Outcomes of patients with severe infection in Uganda according to adherence to the World Health Organization's Integrated Management of Adolescent and Adult Illness fluid resuscitation guidelines

Almasi‐Hashiani, Amir; Saulters, Kacie J.; Muhindo, Rose; Moore, Christopher C.

doi:10.1016/j.jcrc.2017.04.042

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…Interestingly, the investigators found no difference in survival and organ function (despite lactate clearance) between the patients who received fluid resuscitation according to the IMAI guidelines (n=28) and those who did not (n=94). The administered doses of fluids after 6 hours were 3 L in the IMAI group vs. 1.5 L in the no-IMAI group (21). It must be noted, that the rate of HIV-positive patients in the treated groups were quite high (62%) and no details regarding causal therapy was presented by the authors.…”

Section: Discussionmentioning

confidence: 82%

Sole causal therapy worsens outcome as compared to no therapy and combined causal and goal-directed supportive therapy in ovine septic shock

et al. 2018

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Background: There is clear evidence that early causal therapy improves outcome in sepsis and septic shock, whereas recent studies on supportive hemodynamic therapy have produced very conflictive results. The objective of the present study was to determine whether a supportive hemodynamic therapy guided by clinically relevant invasive monitoring improves survival and organ function in a high-lethality model of septic shock in sheep as compared to sole causal therapy including surgical and antimicrobial treatment. Methods: Twenty healthy ewes were anaesthetized and instrumented for hemodynamic surveillance. After laparotomy and fecal withdrawal from the caecum, animals were randomly assigned to one of four groups: sham, control, causal and combined therapy. In all groups but the sham group, feces were injected into the peritoneal cavity. Septic shock was defined as mean arterial pressure (MAP) ≤60 mmHg and arterial lactate concentration ≥1.8 mmol•L −1. Animals of the control group received no therapy, while the causal group received broad-spectrum antibiotic therapy and peritoneal lavage. The combined therapy group received causal therapy plus supportive hemodynamic therapy. Results: The sham animals showed no signs of systemic infection, while all other animals developed septic shock with arterial hypotension and lactic acidosis within 4.0 (4.0-6.8) hours. Induction of causal therapy did not impact on haemodynamics as compared to the control group. Notably, 50% of the control animals and none of the causal therapy animals survived the study. Combined therapy stabilized haemodynamics and improved organ function and survival as compared to control and causal therapy groups. Conclusions: The present data suggest that sole causal sepsis therapy without hemodynamic support worsens outcome even more than natural evolution of sepsis and combined causal and supportive therapy. This underlines the importance of early hemodynamic stabilization in parallel with antibiotic and surgical treatment of the sepsis focus.

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Section: Discussionmentioning

confidence: 82%

Sole causal therapy worsens outcome as compared to no therapy and combined causal and goal-directed supportive therapy in ovine septic shock

et al. 2018

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“…However, in a trial of Ugandan children with severe sepsis due to malaria, 15 a rapid initial bolus of 20-40 ml/kg of normal saline was associated with increased 48-hour mortality. In another study of severe sepsis fluid treatment in Uganda, 16 there was no difference in outcomes if patients received fluids according to the WHO guidelines, or not.…”

Section: Fluid Replacement In Septic Shockmentioning

confidence: 95%

Crystalloids and colloids

Kemp

2020

South Afr J Anaesth Analg

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“…Fourteen studies were included in the analysis of the impact of intravenous uids on mortality (Fig. 2, S3 Table )1 1,12,[23][24][25][26][27][28][29][30][31][32][33][34][35] . The type of uid administered was speci ed as crystalloid in seven studies and was unspeci ed in seven.…”

Section: Intravenous Fluidsmentioning

confidence: 99%

Sepsis Management in Low- and Middle-Income Countries: A Systematic Review

Jenson,

Loevinsohn,

Lukacs

et al. 2024

Preprint

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Background Optimal sepsis management in low-resource settings is the subject of active debate. Given resource limitations, prevalent co-morbidities, and unique infectious epidemiology, resuscitation strategies conceived in resource-rich settings may be difficult to apply more broadly. Evidence from low- and middle-income country (LMIC) settings is disparate and frequently discordant. We sought to synthesize the available data. Methods A systematic search of sepsis resuscitation interventions in LMIC was performed in PubMed, EMBASE, Scopus, Global Health Library databases, and the gray literature in accordance with PRSIMA guidelines. Studies were included if they defined a fluid or antibiotic intervention and measured the effect on in-hospital mortality for patients with undifferentiated sepsis. Studies were categorized based on the volume of fluid administered and the time to antibiotic administration. Results The search yielded 22,088 unique articles, of which 26 studies, encompassing 15,667 patients met the inclusion and were included. Over half the studies (14/26) evaluated the effect of fluid administration on mortality and found a trend toward increased mortality when more than 2 L were administered in the first 6 hours, while 1–2 L was associated with reduced mortality. Among the 15 studies evaluating the impact of antibiotic timing, administration within 3 hours was associated with reduced likelihood of in-hospital mortality. However, there was wide heterogeneity across study methodologies, outcomes, and resource variation. Conclusion Synthesis of the available data suggests that a judicious fluid strategy (between 1 and 2 liters within the first 6 hours) and early antibiotic administration are the most appropriate strategies for undifferentiated sepsis. More research is needed, especially in rural low-resource settings where we found a dearth of available research.

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Outcomes of patients with severe infection in Uganda according to adherence to the World Health Organization's Integrated Management of Adolescent and Adult Illness fluid resuscitation guidelines

Cited by 7 publications

References 16 publications

Sole causal therapy worsens outcome as compared to no therapy and combined causal and goal-directed supportive therapy in ovine septic shock

Sole causal therapy worsens outcome as compared to no therapy and combined causal and goal-directed supportive therapy in ovine septic shock

Crystalloids and colloids

Sepsis Management in Low- and Middle-Income Countries: A Systematic Review

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