Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

Timsit, Jean‐François; Citerio, Giuseppe; Bakker, Jan; Bassetti, Matteo; Benoît, Dominique; Cecconi, Maurizio; Curtis, J. Randall; Hernández, Glenn; Herridge, Margaret S.; Jaber, Samir; Joannidis, Michael; Papazian, Laurent; Peters, Mark; Singer, Pierre; Smith, Martin; Soares, Márcio; Torres, Antoni; Vieillard‐Baron, Antoine; Azoulay, Élie

doi:10.1007/s00134-014-3235-6

Cited by 8 publications

(7 citation statements)

References 73 publications

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“…In our study, the addition of LSF provided only a trend for lower hospital costs and higher effectiveness (i.e., microbiological diagnostic yield) for patients with SES. This was probably because the length of ICU stay was not affected by the earlier identification of micro-organisms, as also observed in other studies [ 8 ].…”

Section: Discussionsupporting

confidence: 68%

“…The first is that we present our results in 2016 when sepsis definitions have changed [ 41 ]. The strengths of our study remain since the patient characteristics were as severe as recent cohorts examined with the new sepsis criteria [ 8 , 38 ]. The second limitation is the LSF test itself since it does not provide antimicrobial susceptibility testing results, as well as the most recent kits of this kind [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Infective endocarditis is also increasing in incidence, with high mortality and morbidity [ 4 , 5 ]. Early initiation of appropriate antimicrobial therapy reduces the morbidity and mortality of these severe infections, prompting the prescription of broad-spectrum antimicrobial agents before the results of microbiological diagnosis (MD) are known [ 6 – 8 ]. This empirical first-line therapy is one of the factors explaining the increase in antimicrobial-resistance prevalence [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Performance and economic evaluation of the molecular detection of pathogens for patients with severe infections: the EVAMICA open-label, cluster-randomised, interventional crossover trial

Cambau

Durand‐Zaleski

Bretagne³

et al. 2017

Intensive Care Med

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PurposeMicrobiological diagnosis (MD) of infections remains insufficient. The resulting empirical antimicrobial therapy leads to multidrug resistance and inappropriate treatments. We therefore evaluated the cost-effectiveness of direct molecular detection of pathogens in blood for patients with severe sepsis (SES), febrile neutropenia (FN) and suspected infective endocarditis (SIE).MethodsPatients were enrolled in a multicentre, open-label, cluster-randomised crossover trial conducted during two consecutive periods, randomly assigned as control period (CP; standard diagnostic workup) or intervention period (IP; additional testing with LightCycler®SeptiFast). Multilevel models used to account for clustering were stratified by clinical setting (SES, FN, SIE).ResultsA total of 1416 patients (907 SES, 440 FN, 69 SIE) were evaluated for the primary endpoint (rate of blood MD). For SES patients, the MD rate was higher during IP than during CP [42.6% (198/465) vs. 28.1% (125/442), odds ratio (OR) 1.89, 95% confidence interval (CI) 1.43–2.50; P < 0.001], with an absolute increase of 14.5% (95% CI 8.4–20.7). A trend towards an association was observed for SIE [35.4% (17/48) vs. 9.5% (2/21); OR 6.22 (0.98–39.6)], but not for FN [32.1% (70/218) vs. 30.2% (67/222), P = 0.66]. Overall, turn-around time was shorter during IP than during CP (22.9 vs. 49.5 h, P < 0.001) and hospital costs were similar (median, mean ± SD: IP €14,826, €18,118 ± 17,775; CP €17,828, €18,653 ± 15,966). Bootstrap analysis of the incremental cost-effectiveness ratio showed weak dominance of intervention in SES patients.ConclusionAddition of molecular detection to standard care improves MD and thus efficiency of healthcare resource usage in patients with SES. ClinicalTrials.gov registration number: NCT00709358.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4766-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Performance and economic evaluation of the molecular detection of pathogens for patients with severe infections: the EVAMICA open-label, cluster-randomised, interventional crossover trial

Cambau

Durand‐Zaleski

Bretagne³

et al. 2017

Intensive Care Med

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“…There is significant variability and heterogeneity in the approach to initial fluid resuscitation [29], with the type and volume of resuscitation fluid, specific immediate goals for fluid therapy and approaches adapted to monitoring hemodynamic and fluid status varying from patient to patient and from practitioner to practitioner [13]. Macro-circulatory goals are currently recognized as poor indicators of microcirculation, especially in sepsis and septic shock [30].…”

Section: Discussionmentioning

confidence: 99%

Early fluid accumulation in children with shock and ICU mortality: a matched case–control study

et al. 2015

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“…However, the ability of crystalloids to expand the intravascular volume is poor and several prior studies have reported that less than 5% of a crystalloid bolus remains in the intravascular space at one hour after the end of the infusion [20,21]. Macrocirculatory goals such as blood pressure or central venous pressure are currently recognized as poor indicators of microcirculation, especially in sepsis and septic shock [22]. Moreover, the microvasculature plays an independent role in tissue perfusion and oxygenation that may not be in uenced by macrovascular alteration [23].…”

Section: Discussionmentioning

confidence: 99%

The effects of fluid therapy during the first 12 hours from septic shock onset in pediatric patients

Kim

Park

et al. 2020

Preprint

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Background: Initial fluid therapy is the cornerstone of hemodynamic resuscitation in pediatric patients suffering from septic shock. This study aimed to evaluate the association between fluid therapy during the first 12 hours from septic shock onset and clinical outcomes in a pediatric cohort.Method: This was a retrospective, observational study of consecutive pediatric patients with septic shock admitted to our multidisciplinary pediatric intensive care unit (PICU) between January 2012 and December 2019. Total fluid administration within the first 12 hours from septic shock onset, patient characteristics, and outcome measurements were collected from validated electronic medical records. Results: A total of 144 cases were included with an overall 28-day mortality rate of 20.1%. Among the survivors, the proportion of fluid received within the first 3 hours (36.9 % vs 25.4%, p=.004) and within the last 3 hours (18.9 % vs 21.3 %, p=.031) of the total amount administered over a 12 hour period from septic shock onset showed a significant difference compared with the non-survivors. The mortality rate was lower in the group receiving the highest proportion of the total administered fluid within the first 3 hours (13.9 % vs 26.4 %, p=.048). Patients receiving the highest proportion of fluid in the last 3 hours had a significantly higher mortality rate (29.6 % vs 14.4 %, p=.025). By multivariable logistic regression analysis, we also found that a higher proportion of administered fluid within the first and last 3 hours was associated with decreased mortality (OR, 0.951; 95% CI, 0.918-0.986; p=.028) and increased mortality (OR, 2.761; 95% CI, 1.175-6.495; p=.020), respectively.Conclusions: An increased fluid intake within the first 3 hours of septic shock onset is associated with a decreased 28-day mortality. Moreover, a higher administration of fluids from 9 to 12 hours after this onset seems to be related to a poorer survival outcome. Treating pediatric septic shock cases with higher amounts of fluid within the first 3 hours of onset and then with more conservative levels thereafter may lead to better survival outcomes.

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Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

Cited by 8 publications

References 73 publications

Performance and economic evaluation of the molecular detection of pathogens for patients with severe infections: the EVAMICA open-label, cluster-randomised, interventional crossover trial

Performance and economic evaluation of the molecular detection of pathogens for patients with severe infections: the EVAMICA open-label, cluster-randomised, interventional crossover trial

Early fluid accumulation in children with shock and ICU mortality: a matched case–control study

The effects of fluid therapy during the first 12 hours from septic shock onset in pediatric patients

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