Hospitalized patients at risk of dying: an Intensive Care Medicine call for papers

Torres, Antoni; Bassetti, Matteo; Bakker, Jan

doi:10.1007/s00134-015-4092-7

Cited by 5 publications

(7 citation statements)

References 9 publications

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“…Hospital mortality among patients receiving a rapid response is high but variable, with a median mortality near 25%. 28 A number of observational trials have reported decreases in mortality with RRS implementation, 13,56–58 but these findings have not been universal, 44 and the observational pre/post nature of these studies leaves open the possibility of residual confounding and Hawthorne effect. 47 In an early landmark study in 2004, Priestley et al reported a ward-randomized trial showing that an RRS reduced hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Rapid response systems

2018

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Section: Discussionmentioning

confidence: 99%

Rapid response systems

2018

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“…This shift is presumed to prevent collateral damage of the pro-inflammatory response, but can also result in loss of immunocompetence and subsequently increase susceptibility to secondary infections. In sepsis patients, this phenomenon is termed sepsis-induced immunoparalysis24, although it is also observed in patients following trauma25 and cardiac resuscitation26 within hours after the insult. Therefore, the disproportionate production of anti-inflammatory cytokines during continuous infusion may mirror inflammation-induced immunoparalysis observed in patients.…”

Section: Discussionmentioning

confidence: 99%

Characterization of a model of systemic inflammation in humans in vivo elicited by continuous infusion of endotoxin

Kiers

Koch

Hamers

et al. 2017

Sci Rep

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Investigating the systemic inflammatory response in patients with critical illness such as sepsis, trauma and burns is complicated due to uncertainties about the onset, duration and severity of the insult. Therefore, in vivo models of inflammation are essential to study the pathophysiology and to evaluate immunomodulatory therapies. Intravenous bolus administration of endotoxin to healthy volunteers is a well-established model of a short-lived systemic inflammatory response, characterized by increased plasma cytokine levels, flu-like symptoms and fever. In contrast, patients suffering from systemic inflammation are often exposed to inflammatory stimuli for an extended period of time. Therefore, continuous infusion of endotoxin may better reflect the kinetics of the inflammatory response encountered in these patients. Herein, we characterize a novel model of systemic inflammation elicited by a bolus infusion of 1 ng/kg, followed by a 3hr continuous infusion of 1 ng/kg/h of endotoxin in healthy volunteers, and compared it with models of bolus administrations of 1 and 2 ng/kg of endotoxin. The novel model was well-tolerated and resulted in a more pronounced increase in plasma cytokine levels with different kinetics and more prolonged symptoms and fever compared with the bolus-only models. Therefore, the continuous endotoxin infusion model provides novel insights into kinetics of the inflammatory response during continuous inflammatory stimuli and accommodates a larger time window to evaluate immunomodulating therapies.

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“…In many of these studies, the quality of the rapid response system as a systematic intervention itself has not been evaluated [ 17 – 20 ]. Previous reviews of rapid response systems have treated rapid response systems as if they were of equal quality and had comparable operating procedures [ 2 , 17 , 19 , 21 ]. Few studies have reported on the response times of their efferent arms and how this may impact patient outcomes [ 13 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the effect of delayed activation of rapid response teams on patient outcomes: a systematic review protocol

Dobson

Thabane

et al. 2018

Syst Rev

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BackgroundRapid response teams have been widely adopted across the world. Although evidence for their efficacy is not clear, they remain a popular means to detect and react to patient deterioration. This may in part be due to there being no standardized approach to their usage or implementation. A key component of their ability to be effective is the speed of response.ObjectiveThe objective of this review is to evaluate the effect of delayed response by rapid response teams on hospital mortality (primary), cardiac arrest, and intensive care transfer rates (secondary).MethodsThis review will include randomized and non-randomized studies which examined the effect of delayed response times by rapid response teams on patient mortality, cardiac arrest, and intensive care unit admission rates. This review will include studies of adult patients who have experienced a rapid response team consultation. The search strategy will utilize a combination of keywords and MeSH terms. MEDLINE and Embase will be searched, as well as examining gray literature. Two reviewers will independently screen retrieved citations to determine if they meet inclusion criteria. Studies will be selected that provide information about the impact of response time on patient outcomes.Comparisons will be made between consults that arrive in a timely manner and consults that are delayed. Quality assessment of randomized studies will be conducted in accordance with guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. Quality assessment of non-randomized studies will be based on the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool. Results of the review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.DiscussionThis systematic review will identify and synthesize evidence around the impact of delayed response by rapid response teams on patient mortality, cardiac arrest, and intensive care transfer rates.Systematic review registrationPROSPERO Registration: CRD42017071842.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0705-x) contains supplementary material, which is available to authorized users.

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Hospitalized patients at risk of dying: an Intensive Care Medicine call for papers

Cited by 5 publications

References 9 publications

Rapid response systems

Rapid response systems

Characterization of a model of systemic inflammation in humans in vivo elicited by continuous infusion of endotoxin

Evaluating the effect of delayed activation of rapid response teams on patient outcomes: a systematic review protocol

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