate-based regional anticoagulation. Filters were changed for filter clotting (53%) and increased transmembrane pressure (47%). For routine circuit changes, 72 hours was the cutoff in 62% of PICUs. Some PICUs (34%) monitored fluid removal goals every 4 hours, with variation from 12 hours (17%) to 24 hours (13%). Fluid removal goals ranged from 1 to 3 mL/kg/h. Liberation from CKRT was performed with a diuretic bolus followed by an infusion (32%) or a diuretic bolus alone (19%).Conclusions and RelevanceThis survey study found a wide variation in current CKRT practice, including organizational aspects, education and training, prescription, and liberation from CKRT, in European PICUs. This finding calls for concerted efforts on the part of the pediatric critical care and nephrology communities to streamline CKRT education and training, research, and guidelines to reduce variation in practice.

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Section: Systemic Prostacyclin 1 (1)mentioning

confidence: 99%

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confidence: 99%

Continuous Kidney Replacement Therapy Practices in Pediatric Intensive Care Units Across Europe

et al. 2022

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“…Dopo la loro pubblicazione, sono apparsi numerosi studi critici nei confronti della modalità con cui le linee guida della Surviving Sepsis Campaign sono state elaborate, anche in considerazione del fatto che la Eli Lilly, azienda produttrice della rhACP, ne ha sovvenzionato la stesura [100][101][102][103][104][105][106][107][108][109][110][111] . In particolare per quanto riguarda questo farmaco, le linee guida fanno riferimento quasi esclusivamente allo studio PROWESS 88 , sulla base del quale la FDA ha limitato le indicazioni a un ristrettissimo numero di pazienti ad alto rischio.…”

Section: Qualcosa Che è Importante Sapereunclassified

Sepsis

et al. 2006

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Sepsis is a complex syndrome difficult to define, to diagnose and to treat. The term defines a group of clinical conditions caused by the systemic answer of the organism to an infection that can cause the dysfunction of one or more organs (severe sepsis) and death. Much more often than one can imagine, ED physicians must diagnose and manage patients with more or less severe sepsis. During the last few years, as it happened for myocardial infarction and stroke, it has been acknowledged the importance of an early treatment also for patients with severe sepsis and septic shock. It has been documented that the attainment of precise haemodynamic goals can influence the prognosis positively. In this work describes recent advances about pathogenesis, diagnosis and therapy of the severe sepsis and septic shock. Innovations on acute and subacute therapy proposed by the Surviving Sepsis Campaign’s collaborative guide lines are presented

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“…The Surviving Sepsis Campaign recommends antibiotics administration within the first hour of sepsis recognition. 4 Studies suggest that timely antibiotic administration in sepsis improves mortality and other clinical outcomes in intensive care unit (ICU) and ED settings. 5,6 However, a meta-analysis has shown no significant difference in mortality between those who received antibiotics within the first hour compared with after 5 h of sepsis recognition.…”

Section: Introductionmentioning

confidence: 99%

Association between timing and adequacy of antibiotics and adverse outcomes in patients with sepsis and septic shock: A multicentre retrospective cohort study

Shetty

Baker

Kabil

et al. 2022

Emerg Medicine Australasia

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Objectives: To investigate the association between the timing and adequacy of antibiotics administered to patients presenting with culturepositive sepsis and septic shock to the ED and in-hospital mortality and/or intensive care unit (ICU) admission. Methods: Multicentre retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia between January 2017 and November 2019. Encounters for patients aged ≥16 years meeting specified criteria for sepsis or septic shock with antibiotic administration within the first 6 h of presentation were included. Results: Of 7611 encounters included in the study, 2328 (31%) were culture positive, and 2228 (29%) met the criteria for septic shock. In culturepositive sepsis encounters, partial or inadequate antibiotic coverage was associated with higher risk of death or ICU admission (adjusted odds ratio [AOR] 1.50, 95% confidence interval [CI] 1.04-2.06 and 1.95, 95% CI 1.28-2.99, respectively). This effect was not significant in septic shock encounters (AOR 1.10, 95% CI 0.64-1.88) with partial coverage and (AOR 1.63, 95% CI 0.81-3.3) inadequate coverage. Time to antibiotics was not significantly associated with the risk of mortality/ICU admission. This inference remained the same when analysis was restricted to cases with adequate antibiotic coverage. Conclusions: In a large multicentre sample of patients with culture-positive sepsis, inadequacy of antibiotics was associated with higher risk of inhospital mortality or ICU admission.

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Comment on “Surviving sepsis campaign guidelines for the management of severe sepsis and septic shock” by Dellinger et al.

Cited by 335 publications

References 6 publications

Continuous Kidney Replacement Therapy Practices in Pediatric Intensive Care Units Across Europe

Continuous Kidney Replacement Therapy Practices in Pediatric Intensive Care Units Across Europe

Sepsis

Association between timing and adequacy of antibiotics and adverse outcomes in patients with sepsis and septic shock: A multicentre retrospective cohort study

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