The race against the "septic shark".


:Great white sharks are responsible for about 10 cases of death annually worldwide, as compared with millions of deaths caused by sepsis. However, the basic principles of avoiding shark attacks and fighting sepsis seem to be similar: avoidance, attention, and speed, if necessary. The present review discusses the current status of the systemic inflammatory response syndrome (SIRS) criteria, which are actually content for discussion because of their low specificity. Current data suggest that one in eight patients with severe sepsis does not fulfill the SIRS criteria and is consequently missed, and therefore the calls for new definitions of sepsis are getting louder. Furthermore, the need for early treatment of sepsis and fast admission to an intensive care unit (ICU) with experienced stuff is reviewed as well as the early and appropriate initiation of therapy, namely antibiotic and volume therapy. A key feature is the analysis of the studies from the so-called "Sepsis Trilogy" (ProCESS, ARISE, and ProMiSe studies), with a focus on the status of early goal-directed therapy (EGDT). The authors of the "Sepsis Trilogy" concluded that there is no benefit regarding survival in septic patients by using EGDT as compared with standard therapy. However, the low mortality of the control groups within the "Sepsis Trilogy" studies as compared with the Rivers et al. study from 2001 leads to the conclusion that there has been an improvement in the therapy of septic patients, most probably due to the early initiation of therapy as a kind of "standard" in sepsis therapy. Finally, the phenomenon of a "large trial disease" is discussed, exemplary in a trial which investigated the maintenance of the "right" mean arterial pressure in sepsis patients. Even if the result of a large randomized trial might be that there is no difference between two study groups, the real exercise is to identify the patient collectives who might benefit or experience harm due to an intervention. In summary, as compared with swimming in dangerous waters, high attention is needed in handling septic patients. Once an attack has occurred, speed is of utmost importance (i.e., initiation of therapy and admission to the ICU) because it appears logical that time is critical in septic patients This may have resulted in the implementation of early (goal-directed) treatment as a "standard" in the treatment of sepsis with significant improvement in survival.


Crit Care


Westphal M,Kampmeier T




Has Abstract


2015-01-01 00:00:00










19 Suppl 3


  • Effects of reduced rebreathing time, in spontaneously breathing patients, on respiratory effort and accuracy in cardiac output measurement when using a partial carbon dioxide rebreathing technique: a prospective observational study.

    abstract:INTRODUCTION:New technology using partial carbon dioxide rebreathing has been developed to measure cardiac output. Because rebreathing increases respiratory effort, we investigated whether a newly developed system with 35 s rebreathing causes a lesser increase in respiratory effort under partial ventilatory support tha...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Tachibana K,Imanaka H,Takeuchi M,Nishida T,Takauchi Y,Nishimura M

    更新日期:2005-10-05 00:00:00

  • Feasibility and reliability of an automated controller of inspired oxygen concentration during mechanical ventilation.

    abstract:INTRODUCTION:Hypoxemia and high fractions of inspired oxygen (FiO2) are concerns in critically ill patients. An automated FiO2 controller based on continuous oxygen saturation (SpO2) measurement was tested. Two different SpO2-FiO2 feedback open loops, designed to react differently based on the level of hypoxemia, were ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Saihi K,Richard JC,Gonin X,Krüger T,Dojat M,Brochard L

    更新日期:2014-02-19 00:00:00

  • Moving beyond tight glucose control to safe effective glucose control.

    abstract::The impressive benefits related to the use of tight glucose control by intensive insulin therapy have not been reproduced until now in multicenter large-scale prospective randomized trials. Although the reasons for these failures are not entirely clear, we suggest the use of a stepwise approach - Safe, Effective Gluco...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Krinsley JS,Preiser JC

    更新日期:2008-01-01 00:00:00

  • Low B and T lymphocyte attenuator expression on CD4+ T cells in the early stage of sepsis is associated with the severity and mortality of septic patients: a prospective cohort study.

    abstract:INTRODUCTION:B and T lymphocyte attenuator (BTLA) is an inhibitory receptor, whose primary role in CD4(+) T cell is thought to inhibit cytokine production. We explore BTLA expression on CD4(+) T cells in healthy controls and septic patients, and assess the correlation of BTLA expression on CD4(+) T cells in the early s...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Shao R,Li CS,Fang Y,Zhao L,Hang C

    更新日期:2015-08-28 00:00:00

  • Copeptin in acute decompensation of liver cirrhosis: relationship with acute-on-chronic liver failure and short-term survival.

    abstract:BACKGROUND:Acute-on-chronic liver failure (ACLF) is characterized by the presence of acute decompensation (AD) of cirrhosis, organ failure, and high short-term mortality rates. Hemodynamic dysfunction and activation of endogenous vasoconstrictor systems are thought to contribute to the pathogenesis of ACLF. We explored...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Kerbert AJC,Verspaget HW,Navarro ÀA,Jalan R,Solà E,Benten D,Durand F,Ginès P,van der Reijden JJ,van Hoek B,Coenraad MJ,CANONIC Study Investigators of the EASL-CLIF Consortium.

    更新日期:2017-12-21 00:00:00

  • Long-term risk of sepsis among survivors of acute kidney injury.

    abstract::Many prior studies have shown that, in critically ill patients, acute kidney injury (AKI) commonly occurs in association with sepsis and its presence portends an increased likelihood of poor outcomes. In contrast, few studies have focused specifically on the influence of AKI on the long-term risk of developing sepsis....

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章


    authors: Clark E,Bagshaw SM

    更新日期:2014-01-24 00:00:00

  • Successful treatment of severe sepsis and diarrhea after vagotomy utilizing fecal microbiota transplantation: a case report.

    abstract:INTRODUCTION:Dysbiosis of intestinal microbiota likely plays an important role in the development of gut-derived infections, making it a potential therapeutic target against sepsis. However, experience with fecal microbiota transplantation (FMT) in the treatment of sepsis and knowledge of the underlying mechanisms are ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Li Q,Wang C,Tang C,He Q,Zhao X,Li N,Li J

    更新日期:2015-02-09 00:00:00

  • DHEA-dependent and organ-specific regulation of TNF-alpha mRNA expression in a murine polymicrobial sepsis and trauma model.

    abstract:INTRODUCTION:Dehydroepiandrosterone (DHEA) improves survival after trauma and sepsis, while mechanisms of action are not yet fully understood. Therefore, we investigated the influence of DHEA on local cytokine expression in a two-hit model. METHODS:Male NMRI mice were subjected to femur fracture/hemorrhagic shock and ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Barkhausen T,Hildebrand F,Krettek C,van Griensven M

    更新日期:2009-01-01 00:00:00

  • Antimicrobial exposure and the risk of delirium in critically ill patients.

    abstract:BACKGROUND:Prior retrospective cross-sectional work has associated antimicrobials with a non-specific phrase: encephalopathy without seizures. The purpose of this study is to determine whether different classes of antimicrobials have differential associations with the daily risk of delirium after critical illness is ad...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Grahl JJ,Stollings JL,Rakhit S,Person AK,Wang L,Thompson JL,Pandharipande PP,Ely EW,Patel MB

    更新日期:2018-12-12 00:00:00

  • Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study.

    abstract:INTRODUCTION:Acute kidney injury (AKI) is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Renal near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in a non-invasive continuous real-time fashion, and reflects tissue perfusion. The aim of this study was to evalua...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Ruf B,Bonelli V,Balling G,Hörer J,Nagdyman N,Braun SL,Ewert P,Reiter K

    更新日期:2015-01-29 00:00:00

  • Safety and efficacy of noninvasive ventilation in patients with blunt chest trauma: a systematic review.

    abstract:INTRODUCTION:This systematic review looks at the use of noninvasive ventilation (NIV), inclusive of noninvasive positive pressure ventilation (NPPV) and continuous positive pressure ventilation (CPAP), in patients with chest trauma to determine its safety and clinical efficacy in patients with blunt chest trauma who ar...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Duggal A,Perez P,Golan E,Tremblay L,Sinuff T

    更新日期:2013-07-22 00:00:00

  • Recorded time periods of bispectral index values equal to zero predict neurological outcome after out-of-hospital cardiac arrest.

    abstract:BACKGROUND:Prognostication in out-of-hospital cardiac arrest (OHCA) survivors is often difficult. Recent studies have shown the predictive ability of bispectral index (BIS) monitoring to assist with early neuroprognostication. The aim of this study was to investigate whether characteristics of BIS values equal to zero ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Eertmans W,Genbrugge C,Haesevoets G,Dens J,Boer W,Jans F,De Deyne C

    更新日期:2017-08-22 00:00:00

  • A pilot study of a new test to predict extubation failure.

    abstract:INTRODUCTION:To determine whether subjecting patients to 100 ml of additional dead space after a 120-minute weaning trial could predict readiness for extubation. METHODS:This was a prospective, non-randomised pilot study in an intensive care unit at a university hospital with 14 beds. It included all non-tracheostomis...

    journal_title:Critical care (London, England)

    pub_type: 临床试验,杂志文章


    authors: Solsona JF,Díaz Y,Vázquez A,Pilar Gracia M,Zapatero A,Marrugat J

    更新日期:2009-01-01 00:00:00

  • Clinical review: the meaning of acid-base abnormalities in the intensive care unit part I - epidemiology.

    abstract::Acid-base abnormalities are common in critically ill patients. Our ability to describe acid-base disorders must be precise. Small differences in corrections for anion gap, different types of analytical processes, and the basic approach used to diagnose acid-base aberrations can lead to markedly different interpretatio...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Gunnerson KJ

    更新日期:2005-10-05 00:00:00

  • Muscle regeneration after sepsis.

    abstract::Severe critical illness is often complicated by intensive care unit-acquired weakness (ICU-AW), which is associated with increased ICU and post-ICU mortality, delayed weaning from mechanical ventilation and long-term functional disability. Several mechanisms have been implicated in the pathophysiology of ICU-AW, but m...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Bouglé A,Rocheteau P,Sharshar T,Chrétien F

    更新日期:2016-05-19 00:00:00

  • Rapid response systems: are they really effective?

    abstract::This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at Further information about the Annual Update in Intensive Care a...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Sandroni C,D'Arrigo S,Antonelli M

    更新日期:2015-03-16 00:00:00

  • Translocation of bacterial NOD2 agonist and its link with inflammation.

    abstract:INTRODUCTION:The gut is often considered as the motor of critical illness through bacterial translocation, which amplifies the inflammatory response and alters the immune status. However, systemic bacterial translocation was rarely proven and endotoxin measurement only reflects translocation of Gram-negative-derived pr...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Kim OY,Monsel A,Bertrand M,Cavaillon JM,Coriat P,Adib-Conquy M

    更新日期:2009-01-01 00:00:00

  • Evidence-based review of the use of the pulmonary artery catheter: impact data and complications.

    abstract::The pulmonary artery catheter (PAC) was introduced in 1971 for the assessment of heart function at the bedside. Since then it has generated much enthusiasm and controversy regarding the benefits and potential harms caused by this invasive form of hemodynamic monitoring. This review discusses all clinical studies condu...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Hadian M,Pinsky MR

    更新日期:2006-01-01 00:00:00

  • Clinical review: Thinking outside the box--an iconoclastic view of current practice.

    abstract::Many advances in medicine have been achieved through challenging established dogma with revolutionary thought and novel practices. Each and every specialty is reinvigorated by regular re-evaluation of processes and practices in the light of new evidence and fresh conceptualization. Challenge can galvanize fresh thinki...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Singer M,Matthay MA

    更新日期:2011-07-26 00:00:00

  • Adequate antibiotic therapy prior to ICU admission in patients with severe sepsis and septic shock reduces hospital mortality.

    abstract:INTRODUCTION:In patients with severe sepsis and septic shock as cause of Intensive Care Unit (ICU) admission, we analyze the impact on mortality of adequate antimicrobial therapy initiated before ICU admission. METHODS:We conducted a prospective observational study enrolling patients admitted to the ICU with severe se...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Garnacho-Montero J,Gutiérrez-Pizarraya A,Escoresca-Ortega A,Fernández-Delgado E,López-Sánchez JM

    更新日期:2015-08-27 00:00:00

  • Common variants of NFE2L2 gene predisposes to acute respiratory distress syndrome in patients with severe sepsis.

    abstract:INTRODUCTION:The purpose of this study was to investigate whether common variants across the nuclear factor erythroid 2-like 2 (NFE2L2) gene contribute to the development of the acute respiratory distress syndrome (ARDS) in patients with severe sepsis. NFE2L2 is involved in the response to oxidative stress, and it has ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Acosta-Herrera M,Pino-Yanes M,Blanco J,Ballesteros JC,Ambrós A,Corrales A,Gandía F,Subirá C,Domínguez D,Baluja A,Añón JM,Adalia R,Pérez-Méndez L,Flores C,Villar J,GRECIA and GEN-SEP networks.

    更新日期:2015-06-16 00:00:00

  • Value of arterial blood gas analysis in patients with acute dyspnea: an observational study.

    abstract:INTRODUCTION:The diagnostic and prognostic value of arterial blood gas analysis (ABGA) parameters in unselected patients presenting with acute dyspnea to the Emergency Department (ED) is largely unknown. METHODS:We performed a post-hoc analysis of two different prospective studies to investigate the diagnostic and pro...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Burri E,Potocki M,Drexler B,Schuetz P,Mebazaa A,Ahlfeld U,Balmelli C,Heinisch C,Noveanu M,Breidthardt T,Schaub N,Reichlin T,Mueller C

    更新日期:2011-01-01 00:00:00

  • Biological markers of lung injury before and after the institution of positive pressure ventilation in patients with acute lung injury.

    abstract:BACKGROUND:Several biological markers of lung injury are predictors of morbidity and mortality in patients with acute lung injury (ALI). The low tidal volume lung-protective ventilation strategy is associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Cepkova M,Brady S,Sapru A,Matthay MA,Church G

    更新日期:2006-01-01 00:00:00

  • A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes.

    abstract:INTRODUCTION:Despite recommendations from professional societies and patient safety organizations, the majority of ICU patients worldwide are not routinely monitored for delirium, thus preventing timely prevention and management. The purpose of this systematic review is to summarize what types of implementation strateg...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,meta分析,评审


    authors: Trogrlić Z,van der Jagt M,Bakker J,Balas MC,Ely EW,van der Voort PH,Ista E

    更新日期:2015-04-09 00:00:00

  • Is there more to glycaemic control than meets the eye?

    abstract::Tight glycaemic control has emerged as a major focus in critical care. However, the struggle to repeat, improve and standardize the results of the initial landmark studies is ongoing. The prospective computerized glycaemic control study by Shulman et al. highlights two emerging and often overlooked aspects of intensiv...

    journal_title:Critical care (London, England)

    pub_type: 评论,社论


    authors: Chase JG,Shaw GM

    更新日期:2007-01-01 00:00:00

  • Strain echocardiography in septic shock - a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome.

    abstract:INTRODUCTION:Myocardial dysfunction is a well-known complication in septic shock but its characteristics and frequency remains elusive. Here, we evaluate global longitudinal peak strain (GLPS) of the left ventricle as a diagnostic and prognostic tool in septic shock. METHODS:Fifty adult patients with septic shock admi...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: De Geer L,Engvall J,Oscarsson A

    更新日期:2015-03-26 00:00:00

  • In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable.

    abstract:BACKGROUND:Esophageal pressure (Pes) can provide information to guide mechanical ventilation in acute respiratory failure. However, both relative changes and absolute values of Pes can be affected by inappropriate filling of the esophageal balloon and by the elastance of the esophagus wall. We evaluated the feasibility...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Mojoli F,Iotti GA,Torriglia F,Pozzi M,Volta CA,Bianzina S,Braschi A,Brochard L

    更新日期:2016-04-11 00:00:00

  • Pre-admission functional status impacts the performance of the APACHE IV model of mortality prediction in critically ill patients.

    abstract:BACKGROUND:Functional status (FS) before intensive care unit (ICU) admission is associated with short-term and long-term outcomes among critically ill patients. However, measures of FS are generally not integrated into ICU-specific mortality prediction models. METHODS:This retrospective cohort study used prospectively...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Krinsley JS,Wasser T,Kang G,Bagshaw SM

    更新日期:2017-05-15 00:00:00

  • Recombinant human activated protein C: current insights into its mechanism of action.

    abstract::Impairment of the protein C pathway plays a central role in the pathogenesis of sepsis. Administration of recombinant human activated protein C (rhAPC) may correct the dysregulated anticoagulant mechanism and prevent propagation of thrombin generation and formation of microvascular thrombosis. Furthermore, it may simu...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Levi M,van der Poll T

    更新日期:2007-01-01 00:00:00

  • Computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose measurement is performed frequently and on time.

    abstract:INTRODUCTION:Control of blood glucose (BG) in critically ill patients is considered important, but is difficult to achieve, and often associated with increased risk of hypoglycemia. We examined the use of a computerized insulin dosing algorithm to manage hyperglycemia with particular attention to frequency and conditio...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Juneja R,Roudebush CP,Nasraway SA,Golas AA,Jacobi J,Carroll J,Nelson D,Abad VJ,Flanders SJ

    更新日期:2009-01-01 00:00:00