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2.
Discov Med ; 29(158): 201-209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007195

RESUMO

Sepsis is an important disorder in intensive care medicine, and the emphasis is not on infections but the imbalance in body reactions and life-threatening organ dysfunction. The infection, the imbalance in the body's reaction, and the deadly organ dysfunction are three aspects of sepsis. Currently, there is still a debate on suitable criteria for the diagnosis of patients with sepsis with continuing changes in the guidelines on sepsis management. Here we summarize recent advances on the definitions, diagnosis, and treatment in the clinical practice of sepsis management in the emergency department. We also highlight future research directions on sepsis. In particular, given the global outbreak of coronavirus disease 2019 (COVID-19), we briefly describe the relationship between COVID-19 and sepsis. How to manage sepsis caused by emerging pathogens such as COVID-19 is a new challenge for care professionals in the emergency department.


Assuntos
Betacoronavirus/patogenicidade , Doenças Transmissíveis Emergentes/terapia , Infecções por Coronavirus/terapia , Tratamento de Emergência/métodos , Pneumonia Viral/terapia , Sepse/terapia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Doenças Transmissíveis Emergentes/complicações , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sepse/diagnóstico , Sepse/virologia , Índice de Gravidade de Doença
3.
Pediatr Crit Care Med ; 21(11): e1031-e1037, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32886460

RESUMO

Severe acute respiratory syndrome coronavirus 2 is a novel cause of organ dysfunction in children, presenting as either coronavirus disease 2019 with sepsis and/or respiratory failure or a hyperinflammatory shock syndrome. Clinicians must now consider these diagnoses when evaluating children for septic shock and sepsis-associated organ dysfunction. The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children provide an appropriate framework for the early recognition and initial resuscitation of children with sepsis or septic shock caused by all pathogens, including severe acute respiratory syndrome coronavirus 2. However, the potential benefits of select adjunctive therapies may differ from non-coronavirus disease 2019 sepsis.


Assuntos
Infecções por Coronavirus/complicações , Pediatria/normas , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Sepse/terapia , Algoritmos , Atitude Frente a Saúde , Betacoronavirus , Criança , Cuidados Críticos/normas , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Pandemias , Ressuscitação/normas , Sepse/etiologia , Choque Séptico/etiologia , Choque Séptico/terapia , Vasoconstritores/uso terapêutico
5.
Emerg Med Clin North Am ; 38(4): 807-818, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981619

RESUMO

Sepsis care has evolved significantly since the initial early goal-directed therapy (EGDT) trials. Early fluid resuscitation, source control, and antibiotic therapy remain cornerstones of care but overall understanding is more nuanced, particularly regarding fluid selection, vasopressors, and inotropic support. Timely nutrition therapy and ventilatory support tend to receive less attention but also are important. Recent research has explored immunomodulation, ß-blockade, and vitamin supplementation. A renewed emphasis on early, aggressive resuscitation reaffirms the importance of emergency medicine providers knowledgeable and skilled in sepsis management.


Assuntos
Ressuscitação/métodos , Sepse/terapia , Angiotensina II/uso terapêutico , Antibacterianos/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Glicemia/análise , Pressão Sanguínea , Cardiomiopatias/etiologia , Cardiomiopatias/terapia , Cardiotônicos/uso terapêutico , Estado Terminal , Serviço Hospitalar de Emergência , Nutrição Enteral , Hidratação , Glucocorticoides/uso terapêutico , Hemodinâmica , Humanos , Escores de Disfunção Orgânica , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Vasoconstritores/uso terapêutico
6.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
7.
Emerg Med Clin North Am ; 38(4): 857-869, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981622

RESUMO

The obesity pandemic now affects hundreds of millions of people worldwide. As obesity rates continue to increase, emergency physicians are called on with increasing frequency to resuscitate obese patients. This article discusses important anatomic, physiologic, and practical challenges imposed by obesity on resuscitative care. Impacts on hemodynamic monitoring, airway and ventilator management, and pharmacologic therapy are discussed. Finally, several important clinical scenarios (trauma, cardiac arrest, and sepsis), in which alterations to standard treatments may benefit obese patients, are highlighted.


Assuntos
Obesidade/complicações , Ressuscitação/métodos , Manuseio das Vias Aéreas/métodos , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Composição Corporal , Fármacos Cardiovasculares/administração & dosagem , Doenças Cardiovasculares/complicações , Relação Dose-Resposta a Droga , Serviço Hospitalar de Emergência , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Medidas de Volume Pulmonar , Consumo de Oxigênio , Farmacocinética , Respiração com Pressão Positiva , Sepse/complicações , Sepse/terapia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
8.
Internist (Berl) ; 61(10): 1010-1016, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32897403

RESUMO

BACKGROUND: Despite ongoing development, mortality in sepsis remains considerable. Various techniques for extracorporeal cytokine removal have been described, but evidence remains conflicting. OBJECTIVES: The aim of this article is to summarize currently used extracorporeal blood purification techniques and their evidence. METHODS: Non-systematic literature review RESULTS: There are currently various blood purification techniques used with different levels of evidence regarding cytokine removal, vasopressor sparing effects and reduction of mortality, including high-volume dialysis with and without high cut-off filters, special adsorption filters (including CytoSorb®, CytoSorbents Europe, Berlin, Germany, and polymyxin­B filters). There is development regarding therapeutic plasma exchange. For some blood purification techniques such as combined plasma filtration and adsorption, multicentric randomized studies found a negative effect on survival. CONCLUSIONS: Despite a theoretical rationale, the use of blood purification methods cannot be recommended for sepsis patients due to the lack of evidence of their efficacy. Heterogeneous inflammatory responses in sepsis render conduction of larger trials difficult. Thus, future studies should cautiously identify appropriate sepsis subtypes to be included. Available techniques should be chosen as individualized complementary treatments and not as competing systems.


Assuntos
Circulação Extracorpórea/métodos , Hemofiltração , Sepse/terapia , Humanos
9.
Br Dent J ; 229(6): 363-370, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32978579

RESUMO

The management of odontogenic infections has improved over recent decades, but further improvements are still required. The ongoing education of GDPs and their dental teams on this issue continues to be important, especially during the current COVID-19 pandemic, where remote triage poses additional difficulties and challenges.Odontogenic infections can lead to sepsis, a potentially life-threatening condition caused by the body's immune system responding in an abnormal way. This can lead to tissue damage, organ failure and death. A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Early recognition and prompt management of sepsis improves outcomes. GDPs and their dental teams should be trained in the recognition and management of sepsis. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis.The aim of this article is to provide an update on the management of odontogenic infections and sepsis.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Sepse , Doenças Dentárias , Betacoronavirus , Humanos , Infecções/complicações , Sepse/diagnóstico , Sepse/terapia
11.
Transplantation ; 104(8): 1662-1667, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732845

RESUMO

BACKGROUND: Centers for Medicare and Medicaid Services (CMS) has proposed a rule change to redefine the metric by which organ procurement organizations (OPOs) are evaluated. The metric relies on Centers for Disease Control and Prevention (CDC) data on inpatient deaths from causes consistent with donation among patients <75 years of age. Concerns have been raised that this metric does not account for rates of ventilation, and prevalence of cancer and severe sepsis, without objective data to substantiate or refute such concerns. METHODS: We estimated OPO-level donation rates using CDC data, and used Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project data from 43 State Inpatient Databases to calculate "adjusted" donation rates. RESULTS: The CMS metric and the ventilation-adjusted CMS metric were highly concordant in absolute terms (Spearman and Pearson correlation coefficients ≥0.95). In the Bland-Altman plot, 100% (48/48) of paired values (standard deviations [SDs] of the CMS and "ventilation adjusted" metrics) were within 1.96 SDs of the mean difference, with near-perfect correlation in Passing and Bablok regression (Lin's concordance correlation coefficient: 0.97). The CMS metric and the ventilation/cancer/sepsis-adjusted metric were highly concordant in absolute terms (Spearman and Pearson correlation coefficients ≥0.94). In the Bland-Altman plot, 97.9% (47/48) of paired values (SDs of the CMS and "ventilation/cancer/sepsis adjusted" metrics) were within 1.96 SDs of the mean difference, with near-perfect correlation in the Passing and Bablok regression (Lin's concordance correlation coefficient: 0.97). CONCLUSIONS: These conclusions should provide CMS, and the transplant community, with comfort that the proposed CMS metric using CDC inpatient death data as a tool to compare OPO is not compromised by its lack of inclusion of ventilation or other comorbidity data.


Assuntos
Benchmarking/normas , Centers for Medicare and Medicaid Services, U.S./normas , Transplante de Rim/normas , Insuficiência Renal Crônica/terapia , Obtenção de Tecidos e Órgãos/organização & administração , Fatores Etários , Idoso , Benchmarking/métodos , Causas de Morte , Comorbidade , Mortalidade Hospitalar , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Insuficiência Renal Crônica/mortalidade , Respiração Artificial/estatística & dados numéricos , Sepse/diagnóstico , Sepse/epidemiologia , Sepse/terapia , Índice de Gravidade de Doença , Obtenção de Tecidos e Órgãos/normas , Estados Unidos/epidemiologia
13.
Crit Care ; 24(1): 493, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778146

RESUMO

BACKGROUND: Administration of dexmedetomidine has been reported to improve inflammatory response in animals. We explored the effects of administering dexmedetomidine on the levels of C-reactive protein (CRP) and procalcitonin, and thus on inflammation, in patients with sepsis enrolled in a randomized clinical trial. METHODS: The DESIRE trial was a multicenter randomized clinical trial in which adult patients with sepsis were sedated with (DEX group) or without (non-DEX group) dexmedetomidine while on mechanical ventilators. As a prespecified sub-analysis, we compared CRP and procalcitonin levels during the first 14 days of treatment between the two groups. The 14-day mortality rate, albumin level, and the number of patients with disseminated intravascular coagulation (DIC) were also assessed. We used generalized linear models to estimate the differences in these outcomes between groups. We also used the Kaplan-Meier method to estimate the 14-day mortality rate and the log-rank test to assess between-group differences. RESULTS: Our study comprised 201 patients: 100 in the DEX group and 101 in the non-DEX group. CRP and procalcitonin levels were lower in the DEX vs. non-DEX group during the 14-day treatment period [CRP-range, 5.6-20.3 vs. 8.3-21.1 mg/dL (P = 0.03); procalcitonin-range, 1.2-37.4 vs. 1.7-52.9 ng/mL (P = 0.04)]. Albumin levels were higher in the DEX group (range, 2.3-2.6 g/dL) than in the non-DEX group (range, 2.1-2.7 g/dL; P = 0.01). The percentage of patients with DIC did not significantly differ between the groups (range, 21-59% and 17-56% for the DEX and non-DEX groups, respectively; P = 0.49). The 14-day mortality rates in the DEX and non-DEX groups were 13 and 21%, respectively (P = 0.16). CONCLUSION: Sedation using dexmedetomidine reduced inflammation in patients with sepsis requiring mechanical ventilation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01760967 . Registered on 4 January 2013.


Assuntos
Dexmedetomidina/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Inflamação/prevenção & controle , Respiração Artificial , Sepse/terapia , Idoso , Proteína C-Reativa/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina/sangue , Sepse/sangue , Resultado do Tratamento
14.
Am J Respir Crit Care Med ; 202(7): 1005-1012, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32614246

RESUMO

Rationale: Tissue Doppler imaging (TDI) is an echocardiographic method that measures the velocity of moving tissue.Objectives: We applied this technique to the diaphragm to assess the velocity of diaphragmatic muscle motion during contraction and relaxation.Methods: In 20 healthy volunteers, diaphragmatic TDI was performed to assess the pattern of diaphragmatic motion velocity, measure its normal values, and determine the intra- and interobserver variability of measurements. In 116 consecutive ICU patients, diaphragmatic excursion, thickening, and TDI parameters of peak contraction velocity, peak relaxation velocity, velocity-time integral, and TDI-derived maximal relaxation rate were assessed during weaning. In a subgroup of 18 patients, transdiaphragmatic pressure (Pdi)-derived parameters (peak Pdi, pressure-time product, and diaphragmatic maximal relaxation rate) were recorded simultaneously with TDI.Measurements and Main Results: In terms of reproducibility, the intercorrelation coefficients were >0.89 for all TDI parameters (P < 0.001). Healthy volunteers and weaning success patients exhibited lower values for all TDI parameters compared with weaning failure patients, except for velocity-time integral, as follows: peak contraction velocity, 1.35 ± 0.34 versus 1.50 ± 0.59 versus 2.66 ± 2.14 cm/s (P < 0.001); peak relaxation velocity, 1.19 ± 0.39 versus 1.53 ± 0.73 versus 3.36 ± 2.40 cm/s (P < 0.001); and TDI-maximal relaxation rate, 3.64 ± 2.02 versus 10.25 ± 5.88 versus 29.47 ± 23.95 cm/s2 (P < 0.001), respectively. Peak contraction velocity was strongly correlated with peak transdiaphragmatic pressure and pressure-time product, whereas Pdi-maximal relaxation rate was significantly correlated with TDI-maximal relaxation rate.Conclusions: Diaphragmatic tissue Doppler allows real-time assessment of the diaphragmatic tissue motion velocity. Diaphragmatic TDI-derived parameters differentiate patients who fail a weaning trial from those who succeed and correlate well with Pdi-derived parameters.


Assuntos
Estado Terminal , Diafragma/diagnóstico por imagem , Contração Muscular/fisiologia , Ultrassonografia Doppler/métodos , Desmame do Respirador , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos , Coma/fisiopatologia , Coma/terapia , Diafragma/fisiologia , Diafragma/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/fisiopatologia , Traumatismo Múltiplo/terapia , Procedimentos Neurocirúrgicos , Período Pós-Operatório , Pressão , Reprodutibilidade dos Testes , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Sepse/fisiopatologia , Sepse/terapia , Resultado do Tratamento
15.
Eur Respir Rev ; 29(157)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32699026

RESUMO

According to the Third International Consensus Definition for Sepsis and Septic Shock, sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Epidemiological data about sepsis from the 2017 Global Burden of Diseases, Injuries and Risk Factor Study showed that the global burden of sepsis was greater than previously estimated. Bacteria have been shown to be the predominant pathogen of sepsis among patients with pathogens detected, while sepsis caused by viruses is underdiagnosed worldwide. The coronavirus disease that emerged in 2019 in China and now in many other countries has brought viral sepsis back into the vision of physicians and researchers worldwide. Although the current understanding of the pathophysiology of sepsis has improved, the differences between viral and bacterial sepsis at the level of pathophysiology are not well understood. Diagnosis methods that can broadly differentiate between bacterial and viral sepsis at the initial stage after the development of sepsis are limited. New treatments that can be applied at clinics for sepsis are scarce and this situation is not consistent with the growing understanding of pathophysiology. This review aims to give a brief summary of current knowledge of the epidemiology, pathophysiology, diagnosis and treatment of viral sepsis.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Sepse/diagnóstico , Sepse/epidemiologia , Causas de Morte , China/epidemiologia , Consenso , Coronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Vírus Sinciciais Respiratórios/isolamento & purificação , Infecções Respiratórias/terapia , Medição de Risco , Sepse/terapia , Choque Séptico/diagnóstico , Choque Séptico/epidemiologia , Choque Séptico/terapia , Análise de Sobrevida
16.
Nat Commun ; 11(1): 3384, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32636379

RESUMO

Targeting single mediators has failed to reduce the mortality of sepsis. We developed a telodendrimer (TD) nanotrap (NT) to capture various biomolecules via multivalent, hybrid and synergistic interactions. Here, we report that the immobilization of TD-NTs in size-exclusive hydrogel resins simultaneously adsorbs septic molecules, e.g. lipopolysaccharides (LPS), cytokines and damage- or pathogen-associated molecular patterns (DAMPs/PAMPs) from blood with high efficiency (92-99%). Distinct surface charges displayed on the majority of pro-inflammatory cytokines (negative) and anti-inflammatory cytokines (positive) allow for the selective capture via TD NTs with different charge moieties. The efficacy of NT therapies in murine sepsis is both time-dependent and charge-dependent. The combination of the optimized NT therapy with a moderate antibiotic treatment results in a 100% survival in severe septic mice by controlling both infection and hyperinflammation, whereas survival are only 50-60% with the individual therapies. Cytokine analysis, inflammatory gene activation and tissue histopathology strongly support the survival benefits of treatments.


Assuntos
Dendrímeros/química , Inflamação/terapia , Nanopartículas/química , Sepse/terapia , Adsorção , Animais , Antibacterianos/uso terapêutico , Citocinas/metabolismo , Feminino , Humanos , Hidrogéis , Lipopolissacarídeos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Nanomedicina , Padrões Moleculares Associados a Patógenos , Células RAW 264.7
18.
Med Klin Intensivmed Notfmed ; 115(7): 609-619, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32725325

RESUMO

Sepsis represents a life-threatening condition that frequently accompanies acute hepatic dysfunction. As a result of systemic inflammation, immune dysregulation, and microcirculatory derangements, different types of liver dysfunction can occur, such as hypoxic hepatitis, sepsis-associated cholestasis, or liver failure. A very serious and late sequela is secondary sclerosing cholangitis of the critically ill patient. Clinical management of sepsis-related liver dysfunction includes the rapid identification and treatment of the suspected underlying infection, hemodynamic stabilization to improve hepatic perfusion, and the optimization of oxygen delivery to the liver. Despite maximum efforts in supportive treatment, the outcome of patients with sepsis or septic shock and concomitant severe hepatic dysfunction remains very poor.


Assuntos
Sepse , Choque Séptico , Estado Terminal , Humanos , Microcirculação , Sepse/diagnóstico , Sepse/terapia
19.
PLoS One ; 15(7): e0236339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697796

RESUMO

BACKGROUND: Indigenous Australians suffer a disproportionate burden of sepsis, however, the performance of scoring systems that predict mortality in Indigenous patients with critical illness is incompletely defined. MATERIALS AND METHODS: The study was performed at an Australian tertiary-referral hospital between January 2014 and June 2017, and enrolled consecutive Indigenous and non-Indigenous adults admitted to ICU with sepsis. The ability of the ANZROD, APACHE-II, APACHE-III, SAPS-II, SOFA and qSOFA scores to predict death before ICU discharge in the two populations was compared. RESULTS: There were 442 individuals enrolled in the study, 145 (33%) identified as Indigenous. Indigenous patients were younger than non-Indigenous patients (median (interquartile range (IQR) 53 (43-60) versus 65 (52-73) years, p = 0.0001) and comorbidity was more common (118/145 (81%) versus 204/297 (69%), p = 0.005). Comorbidities that were more common in the Indigenous patients included diabetes mellitus (84/145 (58%) versus 67/297 (23%), p<0.0001), renal disease (56/145 (39%) versus 29/297 (10%), p<0.0001) and cardiovascular disease (58/145 (40%) versus 83/297 (28%), p = 0.01). The use of supportive care (including vasopressors, mechanical ventilation and renal replacement therapy) was similar in Indigenous and non-Indigenous patients, and the two populations had an overall case-fatality rate that was comparable (17/145 (12%) and 38/297 (13%) (p = 0.75)), although Indigenous patients died at a younger age (median (IQR): 54 (50-60) versus 70 (61-76) years, p = 0.0001). There was no significant difference in the ability of any the scores to predict mortality in the two populations. CONCLUSIONS: Although the crude case-fatality rates of Indigenous and non-Indigenous Australians admitted to ICU with sepsis is comparable, Indigenous patients die at a much younger age. Despite this, the ability of commonly used scoring systems to predict outcome in Indigenous Australians is similar to that of non-Indigenous Australians, supporting their use in ICUs with a significant Indigenous patient population and in clinical trials that enrol Indigenous Australians.


Assuntos
Povos Indígenas/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Medição de Risco/métodos , Sepse/mortalidade , Índice de Gravidade de Doença , Fatores Etários , Idoso , Austrália/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/terapia , Vasoconstritores/uso terapêutico
20.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32605994

RESUMO

BACKGROUND: In 2013, New York introduced regulations mandating that hospitals develop pediatric-specific protocols for sepsis recognition and treatment. METHODS: We used hospital discharge data from 2011 to 2015 to compare changes in pediatric sepsis outcomes in New York and 4 control states: Florida, Massachusetts, Maryland, and New Jersey. We examined the effect of the New York regulations on 30-day in-hospital mortality using a comparative interrupted time-series approach, controlling for patient and hospital characteristics and preregulation temporal trends. RESULTS: We studied 9436 children admitted to 237 hospitals. Unadjusted pediatric sepsis mortality decreased in both New York (14.0% to 11.5%) and control states (14.4% to 11.2%). In the primary analysis, there was no significant effect of the regulations on mortality trends (differential quarterly change in mortality in New York compared with control states: -0.96%; 95% confidence interval [CI]: -1.95% to 0.02%; P = .06). However, in a prespecified sensitivity analysis excluding metropolitan New York hospitals that participated in earlier sepsis quality improvement, the regulations were associated with improved mortality trends (differential change: -2.08%; 95% CI: -3.79% to -0.37%; P = .02). The regulations were also associated with improved mortality trends in several prespecified subgroups, including previously healthy children (differential change: -1.36%; 95% CI: -2.62% to -0.09%; P = .04) and children not admitted through the emergency department (differential change: -2.42%; 95% CI: -4.24% to -0.61%; P = .01). CONCLUSIONS: Implementation of statewide sepsis regulations was generally associated with improved mortality trends in New York State, particularly in prespecified subpopulations of patients, suggesting that the regulations were successful in affecting sepsis outcomes.


Assuntos
Avaliação de Resultados em Cuidados de Saúde , Sepse/mortalidade , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Análise de Séries Temporais Interrompida , Masculino , Avaliação de Resultados em Cuidados de Saúde/legislação & jurisprudência , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/terapia , Estados Unidos/epidemiologia
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