Establishment of SEP-1 national practice guidelines does not impact fluid administration for septic shock patients
Boccio E, Haimovich A, Jacob V, Zhao X, Wira CR, Venkatesh A, Belsky J. Establishment of SEP-1 national practice guidelines does not impact fluid administration for septic shock patients. The American Journal Of Emergency Medicine 2022, 62: 19-24. PMID: 36209655, DOI: 10.1016/j.ajem.2022.09.038.Peer-Reviewed Original ResearchConceptsSeptic shock patientsShock patientsFluid administrationFluid managementSevere sepsis/septic shockSepsis/septic shockEarly Management BundleRetrospective observational analysisDate of presentationNational practice guidelinesUrban academic centerNational quality measuresLogistic regression analysisOdds of complianceHigh-quality careSepsis severityPrimary outcomeSeptic shockED settingResuscitation strategiesBlood culturesPractice patternsOdds ratioPractice guidelinesProvider practicesSepsis Fluid Metric Compliance and its Impact on Outcomes of Patients with Congestive Heart Failure, End-Stage Renal Disease or Obesity
Boccio E, Haimovich A, Jacob V, Maciejewski KR, Wira CR, Belsky J. Sepsis Fluid Metric Compliance and its Impact on Outcomes of Patients with Congestive Heart Failure, End-Stage Renal Disease or Obesity. Journal Of Emergency Medicine 2021, 61: 466-480. PMID: 34088547, DOI: 10.1016/j.jemermed.2021.03.004.Peer-Reviewed Original ResearchConceptsEnd-stage renal diseaseCongestive heart failurePre-existing congestive heart failurePre-existing conditionsMultiple pre-existing conditionsShock patientsHeart failureRenal diseaseEmergency departmentED patient encountersOutcomes of patientsRetrospective chart reviewSeptic shock patientsFluid overload statesLength of stayUrban academic centerFluid goalChart reviewSeptic shockFluid administrationFluid bolusEmergency physiciansObesityPatientsAcademic centersEffect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis
Sevransky J, Rothman R, Hager D, Bernard G, Brown S, Buchman T, Busse L, Coopersmith C, DeWilde C, Ely E, Eyzaguirre L, Fowler A, Gaieski D, Gong M, Hall A, Hinson J, Hooper M, Kelen G, Khan A, Levine M, Lewis R, Lindsell C, Marlin J, McGlothlin A, Moore B, Nugent K, Nwosu S, Polito C, Rice T, Ricketts E, Rudolph C, Sanfilippo F, Viele K, Martin G, Wright D, Nugent K, Spainhour C, Polito C, Moore B, Negrin L, Khan A, Kea B, Krol O, Haq E, Pinkert V, Nguyen K, Brown S, Bledsoe J, Peltan I, Applegate D, Armbruster B, Montgomery Q, Brown K, Daw A, Gong M, Aboodi M, Chen J, Hope A, Gummadi S, Lopez B, Hinson J, Hager D, Ricketts E, Clements C, Gajic O, Kashyap R, Vanmeter D, Busse L, McBride M, Ginde A, Moss M, Finck L, Howell M, McKeehan J, Higgins C, Clare J, McBryde B, Barksdale A, Kalin D, Kruse D, Hilz K, Qadir N, Chang S, Beutler R, Tam A, Harris E, Youngquist S, Middleton E, Davidov E, Plante A, Belsky J, Siner J, Wira C, Brokowski C, Steingrub J, Smithline H, Thornton-Thompson S, Fowler A, Miller S, Narron K, Puskarich M, Prekker M, Hendrickson A, Quinn J, Wilson J, Levitt J, Mann R, Visweswaran A, Gentile N, Marchetti N, Reimer H, Guirgis F, Jones L, Black L, Henson M, Meyer N, Greenwood J, Ittner C, Rivers E, Jayaprakash N, Gardner-Gray J, Hurst G, Pflaum J, Jaehne A, Gill J, Cook A, Janz D, Vonderhaar D, Romaine C, Wilkerson R, McCurdy M, Beach D, Lasko K, Gill R, Price K, Dickson L, Duggal A, Mace S, Hite R, Hastings A, Haukoos J, Douglas I, Trent S, Lyle C, Cupelo A, Gravitz S, Hiller T, Oakes J, LoVecchio F, Quiroga P, Danley S, Mulrow M, Encinas A, Goodwin A, Hall G, Grady A, Exline M, Terndrup T, Pannu S, Robart E, Karow S, Files D, Smith L, Gibbs K, Flores L, Pastores S, Shaz D, Kostelecky N, Case C, Wilkins E, Gaieski D, Baram M, Schwegler D, Renzi N, Mosier J, Hypes C, Campbell E, Hooper M, Sill J, Mitchell K, Hudock K, Lyons M, Gorder K, Ahmad Y, Studer A, Davis J, Barrett M, Nomura J, Knox J, Park P, Co I, McSparron J, Hyzy R, McDonough K, Hanna S, Self W, Semler M, Hays M, Bartz R, Limkakeng A, Sweeney K, Woodburn R, Goyal M, Zaaqoq A, Moriarty T, Oropello J, Zhang Z. Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis. JAMA 2021, 325: 742-750. PMID: 33620405, PMCID: PMC7903252, DOI: 10.1001/jama.2020.24505.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAnti-Inflammatory AgentsAscorbic AcidCritical IllnessDouble-Blind MethodDrug Therapy, CombinationEarly Termination of Clinical TrialsFemaleHumansHydrocortisoneLength of StayMaleMiddle AgedOrgan Dysfunction ScoresRespiration, ArtificialRespiratory InsufficiencySepsisThiamineTreatment OutcomeVasoconstrictor AgentsVitaminsConceptsVasopressor-free daysIntensive care unitVitamin CPlacebo groupCare unitIntervention groupDays of randomizationIntravenous vitamin CPlacebo-controlled trialThirty-day mortalityTotal daily doseKey secondary outcomesAdult patientsSecondary outcomesDaily doseIll patientsPrimary outcomeSubstantial morbidityCardiovascular dysfunctionEmergency departmentCommon syndromeMAIN OUTCOMESepsisPlaceboPatientsF-Actin is associated with a worsening qSOFA score and intensive care unit admission in emergency department patients at risk for sepsis
Belsky JB, Filbin MR, Rivers EP, Bobbitt KR, Jaehne AK, Wisnik CA, Maciejewski KR, Li F, Morris DC. F-Actin is associated with a worsening qSOFA score and intensive care unit admission in emergency department patients at risk for sepsis. Biomarkers 2020, 25: 391-396. PMID: 32421363, DOI: 10.1080/1354750x.2020.1771419.Peer-Reviewed Original ResearchConceptsIntensive care unitEmergency departmentQSOFA scoreIllness severityPlasma levelsThymosin beta 4Quick Sequential Organ Failure Assessment (qSOFA) scoreSequential Organ Failure Assessment scoreIntensive care unit admissionOrgan Failure Assessment scoreCare unit admissionPositive urine cultureSymptoms of sepsisSystemic inflammatory syndromeDiagnosis of sepsisEmergency department patientsSignificant outcome measureBeta 4Unit admissionICU admissionInflammatory syndromeDepartment patientsSeptic shockCare unitED patientsAntibiotic Delays and Feasibility of a 1-Hour-From-Triage Antibiotic Requirement: Analysis of an Emergency Department Sepsis Quality Improvement Database
Filbin MR, Thorsen JE, Zachary TM, Lynch JC, Matsushima M, Belsky JB, Heldt T, Reisner AT. Antibiotic Delays and Feasibility of a 1-Hour-From-Triage Antibiotic Requirement: Analysis of an Emergency Department Sepsis Quality Improvement Database. Annals Of Emergency Medicine 2019, 75: 93-99. PMID: 31561998, DOI: 10.1016/j.annemergmed.2019.07.017.Peer-Reviewed Original ResearchConceptsQuality improvement interventionsHours of triageAntibiotic delaySeptic patientsImprovement interventionsAntibiotic requirementsLower Sequential Organ Failure Assessment scoresSequential Organ Failure Assessment scoreMedicaid Services Severe SepsisOrgan Failure Assessment scoreSurviving Sepsis Campaign recommendationsMost septic patientsOnset of hypoperfusionSurviving Sepsis CampaignAdult septic patientsQuality improvement databaseNational quality measuresMedicaid Services measuresTriage locationInfectious symptomsSevere sepsisChart reviewMost patientsSepsis CampaignPrimary outcomeA review of micronutrients in sepsis: the role of thiamine, l-carnitine, vitamin C, selenium and vitamin D
Belsky JB, Wira CR, Jacob V, Sather JE, Lee PJ. A review of micronutrients in sepsis: the role of thiamine, l-carnitine, vitamin C, selenium and vitamin D. Nutrition Research Reviews 2018, 31: 281-290. PMID: 29984680, DOI: 10.1017/s0954422418000124.Peer-Reviewed Original ResearchConceptsVitamin CLife-threatening organ dysfunctionRole of micronutrientsCurrent available dataSeptic patientsOrgan dysfunctionSeptic shockVitamin DVitamin D.Clinical trialsRole of thiamineThiamine deficiencySepsisHuman studiesHost responseConclusion statementsCellular dysfunctionNormal physiologyMetabolic demandsCarnitinePotential roleDysfunctionPresent reviewCellular turnoverPivotal roleThymosin beta 4 regulation of actin in sepsis
Belsky JB, Rivers EP, Filbin MR, Lee PJ, Morris DC. Thymosin beta 4 regulation of actin in sepsis. Expert Opinion On Biological Therapy 2018, 18: 193-197. PMID: 29508629, PMCID: PMC6556887, DOI: 10.1080/14712598.2018.1448381.Peer-Reviewed Original ResearchConceptsThymosin beta 4Beta 4Life-threatening organ damageAnti-inflammatory genesAnti-inflammatory propertiesComprehensive literature searchMicrocirculatory perturbationsInflammatory mediatorsOrgan damageSepsis resultsSeptic ratsClinical trialsSepsisAnti-oxidative enzymesHost responseLiterature searchAnti-apoptotic enzymesReactive oxygen speciesDecreased concentrationMeasurable levelsMortalityCurrent knowledgeOxygen speciesBinding proteinPatientsEarly goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE
Nguyen HB, Jaehne AK, Jayaprakash N, Semler MW, Hegab S, Yataco AC, Tatem G, Salem D, Moore S, Boka K, Gill JK, Gardner-Gray J, Pflaum J, Domecq JP, Hurst G, Belsky JB, Fowkes R, Elkin RB, Simpson SQ, Falk JL, Singer DJ, Rivers EP. Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE. Critical Care 2016, 20: 160. PMID: 27364620, PMCID: PMC4929762, DOI: 10.1186/s13054-016-1288-3.Peer-Reviewed Original ResearchConceptsEarly goal-directed therapyGoal-directed therapySeptic shockSevere sepsisSepsis mortalitySepsis managementSignificant mortality reductionSurviving Sepsis CampaignAcute myocardial infarctionStandard of careEarly sepsis managementHemodynamic pathogenesisUsual careSepsis CampaignStandard careEmergency departmentMyocardial infarctionEarly managementOutcome benefitsClinical trialsMortality reductionTherapyMortalityTrialsCare