Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

Dellinger, R. Phillip; Levy, Mitchell M.; Carlet, Jean; Bion, Julian; Parker, Margaret M.; Jaeschke, Roman; Reinhart, Konrad; Angus, Derek C.; Brun‐Buisson, Christian; Beale, Richard; Calandra, Thierry; Dhainaut, Jean François; Gerlach, Herwig; Harvey, Maurene A.; Marini, John J.; Marshall, John C.; Ranieri, Marco; Ramsay, Graham; Sevransky, Jonathan; Thompson, B. Taylor; Townsend, Sean R.; Vender, Jeffrey S.; Zimmerman, Janice L.; Vincent, Jean‐Louis

doi:10.1007/s00134-008-1040-9

Cited by 185 publications

(275 citation statements)

References 1 publication

Supporting

Mentioning

263

Contrasting

Unclassified

Order By: Relevance

“…One key component of early goal-directed therapy strategies in SS is the accurate hemodynamic assessment and recognition of the dominant feature of the failing cardiovascular system (defective volume or vascular tone, failing heart pump) with subsequent appropriate management [23,24]. Consistently with this need to accelerate the correct treatment, bedside TTE in the early phase of undifferentiated shock sharply reduces the number of viable diagnosis [25].…”

mentioning

confidence: 99%

“…co-existing disease), a systematic step-by-step assessment is necessary to monitor hemodynamics. Repeated bedside assessment at each hemodynamic deterioration or significant therapeutic variation is the key to the use of Echo in this hemodynamic fashion [14] and allows for prompt recognition and correction of the specific causes of cardiovascular instability, which is mandatory in SS management [20,24,33]. ECHO findings should be appropriately interpreted in the clinical context and integrated with available data from other monitoring tools (systemic arterial mean pressure, central venous pressure and saturation, arterial blood lactates, urine output), especially with the ones concerning the adequacy of tissue perfusion, on which echocardiography is blind.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Echocardiography in the sepsis syndromes

2011

View full text Add to dashboard Cite

Purpose of the review Non-invasiveness and instantaneous diagnostic capability are prominent features of the use of echocardiography in critical care. Sepsis and septic shock represent complex situations where early hemodynamic assessment and support are among the keys to therapeutic success. In this review, we discuss the range of applications of echocardiography in the management of the septic patient, and propose an echocardiography-based goal-oriented hemodynamic approach to septic shock. Recent findings Echocardiography can play a key role in the critical septic patient management, by excluding cardiac causes for sepsis, and mostly by guiding hemodynamic management of those patients in whom sepsis reaches such a severity to jeopardize cardiovascular function. In recent years, there have been both increasing evidence and diffusion of the use of echocardiography as monitoring tool in the patients with hemodynamic compromise. Also thanks to echocardiography, the features of the well-known sepsis-related myocardial dysfunction have been better characterized. Furthermore, many of the recent echocardiographic indices of volume responsiveness have been validated in populations of septic shock patients. Conclusion Although not proven yet in terms of patient outcome, echocardiography can be regarded as an ideal monitoring tool in the septic patient, as it allows (a) first line differential diagnosis of shock and early recognition of sepsis-related myocardial dysfunction; (b) detection of preexisting cardiac pathology, that yields precious information in septic shock management; (c) comprehensive hemodynamic monitoring through a systematic approach based on repeated bedside assessment; (d) integration with other monitoring devices; and (e) screening for cardiac source of sepsis.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Echocardiography in the sepsis syndromes

2011

View full text Add to dashboard Cite

show abstract

“…2 Relationship between total respiratory excursion in central venous pressure from end-expiration to end-inspiration (CVP ee -CVP ei ) and the change in intra-abdominal pressure due to expiratory muscle activity (DIAP). Closed circles represent patients whose DIAP was B3 mmHg until the CVP is 8-12 mmHg, after which alternative methods of hemodynamic support are employed [2,3]. Even modest expiratory muscle activity could cause the CVP to exceed 12 mmHg, potentially leading to inadequate fluid loading.…”

Section: Discussionmentioning

confidence: 99%

“…Central venous pressure (CVP) is commonly used to manage fluid therapy in the intensive care unit (ICU) and is a key component of early goal-directed therapy of septic shock [1][2][3]. Although CVP may not reliably predict fluid responsiveness over a wide range of values [4][5][6], a positive response to fluid is unlikely when the CVP is very high [7,8].…”

Section: Introductionmentioning

confidence: 99%

Use of expiratory change in bladder pressure to assess expiratory muscle activity in patients with large respiratory excursions in central venous pressure

et al. 2012

View full text Add to dashboard Cite

Patients with large respiratory excursions in CVP often have significant expiratory muscle activity that will cause their CVP to overestimate transmural right atrial pressure. The magnitude of expiratory muscle activity can be assessed by measuring ΔIAP. Subtracting ΔIAP from the end-expiratory CVP usually provides a reasonable estimate of the CVP that would be obtained if exhalation were passive.

show abstract

“…Although advances have been made in the knowledge of sepsis in the last decades and the establishment of an international campaign for the improvement of care of patients with this disorder (2), it is still one of the most important causes of death in intensive care units (3). In Brazil, there has been an estimate of 400,000 new cases of sepsis every year (4), and the mortality rates for septic shock are still as high as 56% (5).…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic and Perfusion End Points for Volemic Resuscitation in Sepsis

Ramos

Azevedo²

2010

Shock

View full text Add to dashboard Cite

Sepsis is the systemic inflammatory response syndrome secondary to a local infection, and severe sepsis and septic shock are the more devastating scenarios of this disease. In the last decade, considerable achievements were obtained in sepsis knowledge, and an international campaign was developed to improve the treatment of this condition. However, sepsis is still one of the most important causes of death in intensive care units. The early stages of sepsis are characterized by a variety of hemodynamic derangements that induce a systemic imbalance between tissue oxygen supply and demand, leading to global tissue hypoxia. This dysfunction, which may occur in patients presenting normal vital signs, can be accompanied by a significant increase in both morbidity and mortality. The early identification of high-risk sepsis patients through tissue perfusion markers such as lactate and venous oxygen saturation is crucial for prompt initiation of therapeutic support, which includes early goal-directed therapy as necessary. The purpose of this article was to review the most commonly used hemodynamic and perfusion parameters for hemodynamic optimization in sepsis, emphasizing the physiological background for their use and the studies that demonstrated their effectiveness as goals of volemic resuscitation.

show abstract

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

Cited by 185 publications

References 1 publication

Echocardiography in the sepsis syndromes

Echocardiography in the sepsis syndromes

Use of expiratory change in bladder pressure to assess expiratory muscle activity in patients with large respiratory excursions in central venous pressure

Hemodynamic and Perfusion End Points for Volemic Resuscitation in Sepsis

Contact Info

Product

Resources

About