R. Dellinger

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Mark van den Boogaard

Radboud University Nijmegen

Heather Baid

University of Brighton

Samuel Brown

University of Utah

Arnaldo A da Silva

Hospital Israelita Albert Einstein

József Balla

University of Debrecen

Saeed Safari

Shahid Beheshti University of Medical Sciences

Mari Shinohara

Duke University School of Medicine

Gary Wingrove

Mayo Clinic

Luca Ansaloni

University of Pavia

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Brock University

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Papers by R. Dellinger

Severe Sepsis Beyond the Emergency Department and ICU: Targeting Early Identification and Treatment on the Hospital Floor

Annual Update in Intensive Care and Emergency Medicine

The Surviving Sepsis Campaign (SSC) was created in 2002 with the intent to decrease mortality in ... more The Surviving Sepsis Campaign (SSC) was created in 2002 with the intent to decrease mortality in severe sepsis through educating the public/influencing public policy (Phase I), defining best practice though the creation of guidelines (Phase II), and improving patient management with the development of a sepsis performance improvement program (Phase III). Phase I included introduction of the Campaign at several major international critical care medicine conferences, beginning with the European Society of Intensive Care Medicine (ESICM) meeting in Barcelona, Spain, in 2002. Phase II was designed to create evidence-based guidelines for managing severe sepsis and septic shock through an international consensus committee, including representation from scientific organizations with interest and expertise in sepsis. Phase III included a performance improvement program designed to measure severe sepsis management and outcomes with focus on diagnosis and management in the emergency department (ED) and the intensive care unit (ICU).

The Surviving Sepsis Campaign: Where have we been and where are we going?

Cleveland Clinic Journal of Medicine

The Surviving Sepsis Campaign develops and promotes evidence-based guidelines and performance-imp... more The Surviving Sepsis Campaign develops and promotes evidence-based guidelines and performance-improvement practices aimed at reducing deaths from sepsis worldwide. The most recent guidelines, published in 2013, provide detailed management strategies for acute care, fl uid resuscitation, and vasopressor use. In addition, the campaign has developed simple, short protocols for what to do within 3 and 6 hours of recognition of sepsis. These protocols are associated with reduced mortality rates. KEY POINTS Ideally, intravenous antibiotic therapy should start within the fi rst hour after sepsis is recognized; performance improvement protocols set a target of within 3 hours. A specifi c source of infection that requires source control measures should be sought, diagnosed or excluded, and if located, treated as rapidly as possible. Crystalloids should be used for initial fl uid resuscitation. Adding an albumin-based solution is suggested for patients who require substantial amounts of crystalloids. Vasopressors are indicated for those who remain hypotensive despite fl uid resuscitation. Norepinephrine should be used initially, and if the target mean arterial pressure cannot be achieved, then epinephrine or low-dose vasopressin is added. Corticosteroids should be considered only for patients who remain unstable despite adequate fl uid resuscitation and vasopressor therapy.

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Internal medicine based critical care training: straight internal medicine versus pulmonary

Critical care medicine, 2000

Severe sepsis trials: why have they failed?

Minerva anestesiologica, 1999

Impact of Sepsis Bundle Strategy on Outcomes of Patients Suffering from Severe Sepsis and Septic Shock in China

The Journal of Emergency Medicine, 2013

It is well known that poor sepsis outcomes are related to delays in diagnosis and treatment. The ... more It is well known that poor sepsis outcomes are related to delays in diagnosis and treatment. The aim of this study was to compare the mortality rate between two groups of patients, one group presenting before and one group presenting after implementation of the Surviving Sepsis Campaign (SSC) sepsis performance improvement bundles in the Emergency Department (ED). This was a prospective study. The studied population included severe sepsis and septic shock patients entered in the SSC database who were admitted to the ED between June 2008 and December 2009. Patients were divided into two groups based on when they presented to the ED. Key treatment interventions, admission to the intensive care unit, and in-hospital mortality were compared. In addition, a survey was completed by the treating physicians to identify reasons for failures to comply with indicators. One hundred ninety-five (195) patients with severe sepsis and septic shock were enrolled in the study. Mortality was significantly higher at 44.8% in the baseline group (Group 1) compared to 31.6% in the group studied after the SSC protocol was instituted (Group 2) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Compliance with all elements of the sepsis resuscitation bundle was 1% in Group 1 and 9% in Group 2 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Compliance with all elements of the management bundle was 1% in Group 1 and 12.8% in Group 2. The most frequently reported reasons by physicians for failure to comply with the bundles were: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;did not think it was needed&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;unsure of reason.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; The results revealed a significant drop in mortality after implementing the SSC protocol and sepsis performance improvement bundles in the ED. The barriers to implementing sepsis guidelines are knowledge, attitude, and behavioral barriers.

Anti-tumor necrosis factor therapy for sepsis: Still a player?

Critical Care Medicine, 2001

Endotracheal intubation and mechanical ventilation in severe asthma

Critical Care Medicine, 1993

To determine the occurrence rate of complications and mortality in patients with severe asthma re... more To determine the occurrence rate of complications and mortality in patients with severe asthma requiring endotracheal intubation and mechanical ventilation. Retrospective review of medical records from September 1982 to July 1988. Urban, teaching hospital serving primarily indigent patients. Fifty-seven adult patients with asthma requiring tracheal intubation and mechanical ventilation. None. Fifty-seven patients requiring tracheal intubation and mechanical ventilation during 69 hospital admissions were identified. Medication noncompliance and upper respiratory tract infections were recorded as the most frequent precipitating events for exacerbation of asthma. Forty-nine intubations were initiated because of a clinical diagnosis of respiratory distress, but multiple indications were present in 42 admissions. One or more complications occurred in 31 episodes of endotracheal intubation and mechanical ventilation (45%). Death occurred in four (6%) of 69 admissions. Three of the four deaths occurred in patients who had a cardiorespiratory arrest before hospital admission. While complications occurred in 45% of patients with severe asthma requiring intubation and mechanical ventilation, the mortality rate was low. We conclude that intubation and mechanical ventilation in patients with life-threatening asthma are safe and beneficial interventions.

Reduction In Cytokines/Chemokines In Severe Sepsis: Results From A Phase Li Randomized Placebo-Controlled Double Blind Trial Of Talactoferrin Alfa In Severe …

American Journal of …, 2011

Page 1. / Mini Symposium / Wednesday, May 18/8:15 AM-10:45 AM / Korbel D17 TREATMENTS FOR SEPSIS:... more

Inability to remove an aspirated straight pin by flexible fiberoptic bronchoscopy

Southern Medical Journal, 1984

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for So... more

Fundamental Critical Care Support: Another merit badge or more?

Critical care medicine, 1996

... Fundamental Critical Care Support: Another merit badge or more? Dellinger, R. Phillip MSc MD,... more

Pelvic hematoma after intercourse while on chronic anticoagulation

Annals of Emergency Medicine, 1984

A 41-year-old anticoagulated woman presented with increasing pelvic pain that had begun two days ... more A 41-year-old anticoagulated woman presented with increasing pelvic pain that had begun two days prior during intercourse. An ultrasound and computerized tomographic (CT) scan confirmed the diagnosis of pelvic hematoma. The hematoma resolved spontaneously with normalization of clotting studies. The emergency physician should consider this rare cause of pelvic pain in selected anticoagulated patients. The need for a thorough history in emergency patients is emphasized, as well as the value of ultrasound and CT scan in the diagnosis of this disorder.

Progressive Impairment in Microvascular Circulation in A Porcine Model of Sepsis Assessed By Orthogonal Polarization Spectral Imaging: 503

Phase I trial of the recombinant soluble complement receptor 1 in acute lung injury and acute respiratory distress syndrome

Critical care …, 2000

To determine the safety, pharmacokinetics, biological effects, and immunogenicity of recombinant ... more To determine the safety, pharmacokinetics, biological effects, and immunogenicity of recombinant soluble complement receptor 1 (TP10) in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Open label, ascending dosage, phase I trial. Two academic teaching hospitals. A total of 24 patients diagnosed with ALI/ARDS. A single, 30-min intravenous infusion of 0.1, 0.3, 1, 3, or 10 mg/kg TP10. Serum levels of TP10 increased in proportion to the dose. Mean variable estimates (+/-SD) were half-life of disposition 69.7 +/- 39.7 hrs, plasma clearance 2.39 +/- 1.32 mL/hr/kg, and volume of distribution 190.6 +/- 135.0 mL/kg. Inhibition of complement activity, measured by CH50, was significant for the interaction of dose and time (p = .024). The C3a levels demonstrated a trend for dose which did not reach statistical significance (p = .090) and soluble C5b-9 levels were significant only for dose (p = .023). As expected by the proposed physiologic mechanism, C4a levels were not affected by TP10, dose, or time. The overall mortality rate was 33%. Neither the type nor the frequency rate of specific adverse events were substantially different between dose groups. Seven adverse events in four patients were thought to be possibly related to TP10. TP10 has a half-life of approximately 70 hrs and at doses &gt; or =1 mg/kg, significantly inhibits complement activity at the levels of C3 and C5 in patients with ALI/ARDS. Complement inhibition was more prolonged over time with TP10 doses of 3 and 10 mg/kg. TP10 appears to be safe at the doses tested. Further studies will be required to completely assess the impact of TP10 on pathophysiology and clinical outcome in patients with ALI/ARDS.

Excessive dynamic airway collapse for the internist: new nomenclature or different entity?

Postgraduate Medical Journal, 2011

Excessive dynamic airway collapse (EDAC) refers to abnormal and exaggerated bulging of the poster... more Excessive dynamic airway collapse (EDAC) refers to abnormal and exaggerated bulging of the posterior wall within the airway lumen during exhalation. This condition is pathological if the reduced airway lumen is <50% of the normal. It is a relatively new disease entity that is recognised more easily now with the increased use of multi-detector row CT. EDAC is often asymptomatic

Improved Organ Function at 24 Hours is Associated with Increased Microcirculatory flow during the Early Resuscitation of Patients with Sepsis

Academic Emergency Medicine, 2007

History of Technology in the Intensive Care Unit

by R. Dellinger and Vinod Puri

Critical Care Clinics, 2009

THE HISTORY OF INVASIVE MONITORING Early Invasive Monitoring Invasive monitoring in the intensive... more THE HISTORY OF INVASIVE MONITORING Early Invasive Monitoring Invasive monitoring in the intensive care unit owes a great deal to many forwardthinking pioneers in this field. In 1929, the German resident Forssmann, in an attempt to deliver drugs more effectively for cardiac resuscitation, inserted a nonflow directed (no balloon) catheter into his own arm and advanced it to what was calculated to be his right heart (Fig. 1). He walked to the radiology department to verify its placement by radiography. 1 Forssmann's successful experiment was considered a stunt by the German medical community and he was forced to change his career to urology. Ultimately, he was recognized for his contribution to the development of cardiac catheterization with a Nobel Prize in science in 1956. 1 The next two decades saw the creation of cardiac catheterization laboratories to investigate and treat congenital, rheumatic, and eventually ischemic heart disease. In the 1960s, the only physiologic tool available for bedside evaluation was the central venous pressure (CVP) measurement as first described by Wilson. 2 The limitations of CVP monitoring were becoming evident over the first decade of its use in clinical practice. 3 During this same time Myocardial Infarction Research Units (MIRU) and Shock Research Units (SRU) demonstrated the value of hemodynamic measurements in acutely ill patients with both cardiogenic and other forms of shock. 4,5 Del Guercio and colleagues 6 applied similar techniques for surgical patients. However, for measurement of cardiac output, investigators had to rely on indocyanine green dye dilution techniques. Indocyanine green dye had to be injected into the right atrium

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1074

by R. Dellinger and Marc Torjman

Critical Care Medicine, 2013

1073

by R. Dellinger and Christa Schorr

Critical Care Medicine, 2013

642

by R. Dellinger and Christa Schorr

Critical Care Medicine, 2013

Effect of the inspiratory flow pattern on inspiration/expiration transition of lung vibrations in mechanically ventilated patients

Critical Care, 2008

all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed... more all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%

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Severe Sepsis Beyond the Emergency Department and ICU: Targeting Early Identification and Treatment on the Hospital Floor

Annual Update in Intensive Care and Emergency Medicine

The Surviving Sepsis Campaign: Where have we been and where are we going?

Cleveland Clinic Journal of Medicine

Download

Internal medicine based critical care training: straight internal medicine versus pulmonary

Critical care medicine, 2000

Severe sepsis trials: why have they failed?

Minerva anestesiologica, 1999

Impact of Sepsis Bundle Strategy on Outcomes of Patients Suffering from Severe Sepsis and Septic Shock in China

The Journal of Emergency Medicine, 2013

Anti-tumor necrosis factor therapy for sepsis: Still a player?

Critical Care Medicine, 2001

Endotracheal intubation and mechanical ventilation in severe asthma

Critical Care Medicine, 1993

Reduction In Cytokines/Chemokines In Severe Sepsis: Results From A Phase Li Randomized Placebo-Controlled Double Blind Trial Of Talactoferrin Alfa In Severe …

American Journal of …, 2011

Page 1. / Mini Symposium / Wednesday, May 18/8:15 AM-10:45 AM / Korbel D17 TREATMENTS FOR SEPSIS:... more

Inability to remove an aspirated straight pin by flexible fiberoptic bronchoscopy

Southern Medical Journal, 1984

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for So... more

Fundamental Critical Care Support: Another merit badge or more?

Critical care medicine, 1996

... Fundamental Critical Care Support: Another merit badge or more? Dellinger, R. Phillip MSc MD,... more

Pelvic hematoma after intercourse while on chronic anticoagulation

Annals of Emergency Medicine, 1984

Progressive Impairment in Microvascular Circulation in A Porcine Model of Sepsis Assessed By Orthogonal Polarization Spectral Imaging: 503

Phase I trial of the recombinant soluble complement receptor 1 in acute lung injury and acute respiratory distress syndrome

Critical care …, 2000

Excessive dynamic airway collapse for the internist: new nomenclature or different entity?

Postgraduate Medical Journal, 2011

Improved Organ Function at 24 Hours is Associated with Increased Microcirculatory flow during the Early Resuscitation of Patients with Sepsis

Academic Emergency Medicine, 2007

History of Technology in the Intensive Care Unit

by R. Dellinger and Vinod Puri

Critical Care Clinics, 2009

Download

1074

by R. Dellinger and Marc Torjman

Critical Care Medicine, 2013

1073

by R. Dellinger and Christa Schorr

Critical Care Medicine, 2013

642

by R. Dellinger and Christa Schorr

Critical Care Medicine, 2013

Effect of the inspiratory flow pattern on inspiration/expiration transition of lung vibrations in mechanically ventilated patients

Critical Care, 2008

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