Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021

Evans, Laura; Rhodes, Andrew; Alhazzani, Waleed; Antonelli, Massimo; Coopersmith, Craig M.; French, Craig; Machado, Flávia Ribeiro; McIntyre, Lauralyn; Ostermann, Marlies; Prescott, Hallie C.; Schorr, Christa; Simpson, Steven Q.; Wiersinga, W. Joost; Alshamsi, Fayez; Angus, Derek C.; Arabi, Yaseen M.; Azevedo, Luciano César Pontes; Beale, Richard; Beilman, Gregory J.; Belley‐Côté, Emilie P.; Burry, Lisa; Cecconi, Maurizio; Centofanti, John; Yataco, Angel Coz; Waele, Jan De; Dellinger, R Phillip; Doi, Kent; Du, Bin; Bakker, Jan; Ferrer, Ricard; Gomersall, Charles D; Hodgson, Carol; Møller, Morten Hylander; Iwashyna, Theodore J.; Jacob, Shevin T.; Kleinpell, Ruth; Klompas, Michael; Koh, Younsuck; Kumar, Anand; Kwizera, Arthur; Lobo, Suzana M.; Masur, Henry; McGloughlin, Steven; Mehta, Sangeeta; Mehta, Yatin; Mer, Mervyn; Nunnally, Mark; Oczkowski, Simon; Osborn, Tiffany M.; Papathanassoglou, Elizabeth; Perner, Anders; Puskarich, Michael A.; Roberts, Jason A.; Schweickert, William D.; Seckel, Maureen A.; Sevransky, Jonathan; Sprung, Charles L.; Welte, Tobias; Zimmerman, Janice L.; Levy, Mitchell M.

doi:10.1097/ccm.0000000000005357

Cited by 295 publications

(188 citation statements)

References 25 publications

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“…The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [ 7 ] [ 8 ] and the International Guidelines for Management of Sepsis and Septic Shock 2021 “Surviving Sepsis Campaign” [ 9 ] [ 10 ] established the identification strategies and sequential lines of care to be followed in such cases. Hospital-based strategies have been developed for the early screening of sepsis, both in the intensive care units (ICU), such as the Sequential Organ Failure Assessment (SOFA) scores [ 11 ], and out of the ICU, such as the quick Sequential Organ Failure Assessment (qSOFA) or the National Early Warning Score 2 (NEWS2) [ 12 ] [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

et al. 2022

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Background. The aim of this study was to assess the role of prehospital point-of-care N-terminal probrain natriuretic peptide to predict sepsis, septic shock, or in-hospital sepsis-related mortality. Methods. A prospective, emergency medical service-delivered, prognostic, cohort study of adults evacuated by ambulance and admitted to emergency department between January 2020 and May 2021. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on the validation cohort. Results. A total of 1,360 patients were enrolled with medical disease in the study. The occurrence of sepsis, septic shock, and in-hospital sepsis-related mortality was 6.4% (67 cases), 4.2% (44 cases), and 6.1% (64 cases). Prehospital National Early Warning Score 2 had superior predictive validity than quick Sequential Organ Failure Assessment and N-terminal probrain natriuretic peptide for detecting sepsis and septic shock, but N-terminal probrain natriuretic peptide outperformed both scores in in-hospital sepsis-related mortality estimation. Application of N-terminal probrain natriuretic peptide to subgroups of the other two scores improved the identification of sepsis, septic shock, and sepsis-related mortality in the group of patients with low-risk scoring. Conclusions. The incorporation of N-terminal probrain natriuretic peptide in prehospital care combined with already existing scores could improve the identification of sepsis, septic shock, and sepsis-related mortality.

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Section: Introductionmentioning

confidence: 99%

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

et al. 2022

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“…New sepsis guidelines ( 13 ), international PICS consensus recommendations ( 14 ), and rapidly emerging COVID-19 recovery insights ( 2 , 4 , 15 ) contribute to the urgency and scope of demand for evidence-based implementation and operation of RCs. Health systems operating ICU-RCs to assess and treat community-dwelling ICU survivors with clusters of cognitive, physical, and psychologic impairments have largely served as a care delivery model for newly created COVID-RCs in the United States ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

Danesh

Boehm

Eaton

et al. 2022

Critical Care Explorations

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OBJECTIVES: The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States. DESIGN: Cross-sectional survey. SETTING: Thirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated. PATIENTS: None. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: RC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%). CONCLUSIONS: Operating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.

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“…Understanding when patients’ intravascular compartments are dangerously depleted could allow for home tracking of diuretics and potentially even allow for measured uptitration of diuretics which could reduce the frequency of paracentesis, emergency visits, and hospital admissions. Conversely, having a measure of when the intravascular compartment is replete could allow for early movement down the treatment algorithm of hepatorenal syndrome or sepsis where the first interventions are often to administer large amounts of volume (Biggins et al, 2021; Evans et al, 2021; Garcia‐Tsao et al, 2008). In fact, empiric administration of volume expanders without a sense of intravascular volume status may explain recent detrimental effects of albumin administration in hospitalized patients with cirrhosis (China et al, 2021) or the unexpected harm noted in terlipressin administered too late in type 1 hepatorenal syndrome (Wong et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

The answer at our fingertips: Volume status in cirrhosis determined by machine learning and pulse oximeter waveform

Mazumder

Kazen²,

Carek³

et al. 2022

Physiological Reports

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Objective The objective of our study was to determine if the waveform from a simple pulse oximeter‐like device could be used to accurately assess intravascular volume status in cirrhosis. Methods Patients with cirrhosis underwent waveform recording as well as serum brain natriuretic peptide (BNP) on the day of their cardiac catheterization where invasive cardiac pressures were measured. Waveforms were processed to generate features for machine learning models in order to predict the filling pressures (regression) or to classify the patients as volume overloaded or not (defined as an LVEDP>15). Results Nine of 26 patients (35%) had intravascular volume overload. Regression analysis using PPG features (R2 = 0.66) was superior to BNP (R2 = 0.22). Linear discriminant analysis correctly classified patients with an accuracy of 78%, sensitivity of 60%, positive predictive value of 90%, and an AUROC of 0.87. Conclusions Machine learning‐enhanced analysis of pulse ox waveforms can estimate intravascular volume overload with a higher accuracy than conventionally measured BNP.

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Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021

Cited by 295 publications

References 25 publications

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

The answer at our fingertips: Volume status in cirrhosis determined by machine learning and pulse oximeter waveform

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