Glycaemic variability in patients with severe sepsis or septic shock admitted to an Intensive Care Unit.

Background:  Sepsis is associated with morbidity and mortality, which implies high costs to the global health system. Metabolic alterations that increase glycaemia and glycaemic variability occur during sepsis.

Objective:  To verify mean body glucose levels and glycaemic variability in Intensive Care Unit (ICU) patients with severe sepsis or septic shock.

Method:  Retrospective and exploratory study that involved collection of patients’ sociodemographic and clinical data and calculation of severity scores. Glycaemia measurements helped to determine glycaemic variability through standard deviation and mean amplitude of glycaemic excursions.

Results:  Analysis of 116 medical charts and 6730 glycaemia measurements revealed that the majority of patients were male and aged over 60 years. Surgical treatment was the main reason for ICU admission. High blood pressure and diabetes mellitus were the most usual comorbidities. Patients that died during the ICU stay presented the highest SOFA scores and mean glycaemia; they also experienced more hypoglycaemia events. Patients with diabetes had higher mean glycaemia, evaluated through standard deviation and mean amplitude of glycaemia excursions.

Conclusion:  Organic impairment at ICU admission may underlie glycaemic variability and lead to a less favourable outcome. High glycaemic variability in patients with diabetes indicates that monitoring of these individuals is crucial to ensure better outcomes.

This article by Silveira and colleagues was published in Intensive & critical care nursing; August 2017.  Library members can order the full text of this and other articles via the Rotherham NHS Foundation Trust Library and Knowledge Service website using the article requests online via this link.

Sepsis Intervention Bundle and In-Hospital Mortality

Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality | Anesthesia & Analgesia

Background: We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data.

Conclusions: The University of California, San Francisco, sepsis bundle was associated with a decreased risk of in-hospital mortality across hospital units after robust control for confounders and risk adjustment. The adjusted NNT provides a reasonable and achievable goal to observe measureable improvements in outcomes for patients diagnosed with SS/SS.

Full reference: Prasad, P.A. et al. (2017) Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data. Anesthesia & Analgesia. Vol. 125 (Issue 2) pp. 507–513

Early Antibiotics & Fluids Key in Sepsis Management

Sepsis and septic shock are medical emergencies that require immediate action | Anesthesiology News

Early resuscitation should begin with early antibiotics and fluids, as well as the identification of the source of infection, according to new guidelines that were released at the Society of Critical Care Medicine’s (SCCM) 2017 Critical Care Congress.

In addition, the new guidelines say a health care provider who is trained and skilled in the management of sepsis should reassess the patient frequently at the bedside. “It is not the initial assessment, but the frequent reassessment that will make a difference,” said Andrew Rhodes, MD, FRCP, FRCA, FFICM, the co-chair of the guidelines committee.

Read the full news story here

Latest issue of “Journal of Critical Care” Volume 39 June 2017

This issue includes articles on the “Effect of ulinastatin combined with thymosin alpha 1 on sepsis: a systematic review and meta-analysis of Chinese and Indian patients”, “The accuracy of the bedside swallowing evaluation for detecting aspiratiojournal of critical care.pngn in survivors of acute respiratory failure” and “Acute kidney injury is an independent risk factor for myocardial injury after non cardiac surgery in critical patients”.

The contents page of this latest issue can be accessed via this link

To access the full text of these articles direct from the journal’s homepage you require a personal subscription to the journal.  Individual articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.

Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation with Sepsis

This randomised clinical trial by Kawazoe and colleagues is part of the Dexmedetomidine for Sepsis in Intensive Care Unit Randomized Evaluation (DESIRE) Trial.  It was published in the Journal of the American Medical Association (JAMA) in April 2017.  The physical journal is available in Rotherham Health Care Library.  The electronic version of this article is available via this link with a Rotherham NHS Athens Password.

Importance:  Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis.

Objectives:  To examine whether a sedation strategy with dexmedetomidine can improve clinical outcomes in patients with sepsis undergoing ventilation.

Design, Setting, and Participants:  Open-label, multicenter randomized clinical trial conducted at 8 intensive care units in Japan from February 2013 until January 2016 among 201 consecutive adult patients with sepsis requiring mechanical ventilation for at least 24 hours.

Interventions:  Patients were randomized to receive either sedation with dexmedetomidine (n = 100) or sedation without dexmedetomidine (control group; n = 101). Other agents used in both groups were fentanyl, propofol, and midazolam.

Main Outcomes and Measures:  The co-primary outcomes were mortality and ventilator-free days (over a 28-day duration). Sequential Organ Failure Assessment score (days 1, 2, 4, 6, 8), sedation control, occurrence of delirium and coma, intensive care unit stay duration, renal function, inflammation, and nutrition state were assessed as secondary outcomes.

Results:  Of the 203 screened patients, 201 were randomized. The mean age was 69 years (SD, 14 years); 63% were male. Mortality at 28 days was not significantly different in the dexmedetomidine group vs the control group (19 patients [22.8%] vs 28 patients [30.8%]; hazard ratio, 0.69; 95% CI, 0.38-1.22; P = .20). Ventilator-free days over 28 days were not significantly different between groups (dexmedetomidine group: median, 20 [interquartile range, 5-24] days; control group: median, 18 [interquartile range, 0.5-23] days; P = .20). The dexmedetomidine group had a significantly higher rate of well-controlled sedation during mechanical ventilation (range, 17%-58% vs 20%-39%; P = .01); other outcomes were not significantly different between groups. Adverse events occurred in 8 (8%) and 3 (3%) patients in the dexmedetomidine and control groups, respectively.

Conclusions and Relevance:  Among patients requiring mechanical ventilation, the use of dexmedetomidine compared with no dexmedetomidine did not result in statistically significant improvement in mortality or ventilator-free days. However, the study may have been underpowered for mortality, and additional research may be needed to evaluate this further.

Latest issue of Critical Care Reviews Newsletter 280 23rd April 2017

The 280th Critical Care Reviews Newsletter provides the best critical care research and open access articles from across the medical literature over the past seven days.  The highlights of this week’s edition are a randomised controlled trial examining immunoglobulin G for patients with necrotising soft tissue infection and a feasibility trial investigating corticosteroids in paediatric septic shock; review articles on arginine in the critically ill, nutrition and metabolism in burn patients and pre-hospital ultrasound; as well as three excellent study critiques on FLORALI, HELMET-NIV and targeted temperature management in deceased organ donors.

The full newsletter can be accessed via this link.

Latest Issue of “Intensive Care Medicine” Volume 43 Number 5

intensive-care-medicine

To view Intensive Care Medicine’s latest issue’s contents page follow this link.

Articles included in this issue are a review of “Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future” and “Monitoring dynamic arterial elastance as a means of decreasing the duration of norepinephrine treatment in vasoplegic syndrome following cardiac surgery: a prospective, randomized trial”

To read the full text of these articles from the journal’s homepage requires a personal subscription to “Intensive Care Medicine”.  Individual articles can be ordered from the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.

The full text of articles from issues older than one year ago is available via this link to an archive of issues of Intensive Care Medicine.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.