Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

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To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012."

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Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america.

Alison Freifeld, Eric Bow, Kent A. Sepkowitz … (2011)

This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving. What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens. Finally, we note that all Panel members are from institutions in the United States or Canada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside of North America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.

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Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.

M. B. P. Amato, C Barbas, D M Medeiros … (1998)

In patients with the acute respiratory distress syndrome, massive alveolar collapse and cyclic lung reopening and overdistention during mechanical ventilation may perpetuate alveolar injury. We determined whether a ventilatory strategy designed to minimize such lung injuries could reduce not only pulmonary complications but also mortality at 28 days in patients with the acute respiratory distress syndrome. We randomly assigned 53 patients with early acute respiratory distress syndrome (including 28 described previously), all of whom were receiving identical hemodynamic and general support, to conventional or protective mechanical ventilation. Conventional ventilation was based on the strategy of maintaining the lowest positive end-expiratory pressure (PEEP) for acceptable oxygenation, with a tidal volume of 12 ml per kilogram of body weight and normal arterial carbon dioxide levels (35 to 38 mm Hg). Protective ventilation involved end-expiratory pressures above the lower inflection point on the static pressure-volume curve, a tidal volume of less than 6 ml per kilogram, driving pressures of less than 20 cm of water above the PEEP value, permissive hypercapnia, and preferential use of pressure-limited ventilatory modes. After 28 days, 11 of 29 patients (38 percent) in the protective-ventilation group had died, as compared with 17 of 24 (71 percent) in the conventional-ventilation group (P<0.001). The rates of weaning from mechanical ventilation were 66 percent in the protective-ventilation group and 29 percent in the conventional-ventilation group (P=0.005): the rates of clinical barotrauma were 7 percent and 42 percent, respectively (P=0.02), despite the use of higher PEEP and mean airway pressures in the protective-ventilation group. The difference in survival to hospital discharge was not significant; 13 of 29 patients (45 percent) in the protective-ventilation group died in the hospital, as compared with 17 of 24 in the conventional-ventilation group (71 percent, P=0.37). As compared with conventional ventilation, the protective strategy was associated with improved survival at 28 days, a higher rate of weaning from mechanical ventilation, and a lower rate of barotrauma in patients with the acute respiratory distress syndrome. Protective ventilation was not associated with a higher rate of survival to hospital discharge.

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Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Yngve Falck-Ytter, Charles Francis, Norman A Johanson … (2012)

VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lower-extremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches.

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Journal

Journal ID (iso-abbrev): Crit. Care Med.

Title: Critical care medicine

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Electronic): 1530-0293

ISSN (Print): 0090-3493

Publication date (Electronic): Mar 2017

Volume: 45

Issue: 3

Affiliations

[1 ] 1St. George's Hospital London, England, United Kingdom. 2New York University School of Medicine New York, NY. 3McMaster University Hamilton, Ontario, Canada. 4Brown University School of Medicine Providence, RI. 5Instituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy. 6Vall d'Hebron University Hospital Barcelona, Spain. 7University of Manitoba Winnipeg, Manitoba, Canada. 8Emory University Hospital Atlanta, GA. 9Hadassah Hebrew University Medical Center Jerusalem, Israel. 10Sunnybrook Health Sciences Centre Toronto, Ontario, Canada. 11University of Pittsburgh Critical Care Medicine CRISMA Laboratory Pittsburgh, PA. 12Hospital Raymond Poincare Garches, France. 13Saint Thomas Hospital London, England, United Kingdom. 14University College London Hospitals London, England, United Kingdom. 15Vanderbilt University Medical Center Nashville, TN. 16Service de Reanimation Medicale Paris, France. 17CHIREC Hospitals Braine L'Alleud, Belgium. 18Western Hospital Victoria, Australia. 19Keio University School of Medicine, Tokyo, Japan. 20Vivantes-Klinikum Neukölln, Berlin, Germany. 21Karl Heusner Memorial Hospital Belize Healthcare Partners Belize City, Belize. 22Cooper Health System Camden, NJ. 23University of Mississippi Medical Center Jackson, MS. 24Jupiter Hospital Thane, India. 25Rush University Medical Center Chicago, IL. 26ASAN Medical Center University of Ulsan College of Medicine Seoul, South Korea. 27Hospital de Clinicas de Porto Alegre Porto Alegre, Brazil. 28Federal University of Sao Paulo Sao Paulo, Brazil. 29Regions Hospital St. Paul, MN. 30Saint Michael's Hospital Toronto, Ontario, Canada. 31Washington University School of Medicine St. Louis, MO. 32Ottawa Hospital Ottawa, Ontario, Canada. 33Nepean Hospital, University of Sydney Penrith, New South Wales, Australia. 34Mount Sinai Hospital Toronto, Ontario, Canada. 35UCINC, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. 36University of New South Wales, Sydney, New South Wales, Australia. 37Università dellla Magna Graecia Catanzaro, Italy. 38Fujita Health University School of Medicine, Toyoake, Aich, Japan. 39Rigshospitalet Copenhagen, Denmark. 40Università Sapienza, Rome, Italy. 41Christiana Care Health Services Newark, DE. 42University of Pittsburgh School of Medicine Pittsburgh, PA. 43Stanford University School of Medicine Stanford, CA. 44Kaust Medical Services Thuwal, Saudi Arabia. 45University of Kansas Medical Center Kansas City, KS. 46Wolfson Institute of Biomedical Research London, England, United Kingdom. 47Massachusetts General Hospital Boston, MA. 48California Pacific Medical Center San Francisco, CA. 49University of Amsterdam Amsterdam, Netherlands. 50Erasmé University Hospital Brussels, Belgium. 51University of Amsterdam, Amsterdam, Netherlands. 52Houston Methodist Hospital, Houston, TX.

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DOI: 10.1097/CCM.0000000000002255

PubMed ID: 28098591

SO-VID: 86b9f370-3b35-4e0b-b39b-f135887943ac

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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

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International Journal of Management Studies

Most cited references 429

Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america.

Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.

Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

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Cited by 926

Most referenced authors 10,447