Skip to main content
Erschienen in: Intensive Care Medicine 6/2017

04.04.2017 | Focus Editorial

Focus on infection and sepsis 2017

verfasst von: Ignacio Martin-Loeches, Jose Garnacho-Montero, Saad Nseir

Erschienen in: Intensive Care Medicine | Ausgabe 6/2017

Einloggen, um Zugang zu erhalten

Excerpt

Management of severe infections and sepsis in intensive care units (ICU) represents one of the most common and complex problems in daily clinical practice. Year by year, new studies are helping to improve physicians’ management and this manuscript aims to summarize the most relevant works published during 2015–2016 on these difficult areas of knowledge (Table 1).
Table 1
Selected recent findings on infection and sepsis in the critically ill patient
2017 Surviving Sepsis Campaign controversies
 Critically ill patients frequently not receiving the recommended quantity of fluids during the first 24 h of sepsis or septic shock, mortality increased in patients with severe sepsis receiving <5 L of fluids
 Lower hemoglobin levels not associated with higher mortality or worse quality of life at 1 year after randomization
“Area of need” population studies in sepsis
 Refractory septic shock in pediatric population
 Sepsis in resource-limited settings
qSOFA-65?
 qSOFA accurate in patients with community-acquired pneumonia
 Older patients with influenza prone to higher rates of bacterial co-infection, and higher mortality rates
ICU-acquired infections
 Duration of mechanical ventilation, but not antibiotics, associated with changes in lung microbiome
 Highly heterogeneous patterns of intestinal microbiota in both septic and non-septic ICU patients
 Treatment with probiotics effective and safe to prevent VAP
 De-escalation in ICU patients feasible and associated with better outcomes
qSOFA quick sequential organ failure assessment, VAP ventilator-associated pneumonia, MDR multidrug-resistant bacteria, ICU intensive care unit
Literatur
2.
Zurück zum Zitat Marik PE, Linde-Zwirble WT, Bittner EA et al (2017) Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database. Intensive Care Med. doi:10.1007/s00134-016-4675-y Marik PE, Linde-Zwirble WT, Bittner EA et al (2017) Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database. Intensive Care Med. doi:10.​1007/​s00134-016-4675-y
3.
Zurück zum Zitat Hjortrup PB, Haase N, Bundgaard H et al (2016) Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med 42:1695–1705. doi:10.1007/s00134-016-4500-7 CrossRefPubMed Hjortrup PB, Haase N, Bundgaard H et al (2016) Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med 42:1695–1705. doi:10.​1007/​s00134-016-4500-7 CrossRefPubMed
4.
Zurück zum Zitat Rygard SL, Holst LB, Wetterslev J et al (2016) Long-term outcomes in patients with septic shock transfused at a lower versus a higher haemoglobin threshold: the TRISS randomised, multicentre clinical trial. Intensive Care Med 42:1685–1694. doi:10.1007/s00134-016-4437-x CrossRefPubMed Rygard SL, Holst LB, Wetterslev J et al (2016) Long-term outcomes in patients with septic shock transfused at a lower versus a higher haemoglobin threshold: the TRISS randomised, multicentre clinical trial. Intensive Care Med 42:1685–1694. doi:10.​1007/​s00134-016-4437-x CrossRefPubMed
13.
Zurück zum Zitat Flaatten H, de Lange DW, Artigas A et al (2017) The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. doi:10.1007/s00134-017-4718-z Flaatten H, de Lange DW, Artigas A et al (2017) The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. doi:10.​1007/​s00134-017-4718-z
15.
Zurück zum Zitat Zakharkina T, Martin-Loeches I, Matamoros S et al (2017) The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia. Thorax. doi:10.1136/thoraxjnl-2016-209158 PubMed Zakharkina T, Martin-Loeches I, Matamoros S et al (2017) The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia. Thorax. doi:10.​1136/​thoraxjnl-2016-209158 PubMed
17.
Zurück zum Zitat Zeng J, Wang C-T, Zhang F-S et al (2016) Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial. Intensive Care Med 42:1018–1028. doi:10.1007/s00134-016-4303-x CrossRefPubMed Zeng J, Wang C-T, Zhang F-S et al (2016) Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial. Intensive Care Med 42:1018–1028. doi:10.​1007/​s00134-016-4303-x CrossRefPubMed
20.
Zurück zum Zitat Gutierrez-Pizarraya A, Leone M, Garnacho-Montero J et al (2017) Collaborative approach of individual participant data of prospective studies of de-escalation in non-immunosuppressed critically ill patients with sepsis. Expert Rev Clin Pharmacol 10:457–465. doi:10.1080/17512433.2017.1293520 CrossRefPubMed Gutierrez-Pizarraya A, Leone M, Garnacho-Montero J et al (2017) Collaborative approach of individual participant data of prospective studies of de-escalation in non-immunosuppressed critically ill patients with sepsis. Expert Rev Clin Pharmacol 10:457–465. doi:10.​1080/​17512433.​2017.​1293520 CrossRefPubMed
Metadaten
Titel
Focus on infection and sepsis 2017
verfasst von
Ignacio Martin-Loeches
Jose Garnacho-Montero
Saad Nseir
Publikationsdatum
04.04.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 6/2017
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-017-4787-z

Weitere Artikel der Ausgabe 6/2017

Intensive Care Medicine 6/2017 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.