Early Goal-Directed Therapy: A house collapsing in slow motion The original foundation of the Surviving Sepsis Campaign was the Rivers trial on early goal-directed therapy. This is basically the NINDS trial of the critical care world: a study with ~300 patients showing implausibly positive results, published in NEJM, and rapidly brainwashing an entire discipline. The […]
Search Results for: sepsis
PulmCrit- Sepsis special edition & CBC to diagnose septic shock
The Journal of Thoracic Diseases is about to release a special edition on sepsis, edited by Paul Marik (open access). It’s deliciously rebellious – just look at the table of contents 👇 My article on using the complete blood count to diagnose sepsis is already available, so I’ll summarize it here (yes, I know, you […]
PulmCrit- Metabolic sepsis resuscitation: Strike hard, strike fast, no remorse
Escalation-deescalation There are roughly two strategies for adjusting the intensity of treatment: Titrated strategy: Treatment intensity is adjusted to match the severity of the disease. Escalation-deescalation strategy: Treatment intensity is increased rapidly to exceed disease severity and gain control of the disease. After the patient improves, treatment intensity is reduced. The best strategy depends on […]
Practical Evidence Podcast 015 – Surviving Sepsis Campaign (SSC) Guidelines 2016 (in 2017)
SSC 2016 Guidelines
EMCrit 175 – Fluid Tolerance and Follow-Up on the Fluids in Sepsis Panel with Phillipe Rola
Fluids in Sepsis
We are Complicit – A glimpse into the current state of Severe Sepsis/Septic Shock Quality Measures
Don’t read this unless you want to be annoyed
IBCC chapter & cast: Ascending cholangitis & calculus cholecystitis (community-acquired biliary sepsis)
Biliary infection is a fairly common cause of septic shock (especially ascending cholangitis). Evidence isn’t terrific regarding exactly when and how interventions should be done to obtain source control (particularly among cholecystitis). This chapter attempts to reach some clarity on the topic but honestly, it remains a bit murky.
PulmCrit- Sepsis Research Rant: More fake news, less real news
The following rant focuses on sepsis research, but these principles are universal. I apologize for the agitated nature of this post, but I just can’t hold it in any longer. If I read one more correlational study which tries to imply causation, I might just explode. In order to prevent burnout, I’m going to journal these thoughts instead. So, hang on to your hats, because things are going to get a bit heated.
PulmCrit – Bad news for sepsis-3.0: qSOFA fails validation
Sepsis 3.0 replaced the SIRS criteria with a new risk-stratification tool, qSOFA. qSOFA was initially developed within the Sepsis-3 publication itself. Until now, qSOFA has never been validated. The value of qSOFA vs. SIRS remains controversial.
PulmCrit – ACEP task force on septic shock should replace the Surviving Sepsis Campaign
The critical care community has long been plagued by a series of antiquated, overbearing guidelines created by the Surviving Sepsis Campaign (SSC). The campaign was originally sponsored by Eli Lilly and Edwards Life Sciences, as a commercial marketing campaign. The backbone of the original guidelines was a single center trial by Rivers, which has failed […]
EMCrit 134 – ARISE has arisen; now where do we stand on Severe Sepsis in 2014
the Arise Study (Australasian Resuscitation In Sepsis Evaluation) and Severe Sepsis Care in 2014
PulmCrit Wee – MENDS2: Fentanyl or fentanyl for sedation in mechanically ventilated adults with sepsis
The MENDS2 trial was intended as a study comparing dexmedetomidine to propofol. However, the doses of these medications used in the study weren’t high enough to be impactful. In retrospect, the study may actually be an investigation of how clinicians approach the agitated intubated patient – potentially revealing an over-reliance on opioid infusions.
Community acquired biliary sepsis (ascending cholangitis & calculus cholecystitis)
CONTENTS Rapid Reference 🚀 Introduction Clinical presentation & differential diagnosis Diagnostic tests Labs Ultrasonography CT scan HIDA scan Diagnostic criteria Treatment Antibiotics Interventional tx for ascending cholangitis Interventional tx for cholecystitis Interventional tx for combined cholecystitis & cholangitis Podcast Questions & discussion Pitfalls community-acquired biliary sepsis checklist ✅ investigations Electrolytes, CBC with differential, coags. Liver […]
EMCrit 318 – SSC Guidelines 2021 – The Good, The Bad, & The Ugly and What You Need to Know in Sepsis Resuscitation
It has been a while since we did a sepsis and septic shock update, so the time has come! No better framework for the discussion than the most recent iteration of the Surviving Sepsis Campaign Guidelines. Foreshadowing: they don’t suck as hard as in prior years.
EMCrit 345 – I Guess We Need to Talk about CLOVERS and Fluids in Sepsis (Hopefully for the Last Time Ever)
CLOVERS Trial Primer and Fluids in Septic Shock
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