15 results on '"Webb, Steven"'
Search Results
2. Association between augmented renal clearance and clinical outcomes in patients receiving β-lactam antibiotic therapy by continuous or intermittent infusion: a nested cohort study of the BLING-II randomised, placebo-controlled, clinical trial.
- Author
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Udy AA, Dulhunty JM, Roberts JA, Davis JS, Webb SAR, Bellomo R, Gomersall C, Shirwadkar C, Eastwood GM, Myburgh J, Paterson DL, Starr T, Paul SK, and Lipman J
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- Adult, Aged, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Bacterial Infections microbiology, Cohort Studies, Creatinine pharmacokinetics, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Sepsis microbiology, Treatment Outcome, beta-Lactams administration & dosage, beta-Lactams therapeutic use, Anti-Bacterial Agents pharmacokinetics, Bacterial Infections drug therapy, Metabolic Clearance Rate physiology, Sepsis drug therapy, beta-Lactams pharmacokinetics
- Abstract
Augmented renal clearance (ARC) is known to influence β-lactam antibiotic pharmacokinetics. This substudy of the BLING-II trial aimed to explore the association between ARC and patient outcomes in a large randomised clinical trial. BLING-II enrolled 432 participants with severe sepsis randomised to receive β-lactam therapy by continuous or intermittent infusion. An 8-h creatinine clearance (CL
Cr ) measured on Day 1 was used to identify ARC, defined as CLCr ≥ 130 mL/min. Patients receiving any form of renal replacement therapy were excluded. Primary outcome was alive ICU-free days at Day 28. Secondary outcomes included 90-day mortality and clinical cure at 14 days following antibiotic cessation. A total of 254 patients were included, among which 45 (17.7%) manifested ARC [median (IQR) CLCr 165 (144-198) mL/min]. ARC patients were younger (P <0.001), more commonly male (P = 0.04) and had less organ dysfunction (P <0.001). There was no difference in ICU-free days at Day 28 [ARC, 21 (12-24) days; no ARC, 21 (11-25) days; P = 0.89], although clinical cure was significantly greater in the unadjusted analysis in those manifesting ARC [33/45 (73.3%) vs. 115/209 (55.0%) P = 0.02]. This was attenuated in the multivariable analysis. No difference was noted in 90-day mortality. There were no statistically significant differences in clinical outcomes in ARC patients according to the dosing strategy employed. In this substudy of a large clinical trial of β-lactam antibiotics in severe sepsis, ARC was not associated with any differences in outcomes, regardless of dosing strategy., (Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)- Published
- 2017
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3. A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis.
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Dulhunty JM, Roberts JA, Davis JS, Webb SA, Bellomo R, Gomersall C, Shirwadkar C, Eastwood GM, Myburgh J, Paterson DL, Starr T, Paul SK, and Lipman J
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- Aged, Anti-Bacterial Agents therapeutic use, Double-Blind Method, Drug Administration Schedule, Female, Humans, Infusions, Intravenous, Length of Stay statistics & numerical data, Male, Middle Aged, Prospective Studies, Survival Analysis, Treatment Outcome, beta-Lactams therapeutic use, Anti-Bacterial Agents administration & dosage, Sepsis drug therapy, beta-Lactams administration & dosage
- Abstract
Rationale: Continuous infusion of β-lactam antibiotics may improve outcomes because of time-dependent antibacterial activity compared with intermittent dosing., Objectives: To evaluate the efficacy of continuous versus intermittent infusion in patients with severe sepsis., Methods: We conducted a randomized controlled trial in 25 intensive care units (ICUs). Participants commenced on piperacillin-tazobactam, ticarcillin-clavulanate, or meropenem were randomized to receive the prescribed antibiotic via continuous or 30-minute intermittent infusion for the remainder of the treatment course or until ICU discharge. The primary outcome was the number of alive ICU-free days at Day 28. Secondary outcomes were 90-day survival, clinical cure 14 days post antibiotic cessation, alive organ failure-free days at Day 14, and duration of bacteremia., Measurements and Main Results: We enrolled 432 eligible participants with a median age of 64 years and an Acute Physiology and Chronic Health Evaluation II score of 20. There was no difference in ICU-free days: 18 days (interquartile range, 2-24) and 20 days (interquartile range, 3-24) in the continuous and intermittent groups (P = 0.38). There was no difference in 90-day survival: 74.3% (156 of 210) and 72.5% (158 of 218); hazard ratio, 0.91 (95% confidence interval, 0.63-1.31; P = 0.61). Clinical cure was 52.4% (111 of 212) and 49.5% (109 of 220); odds ratio, 1.12 (95% confidence interval, 0.77-1.63; P = 0.56). There was no difference in organ failure-free days (6 d; P = 0.27) and duration of bacteremia (0 d; P = 0.24)., Conclusions: In critically ill patients with severe sepsis, there was no difference in outcomes between β-lactam antibiotic administration by continuous and intermittent infusion. Australian New Zealand Clinical Trials Registry number (ACT RN12612000138886).
- Published
- 2015
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4. The authors reply.
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Jaeschke R, Webb SA, Annane D, and Dellinger RP
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- Humans, Critical Care standards, Sepsis diagnosis, Sepsis therapy
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- 2013
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5. A protocol for a multicentre randomised controlled trial of continuous beta-lactam infusion compared with intermittent beta-lactam dosing in critically ill patients with severe sepsis: the BLING II study.
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Dulhunty JM, Roberts JA, Davis JS, Webb SA, Bellomo R, Gomersall C, Shirwadkar C, Eastwood GM, Myburgh J, Paterson DL, Starr T, Udy AA, Paul SK, and Lipman J
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- Adult, Aged, Dose-Response Relationship, Drug, Double-Blind Method, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Male, Middle Aged, Prospective Studies, Treatment Outcome, Critical Care methods, Critical Illness therapy, Sepsis drug therapy, beta-Lactams administration & dosage
- Abstract
Background and Rationale: Beta-lactam antibiotics are largely administered by bolus dosing, despite displaying time-dependent pharmacokinetics and pharmacodynamics and there being a strong rationale for continuous administration. The randomised controlled trials conducted to date comparing the mode of betalactam administration have been inconclusive and limited by non-equivalent dosing, unblinded administration and small sample sizes., Objective: A multicentre, randomised controlled trial (the Beta-lactam Infusion Group [BLING] II study) is currently under way, comparing continuous infusion to standard bolus administration of beta-lactam antibiotics in critically ill patients, independent of dose., Design, Settings, Participants and Interventions: BLING II is a Phase IIB, double-blinded, randomised controlled trial recruiting 420 intensive care unit patients with severe sepsis to receive one of three beta-lactam study antibiotics (ticarcillin-clavulanate, piperacillin- tazobactam or meropenem) by either continuous infusion or intermittent bolus administration., Main Outcome Measures: The primary outcome is ICUfree days at Day 28. Secondary outcomes include 90-day survival, clinical cure 14 days after study antibiotic cessation, organ failure-free days at Day 14 and duration of bacteraemia., Results and Conclusions: The study started in July 2012 and will provide clinical evidence as to whether continuous infusion of beta-lactam antibiotics is superior to intermittent bolus administration in critically ill patients with severe sepsis. A Phase III study powered for a survival end point may be justified, based on the results of our study.
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- 2013
6. Reply to Soman et al.
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Dulhunty JM, Roberts JA, Davis JS, Webb SA, Bellomo R, Gomersall C, Shirwadkar C, Eastwood GM, Myburgh J, Paterson DL, and Lipman J
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- Female, Humans, Male, Anti-Bacterial Agents therapeutic use, Sepsis drug therapy, beta-Lactams therapeutic use
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- 2013
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7. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.
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Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, and Moreno R
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- Early Diagnosis, Humans, Intensive Care Units, Sepsis etiology, Critical Care standards, Sepsis diagnosis, Sepsis therapy
- Abstract
Objective: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008., Design: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development., Methods: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Some recommendations were ungraded (UG). Recommendations were classified into three groups: 1) those directly targeting severe sepsis; 2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and 3) pediatric considerations., Results: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 hr of recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 hrs of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1C); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients) (1C); fluid challenge technique continued as long as hemodynamic improvement, as based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥ 65 mm Hg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO2/FIO2 ratio of ≤ 100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 hrs) for patients with early ARDS and a Pao2/Fio2 < 150 mm Hg (2C); a protocolized approach to blood glucose management commencing insulin dosing when two consecutive blood glucose levels are > 180 mg/dL, targeting an upper blood glucose ≤ 180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 hrs after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 hrs of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5 to 10 mins (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C)., Conclusions: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients.
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- 2013
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8. Continuous infusion of beta-lactam antibiotics in severe sepsis: a multicenter double-blind, randomized controlled trial.
- Author
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Dulhunty JM, Roberts JA, Davis JS, Webb SA, Bellomo R, Gomersall C, Shirwadkar C, Eastwood GM, Myburgh J, Paterson DL, and Lipman J
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- Adult, Aged, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents adverse effects, Anti-Bacterial Agents pharmacokinetics, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Sepsis microbiology, Sepsis mortality, Treatment Outcome, beta-Lactams administration & dosage, beta-Lactams adverse effects, beta-Lactams pharmacokinetics, Anti-Bacterial Agents therapeutic use, Sepsis drug therapy, beta-Lactams therapeutic use
- Abstract
Background: Beta-lactam antibiotics are a commonly used treatment for severe sepsis, with intermittent bolus dosing standard therapy, despite a strong theoretical rationale for continuous administration. The aim of this trial was to determine the clinical and pharmacokinetic differences between continuous and intermittent dosing in patients with severe sepsis., Methods: This was a prospective, double-blind, randomized controlled trial of continuous infusion versus intermittent bolus dosing of piperacillin-tazobactam, meropenem, and ticarcillin-clavulanate conducted in 5 intensive care units across Australia and Hong Kong. The primary pharmacokinetic outcome on treatment analysis was plasma antibiotic concentration above the minimum inhibitory concentration (MIC) on days 3 and 4. The assessed clinical outcomes were clinical response 7-14 days after study drug cessation, ICU-free days at day 28 and hospital survival., Results: Sixty patients were enrolled with 30 patients each allocated to the intervention and control groups. Plasma antibiotic concentrations exceeded the MIC in 82% of patients (18 of 22) in the continuous arm versus 29% (6 of 21) in the intermittent arm (P = .001). Clinical cure was higher in the continuous group (70% vs 43%; P = .037), but ICU-free days (19.5 vs 17 days; P = .14) did not significantly differ between groups. Survival to hospital discharge was 90% in the continuous group versus 80% in the intermittent group (P = .47)., Conclusions: Continuous administration of beta-lactam antibiotics achieved higher plasma antibiotic concentrations than intermittent administration with improvement in clinical cure. This study provides a strong rationale for further multicenter trials with sufficient power to identify differences in patient-centered endpoints.
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- 2013
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9. Accuracy of International classification of diseases, 10th revision codes for identifying severe sepsis in patients admitted from the emergency department.
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Ibrahim I, Jacobs IG, Webb SA, and Finn J
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- Adult, Aged, Australia, Female, Hospitalization, Humans, Male, Middle Aged, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Sepsis therapy, Severity of Illness Index, Critical Care, Emergency Service, Hospital, International Classification of Diseases, Sepsis classification, Sepsis diagnosis
- Abstract
Objective: To determine the accuracy of International classification of diseases, 10th revision, Australian modification (ICD-10-AM) codes in identifying severe sepsis in patients admitted from the emergency department (ED)., Design, Setting and Participants: A retrospective cohort study of ED patients transferred to the intensive care unit of a tertiary hospital within 24 hours of leaving ED, 2000- 2006., Main Outcome Measures: Clinical diagnosis of severe sepsis compared with diagnosis-based code (DB-C) categories based on ICD-10-AM codes in the Emergency Department Information Systems (EDIS) and Hospital Morbidity Data System (HMDS); sensitivity, specificity, positive predictive value (PPV) and negative predictive value of these databases., Results: In the study period, 1645 patients were transferred to the ICU from the ED, of whom 254 had severe sepsis. Single discharge ICD-10-AM codes recorded in the EDIS and the principal ICD-10-AM codes recorded in the HMDS that fell into D-BC categories for sepsis, pneumonia, viscous perforation, peritonitis, cholecystitis or cholangitis had a PPV of 85.0% (95% CI, 78.4%-91.6%; 96/113) and 88.2% (95%CI, 72.6%-82.6%; 112/127), respectively. The respective sensitivity was 37.8% (95% CI, 31.8%-43.8%) (96/254) and 44.1% (95% CI, 38.0-50.2) (112/254). In contrast, ICD-10-AM codes in the HMDS that code for infection and organ dysfunction had a PPV of 33.5% (95% CI, 30.0%-37.0%; 227/677) and sensitivity of 89.4% (95% CI, 85.6%-93.2%; 227/254)., Conclusion: ICD-10-AM codes recorded in the EDIS or HMD had limited utility for identifying severe sepsis in patients admitted to ICU from the ED.
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- 2012
10. Cost of surviving sepsis: a novel model of recovery from sepsis in Drosophila melanogaster
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Kaynar, Ata Murat, Bakalov, Veli, Laverde, Silvia Martinez, Cambriel, Amélie I. F., Lee, Byoung-Hoon, Towheed, Atif, Gregory, Alyssa D., Webb, Steven A. R., Palladino, Michael J., Bozza, Fernando A., Shapiro, Steven D., and Angus, Derek C.
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- 2016
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11. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012
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Dellinger, R. P., Levy, Mitchell M., Rhodes, Andrew, Annane, Djillali, Gerlach, Herwig, Opal, Steven M., Sevransky, Jonathan E., Sprung, Charles L., Douglas, Ivor S., Jaeschke, Roman, Osborn, Tiffany M., Nunnally, Mark E., Townsend, Sean R., Reinhart, Konrad, Kleinpell, Ruth M., Angus, Derek C., Deutschman, Clifford S., Machado, Flavia R., Rubenfeld, Gordon D., Webb, Steven, Beale, Richard J., Vincent, Jean-Louis, Moreno, Rui, and The Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup*
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- 2013
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12. Sepsiste Sağkalım Kampanyası: Uluslararası Ağır Sepsis ve Septik Şokun Yönetimi Kılavuzu: 2012.
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Dellinger, R. Phillip, Levy, Mitchell M., Rhodes, Andrew, Annane, Djillali, Gerlach, Herwig, Opal, Steven M., Sevransky, Jonathan E., Sprung, Charles L., Douglas, Ivor S., Jaeschke, Roman, Osborn, Tiffany M., Nunnally, Mark E., Townsend, Sean R., Reinhart, Konrad, Kleinpell, Ruth M., Angus, Derek C., Deutschman, Clifford S., Machado, Flavia R., Rubenfeld, Gordon D., and Webb, Steven A.
- Abstract
Copyright of Journal of the Turkish Society of Intensive Care / Türk Yogun Bakim Dernegi Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2014
13. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study.
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Ho, Kwok M., Lee, Kok Y., Dobb, Geoffrey J., and Webb, Steven A. R.
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SEPSIS ,BLOOD diseases ,COMMUNICABLE diseases ,C-reactive protein ,ACUTE phase proteins ,CHEMOKINES ,INFLAMMATION ,INTENSIVE care units - Abstract
The objective was to assess the ability of potential clinical predictors and inflammatory markers within 24 h of intensive care unit (ICU) discharge to predict subsequent in-hospital mortality. A prospective cohort study of 603 consecutive patients who survived their first ICU admission, between 1 June and 31 December 2005, in a 22-bed multidisciplinary ICU of a university hospital. A total of 26 in-hospital deaths after ICU discharge (4.3%) were identified. C-reactive protein (CRP) concentrations at ICU discharge were associated with subsequent in-hospital mortality in the univariate analysis (mean CRP concentrations of non-survivors = 174 vs. survivors = 85.6 mg/l, p = 0.001). CRP concentrations remained significantly associated with post-ICU mortality (a 10-mg/l increment in CRP concentrations increased the odds ratio [OR] of death: 1.09, 95% confidence interval [CI]: 1.03–1.16); after adjusting for age, the Acute Physiology and Chronic Health Evaluation (APACHE) II predicted mortality, and the Delta Sequential Organ Failure Assessment (Delta SOFA) score. The area under the receiver operating characteristic curve of this multivariate model to discriminate between survivors and non-survivors after ICU discharge was 0.85 (95% CI: 0.73–0.96). The destination and timing of ICU discharge, and the Discharge SOFA score, white cell counts and fibrinogen concentrations at ICU discharge were not significantly associated with in-hospital mortality after ICU discharge. A high CRP concentration at ICU discharge was an independent predictor of in-hospital mortality after ICU discharge in our ICU. [ABSTRACT FROM AUTHOR]
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- 2008
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14. Cefepime versus ceftazidime: considerations for empirical use in critically ill patients
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Roberts, Jason A., Webb, Steven A.R., and Lipman, Jeffrey
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CEPHALOSPORINS , *SEPSIS , *ANTIBIOTICS , *NOSOCOMIAL infections , *GRAM-negative bacterial diseases , *DRUG resistance in microorganisms - Abstract
Abstract: Sepsis and nosocomial infections continue to be a significant problem in intensive care, contributing heavily to mortality and prolonged hospital stay. Early and appropriate antibiotic therapy is critical for optimising outcomes. However, the emergence of highly resistant bacteria, coupled with reduced development of novel antibiotics, means that there is a real threat of development of untreatable nosocomial infections. Cefepime and ceftazidime are broad-spectrum cephalosporins that are widely used to treat Gram-negative nosocomial infections in critically ill patients. Available data suggest that cefepime may have advantages over ceftazidime owing to a broader spectrum of activity and reduced potential for development of bacterial resistance. However, whether either of these agents is superior can only be determined by a head-to-head study evaluating clinical and bacteriological outcomes. Such a study to determine whether apparent differences translate into clinically relevant differences in outcome is indicated. [Copyright &y& Elsevier]
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- 2007
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15. Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study
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Peake, Sandra L., Bailey, Michael, Bellomo, Rinaldo, Cameron, Peter A., Cross, Anthony, Delaney, Anthony, Finfer, Simon, Higgins, Alisa, Jones, Daryl A., Myburgh, John A., Syres, Gillian A., Webb, Steven A.R., and Williams, Patricia
- Subjects
- *
SEPTICEMIA treatment , *RESUSCITATION , *MEDICAL practice , *EMERGENCY medical services , *SEPTIC shock , *COHORT analysis , *PATIENTS - Abstract
Abstract: Aim: Determine current resuscitation practices and outcomes in patients presenting to the emergency department (ED) with sepsis and hypoperfusion or septic shock in Australia and New Zealand (ANZ). Methods: Three-month prospective, multi-centre, observational study of all adult patients with sepsis and hypoperfusion or septic shock in the ED of 32 ANZ tertiary-referral, metropolitan and rural hospitals. Results: 324 patients were enrolled (mean [SD] age 63.4 [19.2] years, APACHE II score 19.0 [8.2], 52.5% male). Pneumonia (n =138/324, 42.6%) and urinary tract infection (n =98/324, 30.2%) were the commonest sources of sepsis. Between ED presentation and 6hours post-enrolment (T6hrs), 44.4% (n =144/324) of patients received an intra-arterial catheter, 37% (n =120/324) a central venous catheter and 0% (n =0/324) a continuous central venous oxygen saturation (ScvO2) catheter. Between enrolment and T6hrs, 32.1% (n =104/324) received a vasopressor infusion, 7.4% (n =24/324) a red blood cell transfusion, 2.5% (n =8/324) a dobutamine infusion and 18.5% (n =60/324) invasive mechanical ventilation. Twenty patients (6.2%) were transferred from ED directly to the operating theatre, 36.4% (n =118/324) were admitted directly to ICU, 1.2% (n =4/324) died in the ED and 56.2% (n =182/324) were transferred to the hospital floor. Overall ICU admission rate was 52.4% (n =170/324). ICU and overall in-hospital mortality were 18.8% (n =32/170) and 23.1% (n =75/324) respectively. In-hospital mortality was not different between patients admitted to ICU (24.7%, n =42/170) and the hospital floor (21.4%, n =33/154). Conclusions: Management of ANZ patients presenting to ED with sepsis does not routinely include protocolised, ScvO2-directed resuscitation. In-hospital mortality compares favourably with reported mortality in international sepsis trials and nationwide surveys of resuscitation practices. [Copyright &y& Elsevier]
- Published
- 2009
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