Complicated intra-abdominal infection is a common case on the units admitting general surgical patients. By definition it is infection that extends beyond the viscus of origin into the peritoneal space, and is associated with abscess or peritonitis. The traditional management approach has been to do the source control and then soak in antibiotics until signs …
PROCESS has been backed up by ARISE in goal-directed therapy for sepsis. PROMISE is awaited (finished recruiting in July). A large (1600), international, randomised, un-blinded, intention-to-treat trial with sensible exclusion criteria, conducted 2008-2014 of excellent quality. ARISE showed no benefit in using a protocolised 6 hour package for septic shock which involved continuous ScvO2 and CVP …
Narrowing down the TRICC concept to septic shock patients, the TRISS trial looked at a transfusion trigger of 7 g/dl or 9 g/dl, using leuco-depleted blood, for the first 90 days of admission. Multi-centre, parallel-grouped and sensibly powered (over 1000 patients), they achieved good separation of Hb values. No mortality difference at 90 days. No greater ischaemic …
SSC international data from more than 28,000 patients with severe sepsis or septic shock emphasises early source control is paramount (closely followed by BP management). Get antibiotics in within 1 hour (2 at the very most) – the clock is ticking! Here, this was timed from the moment of triage or, on the wards, the …
Raghunathan has used some interesting statistics to try and extract the effects of using Saline or Ringer’s lactate in resuscitating sepsis. Elixhauser comborbidities, 5:1 greedy matching, Generalized Estimating Equation models, and “missing-ness” are just a few of the terms I didn’t understand. Nevertheless this appears to be a retrospective study that suggests there’s measurable mortality benefit in using balanced …
Australian lactate enthusiasts have taken a huge dataset and discovered high sugar is not an independent risk factor when the lactate is also high. Given they both take part in the Cori cycle and glycolysis maybe this shouldn’t be a surprise but maybe it also explains NICE-SUGAR and should reassure us that semi-tight control is …
Safdar et al have combined 9 studies and found an NNT of 77 which may not seem fantastic but where the complication is a quality indicator… Time to add them to the line pack for non-tunnelled catheters at least? The varied but often high background CLABSI rate may make you hesitate though.
In this Scottish national audit project a single NEWS score of >8 in the presence of sepsis predicted a >30% chance of ICU admission or dying within 30 days. Interesting from a triage perspective but how about adding the power of a single lactate of more than 2.0 to decide who with sepsis you really should …
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