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Enhancing Recovery From Sepsis: A Review.

Abstract Survival from sepsis has improved in recent years, resulting in an increasing number of patients who have survived sepsis treatment. Current sepsis guidelines do not provide guidance on posthospital care or recovery.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title jama
Publication Year Start




PMID- 29297082
OWN - NLM
STAT- MEDLINE
DCOM- 20180110
LR  - 20180110
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 319
IP  - 1
DP  - 2018 Jan 2
TI  - Enhancing Recovery From Sepsis: A Review.
PG  - 62-75
LID - 10.1001/jama.2017.17687 [doi]
AB  - Importance: Survival from sepsis has improved in recent years, resulting in an
      increasing number of patients who have survived sepsis treatment. Current sepsis 
      guidelines do not provide guidance on posthospital care or recovery.
      Observations: Each year, more than 19 million individuals develop sepsis, defined
      as a life-threatening acute organ dysfunction secondary to infection.
      Approximately 14 million survive to hospital discharge and their prognosis
      varies. Half of patients recover, one-third die during the following year, and
      one-sixth have severe persistent impairments. Impairments include development of 
      an average of 1 to 2 new functional limitations (eg, inability to bathe or dress 
      independently), a 3-fold increase in prevalence of moderate to severe cognitive
      impairment (from 6.1% before hospitalization to 16.7% after hospitalization), and
      a high prevalence of mental health problems, including anxiety (32% of patients
      who survive), depression (29%), or posttraumatic stress disorder (44%). About 40%
      of patients are rehospitalized within 90 days of discharge, often for conditions 
      that are potentially treatable in the outpatient setting, such as infection
      (11.9%) and exacerbation of heart failure (5.5%). Compared with patients
      hospitalized for other diagnoses, those who survive sepsis (11.9%) are at
      increased risk of recurrent infection than matched patients (8.0%) matched
      patients (P < .001), acute renal failure (3.3% vs 1.2%, P < .001), and new
      cardiovascular events (adjusted hazard ratio [HR] range, 1.1-1.4). Reasons for
      deterioration of health after sepsis are multifactorial and include accelerated
      progression of preexisting chronic conditions, residual organ damage, and
      impaired immune function. Characteristics associated with complications after
      hospital discharge for sepsis treatment are not fully understood but include both
      poorer presepsis health status, characteristics of the acute septic episode (eg, 
      severity of infection, host response to infection), and quality of hospital
      treatment (eg, timeliness of initial sepsis care, avoidance of treatment-related 
      harms). Although there is a paucity of clinical trial evidence to support
      specific postdischarge rehabilitation treatment, experts recommend referral to
      physical therapy to improve exercise capacity, strength, and independent
      completion of activities of daily living. This recommendation is supported by an 
      observational study involving 30000 sepsis survivors that found that referral to 
      rehabilitation within 90 days was associated with lower risk of 10-year mortality
      compared with propensity-matched controls (adjusted HR, 0.94; 95% CI, 0.92-0.97, 
      P < .001). Conclusions and Relevance: In the months after hospital discharge for 
      sepsis, management should focus on (1) identifying new physical, mental, and
      cognitive problems and referring for appropriate treatment, (2) reviewing and
      adjusting long-term medications, and (3) evaluating for treatable conditions that
      commonly result in hospitalization, such as infection, heart failure, renal
      failure, and aspiration. For patients with poor or declining health prior to
      sepsis who experience further deterioration after sepsis, it may be appropriate
      to focus on palliation of symptoms.
FAU - Prescott, Hallie C
AU  - Prescott HC
AD  - Department of Internal Medicine and Institute for Healthcare Policy & Innovation,
      University of Michigan, Ann Arbor.
AD  - VA Center for Clinical Management Research, Health Services Research and
      Development Center of Innovation, Ann Arbor, Michigan.
FAU - Angus, Derek C
AU  - Angus DC
AD  - The Clinical Research, Investigation, and Systems Modeling of Acute Illness
      (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh
      School of Medicine, Pittsburgh, Pennsylvania.
AD  - Associate Editor.
LA  - eng
GR  - K08 GM115859/GM/NIGMS NIH HHS/United States
GR  - R01 GM097471/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Review
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - AIM
SB  - IM
MH  - Activities of Daily Living
MH  - Adult
MH  - Cognition Disorders/etiology
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Mental Disorders/etiology
MH  - Sepsis/*complications/physiopathology/*rehabilitation
EDAT- 2018/01/04 06:00
MHDA- 2018/01/11 06:00
CRDT- 2018/01/04 06:00
PHST- 2018/01/04 06:00 [entrez]
PHST- 2018/01/04 06:00 [pubmed]
PHST- 2018/01/11 06:00 [medline]
AID - 2667727 [pii]
AID - 10.1001/jama.2017.17687 [doi]
PST - ppublish
SO  - JAMA. 2018 Jan 2;319(1):62-75. doi: 10.1001/jama.2017.17687.