Sepsis Management in Southeast Asia: A Review and Clinical Experience

Mehta, Yatin; Paul, Rajib; Rabbani, Raihan; Acharya, Subhash Prasad; Withanaarachchi, Ushira Kapilani

doi:10.3390/jcm11133635

Cited by 6 publications

(7 citation statements)

References 122 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First of all, CytoSorb ® therapy is not a primary therapy to treat sepsis, but only an adjunctive option to address the dysregulated immune response as an underlying problem in septic shock patients. So CytoSorb ® is solely used to eliminate cytokines (and other mediators) and decrease the complications of a dysregulated host response[ 8 ]. Thus, objective assessment of CytoSorb ® in septic shock is challenging.…”

Section: Resultsmentioning

confidence: 99%

“…Various endpoints such as haemodynamic stabilisation, improvement in organ function or inflammatory biomarkers, and survival have been recorded in studies with CytoSorb ® in sepsis/septic shock[ 7 , 8 , 10 , 19 ]. Understanding the complexity of the syndrome, assessment of the efficacy of CytoSorb ® treatment in studies should be based on the complexities of critical illness syndromes with endpoints such as haemodynamic stability, inflammatory biomarkers, and/or improvement in organ function rather than mortality.…”

Section: Resultsmentioning

confidence: 99%

“…Despite clinical research efforts and the development of sepsis management guide-lines over the last few decades, the potential to improve the outcome of the condition tends to be limited[ 8 ]. Newer adjuvant therapies, such as the targeted elimination of pathogen-associated toxins and mediators by specific adsorption, are gaining recognition[ 6 , 7 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: An Indian perspective

Mehta,

Ansari,

Mandal

et al. 2024

World J Crit Care Med

Self Cite

View full text Add to dashboard Cite

BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters. Despite standard therapy, the outcomes are poor. Newer adjuvant therapy, such as CytoSorb® extracorporeal haemoadsorption device, has been investigated and shown promising outcome. However, there is a lack of some guidance to make clinical decisions on the use of CytoSorb® haemoadsorption as an adjuvant therapy in septic shock in Indian Setting. Therefore, this expert consensus was formulated. AIM To formulate/establish specific consensus statements on the use of CytoSorb® haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario. METHODS We performed a comprehensive literature on CytoSorb® haemoadsorption in sepsis, septic shock in PubMed selecting papers published between January 2011 and March 2023 2021 in English language. The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps. Using a modified Delphi approach combining evidence appraisal and expert opinion, the following topics related to CytoSorb® in septic shock were addressed: need for adjuvant therapy, initiation timeline, need for Interleukin -6 levels, duration of therapy, change of adsorbers, safety, prerequisite condition, efficacy endpoints and management flowchart. Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question. RESULTS Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question. All 11 experts in the consensus group (100%) participated in the first, second and third round of voting. After three iterative voting rounds and adapting two statements, consensus was achieved on nine statements out of nine statements. The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb® for all indications in the open-ended question (Q10) focusing on “future recommendations for CytoSorb® therapy”. CONCLUSION This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb® haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: An Indian perspective

Mehta,

Ansari,

Mandal

et al. 2024

World J Crit Care Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…Moreover, the pediatricians should avoid to increase vancomycin dosages blindly in clinical practice when the treatment effect is poor, but should reevaluate the whole treatment strategy. As sepsis comprehensive management not only focuses on antimicrobial treatment, but also pays attention to early identification, source control, appropriate supportive care and hemodynamic optimization ( Weiss et al., 2020 ; Mehta et al., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Vancomycin efficiency and safety of a dosage of 40–60 mg/kg/d and corresponding trough concentrations in children with Gram-positive bacterial sepsis

Peng

Guo

Zhang

et al. 2023

Front. Cell. Infect. Microbiol.

View full text Add to dashboard Cite

BackgroundOptimal vancomycin trough concentrations and dosages remain controversial in sepsis children. We aim to investigate vancomycin treatment outcomes with a dosage of 40-60 mg/kg/d and corresponding trough concentrations in children with Gram-positive bacterial sepsis from a clinical perspective.MethodsChildren diagnosed with Gram-positive bacterial sepsis and received intravenous vancomycin therapy between January 2017 and June 2020 were enrolled retrospectively. Patients were categorized as success and failure groups according to treatment outcomes. Laboratory, microbiological, and clinical data were collected. The risk factors for treatment failure were analyzed by logistic regression.ResultsIn total, 186 children were included, of whom 167 (89.8%) were enrolled in the success group and 19 (10.2%) in the failure group. The initial and mean vancomycin daily doses in failure group were significantly higher than those in success group [56.9 (IQR =42.1-60.0) vs. 40.5 (IQR =40.0-57.1), P=0.016; 57.0 (IQR =45.8-60.0) vs. 50.0 (IQR =40.0-57.6) mg/kg/d, P=0.012, respectively] and median vancomycin trough concentrations were similar between two groups [6.9 (4.0-12.1) vs.7.3 (4.5-10.6) mg/L, P=0.568)]. Moreover, there was no significant differences in treatment success rate between vancomycin trough concentrations ≤15 mg/L and >15 mg/L (91.2% vs. 75.0%, P=0.064). No vancomycin-related nephrotoxicity adverse effects occurred among all enrolled patients. Multivariate analysis revealed that a PRISM III score ≥10 (OR =15.011; 95% CI: 3.937-57.230; P<0.001) was the only independent clinical factor associated with increased incidence of treatment failure.ConclusionsVancomycin dosages of 40-60 mg/kg/d are effective and have no vancomycin-related nephrotoxicity adverse effects in children with Gram-positive bacterial sepsis. Vancomycin trough concentrations >15 mg/L are not an essential target for these Gram-positive bacterial sepsis patients. PRISM III scores ≥10 may serve as an independent risk factor for vancomycin treatment failure in these patients.

show abstract

“…According to the latest study, approximately 49 million people worldwide are affected with sepsis, with an estimated mortality rate of 20% [ 2 ]. In the Southeast Asian region, India has the second highest sepsis burden [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Study on Assessing Serum Lactate as an Early Prognostic Determinant in Sepsis Outcome

Tejaswini,

Singhai,

Pawar

et al. 2024

Cureus

View full text Add to dashboard Cite

Background: Apart from being one of the main causes of death, sepsis has recently been considered a chronic critical illness. This has resulted in the implementation of standard treatment recommendations for management, with a focus on the initial phases of treatment. Early detection of sepsis and prognostic grading are now crucial for management. Despite the fact that sequential organ failure assessment score (SOFA), acute physiology, and chronic health evaluation II score (APACHE II) have been widely used in sepsis, there have been shortcomings such as feasibility and many lab parameters involved. As a result, this study was conducted to evaluate the role of serum lactate as an early marker and to compare it to current scoring systems for determining the outcome of sepsis. Methods and Material: This was an observational hospital-based study with 60 individuals recruited over a one-year period from July 2021 to June 2022. Serum lactate, as well as the other laboratory tests required for the computation of SOFA and APACHE II, were performed. The baseline data and the trend of lactate vs standard scores were examined in the first 48 hours, as well as their impact on outcomes in sepsis patients (as measured by mortality rates- patients were followed up for 28 days). The diagnostic accuracy of these scores was calculated using the area under the receiver operating characteristic (ROC) curve (AUROC). Results: The study enrolled 60 people out of a total of 162 people who were screened. The mean age was 48.4 years, with the highest mortality occurring between the ages of 41 and 60 years. Of the total 60 participants, 34 (56.6%) were male, with the respiratory tract being the most common source of infection for sepsis (36.67%). In our study, 46 patients survived while 14 patients died. The mean lactate on admission was 3.1 mmol/L in survivors and 4 mmol/L in non-survivors, whereas APACHE II was 9 and 12.36, and SOFA was 3.63 and 7.79, respectively, in survivors and non-survivors. Serum lactate and prognosis scores were compared in the survivor and non-survivor groups, and the difference in diagnostic accuracy was found to be statistically significant. Conclusions: Serum lactate can be used as an early recognition marker in patients with a probability of sepsis and serial lactate monitoring has a similar diagnostic accuracy in predicting outcomes as the traditional prognostic scoring systems SOFA and APACHE II.

show abstract

Sepsis Management in Southeast Asia: A Review and Clinical Experience

Cited by 6 publications

References 122 publications

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: An Indian perspective

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: An Indian perspective

Vancomycin efficiency and safety of a dosage of 40–60 mg/kg/d and corresponding trough concentrations in children with Gram-positive bacterial sepsis

Study on Assessing Serum Lactate as an Early Prognostic Determinant in Sepsis Outcome

Contact Info

Product

Resources

About