Log in | Register

Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock

R. Phillip Dellinger| Jean M. Carlet| Henry Masur| Herwig Gerlach| Thierry Calandra| Jonathan Cohen| Juan Gea-Banacloche| Didier Keh| John C. Marshall| Margaret M. Parker| Graham Ramsay| Janice L. Zimmerman| Jean-Louis Vincent| M. M. Levy
Special Article
Volume 30, Issue 4 / April , 2004

Pages 536 - 555

Abstract

Objective

To develop management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis.

Design

The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along 5 levels to create recommendation grades from A–E, with A being the highest grade. Pediatric considerations were provided to contrast adult and pediatric management.

Participants

Participants included 44 critical care and infectious disease experts representing 11 international organizations.

Results

A total of 46 recommendations plus pediatric management considerations.

Conclusions

Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually, and even more rapidly when some important new knowledge becomes available.

Keywords

References

  1. Dellinger RP (2003) Cardiovascular management of septic shock. Crit Care Med 31:946–955
    • View reference on PubMed
  2. Friedman G, Silva E, Vincent JL (1998) Has the mortality of septic shock changed with time? Crit Care Med 26:2078–2086
    • View reference on PubMed
  3. Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95:2S–4S
    • View reference on PubMed
  4. Sprung CL, Bernard GR, Dellinger RP (2001) Introduction. Intensive Care Med 27 [Suppl] :S1-S2
  5. Rivers E, Nguyen B, Havstad S et al. (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377
    • View reference on PubMed
  6. Weinstein MP, Reller LP, Murphy JR, Lichtenstein KA (1983) The clinical significance of positive blood cultures: A comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis 5:35–53
    • View reference on PubMed
  7. Blot F, Schmidt E, Nitenberg G, Tancrède C, Laplanche A, Andremont A (1998) Earlier positivity of central venous versus peripheral blood cultures is highly predictive of catheter-related sepsis. J Clin Microbiol 36:105–109
    • View reference on PubMed
  8. Mermel LA, Maki DG (1993) Detection of bacteremia in adults: consequences of culturing an inadequate volume of blood. Ann Intern Med 119:270–272
    • View reference on PubMed
  9. McCabe WR, Jackson GG (1962) Gram negative bacteremia. Arch Intern Med 110:92–100
  10. Kreger BE, Craven DE, McCabe WR (1980) Gram negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 68:344–355
    • View reference on PubMed
  11. Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD (1998) The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 244:379–386
    • View reference on publisher's website
    • View reference on PubMed
  12. Ibrahim EH, Sherman G, Ward S, Ward S, Fraser VJ, Kollef MH (2000) The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 118:146–155
    • View reference on PubMed
  13. Hatala R, Dinh T, Cook DJ (1996) Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis. Ann Intern Med 124:717–725
    • View reference on PubMed
  14. Ali MZ, Goetz MB (1997) A meta-analysis of the relative efficacy and toxicity of single daily dosing versus multiple daily dosing of aminoglycosides. Clin Infec Dis 24:796–809
  15. Amsden GW, Ballow CH, Bertino JS (2000) Pharmacokinetics and pharmacodynamcis of anti-infective agents. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases. Churchill Livingstone, Philadelphia, pp 253–261
  16. Hyatt JM, McKinnon PS, Zimmer GS, Schentag JJ (1995) The importance of pharmacokinetic/pharmacodynamic surrogate markers to outcomes. Focus on antibacterial agents. Clin Pharmacokinet 28:143–160
  17. Jimenez MF, Marshall JC (2001) Source control in the management of sepsis. Intensive Care Med 27:S49–S62
    • View reference on PubMed
  18. Bufalari A, Giustozzi G, Moggi L (1996) Postoperative intraabdominal abscesses: percutaneous versus surgical treatment. Acta Chir Belg 96:197–200
    • View reference on PubMed
  19. Moss RL, Musemeche CA, Kosloske AM (1996) Necrotizing fascitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg 31:1142–1146
    • View reference on PubMed
  20. Centers for Disease Control and Prevention (2002) Guidelines for the prevention of intravascular catheter-related infections. MMWR Morb Mortal Wkly Rep 51:1–29
  21. O’Grady NP, Alexander M, Dellinger EPet al. (2002) Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23:759–769
    • View reference on PubMed
  22. Choi PT, Yip G, Quinonez LG, Quinonez LG, Cook DJ (1999) Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 27:200–210
    • View reference on PubMed
  23. Cook D, Guyatt G (2001) Colloid use for fluid resuscitation: evidence and spin. Ann Intern Med 135:205–208
    • View reference on PubMed
  24. Schierhout G, Roberts I (1998) Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomized trials. BMJ 316:961–964
    • View reference on PubMed
  25. Hollenberg SM, Ahrens TS, Astiz ME, (1999) Practice parameters for hemodynamic support of sepsis in adult patients. Crit Care Med 27:639–660
    • View reference on PubMed
  26. LeDoux D, Astiz ME, Carpati CM, Rackow EC (2000) Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 28:2729–2732
    • View reference on publisher's website
    • View reference on PubMed
  27. Regnier B, Rapin M, Gory G, Lemaire F, Teisseire B, Harari A (1977) Haemodynamic effects of dopamine in septic shock. Intensive Care Med 3:47–53
    • View reference on PubMed
  28. Martin C, Papazian L, Perrin G, Saux P, Gouin F (1993) Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 103:1826–1831
    • View reference on PubMed
  29. Martin C, Viviand X, Leone M, Thirion X (2000) Effect of norepinephrine on the outcome of septic shock. Crit Care Med 28:2758–2765
  30. De Backer D, Creteur J, Silva E, Vincent JL (2003) Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med 31:1659–1667
    • View reference on PubMed
  31. Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J (2000) Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 356:2139–2143
    • View reference on PubMed
  32. Kellum J, Decker J (2003) Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 29:1526–1531
  33. Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D (2003) Circulating vasopressin levels in septic shock. Crit Care Med 31:1752–1758
    • View reference on publisher's website
    • View reference on PubMed
  34. Holmes CL, Patel BM, Russell JA, Russell JA, Walley KR (2001) Physiology of vasopressin relevant to management of septic shock. Chest 120:989–1002
    • View reference on PubMed
  35. Malay MB, Ashton RC, Landry DW, Townsend RN (1999) Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 47:699–705
    • View reference on PubMed
  36. Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA (2001) The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 27:1416–1421
    • View reference on PubMed
  37. Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333:1025–1032
    • View reference on PubMed
  38. Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722
    • View reference on PubMed
  39. Annane D, Sebille V, Charpentier C et al. (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871
    • View reference on PubMed
  40. Briegel J, Forst H, Haller M et al. (1999) Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med 27:723–732
    • View reference on PubMed
  41. Bollaert PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A (1998) Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 26:645–650
    • View reference on PubMed
  42. Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E (2000) A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 283:1038–1045
    • View reference on PubMed
  43. Annane D, Cavaillon JM (2003) Corticosteroids in sepsis: from bench to bedside? Shock 20:197–207
    • View reference on PubMed
  44. Marik PE, Zaloga GP (2003) Adrenal insufficiency during septic shock. Crit Care Med 31:141–145
    • View reference on PubMed
  45. Cooper MS, Stewart PM (2003) Corticosteroid insufficiency in acutely ill patients. N Engl J Med 348:727–734
    • View reference on publisher's website
    • View reference on PubMed
  46. Keh D, Boehnke T, Weber-Carstens S et al. (2003) Immunologic and hemodynamic effects of “low-dose” hydrocortisone in septic shock: a double-blind, randomized, placebo-controlled, crossover study. Am J Respir Crit Care Med 167:512–520
    • View reference on publisher's website
    • View reference on PubMed
  47. Bone RC, Fisher CJ, Clemmer TP (1987) A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 317:653–658
    • View reference on PubMed
  48. Cronin L, Cook DJ, Carlet J, Heyland DK, King D, Lansang MA, Fisher CJ Jr (1995) Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med 23:1430–1439
    • View reference on PubMed
  49. The Veterans Administration Systemic Sepsis Cooperative Study Group (1987) Effect on high-dose glucocorticoid therapy on mortality in patients with clinical signs of sepsis. N Engl J Med 317:659–665
  50. Bernard GR, Vincent JL, Laterre PF et al. Recombinant Human Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344: 699–709
    • View reference on PubMed
  51. Hébert PC, Wells G, Blajchman MA et al. (1999) A multicenter, randomized, controlled clinical trial of transfusion in critical care. N Engl J Med 340:409–417
    • View reference on PubMed
  52. Marik PE, Sibbald WJ (1993) Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 269:3024–3029
    • View reference on PubMed
  53. Lorente JA, Landín L, De Pablo R, Renes E, Rodriguez-Diaz R, Liste D (1993) Effects of blood transfusion on oxygen transport variables in severe sepsis. Crit Care Med 21:1312–1318
    • View reference on PubMed
  54. Corwin HL, Gettinger A, Rodriguez RM et al. (1999) Efficacy of recombinant human erythropoietin in the critically ill patient: a randomized double-blind, placebo-controlled trial. Crit Care Med 27:2346–2350
    • View reference on PubMed
  55. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Shapiro MJ, Corwin MJ, Colton T; EPO Critical Care Trials Group (2002) Efficacy of recombinant human erythropoietin in critically ill patients. JAMA 288:2827–2835
    • View reference on publisher's website
    • View reference on PubMed
  56. Fresh-Frozen Plasma, Cryoprecipitate, and Platelets Administration Practice Guidelines Development Task Force of the College of American Pathologists (1994) Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets. JAMA 271:777–781
    • View reference on PubMed
  57. Report of the Working Group (1997) Guidelines for red blood cell and plasma transfusion for adults and children. CMAJ 156 [Suppl]:S1–24
  58. Practice Guidelines for Blood Component Therapy (1996) A report by the American Society of Anaesthesiologists Task Force on Blood Component Therapy. Anesthesiology 84:732–747
    • View reference on PubMed
  59. Warren BL, Eid A, Singer P et al. (2001) High-dose antithrombin III in severe sepsis. A randomized controlled trial. JAMA 286:1869–1878
    • View reference on PubMed
  60. Amato MB, Barbas CS, Medeiros DM, et al. (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354
    • View reference on PubMed
  61. Stewart TE, Meade MO, Cook DJ et al. (1998) Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group. N Engl J Med 338:355–361
    • View reference on PubMed
  62. Brochard L, Roudat-Thoraval F et al. (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trial Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 158:1831–1838
    • View reference on PubMed
  63. Brower RG, Shanholtz CB, Fessler HE et al. (1999) Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med 27:1492–1498
    • View reference on PubMed
  64. Brower RG, Fessler HE (2000) Mechanical ventilation in acute lung injury and acute respiratory distress syndrome. Clin Chest Med 21:491–510
    • View reference on PubMed
  65. Eichacker PQ, Gerstenberger EP, Banks SM, Cui X, Natanson C (2002) Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med 166:1510–1514
  66. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
    • View reference on PubMed
  67. Hickling KG, Walsh J, Henderson S, Jackson R (1994) Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med 22:1568–1578
    • View reference on PubMed
  68. Bidani A, Tzouanakis AE, Cardenas VJ, Zwischenberger JB (1994) Permissive hypercapnia in acute respiratory failure. JAMA 272:957–962
    • View reference on PubMed
  69. Marini JJ, Ravenscraft SA (1992) Mean airway pressure: physiologic determinants and clinical importance–Part I: physiologic determinants and measurements. Crit Care Med 20:1461–1472
    • View reference on PubMed
  70. Gattinoni L, Marcolin R, Caspani ML, Fumagalli R, Mascheroni D, Pesenti A (1985) Constant mean airway pressure with different patterns of positive pressure breathing during the adult respiratory distress syndrome. Bull Eur Physiopathol Respir 21:275–279
    • View reference on PubMed
  71. Pesenti A, Marcolin R, Prato P, Borelli M, Riboni A, Gattinoni L (1985) Mean airway pressure vs. positive end-expiratory pressure during mechanical ventilation. Crit Care Med 13:34–37
    • View reference on PubMed
  72. Stocker R, Neff T, Stein S, Ecknauer E, Trentz O, Russi E (1997) Prone positioning and low-volume pressure-limited ventilation improve survival in patients with severe ARDS. Chest 111:1008–1017
    • View reference on PubMed
  73. Lamm WJ, Graham MM, Albert RK (1994) Mechanism by which prone position improves oxygenation in acute lung injury. Am J Respir Crit Care Med 150:184–193
    • View reference on PubMed
  74. Jolliet P, Bulpa P, Chevrolet JC (1998) Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome. Crit Care Med 26:1977–1985
    • View reference on PubMed
  75. Gattinoni L, Tognoni G, Pesenti A et al. Prone-Supine Study Group (2001) Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345:568–573
    • View reference on PubMed
  76. Chatte G, Sab JM, Dubois JM, Sirodot M, Gaussorgues P, Robert D (1997) Prone position in mechanically ventilated patients with severe acute respiratory failure. Am J Respir Crit Care Med 155:473–478
    • View reference on PubMed
  77. Drakulovic M, Torres A, Bauer T, Nicolas J, Nogue S, Ferrer M (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851–1858
    • View reference on PubMed
  78. Esteban A, Alia I, Tobin MJ et al. (1999) Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 159:512–518
    • View reference on PubMed
  79. Ely EW, Baker AM, Dunagan DP et al. (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335:1864–1869
    • View reference on PubMed
  80. Esteban A, Alia I, Gordo F et al. (1997) Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 156:459–465
    • View reference on PubMed
  81. Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G (1998) The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548
    • View reference on PubMed
  82. Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477
    • View reference on PubMed
  83. Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27:2609–2615
    • View reference on PubMed
  84. Giostra E, Magistris MR, Pizzolato G, Cox J, Chevrolet JC (1994) Neuromuscular disorder in intensive care unit patients treated with pancuronium bromide. Occurrence in a cluster group of seven patients and two sporadic cases, with electrophysiologic and histologic examination. Chest 106:210–220
    • View reference on PubMed
  85. Rossiter A, Souney PF, McGowan S, Carvajal P (1991) Pancuronium-induced prolonged neuromuscular blockade. Crit Care Med 19:1583–1587
    • View reference on PubMed
  86. Partridge BL, Abrams JH, Bazemore C, Rubin R (1990) Prolonged neuromuscular blockade after long-term infusion of vecuronium bromide in the intensive care unit. Crit Care Med 18:1177–1179
    • View reference on PubMed
  87. Vanderheyden BA, Reynolds HN, Gerold KB, Emanuele T (1992) Prolonged paralysis after long-term vecuronium infusion. Crit Care Med 20:304–307
    • View reference on PubMed
  88. Meyer KC, Prielipp RC, Grossman JE, Coursin DB (1994) Prolonged weakness after infusion of atracurium in two intensive care unit patients. Anesth Analg 78:772–774
  89. Manthous CA, Chatila W (1994) Prolonged weakness after withdrawal of atracurium. Am J Resp Crit Care Med 150:1441–1443
    • View reference on PubMed
  90. Prielipp RC, Coursin DB, Scuderi PE et al. (1995) Comparison of the infusion requirements and recovery profiles of vecuronium and cisatracurium 51W89 in intensive care unit patients. Anesth Analg 81:3–12
    • View reference on PubMed
  91. Brandom BW, Yellon FF, Lloyd ME et al. (1997) Recovery from doxacurium infusion administered to produce immobility for more than four days in pediatric patients in the intensive care unit. Anesth Analg 84:307–314
  92. Rudis MI, Sikora CA, Angus E, Peterson E, Popovich J Jr, Hyzy R, Zarowitz BJ (1997) A prospective, randomized, controlled evaluation of peripheral nerve stimulation versus standard clinical dosing of neuromuscular blocking agents in critically ill patients. Crit Care Med 25:575–583
  93. Frankel H, Jeng J, Tilly E, St Andre A, Champion H (1996) The impact of implementation of neuromuscular blockade monitoring standards in a surgical intensive care unit. Am Surg 62:503–506
    • View reference on PubMed
  94. Berghe G van den, Wouters P, Weekers F et al. (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367
    • View reference on PubMed
  95. Finney SJ, Zekveld C, Elia A, Evans TW (2003) Glucose control and mortality in critically ill patients. JAMA 290:2041–2047
    • View reference on publisher's website
    • View reference on PubMed
  96. Berghe G Van den, Wouters PJ, Bouillon R et al. (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31:359–366
    • View reference on PubMed
  97. Klein S, Kinney J, Jeejeebhoy K, Alpers D, Hellerstein M, Murray M, Twomey P (1997) Nutrition support in clinical practice: review of published data and recommendations for future research directions. A summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. Am J Clin Nutr 66:683–706
    • View reference on PubMed
  98. Mehta RL; McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A, Kaplan RM; Collaborative Group for Treatment of ARF in the ICU (2001) A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 60:1154–1163
    • View reference on PubMed
  99. Kellum J, Angus DC, Johnson JP, Leblanc M, Griffin M, Ramakrishnan N, Linde-Zwirble WT (2002) Continuous versus intermittent renal replacement therapy: a meta-analysis. Intensive Care Med 28:29–37
  100. Cooper DJ, Walley KR, Wiggs BR, Russell JA (1990) Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis: a prospective, controlled clinical study. Ann Intern Med 112:492–498
    • View reference on PubMed
  101. Mathieu D, Neviere R, Billard V, Fleyfel M, Wattel F (1991) Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinical study. Crit Care Med 19:1352–1356
    • View reference on PubMed
  102. Cade JF (1982) High risk of the critically ill for venous thromboembolism. Crit Care Med 10:448–450
    • View reference on PubMed
  103. Belch JJ, Lowe GD, Ward AG, Forbes CD, Prentice CR (1981) Prevention of deep vein thrombosis in medical patients by low-dose heparin. Scott Med J 26:115–117
    • View reference on PubMed
  104. Samama MM, Cohen AT, Darmon JY et al. (1999) A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 341:793–800
    • View reference on publisher's website
    • View reference on PubMed
  105. Borrero E, Bank S, Margolis I, Schulman ND, Chardavoyne R (1985) Comparison of antacid and sucralfate in the prevention of gastrointestinal bleeding in patients who are critically ill. Am J Med 79:62–64
  106. Bresalier RS, Grendell JH, Cello JP, Meyer AA (1987) Sucralfate versus titrated antacid for the prevention of acute stress-related gastrointestinal hemorrhage in critically ill patients. Am J Med 83:110–116
  107. Cook D, Guyatt G, Marshall J et al. (1998) A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med 338:791–797
    • View reference on PubMed
  108. Stothert JC, Simonowitz DA, Dellinger EP et al. (1980) Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill. Ann Surg 192:169–174
    • View reference on PubMed
  109. Pollard AJ, Britto J, Nadel S, DeMunter C, Habibi P, Levin M (1999) Emergency management of meningococcal disease. Arch Dis Child 80:290–296
    • View reference on PubMed
  110. Kanter RK, Zimmerman JJ, Strauss RH, Stoeckel KA (1986) Pediatric emergency intravenous access. Evaluation of a protocol. Am J Dis Child 140:132–134
    • View reference on PubMed
  111. Ngo NT, Cao XT, Kneen R et al. (2001) Acute management of dengue shock syndrome: a randomized double-blind comparison of 4 intravenous fluid regimens in the first hour. Clin Infect Dis 32:204–213
    • View reference on publisher's website
    • View reference on PubMed
  112. Carcillo JA, Davis AL, Zaritsky A (1991) Role of early fluid resuscitation in pediatric septic shock. JAMA 266:1242–1245
    • View reference on publisher's website
    • View reference on PubMed
  113. Powell KR, Sugarman LI, Eskenazi AE, Woodin KA, Kays MA, McCormick KL, Miller ME, Sladek CD (1990) Normalization of plasma arginine vasopressin concentrations when children with meningitis are given maintenance plus replacement fluid therapy. J Pediatr 117:515–522
    • View reference on PubMed
  114. Ceneviva G, Paschall JA, Maffei F, Carcillo JA (1998) Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 102:e19
    • View reference on PubMed
  115. Keeley SR, Bohn DJ (1988) The use of inotropic and afterload-reducing agents in neonates. Clin Perinatol 15:467–489
    • View reference on PubMed
  116. Roberts JD Jr, Fineman JR, Morin FC 3rd et al. (1997) Inhaled nitric oxide and persistent pulmonary hypertension of the new born. Inhaled Nitric Oxide Study Group. N Engl J Med 336:605–610
    • View reference on PubMed
  117. Barton P, Garcia J, Kouatli A, Kitchen L, Zorka A, Lindsay C, Lawless S, Giroir B (1996) Hemodynamic effects of i.v. milrinone lactate in pediatric patients with septic shock. A prospective, double-blinded, randomized, placebo-controlled, interventional study. Chest 109:1302–1312
    • View reference on PubMed
  118. Lindsay CA, Barton P, Lawless S, Kitchen L, Zorka A, Garcia J, Kouatli A, Giroir B (1998) Pharmacokinetics and pharmacodynamics of milrinone lactate in pediatric patients with septic shock. J Pediatr 132:329–334
    • View reference on PubMed
  119. Irazuzta JE, Pretzlaff RK, Rowin ME (2001) Amrinone in pediatric refractory septic shock: an open-label pharmacodynamic study. Pediatr Crit Care Med 2:24–28
    • View reference on publisher's website
    • View reference on PubMed
  120. Lauterbach R, Pawlik D, Kowalczyk D, Ksycinski W, Helwich E, Zembala M (1999) Effect of the immunomodulating agent, pentoxifylline, in the treatment of sepsis in prematurely delivered infants: a placebo-controlled, double-blind trial. Crit Care Med 27:807–814
    • View reference on publisher's website
    • View reference on PubMed
  121. Carcillo JA, Fields AI, American College of Critical Care Medicine Task Force Committee Members (2002) Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 30:1365–1378
  122. De Kleijn ED, Joosten KF, Van Rijn B, Westerterp M, De Groot R, Hokken-Koelega AC, Hazelzet JA (2002) Low serum cortisol in combination with high adrenocorticotrophic hormone concentrations are associated with poor outcome in children with severe meningococcal disease. Pediatr Infect Dis J 21:330–336
    • View reference on publisher's website
    • View reference on PubMed
  123. Riordan FA, Thomson AP, Ratcliffe JM, Sills JA, Diver MJ, Hart CA (1999) Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: evidence of adrenal insufficiency? Crit Care Med 27:2257–2261
    • View reference on PubMed
  124. Min M, U T, Aye M, Shwe TN, Swe T (1975) Hydrocortisone in the management of dengue shock syndrome. Southeast Asian J Trop Med Public Health 6:573–579
    • View reference on PubMed
  125. Sumarmo, Talogo W, Asrin A, Isnuhandojo B, Sahudi A (1982) Failure of hydrocortisone to affect outcome in dengue shock syndrome. Pediatrics 69:45–49
    • View reference on PubMed
  126. Hazelzet JA, Kleijn ED de, Groot R de (2001) Endothelial protein C activation in meningococcal sepsis. N Engl J Med 345:1776–1777
    • View reference on publisher's website
  127. Kleijn ED de, Groot R de, Hack CE, Mulder PG, Engl W, Moritz B, Joosten KF, Hazelzet JA (2003) Activation of protein C following infusion of protein C concentrate in children with severe meningococcal sepsis and purpura fulminans: a randomized, double-blinded, placebo-controlled, dose-finding study. Crit Care Med 31:1839–1847
    • View reference on publisher's website
    • View reference on PubMed
  128. Bilgin K, Yaramis A, Haspolat K, Tas MA, Gunbey S, Derman O (2001) A randomized trial of granulocyte-macrophage colony-stimulating factor in neonates with sepsis and neutropenia. Pediatrics 107:36–41
    • View reference on PubMed
  129. La Gamma EF, De Castro MH (2002) What is the rationale for the use of granulocyte and granulocyte-macrophage colony-stimulating factors in the neonatal intensive care unit? Acta Paediatr Suppl 91:109–116
    • View reference on publisher's website
    • View reference on PubMed
  130. Chaïbou M, Tucci M, Dugas MA, Farrell CA, Proulx F, Lacroix J (1998) Clinically significant upper gastrointestinal bleeding acquired in a pediatric intensive care unit: a prospective study. Pediatrics 102:933–938
    • View reference on PubMed
  131. Gauvin F, Dugas M, Chaïbou M, Morneau S, Lebel D, Lacroix J (2001) The impact of clinically significant upper gastrointestinal bleeding in a pediatric intensive care unit. Pediatr Crit Care Med 2:294–298
    • View reference on publisher's website
    • View reference on PubMed
  132. Alejandria MM, Lansang MA, Dans LF, Mantaring JB (2002) Intravenous immunoglobulin for treating sepsis and septic shock. Cochrane Database Syst Rev (1):CD001090
  133. Meyer DM, Jessen ME (1997) Results of extracorporeal membrane oxygenation in children with sepsis. The Extracorporeal Life Support Organization. Ann Thorac Surg 63:756–761
    • View reference on publisher's website
    • View reference on PubMed
  134. Goldman AP, Kerr SJ, Butt W, Marsh MJ, Murdoch IA, Paul T, Firmin RK, Tasker RC, Macrae DJ (1997) Extracorporeal support for intractable cardiorespiratory failure due to meningococcal disease. Lancet 349:466–469
    • View reference on PubMed
  135. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150:896–903
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement