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An answer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "41" "paginaFinal" => "43" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las nuevas definiciones de SEPSIS y CHOQUE SÉPTICO: ¿Qué nos ofrecen? Una respuesta" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Singer" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Singer" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300097?idApp=WMIE" "url" => "/21735727/0000004100000001/v1_201703040056/S2173572717300097/v1_201703040056/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173572717300073" "issn" => "21735727" "doi" => "10.1016/j.medine.2017.02.004" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "979" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2017;41:28-37" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1999 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 1223 "PDF" => 592 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Declining mortality due to severe sepsis and septic shock in Spanish intensive care units: A two-cohort study in 2005 and 2011" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "28" "paginaFinal" => "37" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Disminución de la mortalidad de la sepsis grave y shock séptico en las ucis españolas: un estudio de dos cohortes en 2005 y 2011" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1270 "Ancho" => 2086 "Tamanyo" => 111729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Resuscitation bundle, accomplished within 6<span class="elsevierStyleHsp" style=""></span>h.</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: CVP: central venous pressure; ScvO<span class="elsevierStyleInf">2</span>: central venous oxygen saturation; ATB: antibiotic.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Sánchez, R. Ferrer, D. Suarez, E. Romay, E. Piacentini, G. Gomà, M.L. Martínez, A. Artigas" "autores" => array:9 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Sánchez" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Ferrer" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Suarez" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Romay" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Piacentini" ] 5 => array:2 [ "nombre" => "G." "apellidos" => "Gomà" ] 6 => array:2 [ "nombre" => "M.L." "apellidos" => "Martínez" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Artigas" ] 8 => array:1 [ "colaborador" => "for the Edusepsis Study Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300073?idApp=WMIE" "url" => "/21735727/0000004100000001/v1_201703040056/S2173572717300073/v1_201703040056/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>" "titulo" => "New definition of sepsis and septic shock: What does it give us?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "38" "paginaFinal" => "40" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Rodríguez, I. Martín-Loeches, J.C. Yébenes" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Rodríguez" "email" => array:1 [ 0 => "ahr1161@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Martín-Loeches" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.C." "apellidos" => "Yébenes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII/URV/IISPV/CIBERES, Tarragona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Multidisciplinary Intensive Care Research Organization (MICRO), Department of Anaesthesia and Critical Care, St James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Mataró, Mataró, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nueva definición de sepsis y <span class="elsevierStyleItalic">shock</span> séptico: ¿qué nos ofrece?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1514 "Ancho" => 1500 "Tamanyo" => 145657 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The “CHAOS Theory” concepts.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A few days ago, new definitions of sepsis and septic shock were launched as a result of a consensus of 19 experts SCCM (Society of Critical Care Medicine) and ESICM (European Society of Intensive Care Medicine).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Perhaps the greatest contribution of this expert opinion consensus has been to recognize sepsis as a difficult to characterize syndromic condition, with a cellular metabolic disorder as a lead condition along with the development of organ failure. However, as the most important feature, the new definition excludes the concept of SIRS (Systemic Inflammatory Response Syndrome) since this term is being considered of not useful anymore. The authors supported this decision mainly based on a retrospective study conducted in Australia and New Zealand<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> in which it was observed (glass half-empty approach) that 1 out of 8 patients (12.5%) with sepsis and multiorgan failure (MOF) did not have at least 2 SIRS criteria. However, these results (glass half-full approach) could be reinterpreted as 7 out of 8 patients (87.5%) did present positive SIRS criteria.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Furthermore, the authors, in the paper on new sepsis definitions, affirmed that SIRS does not represent a dysregulated systemic response compromising host survival for the diagnosis of sepsis anymore. The concept of SIRS, such as expressed by Bone et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> is a clear one and refers to non-specific inflammatory response of the host to an injury. The theory of “CHAOS” proposed by Bone (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) masterfully develops the different interactions between the pro and anti-inflammatory response of the host taking into account a translational view, which has elucidated the different phases or states of patients with sepsis. Moreover, several studies have found a direct association between SIRS severity and clinical progression. Rangel-Frausto et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> showed that mortality significantly increased from 7% to 17% based on the number of SIRS criteria (from two to four respectively). Interestingly, Napolitano et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> observed in trauma patients the relative risk (RR) of mortality increased from 3.46 (interquartile range [IQR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.48–8.11], <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.004) with a SIRS score<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2–6.88 [1.81–22.8], <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.004 for SIRS<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4. In addition, Barie and Hydo<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> reported that the change in SIRS score within the first 24<span class="elsevierStyleHsp" style=""></span>h of treatment was significantly associated with mortality (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Moreover, to define sepsis based on organ dysfunction may have serious limitations. The SOFA score was designed to estimate more objectively organ dysfunction associated with sepsis<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> and its use is common in intensive care units (ICUs), but not in other health care settings,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> where a more large number of patients with sepsis are screened. This is by far the area of detection and Sepsis Code activation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the other hand, it important to highlight that with the previous definitions and international campaigns implementations based on such, mortality of sepsis has dramatically decreased.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> As other authors have previously acknowledged it, SIRS and MOF are not syndromes but merely concepts. SIRS criteria are non-specific physiological responses to an aggression to the host. Whilst SIRS should be promptly identified, MOF should be considered a delayed failure to an inadequate clinical response.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Another important aspect of the recently launched definitions of sepsis is the proposal of “quick SOFA” as a criterion for suspected sepsis if there are two of the three criteria chosen (systolic blood pressure <100<span class="elsevierStyleHsp" style=""></span>mmHg, tachypnea >22<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">–1</span> or altered mentation [derived from Glasgow Coma Score <13]) while SIRS (including tachycardia >90 and tachypnea >20) criteria is deleted. Unfortunately, there is a potential exclusion of physiopathology concept. Vasoconstriction and tachycardia are physiological mediated responses aimed to keep adequate oxygen transport and metabolism. This phenomenon has been extensively studied showing a good correlation between shock index (heart rate/systolic blood pressure ratio) and mortality. This concept is extremely valid and useful in young patients or patients without chronic diseases.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10–12</span></a> Moreover, based on new definitions, to have chosen just hypotension or altered sensorium for sepsis detection, may (a) delay essential therapeutic measures such as early administration of antibiotics and (b) accepting organ failure establishment as the first sign of detection.</p><p id="par0035" class="elsevierStylePara elsevierViewall">As a common rule, the choice of one or other clinical indicator should be related to the goal to be achieved. Thus, if the goal is to detect promptly a wide number of patients at risk (even with the risk of over diagnosis) of one event (sepsis), a very sensitive indicator should be chosen even when less associated specificity. The recent definitions focus on a more specific goal, organ dysfunction, which will somehow jeopardize the detection of patients with sepsis with both lack or delayed identification of patients at risk. Like in other diseases (i.e. stroke, myocardial infarction), the efforts have been made in early detection campaigns rather than very specific approaches.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We have to acknowledge the limitations of the former definitions especially severe sepsis and the new interpretation of septic shock. Now, shock is defined, as a clinical condition associated to vasopressor requirement to maintain a mean arterial pressure of 65<span class="elsevierStyleHsp" style=""></span>mm Hg or greater and serum lactate level greater than 2<span class="elsevierStyleHsp" style=""></span>mmol/L (>18<span class="elsevierStyleHsp" style=""></span>mg/dL) in the absence of hypovolemia. This is something that might be applicable only within the first hours of resuscitation to identify patient's response but not to define a clinical state. It is true that different recent clinical trials have shown an unexpected low mortality in some patients with septic shock. However, there is a lack of timing with this very important change in the concept. For instance, if a patient has a sustained high lactate level, would this define a terminal event after a failure in resuscitation instead?</p><p id="par0045" class="elsevierStylePara elsevierViewall">In summary, we consider that new definitions must foster to adequately characterize identification, management and stratification with an integrative clinical and pathophysiological approach. We wonder, after a careful review of the new definitions, if they are just a confusing episode of research or they bring anything truly needed to improve current clinical practice.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-03-09" "fechaAceptado" => "2016-03-29" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1514 "Ancho" => 1500 "Tamanyo" => 145657 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The “CHAOS Theory” concepts.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 920 "Ancho" => 1473 "Tamanyo" => 57919 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mortality rate in relation to the variation of the SIRS score between day 2 and day 1.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The third International Consensus Definitions for sepsis and septic shock (Sepsis-3)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 4 | 7 | 11 |
2024 October | 122 | 45 | 167 |
2024 September | 144 | 28 | 172 |
2024 August | 198 | 50 | 248 |
2024 July | 157 | 39 | 196 |
2024 June | 139 | 47 | 186 |
2024 May | 152 | 47 | 199 |
2024 April | 85 | 47 | 132 |
2024 March | 62 | 28 | 90 |
2024 February | 51 | 37 | 88 |
2024 January | 47 | 38 | 85 |
2023 December | 53 | 48 | 101 |
2023 November | 78 | 51 | 129 |
2023 October | 91 | 25 | 116 |
2023 September | 78 | 37 | 115 |
2023 August | 43 | 19 | 62 |
2023 July | 63 | 24 | 87 |
2023 June | 51 | 15 | 66 |
2023 May | 77 | 39 | 116 |
2023 April | 70 | 20 | 90 |
2023 March | 102 | 37 | 139 |
2023 February | 107 | 39 | 146 |
2023 January | 119 | 29 | 148 |
2022 December | 102 | 36 | 138 |
2022 November | 114 | 50 | 164 |
2022 October | 116 | 55 | 171 |
2022 September | 99 | 52 | 151 |
2022 August | 72 | 64 | 136 |
2022 July | 48 | 52 | 100 |
2022 June | 57 | 32 | 89 |
2022 May | 71 | 40 | 111 |
2022 April | 88 | 49 | 137 |
2022 March | 101 | 84 | 185 |
2022 February | 127 | 54 | 181 |
2022 January | 197 | 51 | 248 |
2021 December | 155 | 63 | 218 |
2021 November | 154 | 49 | 203 |
2021 October | 262 | 103 | 365 |
2021 September | 157 | 47 | 204 |
2021 August | 157 | 59 | 216 |
2021 July | 102 | 40 | 142 |
2021 June | 104 | 42 | 146 |
2021 May | 153 | 75 | 228 |
2021 April | 282 | 109 | 391 |
2021 March | 205 | 83 | 288 |
2021 February | 161 | 41 | 202 |
2021 January | 116 | 31 | 147 |
2020 December | 77 | 20 | 97 |
2020 November | 66 | 16 | 82 |
2020 October | 58 | 36 | 94 |
2020 September | 56 | 16 | 72 |
2020 August | 28 | 18 | 46 |
2020 July | 54 | 18 | 72 |
2020 June | 34 | 18 | 52 |
2020 May | 24 | 10 | 34 |
2020 April | 37 | 10 | 47 |
2020 March | 18 | 8 | 26 |
2020 February | 52 | 39 | 91 |
2020 January | 20 | 29 | 49 |
2019 December | 35 | 17 | 52 |
2019 November | 29 | 30 | 59 |
2019 October | 19 | 18 | 37 |
2019 September | 32 | 27 | 59 |
2019 August | 29 | 20 | 49 |
2019 July | 28 | 17 | 45 |
2019 June | 18 | 10 | 28 |
2019 May | 35 | 21 | 56 |
2019 April | 13 | 13 | 26 |
2019 March | 21 | 31 | 52 |
2019 February | 23 | 17 | 40 |
2019 January | 24 | 33 | 57 |
2018 December | 49 | 20 | 69 |
2018 November | 98 | 57 | 155 |
2018 October | 75 | 21 | 96 |
2018 September | 50 | 13 | 63 |
2018 August | 19 | 7 | 26 |
2018 July | 35 | 14 | 49 |
2018 June | 40 | 11 | 51 |
2018 May | 19 | 5 | 24 |
2018 April | 32 | 12 | 44 |
2018 March | 86 | 11 | 97 |
2018 February | 18 | 11 | 29 |
2018 January | 32 | 13 | 45 |
2017 December | 18 | 11 | 29 |
2017 November | 25 | 13 | 38 |
2017 October | 18 | 7 | 25 |
2017 September | 19 | 11 | 30 |
2017 August | 21 | 12 | 33 |
2017 July | 14 | 8 | 22 |
2017 June | 26 | 18 | 44 |
2017 May | 20 | 7 | 27 |
2017 April | 33 | 0 | 33 |
2017 March | 2 | 1 | 3 |