Diagnostic Challenges in Sepsis SUMMARY There remains no single tool to reliably identify sepsis. A variety of approaches exist as well as on the horizon in order to identify infection and sepsis. Identification must bridge the identification of infection with clinical assessment of the sepsis syndrome. BACKGROUND
Two Standards of Sepsis Care - The Nighttime Effect SUMMARYQuick Sequential Organ Failure Assessment (qSOFA) has not provided the high predictive performance initially proposed.Modifications to qSOFA has been investigated as a way to improve performance, especially in the Emergency Department (ED).These simple modifications improve qSOFA, but greater analysis is needed to
Two Standards of Sepsis Care - The Nighttime Effect SUMMARY Services in most hospitals differ between day & night or weekend shifts. With clinical staff and hospital resources typically diminished during "off hours", there is increased risk of varying diagnosis, treatments and outcomes of various time sensitive conditions. Limited data indicates, sepsis
Sepsis on the Basis of Suspicion of Infection SUMMARY A suspected or documented infection is required for the diagnosis of sepsis. The lack of a “gold standard” for sepsis diagnosis coupled with the delay of culture results increases the likelihood of including patients in the sepsis management pathway who do not actually
Changes in Sepsis Trends: Real or Artificial? SUMMARY Recent reports indicate a significant increase in the incidence of sepsis with a concomitant drop in mortality. Controversy exists over the true degree of change based on changing definitions and coding practices. Direct clinical indicators of infection and organ dysfunction are preferred
Use of Steroids in Sepsis SUMMARY The use of corticosteroids in sepsis has been recommended on and off for over 40 years. The Surviving Sepsis Campaign (SSC) guidelines previously (2016) did not support steroid use in patients with sepsis, however, the current (2021) recommendation the use of steroids in certain septic shock
3 Major Lactate Considerations in Sepsis SUMMARY Serum lactate measurements have been part of the sepsis bundles since the beginning. The recommendation to use and follow serum lactate concentrations are based on weak and low-quality evidence. Changes in serum lactate concentrations are not solely reflective of changes in production but also based
Should Hemodynamic Profiling be a Sepsis Best Practice? SUMMARY Surviving Sepsis Campaign (SSC) guidelines were previously developed in 2016 and published in 2017. The SSC 2021 guidelines provides an update to the SSC 2016 guidelines. New recommendations are provided for a number of areas in the management of sepsis.
Should Hemodynamic Profiling be a Sepsis Best Practice? SUMMARY Hemodynamic profiles in critically ill patients are complex and change over the sepsis course. Macro-circulatory and micro-circulatory factors contribute equally to the evolving disease state. During the later stages of hemodynamic impairment, both factors must be considered. BACKGROUNDIn addition to
Sepsis Associated Encephalopathy (SAE) SUMMARYSAE is a key manifestation of sepsis occurring in up to 70% of ICU patientsAssociated with higher ICU and hospital mortality and long term consequencesDifficult to assess, diagnose without specific treatment BACKGROUNDSAE is probably the most common type of encephalopathy in the ICUSAE may occur
