Infectious Disease and Sepsis Archives - Page 2 of 8 - PulmCCM
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Infectious Disease and Sepsis Articles

Nov 082013
 
Statins don't help in ventilator-associated pneumonia treatment

Statins have anti-inflammatory and immune-modulating effects, and among critically ill patients, continuing or starting statins have improved soft outcomes in observational and small randomized studies. For example, starting a statin reduced progression of sepsis in ward patients and statins improved organ failure scores in acute lung injury (the HARP trial). But in their first shot at [… read more]

Oct 292013
 
Esmolol infusion reduced septic shock mortality by 40% in RCT

Do I.V. Beta-Blockers Save Lives in Septic Shock? Catecholamines can be toxic — just ask anyone experiencing the heartbreak of tako-tsubo syndrome. Blocking the heart-flogging effects of the hormones epinephrine (adrenaline) and norepinephrine have long been known to improve long-term survival in congestive heart failure. People with septic shock might be the last group you’d consider giving [… read more]

Oct 222013
 

Ultrasound-guided central venous catheter insertion: Standard of care, or preventing procedural skills? By Dr. Philippe Rola Ok, so let me preface this with the fact that I walk around with a handheld ultrasound rather than a stethoscope, and that I examine ALL patients with a focused cardiopulmonary and abdominal exam. My bias towards bedside ultrasound is [… read more]

Oct 192013
 
Overnight intensivists unnecessary in well-staffed ICUs? (Meta-analysis)

24/7 Intensivist Coverage Does Not Improve Outcomes: Meta-Analysis The debate over whether ICUs should be staffed around the clock by intensivist physicians has simmered for more than 20 years, with opinions on both sides driven more by values and personal biases than evidence. Recent studies have confirmed the benefit of daytime intensivists in ICUs but failed [… read more]

Oct 062013
 
Mechanical ventilation in ARDS due to sepsis (Surviving Sepsis Guidelines)

Mechanical Ventilation in ARDS Due to Sepsis See All the Surviving Sepsis Guidelines Sepsis is one of the main causes of acute respiratory distress syndrome (ARDS), in which the lungs are injured by circulating inflammatory mediators, resulting in severely impaired gas exchange usually requiring invasive mechanical ventilation. ARDS also results in poor lung compliance in [… read more]

Sep 292013
 
Blood products for sepsis and septic shock (Surviving Sepsis Guidelines)

Transfusion of Blood Products for Sepsis and Septic Shock See all the Surviving Sepsis Guidelines People with severe sepsis and septic shock frequently experience what could be termed “hematologic failure” — abnormalities of blood cell lines and clotting / antithrombotic proteins that can occur in complex, protean patterns. Anemia, thrombocytopenia, leukopenia, disseminated intravascular coagulation, and [… read more]

Sep 132013
 
Vasopressors for septic shock (Surviving Sepsis Guidelines)

Vasopressors for Septic Shock (Surviving Sepsis Guidelines) See All the Surviving Sepsis Guidelines Vasopressors are provided for septic shock that does not respond to fluid resuscitation. Norepinephrine (Levophed), epinephrine, vasopressin, phenylephrine (Neo-Synephrine), and dopamine are the most commonly used vasopressors for septic shock. To achieve adequate fluid resuscitation, the Surviving Sepsis Guidelines advise at least 30 ml/kg [… read more]

Sep 052013
 

Following “Surviving Sepsis” Guidelines Not Always the Best Care By Dr. Philippe Rola First of all, I would like to commend those involved in the Surviving Sepsis Campaign’s Guidelines. It is a tremendous endeavour that, without a doubt, has heightened awareness and their growing implementation has and will save many lives. I would, however, also [… read more]

Sep 022013
 
Surviving Sepsis Guidelines 2013 - Review & Update

Surviving Sepsis Guidelines 2013 Review & Update The Surviving Sepsis Campaign launched in 2002 as a collaboration between the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, with the shared goal of reducing deaths from sepsis and septic shock around the world. The Surviving Sepsis Campaign periodically publishes its Surviving [… read more]

Sep 022013
 
Surviving Sepsis Guidelines: Diagnosis of Sepsis and Septic Shock

Diagnosis of Severe Sepsis and Septic Shock (from the Surviving Sepsis Guidelines) See all the Surviving Sepsis Guidelines Sepsis is defined as an infection (definite or suspected) with systemic manifestations (any 2 from a list). This definition may seem overly broad — it means that many people with colds and self-limited viral syndromes have sepsis [… read more]

Sep 022013
 
Surviving Sepsis Guidelines: Early Goal Directed Therapy, Initial Fluid Resuscitation

Initial Volume Resuscitation and EGDT for Severe Sepsis/Septic Shock See all the Surviving Sepsis Guidelines An approach including early goal directed therapy with aggressive initial fluid resuscitation has been considered a cornerstone of initial therapy for severe sepsis and septic shock, since a single-center randomized trial showed such a strategy initiated in the emergency department [… read more]

Sep 022013
 
Surviving Sepsis Guidelines: Initial Antibiotic / Antimicrobial Therapy

Initial Antibiotic / Antimicrobial Therapy in Severe Sepsis/Septic Shock For Sepsis, Use the Right Antibiotics at the Right Time (= As Early As Possible) See all the Surviving Sepsis Guidelines  The short version: Give appropriate and effective antibiotics as early as possible for patients known or suspected to be in severe sepsis or septic shock. [… read more]

Jun 262013
 
FDA warns against use of Hetastarch in ICU

U.S. FDA Advises Against Hetastarch Use in ICU European Agency Recommends Ban It was probably only a matter of time. In the wake of large randomized trials suggesting hydroxyethyl starches (HES or hetastarch) cause kidney injury and death in critically ill patients from sepsis and other causes, and the European Medicines Agency formally suggesting this month [… read more]

Jun 162013
 
Decontaminate all incoming ICU patients to reduce infections, says RCT

“Decolonizing” New ICU Patients Reduces Bloodstream Infections: NEJM This article had an erratum posted in NEJM: read more here. In humankind’s battle against bacteria, the ICU is the front line. And with MRSA infection rates doubling in the past 5 years, and the more recent and scary spread of lethal pan-resistant Enterobacteriae, lately the bugs have [… read more]

Jun 162013
 

By Dr. Philippe Rola I was recently scanning the literature in preparation for our symposium, and came across what should have been a 2003 instead of a 2013 publication in the March issue of the CCM Journal, entitled “Point-of-Care Ultrasound to estimate Central Venous Pressure:  A Comparison of Three Techniques.” I have to admit this [… read more]

May 202013
 
Staph vaccine fails in cardiothoracic surgery patients

Staph Vaccine Fails in Cardiothoracic Surgery Patients Staphyloccocus aureus wound infections and bacteremia commonly complicate cardiothoracic surgery, even with meticulous attention to infection prevention. Staph mediastinitis, a deep infection of the surgical wound, is particularly feared and lethal. Vance Fowler et al randomized 8,031 people undergoing sternotomy to receive the V710 vaccine against S. aureus, [… read more]

May 122013
 
Killer carbapenem-resistant bacteria spreading through LTACs

Killer Carbapenem-Resistant Bacteria Spreading Across U.S. Gut-living bacteria like Klebsiella are gaining resistance to carbapenems at an alarming rate, and long-term acute care hospitals (LTACs) and nursing homes seem to be the incubators for these killer bugs spreading across the U.S. Carbapenems  like meropenem and doripenem have been the gold standard to treat infections from [… read more]

Apr 242013
 
Using procalcitonin to guide antibiotics for pneumonia

Use of Procalcitonin to Reduce Unnecessary Antibiotics by Blair Westerly, MD Acute respiratory tract infections have a wide range of disease severity and the use of antibiotics for self-limited infections contributes to antibiotic overuse and antimicrobial resistance, though we have all probably been guilty of it a time or two when we just weren’t sure [… read more]

Mar 242013
 
Passive leg raise offers promise in predicting fluid responsiveness

“Like this … kind of” Passive Leg Raise Improved Management of Patients in Shock* (*some assembly required) by Blair Westerly, MD Providing the right amount of fluid is vital in a critically ill patient, as both too little and too much can result in poor outcomes. Yet even with this understanding, the clinical assessment of [… read more]

Mar 102013
 
Hope floats: Fecal transplants cure >90% of recurrent C. difficile (RCT)

Fecal Transplants Cure C. difficile Infections, When Drugs Can’t Antibiotics are what cause Clostridium difficile infection to emerge in the first place, so it’s perhaps no surprise that the usual treatment — more antibiotics — often fails. From 15-25% of patients with C. difficile are not permanently cured by their initial treatment with metronidazole, and among those [… read more]