Abstract:
OBJECTIVE:In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious process that falls under the generalized term 'sepsis' and includes sepsis-associated organ dysfunction as well." The general definitions introduced as a result of that conference have been widely used in practice and have served as the foundation for inclusion criteria for numerous clinical trials of therapeutic interventions. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. DESIGN:Several North American and European intensive care societies agreed to revisit the definitions for sepsis and related conditions. This conference was sponsored by the SCCM, The European Society of Intensive Care Medicine (ESICM), The American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Surgical Infection Society (SIS). METHODS:The conference was attended by 29 participants from Europe and North America. In advance of the conference, five subgroups were formed to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiologic data, and coagulation parameters. The subgroups corresponded electronically before the conference and met in person during the conference. A spokesperson for each group presented the deliberation of each group to all conference participants during a plenary session. A writing committee was formed at the conference and developed the current article based on executive summary documents generated by each group and the plenary group presentations. The present article serves as the final report of the 2001 International Sepsis Definitions Conference. CONCLUSION:This document reflects a process whereby a group of experts and opinion leaders revisited the 1992 sepsis guidelines and found that apart from expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience, no evidence exists to support a change to the definitions. This lack of evidence serves to underscore the challenge still present in diagnosing sepsis in 2003 for clinicians and researchers and also provides the basis for introducing PIRO as a hypothesis-generating model for future research.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Levy MM,Fink MP,Marshall JC,Abraham E,Angus D,Cook D,Cohen J,Opal SM,Vincent JL,Ramsay G,SCCM\/ESICM\/ACCP\/ATS\/SIS.doi
10.1097/01.CCM.0000050454.01978.3Bsubject
Has Abstractpub_date
2003-04-01 00:00:00pages
1250-6issue
4eissn
0090-3493issn
1530-0293journal_volume
31pub_type
共识发展会议,杂志文章,评审abstract::Factors responsible for determining the position of the oxyhemoglobin equilibrium curve during the neonatal period are briefly reviewed and the clinical implications of these changes are examined. Two clinical trials employing exchange transfusions as an adjunct to conventional therapy of the severe respiratory distre...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197909000-00013
更新日期:1979-09-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that nebulized nitroprusside and inhaled nitric oxide would not differ in producing selective pulmonary vasodilation during hypoxia-induced pulmonary hypertension in piglets. SETTING:University laboratory. SUBJECTS:Five piglets. INTERVENTIONS:Piglets (n = 5) were anesthetized and ins...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200211000-00026
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVES:Hyperammonemia is a key contributing factor for cerebral edema in acute liver failure. Continuous renal replacement therapy may help reduce ammonia levels. However, the optimal timing, mode, intensity, and duration of continuous renal replacement therapy in this setting are unknown. We aimed to study continu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004153
更新日期:2020-02-01 00:00:00
abstract::The performance of three samples each of six brands of flow-directed pulmonary artery (PA) catheters was evaluated. In vivo studies determined the reproducibility of PA waveforms over a range of controlled heart rates when compared to those obtained from a transducer-tipped catheter. In vitro studies determined their ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198703000-00015
更新日期:1987-03-01 00:00:00
abstract:OBJECTIVE:Inflammation and immobility are comorbid etiological factors inducing muscle weakness in critically ill patients. This study establishes a rat model to examine the effect of inflammation and immobilization alone and in combination on muscle contraction, histology, and acetylcholine receptor regulation. DESIG...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0B013E3181659669
更新日期:2008-03-01 00:00:00
abstract::An emergency cricothyrotomy device was placed in 11 anesthetized dogs in order to assess airway damage and problems in placement, ventilation, and design. Posterior airway perforation without esophageal damage occurred in three animals. Submucosal hematomas or cricoid cartilage injury occurred in seven animals. As pla...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198702000-00016
更新日期:1987-02-01 00:00:00
abstract:OBJECTIVE:To investigate relationships between acute adrenergic stress, plasma catecholamine concentrations, and beta 2-adrenergic receptors. DESIGN:Prospective, descriptive study. SETTING:Emergency medical service at a university hospital. PATIENTS:Twenty-seven patients with out-of-hospital cardiac arrest (n = 11),...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199704000-00015
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:To study whether noninvasive pressure support ventilation (NIPSV) with helium/oxygen (He/oxygen), which can reduce dyspnea, PaCO2, and work of breathing more than NIPSV with air/oxygen in decompensated chronic obstructive pulmonary disease, could have beneficial consequences on outcome and hospitalization cos...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.CCM.0000055369.37620.EE
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVES:Conflict is common between physicians and surrogate decision makers around end-of-life care in ICU. Involving experts in conflict management improve outcomes, but little is known about what differences in conflict management styles may explain the benefit. We used simulation to examine potential differences ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001583
更新日期:2016-05-01 00:00:00
abstract:OBJECTIVE:The beneficial effects of hypertonic saline on neuronal survival and on cerebral blood flow have been shown in several animal models of global and focal brain ischemia. Because of the potential benefits of hypertonic solutions, it is hypothesized that hydroxyethyl starch enhances cerebral blood flow and impro...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31824e6750
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that the effects of intravenous injection of latex particles would demonstrate the contribution of phagocytosis by mononuclear phagocytes to the development of Escherichia coli-induced acute lung injury in neutropenic guinea pigs. DESIGN:Prospective, controlled, experimental study. Int...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199606000-00025
更新日期:1996-06-01 00:00:00
abstract:OBJECTIVE:Preoperative intra-aortic balloon pumping (IABP) improves the results of complex coronary surgery. However, its insertion may be harmful or contraindicated in cases of severe and diffuse atherosclerosis of the descending aorta and peripheral arteries. We sought to evaluate the efficacy and safety of transbrac...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000229884.94475.DB
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:To determine the frequency and effects of weaning-related myocardial ischemia on weaning outcomes in patients with coronary artery disease. DESIGN:Prospective cohort study. SETTING:Medical and cardiac intensive care units of a 300-bed teaching community hospital. MEASUREMENTS AND MAIN RESULTS:Three-lead ST...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199910000-00005
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVE:To determine the occurrence rate of complications and mortality in patients with severe asthma requiring endotracheal intubation and mechanical ventilation. DESIGN:Retrospective review of medical records from September 1982 to July 1988. SETTING:Urban, teaching hospital serving primarily indigent patients. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199311000-00023
更新日期:1993-11-01 00:00:00
abstract:OBJECTIVE:To determine whether peptic activity in bronchoalveolar fluid, due to the presence of the gastric proteolytic enzyme pepsin, could serve as a biochemical marker for pulmonary aspiration of gastric contents. DESIGN:Prospective, experimental trial. SETTING:A university animal research laboratory. SUBJECTS:Th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199611000-00019
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVE:During cardiopulmonary bypass, inflammation and immunosuppression is present. We measured circulating mediators and monocyte-based functions and tested the hypothesis that these variables are influenced by methylprednisolone (MP) or tirilazad mesylate (TM) treatment. DESIGN:Randomized, controlled, double-bli...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200111000-00015
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between treatment-related variables for Candida bloodstream infection and hospital mortality. DESIGN:Retrospective cohort analysis. SETTING:Thousand two hundred-bed academic medical center. PATIENTS:A total of 245 consecutive patients with Candida bloodstream infections who rece...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31818b3477
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:Heatstroke is characterized by hyperthermia, vasoplegic shock, and cerebral ischemia and hypoxia. Hyperbaric oxygen (HBO) has been shown to reduce brain ischemia and behavioral dysfunction during cerebral artery occlusion. The efficacy of HBO therapy for resuscitation from heatstroke remains to be determined ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000159193.42628.e8
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVE:Cortisol clearance is reduced in sepsis and may contribute to the development of impaired adrenocortical function that is thought to contribute to the pathophysiology of critical illness-related corticosteroid insufficiency. We sought to assess adrenocortical function using computer-assisted numerical modelin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000721
更新日期:2015-03-01 00:00:00
abstract::The pericardium serves many important functions, but it is not essential for life. Pericardial heart disease comprises only pericarditis and its complications, tamponade and constriction, and congenital lesions. However, the pericardium is affected by virtually every category of disease. The critical care physician is...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000271159.84639.2B
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVE:Keratinocyte growth factor (KGF) is expressed primarily by fibroblasts, is important for alveolar epithelial proliferation/function, and protects against lung injury in multiple animal models. We wished to determine whether acute lung injury/acute respiratory distress syndrome (ALI/ARDS) alveolar fluid induce...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31819fc81a
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:To test whether intensive care unit (ICU) nasal screening for methicillin-resistant Staphylococcus aureus (MRSA) predicts the presence or absence of MRSA infections requiring antimicrobial treatment. DESIGN:A prospective cohort study. SETTING:Medical ICU at Barnes-Jewish Hospital, a 1252-bed urban teaching ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181eeda3f
更新日期:2010-10-01 00:00:00
abstract:SUBJECT:After transient global cerebral ischemia, selective vulnerable brain areas show delayed neurodegeneration with characteristics of apoptosis. Recent data demonstrate potent neuroprotective effects of the application of endogenous growth hormones such as brain-derived neurotrophic factor (BDNF) after focal cerebr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000134223.09056.fc
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVE:To evaluate the efficacy and tolerability of intravenous empiric treatment with meropenem compared with ceftazidime-tobramycin in patients with hospital-acquired lower respiratory tract infections. DESIGN:Prospective, nonblind, randomized trial. SETTING:Multicenter trial conducted at 22 centers. PATIENTS:T...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199710000-00015
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To investigate, in restrictive patients, the influence of pressure ramp slope values on the efficacy of pressure support ventilation. DESIGN:Prospective study. SETTING:A university hospital medical intensive care unit. PATIENTS:Twelve intubated restrictive patients. INTERVENTIONS:Patients were randomly as...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199904000-00023
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large isc...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000150659.15558.23
更新日期:2005-01-01 00:00:00
abstract::This study evaluated the effects of varying colloid concentrations and infusion volumes on survival and plasma volume expansion in rats subjected to an intestinal ischemic shock. Up to 10% solutions of albumin and dextran-40 in lactated Ringer's solution, infused over a 6-h period, had the same effects on hematocrit (...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198509000-00003
更新日期:1985-09-01 00:00:00
abstract:OBJECTIVE:Our objective was to quantify the association between intensive care unit-acquired dysglycemia (hyperglycemia, hypoglycemia, and high variability) and in-hospital mortality. DESIGN:Retrospective, observational study. SETTING:eICU Research Institute participating hospitals with an active tele-ICU program bet...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182656ae5
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Noncuffed, percutaneously inserted central venous catheters (CVCs) are widely used and cause at least 250,000 bloodstream infections (BSIs) in U.S. hospitals each year. We report a prospective study to determine whether inflammation at the insertion site is predictive of CVC-related BSI. METHODS:Percutaneou...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200212000-00003
更新日期:2002-12-01 00:00:00
abstract::This report is intended to familiarize the reader with the current legislation concerning state definitions of death, the pertinent judicial decisions concerning termination of life support and the current status of medical/ethical committees. However, it is of paramount importance to all health care personnel to beco...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00