View clinical trials related to Sepsis.
Filter by:The goal of the NANO trial is to study the longstanding clinical practice of empirically administering intravenous antibiotics to extremely low birthweight (ELBW) infants in the first days of life. In this 802-subject multicenter placebo-controlled randomized clinical trial, the hypothesis to be tested is that the incidence of adverse outcomes is higher in babies receiving empiric antibiotics (EA) in the first week of life compared to babies receiving placebo. The study targets a population of ELBW infants in whom the clinical decision to use or not use EA is currently most challenging -- infants that are clinically stable that did not have a known exposure to intraamniotic infection and were not born preterm for maternal indications. The primary outcome is the composite outcome of late-onset sepsis (LOS), necrotizing enterocolitis (NEC), or death during the index hospitalization. Secondary safety outcomes will include total antibiotic days, days to full enteral feedings, and common morbidities in preterm infants that have previously been linked to EA, e.g. retinopathy of prematurity and bronchopulmonary dysplasia. Weight and length z-score, and head circumference, are standard measures to be collected weekly by clinical team per a standardized protocol.
Sepsis is a serious medical condition associated with a high incidence and mortality rate. It is the leading cause of death in ICU worldwide. Nowadays sepsis was redefined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Despite the progress made in the pathogenesis of sepsis and advances achieved in medical interventions, the management of sepsis remains a challenge for clinicians. The core problem that precludes the promotion in the management of sepsis is the lack of early and precise prediction. The metabolic profiles will be significantly changed when body suffers from sepsis even though the organ function remains normal, thus making it possible to predict sepsis in the early stage through the detection of the metabolites.
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. It is the most expensive healthcare condition to treat in United States and has a mortality rate of nearly 30%. It is widely known that exaggerated inflammation and imbalance between sympathetic and parasympathetic arms of the autonomic nervous system (ANS) contribute to progression and adverse outcomes in sepsis. The role of unchecked inflammation and unregulated ANS as a potential treatment target is an important gap in our knowledge that should be explored. Cholinergic anti-inflammatory pathway (CAP) is an intricate network where the ANS senses inflammation by vagus nerve afferents and tries to regulate it by vagus nerve efferents to the reticuloendothelial system. The central hypothesis of this pilot clinical trial is that transcutaneous vagus nerve stimulation (TVNS) at tragus of the external ear can activate the CAP to suppress inflammation and improve autonomic imbalance as measured by inflammatory cytokine levels and heart rate variability (HRV) analysis. The investigators plan to randomize patients with septic shock into active and sham stimulation groups and study the effects of vagal stimulation on inflammatory cytokines, HRV and a clinical severity score of sepsis. Both groups will continue to receive the standard of care treatment for sepsis irrespective of group assignments. The investigators hypothesize that 4 hours of TVNS will suppress inflammatory markers and improve the balance between sympathetic and parasympathetic arms of ANS as measured by HRV, resulting in improved Sequential Organ Failure Assessment Score (SOFA). The preliminary data generated from this pilot study will lay the foundation for a larger clinical trial.
The pharmacokinetics of antimicrobials is profoundly modified in Intensive care unit (ICU) patients. To adapt the treatment, it is recommended to measure blood levels of antibiotics. Some antibiotics, such as amikacin, are easy to monitor, while for other molecules, such as piperacillin/tazobactam, the drug monitoring is more difficult to obtain. These two molecules have similar physicochemical characteristics (hydrophilicity) and therefore have closed pharmacokinetic properties. OPTIMA is a study aiming at criteria will be used to judge whether the pharmacokinetic (PK) parameters of amikacin are predictive of those of piperacillin and tazobactam.
Alterations of acid-base equilibrium are very common in critically ill patients and understanding their pathophysiology can be important to improve clinical treatment.
The sepsis syndrome has recently been more stringently defined as "a life-threatening organ dysfunction caused by a dysregulated host response to infection". Clinical and paraclinical tools are investigated for their ability to adequately recognize sepsis early.
Septic shock is a major cause of morbidity and mortality. SIRS (systemic inflammatory response syndrome) can progress over hours to days to severe sepsis and septic shock. Currently, lactate levels are used to guide resuscitative efforts and have been shown to be a predictor of mortality independent of vital sign abnormalities (1). However, their use seems to be limited to trending in a given patient, and not for prognostic value of a single level (2). This is because there is significant overlap in lactate levels of individuals who progress to death and multisystem organ failure as compared to those who do not (2). Blood cultures are also extensively used to detect blood stream infection (BSI), but these are time consuming and are not immediately useful to clinicians caring for sick patients. A biomarker that adequately distinguishes between patients at high risk for progression to severe sepsis/shock/death and those who will not would be helpful in the appropriate initiation of aggressive treatment and appropriate disposition of patients in clinical care. Previously, the investigators demonstrated that sPLA2-IIA detected by ELISA assay had a sensitivity of 87% and a specificity of 91% in detecting sepsis (3). Zeus Pharmaceuticals has developed a bedside point-of-care test measuring sPLA2-IIA in real time. The investigators propose to study this assay in terms of its discriminatory value in distinguishing between SIRS from non-infectious causes, sepsis, severe sepsis, and septic shock in a cohort of patients presenting to the emergency department at Anderson and Bethlehem campuses. The investigators propose to better define the threshold level for this marker assay as well as seek to establish its utility in a clinical population. The investigators will take samples of blood from emergency department patients presenting who meet SIRS criteria or have a positive q-SOFA screen. The investigators will take subsequent samples of blood when lactate levels are redrawn as per St. Luke's sepsis protocol. After informed consent is obtained, blood specimens will be run in analyzer provided by Zeus for sPLA2-IIA. The investigators will record presence and quantity of sPLA2-IIA, as well as other markers of sepsis such as lactate, vital signs, blood cultures, and patient oriented outcomes (ie ICU days, organ dysfunction, and survival to discharge). Printouts from analyzer will be stored in locked cabinet, and remaining blood will be discarded. The data will then be compiled by the investigators at St. Luke's University Hospital. The results will be correlated with the patients' clinical progression to determine the biomarker's utility and cut-off values for predicting progression of SIRS. As clear threshold levels for this marker have yet to be defined, the investigators would like to enroll patients meeting criteria until the investigators have enrolled 50 patients with septic shock. It is anticipated that, proportionally, this will lead to enrollment of 75-100 patients with severe sepsis, 100-150 patients with sepsis, and 100-150 patients meeting SIRS criteria who are not septic. This will help delineate if there is any value in this assay for distinguishing among the severity of sepsis pathophysiology.
There is currently no uniform target for serum albumin levels in some pathological conditions, but recent studies have shown that serum albumin concentrations, disease severity, and mortality rates have been linked. Although the exact mechanism is unclear, serum albumin levels may have a protective effect on the potential antioxidant effect of maintaining physiological homeostasis and its anti-inflammatory effects. The indication and efficacy of parenteral albumin therapy in the care of patients in critical condition has long been a hot topic. Although previous mortality endpoint studies were negative, it is not certain that they can be used clearly in intensive care. According to earlier research, albumin is a very important circulating antioxidant. It is believed that early suplementattion of albumin may have a beneficial effect on oxidative stress and inflammation in septic patients. The aim of our study is to investigate changes in parameters (inflammation, oxidative stress) that can be directly influenced by the administration of albumin in septic cases in need of intensive care. Also in our earlier, relatively small number of studies, chemiluminescence analysis of non-enzymatic total antioxidant capacity showed an increase in total antioxidant capacity in septic patients. The proposed study may also clarify the background of pathophysiological changes behind this phenomenon.
The extent and duration of tissue hypoxia is a major determinant of outcome following major, high-risk surgery and in critical illness. Prompt restoration of tissue oxygenation through resuscitation in all likelihood improves outcomes. There are currently no bedside monitors in clinical practice that track tissue perfusion per se, instead clinicians rely on crude surrogates such as heart rate and blood pressure, urine output, serum lactate of global flow (cardiac output) monitoring. This is a first-in-man trial of a new device to measure tissue oxygenation in real time in a major, high-risk surgical and critical care cohort. The device consists of an oxygen sensing probe incorporated into a modified urinary catheter, which relies on photoluminescence technology and the quenching properties of oxygen. Once inserted, the drained bladder collapses round and envelopes the probe which continuously measures tissue oxygenation of the bladder urothelium. The investigators hope to (i) Establish that tissue oxygenation can be safely monitored using this technology, deployed in this way. (ii) Define a normal range for bladder tissue oxygenation in man as measured using this device. (iii) Compare tissue oxygenation against other markers of perfusion status in current clinical practice and assess its performance at detecting inadequate perfusion against these other modalities. (iv) assess the diagnostic and prognostic capabilities of the tissue oxygenation monitoring at detecting hypo-perfusion and predicting outcome. (v) Further assess the tissue response to an 'oxygen challenge' in identifying occult hypo-perfusion. (vi). Provide pilot work required to inform future, interventional studies where similar patients would be resuscitated to tissue oxygenation targets alongside routine clinical practice.
Antibiotic therapy for early onset neonatal sepsis recommended by international guidelines and relevant studies is only kind of treatment regimen that penicillin G/ penicillin/ampicillin combined with gentamicin as the first-line treatment regimen. However, it is not applicable to the clinical practice in many countries and regions. We aim to study efficacy and safety of antibiotics in the treatment of early onset neonatal sepsis.