PCT-assisted antibiotic therapy
|
|
- Lizbeth McLaughlin
- 5 years ago
- Views:
Transcription
1 PCT-assisted antibiotic therapy Prof. Zsolt Molnár Department of Anaesthesia and Intensive Care University of Szeged Hungary
2 Problems with the definition of sepsis
3 Definitive diagnoses with definitive treatment
4 Sepsis is not a definitive diagnosis Sepsis-syndrome and Las Vegas : Fever or hypothermia (> 38.3 o C or < 35.0 o C) Tachycardia (>90/min) Leukocytosis or leukopenia (> cells/mm 3, < 4000cells/mm 3, or > 10% immature forms) Hypotension (<90mmHg)
5 Sepsis is not a definitive diagnosis Sepsis-syndrome and Las Vegas : Fever or hypothermia (> 38.3 o C or < 35.0 o C) Tachycardia (>90/min) Leukocytosis or leukopenia (> cells/mm 3, < 4000cells/mm 3, or > 10% immature forms) Hypotension (<90mmHg)
6 Sepsis is not a definitive diagnosis Consensus conference ACCP/SCCM: Infection Bacteraemia Systemic inflammatory response syndrome (SIRS) Sepsis = SIRS + Infection Severe sepsis (Sepsis + one organ dysfunction) Septic shock (hypoperfusion despite adequate fluid load) Multiple System Organ Failure (MSOF) ACCP/SCCM. Crit Care Med 1992; 20: 864
7 Sepsis definition SSC 2012 Sepsis is not a disease but a consensus
8 Pathomechanism I n s u l t Endotoxin, Trauma, Sterile inflammation, Operation, etc. Humoral activity Interferon, Complement Sepsis M a and c r o p Love h a g e s TNF; IL-1,6,10; PAF Fisiol. reactions Fever, Metabolic changes E n d o t h e l P M N FR, PAF, Chemotaxis It isn t the insult, but host response what determines NO, severity E-selectin, NFkB and outcome Sepsis, SIRS MSOF Molnár and Shearer Br J Int Care Med 1998; 8: 12
9 DAMP = Damage Assosiated Molecular Pattern PAMP = Pathogen Associated Molecular Pattern DAMP SIRS versus PAMP SIRS G+ Surgery, Trauma, Pancreatitis Isch-reperf. G- F (Courtesy of Janos Fazakas)
10 PCT kinetics after esophagectomy 15 S = 130 NS = 23 *p<0.05 * 2-5 ng/ml Procalcitonin (ng ml-1) 10 5 t 0 t 24 t 48 0 Survivors Non-survivors t 72 Data are presented as minimum, maximum, 25-75% percentile and median. For statistical analysis Mann-Whitney U test was used. Szakmány T, Molnár Z. Can J Anaesth 2003; 50:
11 The expected course of PCT concentrations in a surgical patient without serious bacterial infection Lindberg et al., Scand J Clin Lab Invest 2002; 62:
12 Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock Clec h et al. Crit Care Med 2006; 34: Medical patients: SIRS: PCT = 0.3 ( ) ng/ml Septic shock: PCT = 8.4 ( ) ng/ml PAMP Surgical patients: SIRS: PCT = 5.7 ( ) ng/ml Septic shock: PCT = 34 (7-76) ng/ml DAMP+PAMP Sepsis homogenious group of patients ie One size does not fit all 1 ng/ml, sens: 80% - spec: 94% 9.7 ng/ml, sens: 91% - spec: 74%
13 Nature Reviews Immunology Volume 13 December Proinlflammation Antiinlflammation
14 Nature Reviews Immunology Volume 13 December Overwhelming inflammation vs. prolonged immunosupression: Both can be deadly! Proinlflammation Antiinlflammation
15 Immunosupression over time less PCT response Priority of PCT kinetics over absolute values?
16
17 Is this patient septic or not?
18 I have never treated SEPSIS in my life! But
19 Does the patient have infection or not? Infection = ABs No infection = No ABs
20 Signs of infection Clinical signs: Most important Not good enough Fever (>38 o C), WBC (>12 000): Low sensitivity (~50%) Poooor! Galicier L and Richet H. Infect Control Hosp Epidemol 1985; 6: 487 Microbiology: Results: 24 hours or more Very late!
21 We need biomarkers! At least 173 of them!! My favourite is: procalcitonin (PCT)
22 The 3 fundamental questions to answer 1. Is there infection should I start empirical ABs? 2. Is it effective? 3. When should I stop?
23 Is there infection?
24 Christ-Crain M, et al. Lancet 2004; 363: Relative reduction in AB exposure : 50% No difference in outcome Proven infection: 21%
25 Layios N, et al. Crit Care Med 2012; 39: Limitations: 40% surgical patients (0.25, 0.5, 1.0 ng/ml cut off too low) In the whole sample ~90% of patients with PCT>1ng/ml received ABs
26 The EProK-study Trásy D et al.,(in review)
27 Increasing procalcitonin may be a good indicator of starting empirical antibiotic treatment in critically ill patients Patients with suspected infection = 209 PCT available at T -1 = 114 Infection = 85 No-infection = 29
28 Predicting infection (T -1 T 0 ) Trásy D et al.,(manuscript under submission) 77 % 85 % Kinetics over absolute values! Forget about CRP, WBC and T!
29 Tsangaris at al.: BMC Infectious Disease 2009;9: Infection Increasing PCT/24 h: May be a good indicator of infection The PCT value on the day of fever onset must be compared with previous day PCT values (chronic critically ill patient) No change in PCT/24 h: May be a good indicator of no infection Day before fever No infection
30 How does it work in clinical practice? Medical patients: SIRS: PCT = 0.3 ( ) ng/ml Septic shock: PCT = 8.4 ( ) ng/ml Clec h et al. Crit Care Med 2006; 34: Surgical patients: You admitted 2 hemodynamically stable critically ill patients from the ward SIRS: PCT = 5.7 ( ) ng/ml Septic shock: PCT = 34 (7-76) ng/ml AB yes? AB yes AB no 1 ng/ml, sens: 80% - spec: 94% 3 ng/ml 1-3 ng/ml 5-3 ng/ml AB no? AB yes AB no 9.7 ng/ml, sens: 91% - spec: 74%
31 Is the AB effective?
32 International guidelines
33 local protocols
34 BMC Infectious Diseases 2007, 7:21 28%
35 The EProK-study Trásy D et al.,(under review)
36 The EProK-study Patients with suspected infection= 209 Proven infection = 169 Effective AB = 127 (77%) Ineffective AB = 38 (23%) No infection = 44 Kinetics of PCT during T 0 -T 16 -T 24 : vs. Trásy D et al.,(under review) May indicate effective/ineffective AB treatment
37 PCT-kinetics to predict AB-effectiveness Trásy D et al.,(under review) PCT t 0 - t 16 PCT t 0 - t 24 55% 71% ( ) 75% ( ) 46% ( ) 89% ( ) < % 73% ( ) 82% ( ) 56% ( ) 91% ( ) <0.001 ICU mortality: Effective: 35%, Ineffective: 62%, p<0.001
38 Surgical and medical patients
39 The EProK-study Trásy D et al.,(under review) Medical: ~ 5ng/ml Surgical: ~20 ng/ml Absolute values are different, but kinetics are similar
40 Stopping AB-therapy
41 Lancet 2010; 375:
42 Mean difference without ABs: 2.7 days Relative reduction in AB exposure: 23% Lancet 2010; 375:
43 Inexperienced units Low (and fixed!) cut off values (<0.1 ng/ml or >90% decrease) Powered for 25% (3.75 day) reduction underpowered to show a significant 2 day reduction
44 Surviving Sepsis Guideline Dellinger RP et al Crit Care Med 2013; 41:
45 The 3 main answers with PCT 1. Is there infection? 2. Is the AB effective? 3. When to stop? Brave to withhold ABs Helps decision within h You may reduce AB exposure
46 Final thoughts
47 The most important lesson Auguste Rodin: The Thinker (1880)
48 Motto It doesn t matter whether you ve done the right thing, but whether you ve done everything to do the right thing (Rephrased by ZM from Bhagavad Gita)
49 Free for junior doctors (<29)!
PCT-assisted antibiotic therapy
PCT-assisted antibiotic therapy Prof. Zsolt Molnár zsoltmolna@gmail.com Department of Anaesthesia and Intensive Care University of Szeged Hungary Problems with the definition of sepsis Sepsis is not a
More informationProcalcitonin kinetics guided antibiotic management of the critically ill patient
Procalcitonin kinetics guided antibiotic management of the critically ill patient András LOVAS MD, PhD, EDIC, EDAIC University of Szeged, Hungary Department of Anaesthesiology and Intensive Therapy 19/11/2016,
More informationAdsorbtion of Cytokines Early in Septic Shock: the ACESS trial
Adsorbtion of Cytokines Early in Septic Shock: the ACESS trial Prof. Zsolt Molnár zsoltmolna@gmail.com Department of Anaesthesia and Intensive Care University of Szeged Hungary Pathophysiology Local insult
More informationImportance of kinetics of procalcitonin in septic patients. János Fazakas MD, PhD Semmelweis University, Department of Transplantation and Surgery
Importance of kinetics of procalcitonin in septic patients János Fazakas MD, PhD Semmelweis University, Department of Transplantation and Surgery Host pathogen interactions the innate and the adaptive
More informationFluorescence immunoassay Point of care test Wide range PCT. whole blood. plasma. serum
Fluorescence immunoassay Point of care test Wide range PCT whole blood serum plasma ichroma PCT Description ichroma PCT along with ichroma Reader is a fluorescence immunoassay for quantitative determination
More informationThe Usefulness of Sepsis Biomarkers. Dr Vineya Rai Department of Anesthesiology University of Malaya
The Usefulness of Sepsis Biomarkers Dr Vineya Rai Department of Anesthesiology University of Malaya 1 What is Sepsis? Whole Body Inflammatory State + Infection 2 Incidence and Burden of Sepsis in US In
More informationDisclosures. Objectives. Procalcitonin: Pearls and Pitfalls in Daily Practice
Procalcitonin: Pearls and Pitfalls in Daily Practice Sarah K Harrison, PharmD, BCCCP Clinical Pearl Disclosures The author of this presentation has no disclosures concerning possible financial or personal
More informationADVANCES IN BIOMARKER TESTING FOR SEPSIS AND BACTERIAL INFECTIONS
ADVANCES IN BIOMARKER TESTING FOR SEPSIS AND BACTERIAL INFECTIONS ERIC H GLUCK MD JD FCCP FCCM DIRECTOR OF CRITICAL SERVICES SWEDISH COVENANT HOSPTIAL DISCLOSURES: Speaking engagements and consulting:
More informationUse of surrogate inflammatory markers in the diagnosis & monitoring of patients with severe sepsis
Thursday 11 th June 2015 Use of surrogate inflammatory markers in the diagnosis & monitoring of patients with severe sepsis Dr Duncan Wyncoll Guy s & St Thomas NHS Trust, London Conflicts of Interest In
More informationBiomarkers for streamlining of Antibiotics in patients with severe infection.
Biomarkers for streamlining of Antibiotics in patients with severe infection. Philipp Schuetz, MD Feb, 2013 Email: Schuetzph@gmail.com You see this patient in your ICU -3d: Cough, Dyspnoe, Sputum T: 38.8
More informationSHOULD THERAPEUTIC AGENTS FOR SEPSIS TARGET THE GLYCOCALYX?
SHOULD THERAPEUTIC AGENTS FOR SEPSIS TARGET THE GLYCOCALYX? Sir Ganga Ram Hospital New Delhi, India Dr. Seema Bhargava Senior Consultant & Chairperson Department of Biochemistry & Professor, GRIPMER Sir
More informationBIOMARKERS IN SEPSIS
BIOMARKERS IN SEPSIS Dr. Syed Ghulam Mogni Mowla Assistant Professor, Medicine, DMC BSMCON 17 WHY WE NEED TO KNOW Sepsis and its complications are a common cause of infectious disease illness and mortality
More informationResearch Article In Critically Ill Patients, Serum Procalcitonin Is More Useful in Differentiating between Sepsis and SIRS than CRP, Il-6, or LBP
Critical Care Research and Practice Volume 2011, Article ID 594645, 6 pages doi:10.1155/2011/594645 Research Article In Critically Ill Patients, Serum Procalcitonin Is More Useful in Differentiating between
More informationUsefulness of Procalcitonin in the management of Infections in ICU. P Damas CHU Sart Tilman Liège
Usefulness of Procalcitonin in the management of Infections in ICU P Damas CHU Sart Tilman Liège Procalcitonin Peptide 116 AA Produced by parenchymal cells during «sepsis»: IL1, TNF, IL6 : stimulators
More informationNorepinephrine in septic shock
Norepinephrine in septic shock Prof. Zsolt Molnár zsoltmolna@gmail.com Department of Anaesthesia and Intensive Therapy University of Szeged, Hungary A few months ago should we give it earlier? (Courtesy
More informationUsing procalcitonin (PCT) to improve the odds in sepsis management
Using procalcitonin (PCT) to improve the odds in sepsis management Disclaimer This guide provides information for healthcare professionals on the optimal use of procalcitonin (PCT) testing and the subsequent
More informationL utilizzo della Procalcitonina in Medicina d Urgenza
L utilizzo della Procalcitonina in Medicina d Urgenza Stefania Battista Dirigente Medico S.C. Medicina d Urgenza Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino Savona, 15 ottobre 2009
More informationUse of procalcitonin assay to streamline antibiotic usage. Dr Kristine Luk
Use of procalcitonin assay to streamline antibiotic usage Dr Kristine Luk Outline Procalcitonin physiology & kinetics Limitations Different settings - primary care & AED - critically ill patients - neutropenic
More information5/1/2015 SEPSIS SURVIVING SEPSIS CAMPAIGN HOW TO APPROACH THE POSSIBLE SEPTIC CHILD 2015 INFECTION CAN BE CONFIRMED BY:
SURVIVING SEPSIS CAMPAIGN HOW TO APPROACH THE POSSIBLE SEPTIC CHILD 2015 Omer Nasiroglu MD Baptist Children s Hospital Pediatric Emergency Department SEPSIS IS A SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
More informationDIAGNOSIS AND INVESTIGATIONS FOR SEPSIS. B. Mrara
DIAGNOSIS AND INVESTIGATIONS FOR SEPSIS B. Mrara CH C.H. Baragwanath ICU OUTLINE Introduction Diagnostic issues in sepsis Diagnosis and investigations for sepsis: clinical and laboratory lb investigations
More informationSeptic Shock. Rontgene M. Solante, MD, FPCP,FPSMID
Septic Shock Rontgene M. Solante, MD, FPCP,FPSMID Learning Objectives Identify situations wherein high or low BP are hemodynamically significant Recognize complications arising from BP emergencies Manage
More informationSepsis the clinical syndrome
Sepsis the clinical syndrome João Gonçalves Pereira ICU director Vila Franca Xira Hospital Systemic Inflamatory Response 2 Temperature 38ºC or 36ºC bacteraemia other trauma HR 90/min INFECTION RR 20/min
More informationBiomarkers in sepsis: Utility in critical care
Biomarkers in sepsis: Utility in critical care Fathima Paruk, PhD Charlotte Maxeke Johannesburg Academic Hospital and University of Witwatersrand Kumar A et al, Chest 2009; 136:1237-48. von Gunten et al
More informationBiomarcadores. orientação terapêutica
Biomarcadores estratificação do risco e orientação terapêutica Pedro Póvoa Faculdade de Ciências Médicas Universidade Nova de Lisboa Unidade de Cuidados Intensivos Médicos Hospital de São Francisco Xavier
More informationSepsis is an important issue. Clinician s decision-making capability. Guideline recommendations
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 Clinicians decision-making capability Guideline recommendations Sepsis is an important issue 8.7%
More informationBIOMARKERS IN SEPSIS: DO THEY REALLY GUIDE US? Asist. Prof. M.D. Mehmet Akif KARAMERCAN Gazi University School of Medicine Depertment of Emergency
BIOMARKERS IN SEPSIS: DO THEY REALLY GUIDE US? Asist. Prof. M.D. Mehmet Akif KARAMERCAN Gazi University School of Medicine Depertment of Emergency Medicine 1 NO CONFLICT OF INTEREST 2 We do not fully understand
More informationClinical Guide to Use of PROCALCITONIN. for Diagnosis and PCT-Guided Antibiotic Therapy
Clinical Guide to Use of PROCALCITONIN for Diagnosis and PCT-Guided Antibiotic Therapy The content of this booklet was kindly written by: Philipp Schuetz, MD, MPH Privat Dozent for Endocrinology and Internal
More informationProcalcitonin YUKON KUSKOKWIM HEALTH CORPORATION PRESENTED BY: CURT BUCHHOLZ, MD AUGUST 2017
Procalcitonin YUKON KUSKOKWIM HEALTH CORPORATION PRESENTED BY: CURT BUCHHOLZ, MD AUGUST 2017 Procalcitonin (PCT) PCT isbeing studied as a biomarker for infection PCT consists of 116 amino
More informationPrognostic role of adrenomedullin in sepsis
Int. J. Adv. Res. Biol. Sci. (2016). 3(5): 136-141 International Journal of Advanced Research in Biological Sciences ISSN: 2348-8069 www.ijarbs.com Volume 3, Issue 5-2016 Research Article Prognostic role
More informationSEPSIS AND SEPTICEMIA St. Charles Bend / Dec. 18, 2015
SEPSIS AND SEPTICEMIA St. Charles Bend / Dec. 18, 2015 DEFINITIONS SYSTEMIC INFLAMMATORY RESPONSE SYNDROME SEPSIS SEVERE SEPSIS SEPTIC SHOCK MULTIPLE ORGAN FAILURE BACTEREMIA SEPTICEMIA THOMAS C CESARIO
More informationEarly procalcitonin kinetics and adequate empiric antibiotic therapy in critically ill
Early procalcitonin kinetics and adequate empiric antibiotic therapy in critically ill PhD Thesis Domonkos Trásy M.D. Department of Anaesthesiology and Intensive Therapy Doctoral School of Multidisciplinary
More informationResearch paper 45. Address: Department of Anaesthesiology, University of Erlangen-Nuremburg, Krankenhausstr. 12, D Erlangan, Germany.
Research paper 45 Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS Michael Meisner, Klaus Tschaikowsky,
More informationKey Points. Angus DC: Crit Care Med 29:1303, 2001
Sepsis Key Points Sepsis is the combination of a known or suspected infection and an accompanying systemic inflammatory response (SIRS) Severe sepsis is sepsis with acute dysfunction of one or more organ
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationDiagnostic role of soluble triggering receptor expressed on myeloid cell-1 in patients with sepsis
190 Wang et al Original Article Diagnostic role of soluble triggering receptor expressed on myeloid cell-1 in patients with sepsis Hong-xia Wang, Bing Chen Department of Emergency Medicine, Second Hospital
More informationPCT. PCT in Bacterial Infections and Sepsis. Early Diagnosis. Assessment of Severity and Prognosis. Support for Therapeutic Decision Making
PCT PCT in Bacterial Infections and Sepsis Early Diagnosis Assessment of Severity and Prognosis Support for Therapeutic Decision Making Diagnosis and monitoring of sepsis Clinical need for earlier detection
More informationSepsis: Mitigating Denials Amid Definition Disparity
Sepsis: Mitigating Denials Amid Definition Disparity White Paper - April 2017 Sepsis Criteria at a Glance The Society of Critical Care Medicine (SCCM) met in 2016 to update the definition of sepsis. During
More informationSepsis as Seen by the CMO. Randy C. Roth, MD Chief Medical Officer
Sepsis as Seen by the CMO Randy C. Roth, MD Chief Medical Officer 1 Challenges of Sepsis Sepsis, like many disease processes, is much more than a clinical challenge. For Hospitalists, we are treating the
More informationGuess or get it right?
Guess or get it right? Antimicrobial prescribing in the 21 st century Robert Masterton Traditional Treatment Paradigm Conservative start with workhorse antibiotics Reserve more potent drugs for non-responders
More informationEFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
More information/////// Procalcitonin. Solutions for Emergency Diagnostics. A Novel Biomarker for Bacterial Infections and Sepsis. VIDAS Emergency Assays
/////// Solutions for Emergency Diagnostics 2015 BIOMÉRIEUX, INC. BIOMÉRIEUX, THE BLUE LOGO AND VIDAS ARE USED PENDING AND/OR REGISTERED TRADEMARKS BELONGING TO BIOMÉRIEUX SA OR ONE OF ITS SUBSIDIARIES
More informationCurrent State of Pediatric Sepsis. Jason Clayton, MD PhD Pediatric Critical Care 9/19/2018
Current State of Pediatric Sepsis Jason Clayton, MD PhD Pediatric Critical Care 9/19/2018 Objectives Review the history of pediatric sepsis Review the current definition of pediatric sepsis Review triage
More informationSepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment
Sepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment What is sepsis? Life-threatening organ dysfunction caused by a dysregulated host response to infection A 1991 consensus
More informationDiagnosis and Management of Sepsis. Disclosures
Diagnosis and Management of Sepsis David Shimabukuro, MDCM Medical Director, 13 ICU Physician Lead, UCSF Sepsis Bundle Compliance and Mortality Reduction I have no disclosures Disclosures 1 The following
More informationEndothelium as a part of septic Multiple Organ Dysfunction Syndrome (MODS)-is endocan an answer?
Endothelium as a part of septic Multiple Organ Dysfunction Syndrome (MODS)-is endocan an answer? Małgorzata Lipinska-Gediga Department of Anaesthesiology and Intensive Therapy Medical University Wroclaw,
More informationJohn Park, MD Assistant Professor of Medicine
John Park, MD Assistant Professor of Medicine Faculty photo will be placed here park.john@mayo.edu 2015 MFMER 3543652-1 Sepsis Out with the Old, In with the New Mayo School of Continuous Professional Development
More informationManagement of Severe Sepsis:
Management of Severe Sepsis: Update from the Surviving Sepsis Campaign Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University NONE Disclosures Review evidence-based international sepsis
More informationUpdates in Sepsis 2017
Mortality Cases Total U.S. Population/1,000 Updates in 2017 Joshua Solomon, M.D. Associate Professor of Medicine National Jewish Health University of Colorado Denver Background New Definition of New Trials
More informationSepsis Management: Past, Present, and Future
Sepsis Management: Past, Present, and Future Benjamin Ferrell, MD Tennessee ACP Meeting October 28, 2017 Learning Objectives Identify the most updated definition and clinical criteria for sepsis Describe
More informationSpotting and Surviving Sepsis
Spotting and Surviving Sepsis Thomas Koshy, Ph.D. Sr. Director, Scientific Affairs Alere September 12, 2013 FOR INTERNAL USE ONLY. NOT FOR PRINT OR DISTRIBUTION 1 Learning Objectives Discuss the scope
More informationSepsis and Septicemia: Clear up Coding and Documentation Confusion october 2009
Sepsis and Septicemia: Clear Up Coding and Documentation Confusion W h i t e p a p e r Sepsis. Severe sepsis. SIRS. Septicemia. Unfortunately, this isn t a case of tomato, tomahto. Coders and physicians
More informationSURVIVING SEPSIS: Early Management Saves Lives
SURVIVING SEPSIS: Early Management Saves Lives Pat Posa RN, BSN, MSA System Performance Improvement Leader St. Joseph Mercy Health System Ann Arbor, MI Patricia.posa@stjoeshealth.org Objectives a. Understand
More informationDetecting and Removing Endotoxin in sepsis
Toronto 2015 Detecting and Removing Endotoxin in sepsis Claudio Ronco, MD Department of Nephrology Dialysis and Transplantation International Renal Research Institute San Bortolo Hospital Vicenza Italy
More informationHE Model for Sepsis POCT
HE Model for Sepsis POCT 1. To analyse the impact of a diagnostic test on the treatment of patients with sepsis, using patient data and expert elicitation 2. To build a business case to use POCT in A&E
More informationInitial Resuscitation of Sepsis & Septic Shock
Initial Resuscitation of Sepsis & Septic Shock Dr. Fatema Ahmed MD (Critical Care Medicine) FCPS (Medicine) Associate professor Dept. of Critical Care Medicine BIRDEM General Hospital Is Sepsis a known
More informationThe Sepsis Timebomb. James Wigfull Critical Care and Anaesthesia Sheffield Teaching Hospitals
The Sepsis Timebomb James Wigfull Critical Care and Anaesthesia Sheffield Teaching Hospitals Relationship of SIRS, Sepsis and Infection BACTEREMIA PANCREATITIS INFECTION FUNGEMIA PARASITEMIA VIREMIA SEPSIS
More informationPatient Safety Safe Table Webcast: Sepsis (Part III and IV) December 17, 2014
Patient Safety Safe Table Webcast: Sepsis (Part III and IV) December 17, 2014 Presenters Mark Blaney, RN Regional Nurse Educator CHI Franciscan Health Karen Lautermilch Director, Quality & Performance
More informationBiomarkers in sepsis. Dr S Omar University of Witwatersrand CHBAH Bara ICU
Biomarkers in sepsis Dr S Omar University of Witwatersrand CHBAH Bara ICU Procalcitonin PCT biomarker 1993- described as a sepsis associated protein Identical to the precursor protein of calcitonin which
More informationSeptic shock in children. Is it different than adults? Peter Kanizsai, MD, PhD associate professor in emergency medicine
Septic shock in children. Is it different than adults? Peter Kanizsai, MD, PhD associate professor in emergency medicine http://www.ipaustralia.com.au/applicant/clinical-excellence-commission/trademarks/1473265/
More informationThe Use of Procalcitonin Monitoring in Critically Ill Adults for Early Identification and Treatment of Sepsis
St. Catherine University SOPHIA Master of Arts in Nursing Theses Nursing 4-2012 The Use of Procalcitonin Monitoring in Critically Ill Adults for Early Identification and Treatment of Sepsis Raquel DeLaMater
More informationA BRIEF HISTORY OF SEPSIS. Euan Mackay
A BRIEF HISTORY OF SEPSIS Euan Mackay Aims History of sepsis definition Validity of new definition Hippocrates 4 th century BC Hippocrates introduced the term "σήψις the process of decay or decomposition
More informationInternational Journal of Advanced Research in Biological Sciences ISSN : Research Article
International Journal of Advanced Research in Biological Sciences ISSN : 2348-8069 www.ijarbs.com Research Article Serum level of IL-6, IL-10 and PCT as a prognostic marker in post traumatic sepsis patients.
More informationSepsis Management Update 2014
Sepsis Management Update 2014 Laura J. Moore, MD, FACS Associate Professor, Department of Surgery The University of Texas Health Science Center, Houston Medical Director, Shock Trauma ICU Texas Trauma
More informationPRELIMINARY PROGRAMME
www.sepseast2018.com PRELIMINARY PROGRAMME NOVEMBER 15-17, 2018 Danubius Health Spa Resort Helia Budapest, Hungary PROGRAM 15 NOVEMBER 2018, THURSDAY 08:20-08:30 WELCOME! Zsolt Molnar, Hungary 08:30-09:45
More informationSEPSIS & SEPTIC SHOCK
SEPSIS & SEPTIC SHOCK DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and mitigate potential bias
More informationEffectively Managing Sepsis Denials
Effectively Managing Sepsis Denials Krysten Brooks, RN, BSN, MBA Senior Inpatient Consultant 3M Health Information Systems This is the Full Title of a Session Atlanta, GA 1 Learning Objectives At the completion
More informationBiochemical and Hematological Markers of Inflammation Accurately Predict Sepsis and its Severity in ICU Patients
Sysmex Journal International Volume 29 No.1 (2019) Published 8 March, 2019 Original Article ISSN 2434-7825 Biochemical and Hematological Markers of Inflammation Accurately Predict Sepsis and its Severity
More informationJawad Nazir, MD, FACP Medical Director, Infection Prevention and Control Avera Health and Avera McKennan Hospital Clinical Associate Professor of
Jawad Nazir, MD, FACP Medical Director, Infection Prevention and Control Avera Health and Avera McKennan Hospital Clinical Associate Professor of Medicine Sanford School of Medicine, Univ of South Dakota
More informationPathologic Mechanisms of Septic Shock
Pathologic Mechanisms of Septic Shock Kenneth J. Goodrum, Ph.D. Dept. Biomedical Sciences Ohio University College of Osteopathic Medicine Outline of Topics Definitions: SIRS, sepsis, shock, MODS Morbidity/mortality
More information8/28/2015. ACP Toolbox SYSMEX CLINICAL SUPPORT TEAM SYSMEX CUSTOMER RESOURCE CENTER. Maggie Fischer BSN, RN, MS Carolyn Williams, BSN, RN, CRNI
ACP Toolbox Maggie Fischer BSN, RN, MS Carolyn Williams, BSN, RN, CRNI SYSMEX CLINICAL SUPPORT TEAM Available to provide education and resources: Tailored presentations Customer Resource Center tools Current
More informationSEPSIS: Seeing Through the. W. Graham Carlos MD, MSCR, ATSF, FACP
SEPSIS: Seeing Through the W. Graham Carlos MD, MSCR, ATSF, FACP Objectives Forget everything you have known about sepsis Learn new things Objectives Define sepsis Explain why Early Goal Directed Therapy
More informationThe Septic Patient. Dr Arunraj Navaratnarajah. Renal SpR Imperial College NHS Healthcare Trust
The Septic Patient Dr Arunraj Navaratnarajah Renal SpR Imperial College NHS Healthcare Trust Objectives of this session Define SIRS / sepsis / severe sepsis / septic shock Early recognition of Sepsis The
More informationALSO AVAILABLE: biomérieux S.A Marcy l Etoile France Tel. : 33 (0) Fax : 33 (0)
12-13 / 9304555 010/GB/A / This document is not legally binding. biomérieux reserves the right to modify specifications without notice / BIOMERIEUX, the blue logo, and Empowering Clinical Decisions and
More informationnumber Done by Corrected by Doctor موسى العبادي
number 12 Done by Corrected by Doctor موسى العبادي Morphology of Granulomatous Inflammations The first image (left) shows a lung alveolus in which necrosis is taking place. The image below it shows the
More informationNothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
More information9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
More informationSepsis Early Recognition and Management. Therese Hughes, PhD, MPA, RN
Sepsis Early Recognition and Management Therese Hughes, PhD, MPA, RN 1 Sepsis a Deadly Progression Affects millions around the world each year, killing one in four Contributes to approximately 50% of all
More informationTERMINOLOGY SIRS 10/30/2014 SURVIVING SEPSIS: FROM THE OFFICE TO THE ICU
Lisa Johnson DrNP, CRNP, ACNP BC Director, AG ACNP Program, DeSales University ACNP with Eastern Pennsylvania Infectious Disease Associates SURVIVING SEPSIS: FROM THE OFFICE TO THE ICU TERMINOLOGY Infection
More informationSepsis overview. Dr. Tsang Hin Hung MBBS FHKCP FRCP
Sepsis overview Dr. Tsang Hin Hung MBBS FHKCP FRCP Epidemiology Sepsis, severe sepsis, septic shock Pathophysiology of sepsis Recent researches and advances From bench to bedside Sepsis bundle Severe sepsis
More informationInflammatory Statements
Inflammatory Statements Using ETCO 2 Analysis in Sepsis Syndromes George A. Ralls M.D. Orange County EMS System Sepsis Sepsis Over 750,000 cases annually Expected growth of 1.5% per year Over 215,000 deaths
More informationSepsi: nuove definizioni, approccio diagnostico e terapia
GIORNATA MONDIALE DELLA SEPSI DIAGNOSI E GESTIONE CLINICA DELLA SEPSI Giovedì, 13 settembre 2018 Sepsi: nuove definizioni, approccio diagnostico e terapia Nicola Petrosillo Società Italiana Terapia Antiinfettiva
More informationESCMID Online Lecture Library. by author
What room for biomarkers in the management of anti-infective therapy Philippe Montravers Hôpital Bichat-Claude Bernard, Pole SUPRA APHP UFR Paris Diderot, Paris 7, Paris Cité Sorbonne Disclosures Speaker
More informationSepsis and Shock States
Sepsis and Shock States Presented By: Cynthia Webner BSN, RN, CCRN, CMC www.cardionursing.com CNEA 2009 1 INFECTION Inflammatory response to microorganisms, or Invasion of normally sterile tissues SYSTEMIC
More informationNo conflicts of interest to disclose
No conflicts of interest to disclose Introduction Epidemiology Surviving sepsis guidelines 2012 Updates Resuscitation protocols Map Goals Transfusion Sepsis-3 Bundle Management Questions Sepsis is a systemic,
More informationDiagnosis and Management of Sepsis and Septic Shock. Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire
Diagnosis and Management of Sepsis and Septic Shock Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire Financial: none Disclosures Objectives: Identify physiologic principles of septic
More information6/29/2017. Role of Biomarkers in the Management of Heart Failure Patients. What s New in Biomarkers for HF Patients?
What s New in Biomarkers for HF Patients? Role of Biomarkers in the Management of Heart Failure Patients Lori B. Daniels, MD, MAS, FACC Professor of Medicine Director, Cardiovascular Intensive Care Unit
More informationGlobal Updates on Sepsis. Lizzie Barrett Nurse Educator, Intensive Care Unit Nepean Hospital, Sydney, Australia Prepared August 2016
Global Updates on Sepsis Lizzie Barrett Nurse Educator, Intensive Care Unit Nepean Hospital, Sydney, Australia Prepared August 2016 The global picture Sepsis affects approx. 30 million people worldwide
More informationSepsis: Identification and Management in an Acute Care Setting
Sepsis: Identification and Management in an Acute Care Setting Dr. Barbara M. Mills DNP Director Rapid Response Team/ Code Resuscitation Stony Brook University Medical Center SEPSIS LECTURE NPA 2018 OBJECTIVES
More informationINFECTION/ INFLAMMATION
HAEMATOLOGY OCTOBER 2017* WHITE PAPER INFECTION/ INFLAMMATION Novel haematological parameters for rapidly monitoring the immune system response Patients with inflammatory disease are common on hospital
More informationAdvancements in Sepsis
Objectives Advancements in Sepsis Brian Gilbert, PharmD PGY-1 Pharmacy Resident Jackson Memorial Hospital 3/13/2016 www.fshp.org Pharmacist objectives Review recent updates in resuscitation strategies
More informationSepsis 3 & Early Identification. Disclosures. Objectives 9/19/2016. David Carlbom, MD Medical Director, HMC Sepsis Program
Sepsis 3 & Early Identification David Carlbom, MD Medical Director, HMC Sepsis Program Disclosures I have no relevant financial relationships with a commercial interest and will not discuss off-label use
More informationOHSU. Update in Sepsis
Update in Sepsis Jonathan Pak, MD June 1, 2017 Structure of Talk 1. Sepsis-3: The latest definition 2. Clinical Management - Is EGDT dead? - Surviving Sepsis Campaign Guidelines 3. A novel therapy: Vitamin
More informationSepsis: Update on Diagnosis, Evaluation and Management
Sepsis: Epidemiology Sepsis: Update on Diagnosis, Evaluation and Management Michael J. Apostolakos, MD Professor of Medicine Director of Adult Critical Care University of Rochester ~ 750,000 cases per
More informationClinical Guide to Use of PROCALCITONIN. for Diagnosis and Guidance of Antibiotic Therapy
Clinical Guide to Use of PROCALCITONIN for Diagnosis and Guidance of Antibiotic Therapy THE CONTENT OF THIS BOOKLET WAS KINDLY WRITTEN BY: Philipp SCHUETZ, MD, MPH Privat Dozent for Endocrinology and Internal
More informationPlasma concentrations of copeptin, C-reactive protein and procalcitonin are positively correlated with APACHE II scores in patients with sepsis
Research Report Plasma concentrations of copeptin, C-reactive protein and procalcitonin are positively correlated with APACHE II scores in patients with sepsis Journal of International Medical Research
More informationUpdate on Sepsis Diagnosis and Management
CHAPTER 12 Update on Sepsis Diagnosis and Management Kevin Alexander, DPM INTRODUCTION Sepsis and septic shock have become a large problem in the health care system that affects at least 1 million people
More informationSurviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012
本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012 Definition Sepsis the presence of infection with
More informationUse of Blood Lactate Measurements in the Critical Care Setting
Use of Blood Lactate Measurements in the Critical Care Setting John G Toffaletti, PhD Director of Blood Gas and Clinical Pediatric Labs Professor of Pathology Duke University Medical Center Chief, VAMC
More informationSepsis Update: Early Identification and Management
Sepsis Update: Early Identification and Management Q&A From the Live Webinar Presenter: Tom Ahrens, RN, PhD, FAAN Live webinar: Thursday, May 09, 2013 The AACN Critical Care Webinar Series is not only
More informationSepsis Awareness and Education
Sepsis Awareness and Education Meets the updated New York State Department of Health (NYSDOH) requirements for Infection Control and Barrier Precautions coursework Element VII: Sepsis Awareness and Education
More information