Implication of a Sepsis Protocol in a Respiratory Intensive Care Unit: A 12 Month Experience (original) (raw)
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Tüberküloz ve toraks, 2015
Risk factors for multiorgan failure and mortality in severe sepsis patients who need intensive care unit follow-up Introduction: Multiorgan failure (MOF) is a primary cause of morbidity and mortality in sepsis patients in intensive care units (ICU). Finding risk factors and solving preventable problems of MOF in patients who have sepsis can be a favourable step for decreasing mortality. We aimed to examine multiorgan failure and mortality related risk factors in intensive care unit patients who have sepsis. Materials and Methods: A retrospective data collection and prognostic cohort study was performed. Between January 2009-March 2010, patients accepted to the 22-bed pulmonary intensive care unit with the diagnosis of sepsis were enrolled. Patients' demographic data, ICU severity scores, application of mechanical ventilation, causative agent of sepsis, number of ICU days and presence of mortality were recorded. Logistic regression analysis was carried out for risk factors. Results: 347 patients with sepsis were involved in the study. 43 of the patients (12.4%) developed MOF and overall mortality rate was 14.9% (n= 52). Presence of resistant pathogen, presence of shock, application of TPN and high APACHE II score were found to be risk factors for MOF [p= 0.015 Odds ratio (OR) 3.47
Van veterinary journal, 2021
Coagulation abnormalities and myocardial injury frequently occur during sepsis. The aim of the present study was to evaluate the coagulation parameters and cardiac-specific biomarkers at set intervals in septic neonatal calves. Ten healthy calves and 20 septic calves were included in the study. For detecting coagulation parameters prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, fibrinogen, antithrombin III (AT III), thrombocyte and, for cardiac biomarkers cardiac troponin (cTn) I, T, and creatine kinase-MB (CK-MB) were evaluated on admission, 24 and 72 hours later in septic calves and once in healthy calves. The results of coagulation parameters showed a significant elevation of PT and APTT times from the time of admission until the 72nd hour and a significant reduction of AT III and fibrinogen from the time of admission until the 72nd hour. Cardiac troponin T was high in the 72nd hour, and CK-MB was high in the time of admission, 24th and 72nd hours in septic calves compare to the healthy calves. There was a correlation between PT, APTT, fibrinogen with cardiac troponin T. In conclusion, cardiac damage can develop during the hypercoagulable state of disseminated intravascular coagulation (DIC), and maybe it is responsible for the elevation of cTnT and CK-MB and worse outcome in neonatal septic calves.
Turkiye Klinikleri Journal of Medical Sciences, 2013
Sepsis and systemic inflammatory response syndrome (SIRS) are the most common causes of acute kidney injury (AKI) in intensive care unit (ICU) patients. This study aimed to investigate the relationship of infection, the causative microorganisms and their antimicrobial resistance patterns in ICU patients with sepsis/SIRS with the presence of AKI. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The microbiological data of 109 ICU patients with sepsis/SIRS with serum creatinine level <2 mg/dl and without known history of renal disease were evaluated retrospectively. R Re es su ul lt ts s: : AKI incidence in sepsis (52%) and in SIRS groups (57%) were similar. In total, 61% of the patients were septic and 157 microorganisms were isolated. The most frequently isolated bacteria was coagulasenegative Staphylococci (22%). Isolation rate of A. baumannii in samples of patients with AKI was significantly more compared to those of without AKI (p=0.03). although isolation rate of Pseudomonas aeruginosa was higher in AKI group, the difference was not statistically significant. Multidrug resistance was more prevalent in A. baumannii strains isolated from AKI patients, and foun as 61%. C Co on n-c cl lu us si io on n: : The resistant acinetobacter infections in ICUs are considered as a the most threatfull problems in most ICUs throughout the world. In our hospital's ICU, incidence of infection due to resistant A. baumannii was found in mostly in AKI patients. Since immunosupressed AKI patients are more vulnerable to infection, the proper control of infection and appropiate antibiotic treatment become crucial factors for a better outcome in ICUs, especially in AKI patients. K Ke ey y W Wo or rd ds s: : Intensive care units; acinetobacter infections; drug resistance, multiple; acute kidney injury Ö ÖZ ZE ET T A Am ma aç ç: : Sepsis ve sistemik inflammatuar yanıt sendromu (SIYS), yoğun bakım ünitesi hastalarında (YBÜ) akut böbrek hasarı (ABH)'nın en önemli nedenlerindendir. Bu çalışmada, sepsis/ SIYS'si olan YBÜ hastalarında enfeksiyonun, etken mikroorganizmaların ve antimikrobiyal direnç paternlerinin ABH varlığı ile ilişkisinin araştırılması amaçlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Sepsis/SIYS gelişen, bilinen renal bozukluğu bulunmayan ve serum kreatinin düzeyi <2 mg/dL olan toplam 109 YBÜ hastasının mikrobiyolojik verileri geriye dönük olarak değerlendirildi. B Bu ul lg gu ul la ar r: : ABH insidansı, SIYS'lı grupta (%57) ve sepsisli grubta (%52) benzer oranlarda saptandı. Toplam %61 hastada sepsis saptandı ve 157 mikroorganizma izole edildi. En sık izole edilen bakteri koagülaz negatif stafilokok (%22) idi. ABH'ı olan hastalarda ABH olmayanlara kıyasla, Acinetobacter baumannii izolasyonu anlamlı derecede daha yüksek oranda bulundu (p=0,03). Pseudomonas aeruginosa izolasyonu ise ABH grubunda daha yüksek olmasına rağmen aradaki fark anlamlı bulunmadı. Çoğul ilaç direnci en fazla A. baumannii'de gözlendi ve ABH'lı hastadan izole edilen A. baumannii izolatlarının %61'inde çoğul ilaç direnci vardı. S So on nu uç ç: : YBÜ'lerindeki dirençli Asinetobakter enfeksiyonları tüm dünyadaki YBÜ'lerinin en korkutucu sorunu olarak kabul edilmektedir. Hastanemiz YBÜ'nde, dirençli A. baumannii kaynaklı enfeksiyon yüksek oranda ABH'ı olan hastalarda saptanmıştır. Zaten immunosupresif olan ABH hastaları enfeksiyona daha yatkın olmaları nedeni ile, bu hastalarda enfeksiyon kontrolü ve uygun antibiyotik tedavisi, YBÜ'nde daha iyi bir tedavi sonlanımı için çok önemli faktörleri oluşturmaktadır. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Yoğun bakım üniteleri; acinetobacter enfeksiyonları; ilaç direnci, çoklu; akut böbrek hasarı T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 13 3; ;3 33 3((2 2)): :4 48 85 5-9 92 2
Çocuk Yanık Merkezinde Sepsis Tedavisinde Terapötik Plazma Değişimi Uygulaması
Turkish Journal of Pediatric Disease
Objective: In our study, we aimed to analyze the use of Therapeutic plasma exchange (TPE) in the manage-ment of septic and Thrombocytopenia-associated multiple-organ failure (TAMOF) in the burn in-tensive care unit of a children’s hospital retrospectively. Material and Methods: Demographic, clinical, and laboratory data of the pediatric burn patients who were applied TPE between 1 January 2016 and 1 January 2021 were obtained from the hospital information system and medical records and analyzed. The patients were divided into two groups those who died du-ring follow-up and those who recovered. Results: TPE was performed on 14 burned children (Boy: Girl 5:9). The median age of the patients was 6,6 years (range 1-18 years). The mean TBSA of the patients was 47.76% (20-75). The most common cause of burns was flame burn. The mean hospital stay of the patients was 18.4±12.6 (7-94) days. 4 patients in group 1 recovered and 10 patients in group 2 died during follow-up. There was no statist...
Istanbul Medical Journal, 2019
Amaç: Sepsis hastanede yatan hastalarda en önemli ölüm nedenlerinden biri olsa da mortalite ve morbiditeyi öngörmeye yönelik erken prediktif faktörlerle ilgili bilgiler sınırlıdır. Bu çalışmada acil servise başvuran ve sepsis ön tanılı 65 yaş ve üzeri erişkin hastalarda tanımlanmış arteriyel kan gazı parametreleriyle 30 günlük mortalite arasındaki ilişkinin belirlenmesi amaçlandı. Yöntemler: Mart-Ağustos 2017 tarihleri arasındaki 5 aylık süreçte acil serviste sepsis ön tanısı konulmuş 65 yaş üzeri hastaların arteriyel kan gazı parametreleri retrospektif olarak incelendi. Kan gazı parametrelerinden pH, laktat, anyon açığı, bikarbonat ve baz açığı ile 30 günlük mortalite arasındaki ilişki analiz edildi. Bulgular: Sepsis tanılı 103 yaşlı hasta çalışmaya dahil edildi. Hastaların 58'i (%56,3) kadındı ve yaş ortalaması 77,74±8,45 yıl (aralık: 65-99) olarak saptandı. Hastaların 22 (%21,4) tanesi 30 gün içerisinde öldü. Başvuru "Hızlı Sepsisle İlgili Organ Yetmezliği Değerlendirmesi" değerleri 32 (%31,1) hastada 2 veya daha üzeri olarak saptandı. Parametrelerden bikarbonat (p=0,001), laktat (p<0,001), anyon açığı (p=0,007) ve baz açığı (p=0,001) değerlerinin 30 günlük mortalite ile anlamlı olarak ilişkili olduğu bulundu. Sonuç: Çalışmamızda 65 yaş ve üzeri sepsis ön tanılı hastalarda arteriyel kan gazında saptanan laktat, bikarbonat, anyon açığı ve baz fazlalığı düzeylerinin 30 günlük mortalite ile ilişkili olduğunu saptadık. Septik hastalarda bu parametreler yakından izlenmelidir. Bu parametrelerin izlenmesi, sepsis ön tanılı acil servis hastalarında erken klinik karar almaya yardımcı olabilir ve sepsis sonucunu etkileyebilir.
Jurnal Penyakit Dalam Indonesia
Pendahuluan. Hipoalbuminemia merupakan prediktor kuat terhadap mortalitas pada pasien non operatif maupun operatif. Albumin berperan mempertahankan tekanan onkotik pada kondisi kritis seperti sepsis. Pemberian human serum albumin (HSA) eksogen pada sepsis dengan kondisi hipoalbuminemia masih kontroversial dengan hasil luaran yang bervariasi. Penelitian ini dilakukan untuk mengetahui perbandingan mortalitas antara pasien sepsis dengan kondisi hipoalbuminemia yang diberikan albumin intravena dan tanpa pemberian albumin intravena serta mengetahui faktor yang berpengaruh terhadap mortalitas pasien sepsis. Metode. Penelitian observasional dengan pendekatan prospektif melibatkan 75 subjek penelitian usia >18 tahun dengan sepsis disertai hipoalbuminemia (<2,5 g/dL) yang dirawat di ruangan high care unit RSUD dr. Saiful Anwar Malang selama periode 1 September 2018-31 Agustus 2019 yang terbagi menjadi dua kelompok, yaitu kelompok albumin dan nonalbumin. Kedua kelompok diikuti selama hospitalisasi sampai pulang atau meninggal dunia. Perbedaan mortalitas antara kedua kelompok dianalisis dengan uji bivariat chi square. Faktor yang paling berpengaruh terhadap mortalitas dianalisis dengan uji multivariat regresi logistik berganda. Hasil. Didapatkan 39 orang (52%) dari kelompok albumin dan 36 orang (48%) dari kelompok non albumin. Perbedaan jumlah mortalitas antara kelompok albumin dan nonalbumin {25 (64,1%) vs. 16 (44,4%) yang mana perbedaan tersebut tidak bermakna secara statistik dengan nilai OR 2 (p=0,138}. Faktor yang berpengaruh terhadap mortalitas antara lain: skor SOFA (OR 34,27, p<0,001), nilai MAP (OR 8, p<0,001), kondisi syok septik (OR 4,31, p=0,03), diabetes melitus (OR 0,28, p=0,009), kondisi gagal nafas (OR 8,02, p<0,001), penurunan kesadaran (OR 64,75, p<0,001), gagal kardiovaskular (OR 6, p<0,001), dan kondisi gagal hematologi (OR 3,05, p=0,027). Faktor yang paling dominan berpengaruh terhadap mortalitas pasien sepsis adalah penurunan kesadaran (OR 2,67, p=0,001). Simpulan. Pemberian transfusi albumin tidak memberikan perbedaan bermakna terhadap kejadian mortalitas pada pasien sepsis dengan kondisi hipoalbuminemia. Faktor yang paling berpengaruh terhadap mortalitas pasien sepsis adalah kondisi penurunan kesadaran.
Sepsis and Septic Shock: Outcomes in Elderly and Very Elderly Critically Ill Patients
Turkish Journal of Intensive Care
Sepsis-septik şok gelişimi ile yaşın ilişkisi özellikle erişkinlerde açık değildir. Yaşlı ve çok yaşlı hastalarda sepsis ve septik şokun insidans, prognoz ve mortalitesi ile ilgili az sayıda çalışma bulunmaktadır. Bu çalışma ile yaşlı ve çok yaşlı yoğun bakım ünitesi(YBÜ) hastalarında yaşın sepsis ve septik şokun sonuçları üzerine etkisini göstermeyi amaçladık. Gereç ve Yöntem: Bu çalışma yoğun bakım ünitemizde yapılan retrospektif gözlemsel bir çalışma olup 200 yaşlı ve çok yaşlı sepsis-septik şok hastası çalışmaya alınmıştır. Bulgular: Sepsis-septik şok ilişkili mortalite oranı 61.5%(123 hasta)di. En sık enfeksiyon odağı akciğer(% 56.5, 113 hasta) ve üriner sistemdi(35%, 70 hasta). Yaşlı(61.2%, 82 hasta) ve çok yaşlı hastalar(62.1%, 41 hasta) arasında mortalite açısından anlamlı fark yoktu. YBÜ kabülünde Sıralı Organ Yetmezliği skoru(SOFA) (1.195 OR ve 1.052-1.358% 95 CI, p = 0.006) ve invazif mekanik ventilasyon gereksinimi (4.330 OR ve 1.529-12.258% 95 CI, p = 0.006), YBÜ takibinin sonunda böbrek yetmezliği gelişmesi(6.457 OR ve 1.795-23.233% 95 CI, p = 0.004) ve oral yoldan beslenme yetersizliği (0.064 OR ve 0.018-0.226 95% CI, p = 0.0001) YB mortalitesi için bağımsız risk faktörleri olarak bulundu. SONUÇ: Sonuç olarak,bu çalışmada yaşlı ve çok yaşlı hastalar arasında sepsis-septik şoka bağlı mortalite oranları açısından anlamlı fark yoktu. Ancak yoğun bakım ünitesine kabulu sırasında organ hasarı varlığı ve takipte komplikasyon gelişimi mortaliteyi etkilemekteydi.
Risk factors for death in patients with sepsis in an intensive care unit
Northeast Network Nursing Journal, 2018
Objective: to determine the main risk factors for death in patients with sepsis in an intensive care unit. Methods: it is a retrospective cohort study, wich included 126 patient chorts lhat had clinical and clinical and laboratory diagnosis of sepsis were considered eligible. The conditional probability of death was calculated through the Kaplan-Meier method and the risk of death was estimated by the hazard ratio, using a Cox regression model with p<0.050. Results: a total of 124 patients were included in the study. The main focus of infection was the respiratory system. Regarding the outcome, 40.3% patients with sepsis, 73.9% with severe sepsis and 69.2% with septic shock died. Patients with abdominal sepsis and using vasopressors were at higher risk of death. Conclusion: septic patients with abdominal source of infection and using vasopressor agents had a higher risk of dying, while patients who were tracheostomized had a better chance of living. Descriptors: Intensive Care Units; Sepsis; Risk Factors; Death; Nursing Care. Objetivo: determinar os principais fatores de risco para a morte em pacientes com sepse em uma unidade de terapia intensiva. Métodos: trata-se de uma coorte retrospectiva, onde foram incluídos 124 prontuários de pacientes que tiveram diagnóstico clínico e laboratorial de sepse. A probabilidade condicional de morte foi calculada através do método de Kaplan-Meier; o risco de morte foi estimado pela razão de risco, utilizando modelo de regressão de Cox com p<0,050. Resultados: o foco principal da infecção foi o sistema respiratório. Em relação ao desfecho, morreram 40,3% pacientes com sepse, 73,9% com sepse grave e 69,2% com choque séptico. Os pacientes com sepse abdominal e que utilizaram vasopressores apresentaram maior risco de morte. Conclusão: pacientes sépticos com fonte abdominal de infecção e fazendo uso de agentes vasopressores apresentaram maior risco de morte, enquanto que pacientes traqueostomizados tiveram melhores chances de sobreviver.
Erciyes Medical Journal, 2022
Objective: Sepsis is a clinical condition that requires urgent treatment. Most patients with sepsis require intensive care. There is a high mortality rate. The primary aim of the present study was to examine risk factors for mortality in patients with sepsis or septic shock in a medical intensive care unit (ICU). The secondary objective was to analyze the demographic and clinical characteristics of these patients. Materials and Methods: This prospective study was conducted in a medical ICU. Patients diagnosed with sepsis according to the international consensus definition (Sepsis-3) and requiring ICU treatment were included in the study. Demographic and clinical characteristics were recorded and analyzed. Results: A total of 134 patients with sepsis were enrolled in the study. The mean age was 60±18 years and 49% were male. The most frequent reasons for admission to the ICU were respiratory failure (45.5%) and shock (44%). Gram-negative bacteria were present in 48%, Gram-positive bacteria in 15%, fungus in 8%, and there was no culture positivity in 29% of the patients. The in-hospital mortality rate was 51%. The need for vasopressor drugs (odds ratio [OR]: 4.612, 95% confidence interval [CI]: 1.273-16.781) or mechanical ventilation (OR: 25.312, 95% CI: 4.225-151.852) was an independent risk factor for mortality. Conclusion: Patients treated in the ICU for sepsis or septic shock had a high mortality rate. The need for vasopressor drugs or mechanical ventilation was an independent risk factor for mortality.
SDÜ Sağlık Bilimleri Dergisi, 2017
Objective: We aimed to investigate the therapeutic role of Oxytocin (OT) in sepsis induced rats and its effects on kidneys. Sepsis was induced in 24 of them by cecal ligationperforation (CLP) method. Material-Method: One of the groups of CLP did not recieve any treatment while either saline 1 ml/kg or OT 0.4 mg/kg was applied intraperitoneally to the other groups within the first hour of surgery. 8 rats were sham-operated and 8 rats were spared as control group. Plasma TNF-α α (Tumor necrosis factor-α), CRP (C reactive Protein), MDA (Malondialdehyde) levels, total antioxidant capacity (TAC), creatinine level and peripheral leukocyte (WBC) counts were measured. Results: TNF-α, CRP, MDA, TAC levels and WBC counts were significantly increased in CLP and CLP-saline groups, on the contrary they are decreased in CLP-OT group. Histopathologically loss of brush border, tubular dilatation and mononuclear cell infiltration was significantly decreased in CLP-OT group but there was no significant difference in erytrocyte extravasation and cast formation when compared to CLP and CLP-saline groups. Conclusions: Our results indicate that OT may have a therapeutic value in limiting sepsis induced inflammation and organ damage.