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      Sepsis and Critical Illness Research Center investigators: protocols and standard operating procedures for a prospective cohort study of sepsis in critically ill surgical patients

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          Abstract

          Introduction

          Sepsis is a common, costly and morbid cause of critical illness in trauma and surgical patients. Ongoing advances in sepsis resuscitation and critical care support strategies have led to improved in-hospital mortality. However, these patients now survive to enter state of chronic critical illness (CCI), persistent low-grade organ dysfunction and poor long-term outcomes driven by the persistent inflammation, immunosuppression and catabolism syndrome (PICS). The Sepsis and Critical Illness Research Center (SCIRC) was created to provide a platform by which the prevalence and pathogenesis of CCI and PICS may be understood at a mechanistic level across multiple medical disciplines, leading to the development of novel management strategies and targeted therapies.

          Methods

          Here, we describe the design, study cohort and standard operating procedures used in the prospective study of human sepsis at a level 1 trauma centre and tertiary care hospital providing care for over 2600 critically ill patients annually. These procedures include implementation of an automated sepsis surveillance initiative, augmentation of clinical decisions with a computerised sepsis protocol, strategies for direct exportation of quality-filtered data from the electronic medical record to a research database and robust long-term follow-up.

          Ethics and dissemination

          This study has been registered at ClinicalTrials.gov, approved by the University of Florida Institutional Review Board and is actively enrolling subjects. Dissemination of results is forthcoming.

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          Most cited references26

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          Systemic inflammatory response syndrome criteria in defining severe sepsis.

          The consensus definition of severe sepsis requires suspected or proven infection, organ failure, and signs that meet two or more criteria for the systemic inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and construct validity of this approach.
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            Sepsis Pathophysiology, Chronic Critical Illness, and Persistent Inflammation-Immunosuppression and Catabolism Syndrome.

            To provide an appraisal of the evolving paradigms in the pathophysiology of sepsis and propose the evolution of a new phenotype of critically ill patients, its potential underlying mechanism, and its implications for the future of sepsis management and research.
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              The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study.

              The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. A total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. Fifty-seven (17%) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5% of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75% sensitive and 83% specific for patients who required transfer to ITU or HDU. The MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                1 August 2017
                : 7
                : 7
                : e015136
                Affiliations
                [1 ] departmentDepartment of Surgery , Sepsis and Critical Illness Research Center in Gainesville, University of Florida Health , Gainesville, Florida, USA
                [2 ] departmentDepartment of Surgery , University of Florida Health , Gainesville, Florida, USA
                [3 ] departmentDepartment of Anesthesiology , University of Florida Health , Gainesville, Florida, USA
                [4 ] departmentDepartment of Biostatistics , University of Florida Health , Gainesville, Florida, USA
                [5 ] departmentDepartment of Medicine , University of Florida Health , Gainesville, Florida, USA
                [6 ] Institute on Aging, University of Florida Health , Gainesville, Florida, USA
                Author notes
                [Correspondence to ] Dr Scott C Brakenridge; Scott.Brakenridge@ 123456surgery.ufl.edu
                Article
                bmjopen-2016-015136
                10.1136/bmjopen-2016-015136
                5642775
                28765125
                0b19defd-a4ec-4497-86cb-3d277332b512
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 10 November 2016
                : 12 May 2017
                : 30 June 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000057, National Institute of General Medical Sciences;
                Categories
                Intensive Care
                Protocol
                1506
                1707
                1692
                1694
                1702
                1730
                1737
                Custom metadata
                unlocked

                Medicine
                immunology,health informatics,adult intensive & critical care,adult surgery,protocols & guidelines

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