2,833 publications from this institution
The Surviving Sepsis Campaign (SSC) is an international effort to reduce mortality in severe sepsis and septic shock. The campaign included the creation of evidence-based guidelines sponsored and endorsed by 11 international organizations. From these guidelines, sepsis change bundles for initial resuscitation (6 hours) and management (24 hours) were created as a performance improvement tool. In this issue of Critical Care, Gao et al. have evaluated performance at their institution by using a close adaptation of the two SSC bundle sets and demonstrated an association between 100 % compliance with the bundle elements and clinical outcome. The next step will be to demonstrate that the use of education and feedback for performance improvement will increase compliance and decrease mortality in the patient population in general. As members of the Surviving Sepsis Campaign (SSC), we are pleased to comment on the study by Gao et al. published in this issue of Critical Care [1]. Protocolized care now exists for a heart attack or a stroke, based on advances detailed in the medical literature. Until now there has been no attempt to reproduce such an approach in severe sepsis despite recently published studies that have shown decreased mortality and morbidity as a result of interventions applied to patients with severe sepsis [2-6]. The SSC (www.survivingsepsis.org) hopes to change that. The campaign is administered by the Society of Critical Care
SCOPUS: le.j
Rapotec, Alessandro; Piagnerelli, Michael; Vincent, Jean-Louis; Boudjeltia, Karim Zouaoui; Richard, Thibaut; Vanhaeverbeek, Michel Author Information
Background: Severe sepsis is defined as sepsis plus organ dysfunction. There is a need to quantify this dysfunction, and several scoring systems have been developed. Method: Review of the pertinent English-language literature. Results: Early scoring of organ failure simply counted the number of failing organs, but the degree of dysfunction is an important variable. The first system to grade dysfunction was the multiple organ dysfunction score (MODS). The drawback of MODS is the variable used to quantify cardiovascular failure. To alleviate this limitation, the Brussels score was developed. However, it, too, was suboptimal and was replaced by the sequential or sepsis-related organ failure assessment (SOFA) score. There is a clear correlation between the total SOFA score and the mortality rate, and in certain studies, the total SOFA score was at least as good as traditional methods of predicting death. A key advantage of these simple scores is that they can be repeated to follow the course of organ dysfunction. The evolution of the SOFA score has been used to demonstrate the effects of various therapeutic interventions. Conclusion: Quantifying organ dysfunction in patients with sepsis can assist in assessing prognosis and determining treatment effectiveness. The simplicity, reliability, and reproducibility of current scores facilitate their widespread use.
There has been considerable development in the field of noninvasive hemodynamic monitoring in recent years. Multiple devices have been proposed to assess blood pressure, cardiac output, and tissue perfusion. All have their own advantages and disadvantages and selection should be based on individual patient requirements and disease severity and adjusted according to ongoing patient evolution.
