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Canine parvovirus 2 (CPV-2) is a highly contagious enteric virus that causes high morbidity and mortality, especially in dogs under six months of age. Recovery from this illness is dependent on several factors, including the patient's prognosis for adequate therapy. The aim of this study was to evaluate the risk factors associated with the death outcome in CPV-2 positive dogs in a case-control study conducted at the Veterinary Hospital of the Universidade Federal de Lavras (HV-UFLA) in Lavras, Minas Gerais, Brazil. Twenty-six dogs with CPV-2 symptoms that arrived at the HV-UFLA between 2017 and 2018 were evaluated for inclusion in the study. Data on medical history, clinical signs, blood count and rapid test of parvovirus and faecal test for polymerase chain reaction (PCR) were collected for all the animals. All the dogs received treatment at the HV-UFLA, and the overall fatality rate due to canine parvovirus was 30.77%. Descriptive analysis and univariate and multivariate statistical analyses (logistic regression) were performed to assess the variables that were possibly associated with an unfavourable prognosis (death). In the univariate and multivariate analyses, Systemic Inflammatory Response Syndrome (SIRS) was observed to be a significant risk factor for an unfavourable prognosis in canine parvovirus, as it increased the risk of death by 12.96 times (95% CI 1.85-133.70; P < 0.01) compared with patients who did not exhibit SIRS. Thus, SIRS was strongly associated with an unfavourable prognosis, suggesting that it can be used as a prognostic indicator for canine parvovirus in veterinary practice. [ABSTRACT FROM AUTHOR]

Sepsis is characterized as a systemic inflammatory response triggered by inflammatory mediators in response to microbial agents or toxins. Its acute course often rapidly progresses to septic shock and multiorgan dysfunction, thus highlighting the urgency in addressing this complex and potentially fatal condition. Therefore, the aim of the study was to address the relevance of nursing's role in the early identification and treatment of sepsis. The study method consisted of an integrative literature review carried out in the databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE/PUBMED), Latin American and Caribbean Literature in Sciences of Health (LILACS) and Web of Science (WoS), during the month of January 2024. The study reinforced the importance of the nursing team in the early identification and treatment of sepsis, contributing to the improvement of clinical results and the reduction of mortality associated with this condition. Therefore, by recognizing nursing as a key player in the multidisciplinary approach to sepsis, this study highlights the need for continuous investments in education and training to enable the nursing team to perform their role even more effectively. [ABSTRACT FROM AUTHOR]

The rational use of antimicrobials promotes lower risk for the patient and the development of bacterial resistance. Thus, the objective was to evaluate the use of procalcitonin (PCT) as an auxiliary test in monitoring antimicrobial treatment for patients with respiratory infection (RI) or sepsis, admitted to Intensive Care Units (ICU). The data were collected from electronic medical records. The 235 selected patients were divided based on adherence to the institutional protocol that guides the request for PCT, into group 1 (PCT in accordance with the protocol) (n=33); group 2 (PCT not in accordance with the protocol) (n=25) and group 3 (PCT not requested) (n=177). Patients in group 1 had a shorter average duration of antibiotic therapy than the other groups. The length of hospitalization and ICU stay was shorter in group 3 compared to group 2. There was a statistical difference in outcomes; there was a higher frequency of deaths than discharges in groups 2 and 3, unlike group 1, where discharges outnumbered deaths. Discontinuation of treatment based on a PCT protocol leads to a reduction in antimicrobial exposure in patients with lower respiratory tract infections or sepsis, with no negative impact on mortality. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) significantly affects patient morbidity and mortality. AKI represents a very heterogeneous syndrome that continues to be a very common problem faced by emergency and intensive care physicians. The year 2023 in the field of critical care nephrology cannot be seen as a breakthrough, yet several interesting articles appeared in this field covering a wide range of topics from the diagnosis of AKI, the need to understand the different phenotypes of AKI, the pathophysiology of sepsis-associated AKI (SA-AKI), to the consensus opinion on the treatment of AKI, including the kidney support therapy and purification methods and all non-negligible risks associated with extracorporeal methods. This summary article offers a brief insight into the given topics. [ABSTRACT FROM AUTHOR]

This year's summary critically discusses important publications regarding to adjuvant corticosteroid therapy in community-acquired pneumonia, blood-glucose control, supraventricular arrhytmias treatment, and fluid therapy in critically ill septic patiens. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia (CAP) is an acute inflammatory disease of the lung parenchyma acquired outside the healthcare facilities or within 48 hours after admission to the hospital. Despite the availability of antibiotics, pneumonia remains the leading cause of death from infectious causes, according to World Health Organization data. Although it might seem that the treatment of lower respiratory tract infections is a closed chapter in a medical textbooks, it is quite the opposite. Our perception of pneumonia as a unifying diagnosis comes with a burden of heterogeneity and we need to approach each patient individually, based on their disease-specific phenotype. The adjuvant use of corticosteroids to modulate and dampen inflammation-induced lung injury in severe community-acquired pneumonia has been a matter of debate for the last twenty years. Up until recently, clinical trials and meta-analyses yielded conflicting results. Therefore, the last consensus of four respected European societies, recommends using corticosteroids in patients with severe community-acquired pneumonia only if septic shock is present. Unfortunately, those guidelines had been released shortly before the largest trial ever conducted on this group of patients (CAPE COD), which indicated different conclusions. This will probably lead to a reevaluation of the current strict recommendations for the use of corticosteroids. The following text aims to provide a brief clinically-oriented review of this controversial topic and present a perspective of our intensive care unit for further discussion until we have new relevant data and subsequent guidelines. [ABSTRACT FROM AUTHOR]

Sepsis is a heterogeneous dynamic syndrome characterized by severe organ dysfunction caused by a dysregulated host response to infection. The innate and adaptive immune response plays a key role in the response to infectious insult in the development of sepsis or septic shock, the most severe form of this nosological entity. Uncontrolled and late diagnosed infection can be fatal even in previously healthy individuals, chronic patients with comorbidities have an increased risk of developing sepsis. Critically ill patients of all ages with failure of basic life functions in intensive care units are the most at risk group. Rapid and effective diagnosis of impending septicemia is crucial for disease management and good clinical outcome. Modern medicine uses a range of diagnostic options from the ever-important and unforgettable anamnesis taking to the most sophisticated laboratory, functional or imaging methods. Biomarkers play an important aid in the early recognition of sepsis and should ideally be comprehensive for early diagnosis, prognosis, disease risk stratification and treatment. This review article notes two parameters that are inexpensive, rapidly available, and part of the routinely indicated blood count with differential blood cell budget. Immature platelet and granulocyte fractions are of interest to clinicians and researchers in the diagnosis of sepsis and in the prediction of disease severity and mortality. The following text summarizes the current knowledge about immature platelet and immature granulocyte forms, mainly in the field of sepsis in intensive care patients. [ABSTRACT FROM AUTHOR]

Objective: to analyze the factors associated with sepsis, as well as the conditions that predict death in elderly people admitted to Intensive Care Units, with an initial diagnosis of acute respiratory diseases not related to health care. Methodology: mixed cohort epidemiological study, carried out between September 2019 and September 2020. Data were collected from electronic medical charts and associations were checked in bivariate analysis and logistic regression. Results: of the studied 228 elderly people, 125 (54.5%) passed away and 204 (89.5%) had sepsis. Urinary invasive devices (RR=1.754; 95% CI 1.360-2.263), presence of sepsis based on the Sepsis-3 consensus (RR=3.55; 95% CI 1.23-10.27) and Covid-19 (RR=1. 39; 95% CI 1.08-1.78) were predictors for death. Conclusion: the factors associated with sepsis among patients with Covid-19 and other respiratory infections are different. The conditions that predict death for elderly people with acute respiratory infections not related to health care were: sepsis, Covid-19 and urinary invasive device. [ABSTRACT FROM AUTHOR]

Objectives. To assess antibiotic susceptibility of World Health Organization (WHO) priority bacteria (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus, and Streptococcus pneumoniae) in blood cultures at the Orinoquía regional hospital in Colombia. Methods. This was cross-sectional study using routine laboratory data for the period 2019--2021. Data on blood samples from patients suspected of a bloodstream infection were examined. We determined: the total number of blood cultures done and the proportion with culture yield; the characteristics of patients with priority bacteria; and the type of bacteria isolated and antibiotic resistance patterns. Results. Of 25 469 blood cultures done, 1628 (6%) yielded bacteria; 774 (48%) of these bacteria were WHO priority pathogens. Most of the priority bacteria isolated (558; 72%) were gram-negative and 216 (28%) were gram-positive organisms. Most patients with priority bacteria (666; 86%) were hospitalized in wards other than the intensive care unit, 427 (55%) were male, and 321 (42%) were ≥ 60 years of age. Of the 216 gram-positive bacteria isolated, 205 (95%) were Staphylococcus aureus. Of the 558 gram-negative priority bacteria isolated, the three most common were Escherichia coli (34%), Klebsiella pneumoniae (28%), and Acinetobacter baumannii (20%). The highest resistance of Staphylococcus aureus was to oxacillin (41%). For gram-negative bacteria, resistance to antibiotics ranged from 4% (amikacin) to 72% (ampicillin). Conclusions. Bacterial yield from blood cultures was low and could be improved. WHO priority bacteria were found in all hospital wards. This calls for rigorous infection prevention and control standards and continued surveillance of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Objetivo: Investigar a influência de uma sessão de mobilização passiva na função endotelial de pacientes com sepse. Métodos: Este foi um estudo quaseexperimental duplo-cego e de braço único com desenho pré e pós-intervenção. Participaram 25 pacientes com diagnóstico de sepse hospitalizados em unidade de terapia intensiva. Avaliou-se a função endotelial basal (pré-intervenção) e imediatamente pós-intervenção por meio de ultrassonografia da artéria braquial. Foram obtidas a dilatação mediada pelo fluxo, a velocidade pico de fluxo sanguíneo e a taxa de cisalhamento pico. A mobilização passiva consistiu na mobilização bilateral (tornozelos, joelhos, quadris, pulsos, cotovelos e ombros), com três séries de dez repetições cada, totalizando 15 minutos. Resultados: Após a mobilização, encontramos aumento da função de reatividade vascular em relação à pré-intervenção: dilatação mediada pelo fluxo absoluta (0,57mm ± 0,22 versus 0,17mm ± 0,31; p < 0,001) e dilatação mediada pelo fluxo relativa (17,1% ± 8,25 versus 5,08% ± 9,16; p < 0,001). O pico de fluxo sanguíneo na hiperemia (71,8cm/s ± 29,3 versus 95,3cm/s ± 32,2; p < 0,001) e a taxa de cisalhamento (211s ± 113 versus 288s ± 144; p < 0,001) também aumentaram. Conclusão: Uma sessão de mobilização passiva foi capaz de aumentar a função endotelial em pacientes graves com sepse. Estudos futuros são necessários para investigar se um programa de mobilização pode ser aplicado como intervenção benéfica para melhorar clinicamente a função endotelial em pacientes hospitalizados por sepse. [ABSTRACT FROM AUTHOR]

The objective was to identify through the literature the main factors of occurrence of sepsis in the adult Intensive Care Unit (ICU). Results: Infections that can lead to sepsis are most commonly found in the lungs, abdomen or urinary tract. Patients who use devices such as orotracheal intubation (OTI) under pulmonary ventilation, pulmonary artery catheter, indwelling urinary catheter (CVD) increase the risk of triggering an infection. Conclusion: In addition to the outbreaks of infections, risk factors such as age over 65 years, longer average length of stay in the ICU and male gender, increase the risk of developing life-threatening organ dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To describe the process of implementing a participatory and multifaceted intervention to improve sepsis care and its effects on improving the quality of care. Materials and methods: This is a before-after quasi-experimental study conducted in 2017/2018 in the emergency service of a hospital in Northeast Brazil. The quality of care of 564 patients diagnosed with sepsis was assessed using nine process criteria and one result criterion. The intervention was participatory and multifaceted, being applied for 10 months. Results: After the intervention, the number of non-conformities decreased by 67% (843 vs 506), and all 10 criteria improved, with a significant improvement (p<0.05) in eight of them. Lethality decreased by 10% (p=0.005). Conclusion: The intervention model presented was effective in improving the quality of care for sepsis in the emergency service, with the possibility of scaling up its use in Brazilian hospitals. [ABSTRACT FROM AUTHOR]

Intravenous beta blockers have proven to be a reliable class of medications in treating tachyarrhythmias of various underlying causes and in managing severe hypertension. There is an ever-growing number of indications for the use of beta blockers, since the vast majority of medical emergencies result in extreme catecholamine secretion, leading to associated side-effects. These side-effects can be prevented by using beta blockers. Recent findings support the idea that beta blockers can be beneficial in sepsis, shock, acute heart failure, trauma, thermal trauma, and other medical emergencies associated with tachycardia or tachyarrhythmia. Beta blockers can be highly beneficial even in the case of cardiac arrest when caused by ventricular arrhythmia. Overall, beta blockers reduce the incidence of arrhythmias and improve hemodynamic and some metabolic parameters, resulting in a lower mortality rate, shorter duration of mechanical ventilation and hospitalization due to medical emergencies, improved recovery from mechanical trauma and thermal trauma, as well as improved neurological outcome in cardiac arrest patients. New ultrashort-acting and highly β1-selective beta blockers have given rise to further opportunities. The following review deals with the well- and less well-known indications for the use of intravenous beta blockers in acute cardiology and presents practical instructions for their use. [ABSTRACT FROM AUTHOR]

The sepsis is a problem of public health, that kills million of people around the world e conceive high costs for the Brazil. Therefore, aimed to describe the hospital costs with hospitalizations of patient with sepsis in Ceará and in Brazil. There is a longitudinal, retrospective study, carried out on the DATASUS databases in the period of January 2020 to January 2021, about the áreas of Ceará and Brazil. It was registereds 118.944 hospitalizations in the country, corresponding to R$445.816.620,00; and 4.141 hospitalizations in Ceará equivalent to R$16.322.388,21. The Southeast got the most hospitalizations, total costs and medium costs, while the North presentes the most diary costs. The people more affected were men, elderly and white people. Thus, is fundamental set public politics acording with the most vulnerable people, and that aim capacitate the health care workers, to reduce the damages for sepsis. [ABSTRACT FROM AUTHOR]

Sepsis is the leading cause of death from infectious diseases. This is one of the most common causes of death. Time is a key factor in starting treatment early, and therefore recognizing patients with a high risk of development of sepsis who are not recognized as critical at the time of admission. In addition to the established biomarkers such as C-reactive protein or procalcitonin, new biomarkers are emerging that reflect their cell in the immune response. One of these biomarkers is Monocytic Distribution Width (MDW). Three subpopulations of monocytes and dendritic cells were characterized in peripheral blood. During sepsis, functional reprogramming occurs between monocytes and macrophages, which causes not only morphological changes but also changes in cell volume. These changes are reflected in the so-called monocytic distribution width, which can be a potential biomarker, or a complementary biomarker, for early diagnosis of sepsis at emergency departments. This is a parameter routinely determined with a differential leukocyte count. According to the recent literature, a suitable MDW cut-off value for sepsis is approximately 23.0 for samples with K3EDTA (respectively 20.5 for K2EDTA). [ABSTRACT FROM AUTHOR]

Objective: To analyze the correlation between glycocalyx disruption measured via the serum syndecan-1 level and organ dysfunctions assessed by the PELOD-2 score and to evaluate its association with mortality in pediatric sepsis. Methods: We performed a prospective observational study in a tertiary public hospital. Sixty-eight pediatric patients diagnosed with sepsis according to International Pediatric Sepsis Consensus Conference criteria were consecutively recruited. We performed measurements of day 1 and day 5 serum syndecan-1 levels and PELOD-2 score components. Patients were followed up to 28 days following sepsis diagnosis. Results: Overall, the syndecan-1 level was increased in all subjects, with a significantly higher level among septic shock patients (p = 0.01). The day 1 syndecan-1 level was positively correlated with the day 1 PELOD-2 score with a correlation coefficient of 0.35 (p = 0.003). Changes in syndecan-1 were positively correlated with changes in the PELOD-2 score, with a correlation coefficient of 0.499 (p < 0.001) during the first five days. Using the cutoff point of day 1 syndecan-1 ≥ 430ng/ mL, organ dysfunction (PELOD-2 score of ≥ 8) could be predicted with an AUC of 74.3%, sensitivity of 78.6%, and specificity of 68.5% (p = 0.001). Conclusion: The day 1 syndecan-1 level was correlated with the day 1 PELOD-2 score but not 28-day mortality. Organ dysfunction (PELOD-2 ≥ 8) could be predicted by the syndecan-1 level in the first 24 hours of sepsis, suggesting its significant pathophysiological involvement in sepsis-associated organ dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To analyze the prevalence of Sepsis in Intensive Care Unit from a teaching hospital. Methods: Descriptive study, exploratory, retrospective with quantitative approach produced at the Intensive Care Unit from a reference hospital in Teresina -- PI, Brazil, which data were collected from 221 patients records hospitalized in this sector, in 2018. The data analysis was conducted with the Statistical Package for the Social Sciences, by means of descriptive and inferential statistics. Results: The prevalence of Sepsis at the Intensive Care Unit was 20,36% (n=45). The average length was of 10,73 days (SD +-15,53) and most part of them evolved to death 62,2% (n=28). Conclusion: The prevalence of Sepsis in the present study was low compared to the global index, which are higher. This is a matter of Public Health with high cost services that leads to mortality. [ABSTRACT FROM AUTHOR]

To analyze the knowledge of nurses regarding sepsis and the new updates to the Sepsis-3 consensus. Cross-sectional study carried out with 123 nurses from a general hospital located in the region of Belo Horizont located in Minas Gerais, Brazil. A structured questionnaire with 10 multiple-choice questions was applied. The data were analyzed using descriptive statistics, chi-square test and multiple logistic regression. The age of the participants ranged from 23 to 54 years, with an average of 34 (± 7.4). The majority were female (68.3%) with training time equal to or greater than 5 years (50.4%). Formation time (p=0.011) and period in current position (p=0.006) were associated with satisfactory knowledge in relation to Sepsis. The conclusion showed that formation time and the period in the current position were related to satisfactory knowledge, however, the results need to be interpreted with caution among the participants of this study. [ABSTRACT FROM AUTHOR]

Red blood cell transfusion is thought to improve cell respiration during septic shock. Nevertheless, its acute impact on oxygen transport and metabolism in this condition remains highly debatable. The objective of this study was to evaluate the impact of red blood cell transfusion on microcirculation and oxygen metabolism in patients with sepsis and septic shock. We conducted a search in the MEDLINE®, Elsevier and Scopus databases. We included studies conducted in adult humans with sepsis and septic shock. A systematic review and meta-analysis were performed using the DerSimonian and Laird random-effects model. A p value < 0.05 was considered significant. Nineteen manuscripts with 428 patients were included in the analysis. Red blood cell transfusions were associated with an increase in the pooled mean venous oxygen saturation of 3.7% (p < 0.001), a decrease in oxygen extraction ratio of -6.98 (p < 0.001) and had no significant effect on the cardiac index (0.02L/minute; p = 0,96). Similar results were obtained in studies including simultaneous measurements of venous oxygen saturation, oxygen extraction ratio, and cardiac index. Red blood cell transfusions led to a significant increase in the proportion of perfused small vessels (2.85%; p = 0.553), while tissue oxygenation parameters revealed a significant increase in the tissue hemoglobin index (1.66; p = 0.018). Individual studies reported significant improvements in tissue oxygenation and sublingual microcirculatory parameters in patients with deranged microcirculation at baseline. Red blood cell transfusions seemed to improve systemic oxygen metabolism with apparent independence from cardiac index variations. Some beneficial effects have been observed for tissue oxygenation and microcirculation parameters, particularly in patients with more severe alterations at baseline. More studies are necessary to evaluate their clinical impact and to individualize transfusion decisions. [ABSTRACT FROM AUTHOR]

Sepsis is an acute organ dysfunction secondary to infection and its hospital mortality rates have been decreasing in many countries in recent years. This reduction in mortality results in a greater number of patients being discharged from the hospital, but survivors often experience new disabilities (physical, cognitive and psychological) and worsening chronic long-term health conditions. In addition, the post-discharge evolution leads to a high risk of death and frequent readmissions in the first months after hospitalization, as well as a high use of health resources. This review aims to describe the long-term morbidity and mortality of survivors of sepsis, its effects on the health system and the possible actions aimed at minimizing the sequelae of this syndrome that affects approximately 1/3 of patients admitted to intensive care units. [ABSTRACT FROM AUTHOR]

The year 2020 was marked by the COVID-19 pandemic. However, a number of papers were published during this period regarding the diagnosis and support of failing organ systems (respiratory, cardiovascular) but also sepsis, renal replacement and the general issue of providing general intensive care of high quality. [ABSTRACT FROM AUTHOR]

Sepsis is a systemic infection that causes multiple organ dysfunction. HSP70 is a protein responsive to cell stress, in particular oxidative stress. Therefore, this literature review sought to investigate the roles of HSP70 and oxidative stress in the pathophysiology of sepsis and the possibility of HSP70 as a therapeutic target. HSP70 exerts a protective effect when located in cells (iHSP70), and its decrease, as well as its increase in the extracellular environment (eHSP70), under oxidative stress is a biomarker of sepsis severity. In addition, therapies that increase iHSP70 and treatment with HSP70 promote sepsis improvement. [ABSTRACT FROM AUTHOR]

The objective of the study is to outline the profile of patients admitted to an Adult Intensive Care Unit of a Teaching Hospital in the Interior of São Paulo with sepsis and to evaluate the risk factors and clinical characteristics associated with the evolution to sepsis considering as outcomes of worsening septic shock and death. Medical records of patients in the Adult ICU were analyzed from July 2017 to July 2019, and a case-control study was carried out on these patients, considering 3 outcomes: sepsis, septic shock and death. The study included 154 patients admitted to the ICU during the study period. Of these, 105 patients with sepsis were included. The risk factors found were hyperthermia, anemia, renal failure, hyperkalaemia and the need for mechanical ventilation. Further reflection on sepsis is necessary, which is still one of the main causes of death in the ICU, causing high socioeconomic impact due to the high hospital cost and limited therapies. [ABSTRACT FROM AUTHOR]

The weaning of mechanical ventilation should be started when the cause that contributed to the respiratory discomfort is in resolution. The inefficacy in the removal of this support propitiates the patient to prolonged weaning. This study aimed to know the factors associated with prolonged weaning from mechanical ventilation, analyzing them with the clinical outcome. A quantitative prospective documentary research was performed in an Intensive Care Unit of a Public Hospital in Fortaleza, Brazil, from August 2017 to January 2018. Population comprised of patients over 18 years of age in prolonged weaning from mechanical ventilation. The instrument used was a form. Descriptive analysis and Mann-Whitney Test, with significance of 5% (p <0.05) were used. There were evaluated 44 medical records, with a mean age of 61.8 years, 63.6% female. The majority (30%) of the patients (68.18%) remained in the intensive care unit for 10 to 30 days with 24.0 ± 11.8 days of mechanical ventilation. The presence of sepsis and the use of vasoactive drugs were factors associated with prolonged weaning. There was a higher incidence of mortality in those who used vasoactive drugs. In the clinical outcome, 17 (38.6) patients evolved to death and 27 (61.4%) were discharged to the ward. Thus, prolonged weaning from mechanical ventilation is associated with factors that increase length of hospital stay. Knowledge of these factors with a thorough clinical approach helps to optimize weaning, reducing hospital stay and hospital costs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the knowledge about sepsis of nurses in an emergency service. Method: Cross-sectional, quantitative study, developed at a University Hospital. Involved 41 nurses, the sociodemographic, work and sepsis knowledge data were collected through structured instruments and analyzed using descriptive and inferencial statistics. Results: 11 (26.83%) reported having sepsis content in admission training. Most of the questions got higher hit rate than errors. Those with low success rates were definition (2; 4.76%) and maximum time to start antibiotic therapy (17; 40.48%). Conclusions: Nurses were outdated regarding the most recent protocols on sepsis definition and management. Thus, this study points to the need for institutional measures to consolidate and update this content. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether reactive hyperemia measured by peripheral arterial tonometry correlates with markers of endothelial dysfunction and may be used to identify sepsis in critical illness. Methods: A prospective study was performed using a cohort of critically ill patients. Endothelial dysfunction was assessed on admission by quantifying reactive hyperemia-peripheral arterial tonometry and plasma levels of endothelin-1, soluble E-selectin, endocan and syndecan-1. Septic patients were compared to patients without evidence of infection. Results: Fifty-eight septic patients were compared to 28 controls. The natural logarithm of reactive hyperemiaperipheral arterial tonometry was negatively correlated with cardiovascular comorbidities, disease severity and plasma levels of soluble E-selectin (p = 0.024) and syndecan-1 (p < 0.001). The natural logarithm of reactive hyperemiaperipheral arterial tonometry was lower in septic patients than in controls (0.53 ± 0.48 versus 0.69 ± 0.42, respectively). When adjusted for age, the multivariable model predicted that each 0.1-unit decrease in natural logarithm of reactive hyperemia-peripheral arterial tonometry increased the odds for infection by 14.6%. m. Conclusion: Reactive hyperemiaperipheral arterial tonometry is closely related to soluble E-selectin and syndecan-1, suggesting an association between endothelial activation, glycocalyx degradation and vascular reactivity. Reactive hyperemia-peripheral arterial tonometry appears to be compromised in critically ill patients, especially those with sepsis. [ABSTRACT FROM AUTHOR]

Recently, the therapeutic approach using the extracorporeal hemadsorption technologies attracted much attention. Effort to affect the patophysiological processess associated with critical illness represents an attractive concept, that penetrates into clinical practice. Here we present the critical opinion on current status of hemadsorption therapy in critical ill patients in the context of published evidence. [ABSTRACT FROM AUTHOR]

Objective: to verify the knowledge of nursing professionals regarding the signs and symptoms of sepsis. Method: a descriptive study that was performed in a large hospital located in the eastern region of Belo Horizonte, Brazil. The sample comprised 61 participants in the inpatient sector who answered a questionnaire with 25 objective and multiple choice questions. Results: most professionals totally agreed on temperature >38oC (82.0%), oliguria (80.3%), heart rate >90 (68.8%), delirium (59.0%) and hypotension (80.3%). However, cardiovascular phenomena in clinical findings did not reach satisfactory frequency, as nursing professionals totally disagreed (49.2%) about hypovolemia, peripheral vasodilation, myocardial depression, and hypermetabolism. Conclusion: the nursing staff has a good knowledge on the subject, but there was difficulty in correctly assessing cardiovascular phenomena, reinforcing the need for training in relation to the institutional protocol. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock. Methods: This was an observational, single-center study with a retrospective analysis of the time to clearance of abdominal septic focus. Patients were classified according to the time to focus clearance into an early (≤ 12 hours) or delayed (> 12 hours) group. Results: A total of135 patients were evaluated. There was no association between time to focus clearance and hospital mortality (≤ 12 hours versus > 12 hours): 52.3% versus 52.9%, with p = 0.137. Conclusion: There was no difference in hospital mortality among patients with sepsis or septic shock who had an infectious focus evacuated before or after 12 hours after the diagnosis of sepsis. [ABSTRACT FROM AUTHOR]

Objective: to identify nurses' knowledge about sepsis and septic shock in a teaching hospital. Method: cross-sectional descriptive study carried out in a public hospital in a brazilian capital. The sample consisted of 47 nurses who provided care to adult patients in inpatient units. Data collection took place between July and August 2017. The results were presented using descriptive statistics. Results: most nurses studied about sepsis during graduation, but 40.4% reported having difficulties in the care of septic patients, 70.2% answered incorrectly about the current definition of sepsis and 51% either listed unused signs to identify sepsis or described only signs of the systemic inflammatory response syndrome. Conclusion: it is possible to reflect that perhaps these participants only "do" or follow prescriptions. These participants had little knowledge about the definition and classification of sepsis, as well as difficulties in the early identification of systemic changes. [ABSTRACT FROM AUTHOR]

Objective: to verify the effectiveness of the articulation of traditional and active teaching methods to develop nursing students' knowledge about sepsis. Method: quasi-experimental, cross-sectional, before-after study conducted with 27 nursing students through a sepsis workshop. Five teaching strategies were applied: expository lecture, sepsis parody, team debate, memory game and case study, followed by cognitive testing. After 3 months, there was a new application of the cognitive test. Results: there was an increase in the average of right answers in the immediate post-test with statistical significance (p <0.001). Three months later, the average of correct answers was close to the previous test, but there was no significant relevance (p> 0.05) for knowledge retention. Conclusion: the articulation of traditional and active learning methods lead to the development of knowledge about sepsis. Objetivo: verificar a efetividade da articulação de métodos tradicionais e ativos de ensino para desenvolver conhecimento de estudantes de enfermagem sobre sepse. Método: estudo quase experimental, transversal, do tipo antes e depois, realizado com 27 estudantes de enfermagem por meio de um workshop sobre sepse. Houve aplicação de 5 estratégias de ensino: palestra expositiva, paródia sobre sepse, debate entre equipes, jogo da memória e estudo de caso, seguidas de teste cognitivo. Após 3 meses, ocorreu nova aplicação do teste cognitivo. Resultados: constatou-se aumento da média de acertos no pós-teste imediato com significância estatística (p< 0,001). Três meses após, a média de acertos foi próxima ao teste anteriormente realizado, porém, não houve relevância significativa (p>0,05) para retenção do conhecimento. Conclusão: a articulação de métodos tradicionais e ativos de aprendizagem provocam desenvolvimento de conhecimento sobre a sepse. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of stratification to identify and target antioxidant therapy for animal models of lethal sepsis and in patients who develop sustained hypotension. Methods: Rats were subjected to sepsis induced by cecal ligation and puncture. Animals were divided into two groups: those with high and low plasma levels of interleukin-6. Following stratification, N-acetylcysteine plus deferoxamine or saline was administered to animals starting 3 and 12 hours after surgery. N-Acetylcysteine plus deferoxamine or placebo was administered within 12 hours of meeting the inclusion criteria in hypotensive patients. Results: N-Acetylcysteine plus deferoxamine increased survival in the cecal ligation and puncture model when administered 3 and 12 hours after sepsis induction. When dividing animals that received antioxidants using plasma interleukin-6 levels, the protective effect was observed only in those animals with high IL-6 levels. The antioxidant effect of N-acetylcysteine + deferoxamine was similar in the two groups, but a significant decrease in plasma interleukin-6 levels was observed in the high-interleukin- 6-level group. Compared with patients treated with antioxidants in the lowinterleukin- 6 subgroup, those in the high-interleukin-6 subgroup had a lower incidence of acute kidney injury but were not different in terms of acute kidney injury severity or intensive care unit mortality. Conclusion: Targeting antioxidant therapy to a high inflammatory phenotype would select a responsive population. [ABSTRACT FROM AUTHOR]

Current COVID-19 epidemics was declared on December 31, 2019 at the Wuhan city seafood market, rapidly spreading throughout China, and later reaching several countries (mainly South Korea, Japan, Italy and Iran) and, since March 1, reaching Portugal. Most of the infected patients present with mild symptoms, not requiring hospitalization. Among those admitted to the hospital, 6% to 10% require admission to the intensive care unit. These recommendations are aimed to support the organization of intensive care services to respond COVID-19, providing optimized care to the patient and protection for healthcare professionals. [ABSTRACT FROM AUTHOR]

Sepsis is a generalized inflammation with high morbidity and mortality, whose recognition and early treatment are essential factors for a better patient's quality of life; if not identified and treated promptly, could lead to death. This integrative review article aims to identify the techniques based on artificial intelligence adopted, their respective accuracy, sensitivity and specificity for early identification in cases of sepsis in a hospital environment. The research, adapted from the PRISMA method, was performed in five databases indexed from the following descriptors: sepsis, septic, forecasting, predict, prediction, detection, predicting, diagnosis, assessment, machine learning, artificial intelligence, data mining and deep learning. A total of 333 articles were identified, 21 with reference to the early recognition of sepsis by 16 techniques. The results showed that the neural networks performed better, varying the accuracy between 76% and 93%, the decision trees between 69.0% and 91.5% and the statistical methods between 56% and 89%. It is concluded that the most influential factor in the early identification of the diagnosis is the variety and quality of the data. The challenge in relation to pre-processing is also evident, since the data are generally from heterogeneous sources, collected with different criteria, methods and objectives. [ABSTRACT FROM AUTHOR]

The objective was to identify the most frequent types of sepsis in patients who died and the disease at the time of hospitalization. The present study analyzed retrospectively the type of sepsis outbreak described in the death certificate and compared with the patients' entry disease, the sample was composed of medical records and death certificates from January to March 2018. This research showed that the majority of patients were male over 60 years of age, the most common focus was the pulmonary, orotracheal intubation, the most frequently used invasive procedure. Pulmonary diseases were the ones that appeared the most as a diagnosis of hospitalization, followed by established sepsis, which can be justified by patients with a history of rehospitalization. Through the identification of the underlying disease and the type of sepsis, it is possible to point out the necessity of the early characterization of the same. [ABSTRACT FROM AUTHOR]

Aims: Development and validation of the contents of a checklist to evaluate the qualification of health professionals in septic patient care with clinical simulation. Method: instrument validation study, with two-stage structural design: instrument construction and validation of the checklist contents using the Delphi technique in two rounds. Results: The content validation was composed of ten items and forty-three sub-items analyzed by the evaluators. Through the Content Validity Index, four items with strong validation evidence were identified, Content Validity Index = 0.8. We restructured the checklist according to the evaluators recommendations, maintaining the ten items, but reducing them to twenty-six sub-items, which in the second round Delphi presented a percentage of agreement above 80% for all variables relevant to the instrument. Conclusion: This method was effective to validate the checklist contents that will evaluate the qualification of health professionals in septic patient care, through clinical simulation. [ABSTRACT FROM AUTHOR]

Introduction. Sepsis is defined as a multiple organ dysfunction secondary to an infectious process that can progress to septic shock, increasing the risk of mortality. Recent findings pertaining to Sepsis allow us to perform early diagnoses and timely therapeutic treatments with short and medium-term reductions in mortality. Division of Covered Topics. Non-systematic literary research was conducted in databases and digital libraries (PubMed, Cochrane, Lilacs), including articles in English and Spanish from 2005 to 2018 that included the topics of interest. A detailed description was made of the definition of sepsis and septic shock, their classification, physiopathology, diagnosis, hemodynamic monitoring and treatment. Conclusions. Sepsis is a medical emergency with a high mortality rate that requires a timely diagnosis. The diagnosis can be performed with the Sepsis Related Organ Failure Assessment (SOFA) score, and quickly beginning empirical antibiotic treatment and reanimation guided by goals, as these measures have shown a reduction in fatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To identify the underlying factors that affect fluid resuscitation in septic patients. Methods: The present study was a case-control study of 181 consecutive patients admitted to a Medical Intensive Care Unit between 2012 and 2016 with a diagnosis of sepsis. Demographic, clinical, radiological and laboratory data were analyzed. Results: One hundred-thirty patients (72%) received = 30mL/kg of IV fluids on admission. On univariate analyses, a past history of coronary artery disease and heart failure was associated with less fluid therapy. On multivariate analyses, a history of heart failure (OR = 2.31; 95%CI 1.04 - 5.14) remained significantly associated with receiving less IV fluids. Left ventricular ejection fraction, systolic/diastolic function, left ventricular hypertrophy and pulmonary hypertension were not associated with IV fluids. The amount of IV fluids was not associated with differences in mortality. During the first 24 hours, patients with a past history of heart failure received 2,900mLof IV fluids [1,688 - 4,714mL] versus 3,977mL [2,500 - 6,200mL] received by those without a history of heart failure, p = 0.02. Conclusion: Septic patients with a past history of heart failure received 1L less IV fluids in the first 24 hours with no difference in mortality. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of the presence of sepsis on in-hospital mortality after intensive care unit discharge. Methods: Retrospective, observational, single-center study. All consecutive patients discharged alive from the intensive care unit of Hospital Vila Franca de Xira (Portugal) from January 1 to December 31, 2015 (N = 473) were included and followed until death or hospital discharge. In-hospital mortality after intensive care unit discharge was calculated for septic and non-septic patients. Results: A total of 61 patients (12.9%) died in the hospital after being discharged alive from the intensive care unit. This rate was higher among the patients with sepsis on admission, 21.4%, whereas the in-hospital, postintensive care unit mortality rate for the remaining patients was nearly half that, 9.3% (p < 0.001). Other patient characteristics associated with mortality were advanced age (p = 0.02), male sex (p < 0.001), lower body mass index (p = 0.02), end-stage renal disease (p = 0.04) and high Simplified Acute Physiology Score II (SAPS II) at intensive care unit admission (p < 0.001), the presence of shock (p < 0.001) and medical admission (p < 0.001). We developed a logistic regression model and identified the independent predictors of inhospital mortality after intensive care unit discharge. Conclusion: Admission to the intensive care unit with a sepsis diagnosis is associated with an increased risk of dying in the hospital, not only in the intensive care unit but also after resolution of the acute process and discharge from the intensive care unit. [ABSTRACT FROM AUTHOR]

The hematological analysis in a sepsis is of great clinical importance to direct decision making by the clinical body and consequently improving the patient's prognosis. These analyzes should be conducted by qualified and trained professionals. For visualization of initial and subtle changes a good microscopic practice is required by the laboratory. Patients with sepsis need rapid diagnosis because of the exacerbated complications they present. A patient with an initial sepsis presents alterations in a hemogram such as leukocytosis, neutrophilia and leftsided deviation, since the patient in Intensive Care Unit presents differentiated alterations such as leucopenia, thrombopenia and anemia, these changes may change the clinical every patient, so they should be well punctuated. For example, a picture of leukocytosis followed by leukopenia with the presence of toxic granulations with or without a high lactate platelet count requires greater attention from the medical staff. The number of ICU deaths has increased in the last 30 years and the worldwide incidence of sepsis increased by approximately 13% at a rate of 13.7% per year. Thus, it is estimated that, each year, more than 18 million people develop sepsis, besides being a great generator of costs in the public and private sectors. This scenario requires the need to use sophisticated equipment, expensive drugs and demands a lot of work from the medical team, greatly increasing patient costs, as well as being related to a higher mortality rate. [ABSTRACT FROM AUTHOR]

Aim: To identify the association of demographic, clinical and therapeutic management aspects with the outcome of patients diagnosed with sepsis in a hospital emergency. Method: retrospective documentary, 312 records of septic patients, descriptive analysis, comparisons of categorical data were used using Chi-square or Fisher's exact tests, with Monte Carlo correction. Results: mean age 65 (± 17.66) years, 51.3% were women, 52.6% hypertensive, 28.5% diabetic, 27.2% heart disease, 74% diagnosed with sepsis 52.3% infectious pulmonary focus. There is an association between demographic variables and outcomes (p <0.05). History of stroke, cirrhosis, heart disease, and septic shock are associated with death (p <0.05). Warning signs and organ dysfunction evaluated are associated with the outcome. Infectious focus (p = 1) and tachycardia (p = 0.823) has no association with outcome or severity of sepsis (p = 0.120). Conclusion: there is an association between patient demographic profile, comorbidities, organ dysfunction and therapeutic management, with sepsis severity and outcome. [ABSTRACT FROM AUTHOR]

To describe the main clinical and biochemical changes in septic patients upon admittance to intensive care units and determine whether the clinical and biochemical criteria are associated to the length of the patient's hospitalization. Quantitative, descriptive, documentary and retrospective study, based on a sample of 176 eligible patient charts. Hypotension and tachycardia are related to changes in levels of consciousness, while tachypnea and leukocyte changes are related to respiratory disorders. The PaO2/FiO2 ratio, central venous pressure (CVP) and lactate levels increased patients' hospitalization period in intensive care units. Hypotension, tachycardia and abnormal central venous pressure were the main clinical changes found in the study sample. Leukocytosis and changes in the PaO2/FiO2 ratio were the main markers found. The predominant factors affecting hospitalization time were changes in the PaO2/FiO2 ratio, changes in lactate levels and decrease in central venous pressure. [ABSTRACT FROM AUTHOR]

Sepsis is defined as a clinical syndrome that consisting of a systemic inflammatory response associated with a focus of infection and it's one of the main causes of death in the intensive care units in Brazil. Identify the main Sepsis site infection in the intensive care units. Integrative review of the literature, carried out in national studies in intensive care units in Brazil with septic patients, using the BIREME database. The site of infection with the highest prevalence in 100% of the research was respiratory one. The mean mortality rate was 47.4%. The male gender prevailed in 100% of the research. The average of patients was 61.3 years and the prevalence rate was 45.5%. The most frequent site in sepsis cases is respiratory one and there is a requirement for further research about sepsis. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical characteristics and outcomes of patients with community-acquired and hospitalacquired sepsis. Methods: This is a retrospective cohort study that included all patients with a diagnosis of sepsis detected between January 2010 and December 2015 at a private hospital in southern Brazil. Outcomes (mortality, intensive care unit and hospital lengths of stay) were measured by analyzing electronic records. Results: There were 543 hospitalized patients with a diagnosis of sepsis, with a frequency of 90.5 (85 to 105) cases/year. Of these, 319 (58%) cases were classified as hospitalacquired sepsis. This group exhibited more severe disease and had a larger number of organ dysfunctions, with higher hospital [8 (8 - 10) versus 23 (20 - 27) days; p < 0.001] and intensive care unit [5 (4 - 7) versus 8.5 (7 - 10); p < 0.001] lengths of stay and higher in-hospital mortality (30.7% versus 15.6%; p < 0.001) than those with community-acquired sepsis. After adjusting for age, APACHE II scores, and hemodynamic and respiratory dysfunction, hospital-acquired sepsis remained associated with increased mortality (OR 1.96; 95%CI 1.15 - 3.32, p = 0.013). Conclusion: The present results contribute to the definition of the epidemiological profile of sepsis in the sample studied, in which hospital-acquired sepsis was more severe and was associated with higher mortality. [ABSTRACT FROM AUTHOR]

Cardiac troponins T and I are considered highly sensitive and specific markers for the diagnosis of acute myocardial infarction. Currently, a series of nonprimary cardiac abnormalities may manifest as an elevation in high-sensitive assays. The reduction in their detection limits has allowed earlier diagnosis and the use of evidence-based therapeutic measures; however, this characteristic has increased the spectrum of detectable noncoronary heart diseases, which poses challenges for characterizing acute coronary syndromes and creates a new role for these tests in known disorders in intensive care units, especially sepsis. Management of patients through a greater understanding of how these markers behave should be re-evaluated to ensure their correct interpretation. [ABSTRACT FROM AUTHOR]

Solid organ transplantation is the only way to treat end-stage organ disease. Survival of the patients with a transplanted organ has improved significantly in the last decades. It has been mainly due to the careful selection of organ transplant candidates from the waiting lists, improved surgical techniques and advances in intensive care and immunosuppressive therapy. This has logically led to an increase in the number of these patients on the follow-up, treated in the emergency departments and admitted to hospitals and intensive care units. The anaesthetic and intensive care management of the transplant recipients is similar to standard practice but there are physiological and pharmacological specific aspects including the adverse effects of immunosuppression, the risk of infection and the risk of rejection which the anaesthetist and the intensivist should consider. One of the most common reasons for hospital admission of the transplanted patients is infection and sepsis, the most common cause of morbidity and mortality in these patients. The cornerstones in the treatment of sepsis are early pathogen identification, infection source control and supportive therapy including temporary withdrawal of the immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the accuracy of IL-3 to predict the outcome of septic patients. Methods: Prospective cohort study with adult patients in an intensive care unit with sepsis or septic shock diagnosed within the previous 48 hours. Circulating IL-3 levels were measured upon inclusion (day 1) and on days 3 and 7. The primary outcome was hospital mortality. Results: One hundred and twenty patients were included. Serum levels of IL-3 on day 1 were significantly higher among patients who died than among patients who survived the hospital stay (91.2pg/mL versus 36pg/mL, p = 0.024). In a Cox survival model considering the IL-3 levels at inclusion, age and sequential SOFA, IL-3 values remained independently associated with mortality (HR 1.032; 95%CI 1.010 - 1.055; p = 0.005). An receiver operating characteristic curve was built to further investigate the accuracy of IL-3, with an area under the curve of 0.62 (95%CI 0.51 - 0.73; p = 0.024) for hospital mortality. A cutoff initial IL-3 value above 127.5pg/mL was associated with hospital mortality (OR 2.97; 95%CI: 1.27 - 6.97; p = 0.0019) but with a low performance (82% for specificity, 39% for sensibility, 53% for the positive predictive value, 72% for the negative predictive value, 0.73 for the negative likelihood and 2.16 for the positive likelihood ratio). Conclusion: Higher levels of IL-3 are shown to be independently associated with hospital mortality in septic patients but with poor clinical performance. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the short-term evolution of patients with septic shock refractory to norepinephrine treated with vasopressin in an intensive care unit of a university hospital. Methods: An unmatched retrospective study (case series) was performed. Clinical, laboratory, and anthropometric data were collected from patients who received vasopressin infusion for treatment of catecholamine-refractory shock from December 2014 to June 2016. For the assessment of severity, APACHE II and SOFA scores were used. The main outcome was mortality at 3 and 30 days. Results: A total of 80 patients were included, of which 60% were male. In 86.3% of the cases, APACHE II was observed in the highest ranges (> 20). The 30-day mortality was 86.2%, and 75% of the patients died within 72 hours after starting vasopressin. Conclusion: The series evaluated had high mortality in the first 72 hours of treatment with vasopressin. The use of vasopressin in patients who are refractory to norepinephrine had little or no impact on mortality. It was not possible to exclude the possibility that the high mortality in the present study was linked to the relatively late onset (after established refractoriness of norepinephrine) of vasopressin; this hypothesis should be further evaluated in a randomized study. [ABSTRACT FROM AUTHOR]

With the objective of identifying the epidemiological profile of HELGJ ICU hospitalizations in Valença-RJ, a retrospective, quantitative approach was used to analyze the patients seen between January and June 2016, evaluating those who reached the sector, the amount of death by associated pathology, gender and age group. It was observed that of the 203 patients admitted to the ICU studied, 74% were discharged. When both sexes were included, 52 patients died, with a mean mortality rate of 26%, which predominated in males and over 60 years of age. The main causes of admission were cardiovascular (21.1%), followed by sepsis (19.7%). However, this relationship is reversed by analyzing the main causes of death, with sepsis (38.4%) being the most prevalent, followed by cardiovascular causes (21.1%). The duration of hospitalization generally did not exceed 07 days. The values obtained in our study can be compared to those reported in other units of Brazil and the world, keeping the epidemiological differences and the characteristics of the services. Other information can be added to those already collected in the unit and a historical series should be created to allow the continuous search for quality in health care. [ABSTRACT FROM AUTHOR]