Posts Tagged ‘septic shock’

The Final Nail in Early Goal Directed Therapy’s Coffin?

Posted by • March 24th, 2015

You are called to evaluate Ms. Smith urgently.  She reports several days of progressive malaise, weakness and a new cough. On your exam she is tachycardic, tachypneic and febrile.  You diagnose Ms. Smith with sepsis and explain the importance of quickly treating this life-threatening condition.  In the United States, situations like this—presentations leading to the… Read More…

Blood-Pressure Target in Patients with Septic Shock

Posted by • April 25th, 2014

In a multicenter, open-label trial, patients with septic shock were treated to maintain a mean arterial pressure target of either 80 to 85 mm Hg or 65 to 70 mm Hg. There were no significant between-group differences in 28-day mortality or in 90-day mortality. Septic shock is characterized by arterial hypotension despiteadequate fluid resuscitation. Clinical Pearls •… Read More…

Risks and Benefits Associated with High vs. Low Target Blood Pressure in Septic Shock Patients

Posted by • April 23rd, 2014

Mr. G is a 59-year-old patient with a history of chronic hypertension who presents to the ICU with septic shock. As his physician, you want to make the best decisions to manage his complicated condition. You recall that the Surviving Sepsis Campaign has guidelines for this very situation, and they recommend reversal of his initial… Read More…

Take the Critical Care Challenge

Posted by • April 18th, 2014

In this month’s Critical Care Challenge, our  77-year-old patient is on mechanical ventilation in the ICU after an emergency colon resection, complicated by septic shock and acute liver failure. Since it appears his stay in the ICU will be prolonged, what measures would you take to optimize his long-term recovery? Participate in the poll and share… Read More…

Severe Sepsis and Septic Shock

Posted by • August 30th, 2013

Sepsis, a complex physiological and metabolic response to infection, is a common reason for admission to an intensive care unit. The first article in our Critical Care Medicine review series examines the basis, diagnosis, and current treatment of this disorder. In 1992, an international consensus panel defined sepsis as a systemic inflammatory response to infection, noting… Read More…

New NEJM Review Series: Critical Care

Posted by • August 29th, 2013

The first article in a new series on Critical Care, Severe Sepsis and Septic Shock, is now available on NEJM.org. Sepsis, a complex physiological and metabolic response to infection, is a common reason for admission to an ICU. This review, from University of Pittsburgh’s Derek Angus and University of Amsterdam’s Tom van der Poll, examines the… Read More…

Take the Critical Care Challenge

Posted by • August 15th, 2013

A 77-year-old man is admitted to the ICU after resection of the rectosigmoid colon for gross fecal peritonitis. What should be done first? On August 29th, we will publish the first article in a new series on Critical Care, Severe Sepsis and Septic Shock. In advance of its release, we have published a case on NEJM.org that… Read More…

Reduced Cortisol Breakdown in Critical Illness

Posted by • April 17th, 2013

The 65-year old woman’s stomach started to hurt about a week ago. She thought nothing much of it at first, but the pain intensified and she started spiking fevers, feeling weak and dizzy. When she couldn’t get out of bed, her husband called for an ambulance. By the time she arrives at the hospital, her blood pressure… Read More…

DrotAA in Adults with Septic Shock

Posted by • May 30th, 2012

A 42-year old woman presents to the intensive care unit in septic shock from an untreated urinary tract infection. When her blood pressure does not respond to fluids, the team moves quickly. She’s soon intubated and a central line is placed to administer norepinephrine. Despite early initiation of broad-spectrum antibiotics, her vasopressor requirements continue to escalate. Most… Read More…

Comparison of Dopamine and Norepinephrine in the Treatment of Shock

Posted by • March 3rd, 2010

This week, De Backer et al. report on a multicenter clinical trial in which they randomly assigned 1679 patients with shock to receive either dopamine or norepinephrine to restore and maintain blood pressure. With regard to the primary endpoint of 28-day mortality, there was no difference between the two pressors. However, dopamine was unexpectedly associated… Read More…