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10.1007/s00134-016-4574-2 http://scihub22266oqcxt.onion/10.1007/s00134-016-4574-2 C5106490!5106490!27709263     free     free     free Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       Intensive+Care+Med 2016 ; 42 (12): 1948-57 Nephropedia Template TP {{tp|p=27709263|t=2016. Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition |pdf=|usr=}}{{27709263}} gab.com Text Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition JO: Intensive Care Med http://www.kidney.de/pget.php?&tw=1&pmid=27709263 #FOAvip Purpose: Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts? definition of paediatric RSS. Methods: We conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality). Results: From the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89?0.94), and 0.956 (95 % CI 0.93?0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality. Conclusions: This ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock. Electronic supplementary material: The online version of this article (doi:10.1007/s00134-016-4574-2) contains supplementary material, which is available to authorized users. Twit Text FOAVip Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition ????Intensive Care Med http://www.kidney.de/pget.php?&tw=1&pmid=27709263 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=27709263 #FOAvip English Wikipedia <ref>{{Cite pmid|27709263}}</ref> Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition #MMPMID27709263 Morin L; Ray S; Wilson C; Remy S; Benissa MR; Jansen NJG; Javouhey E; Peters MJ; Kneyber M; De Luca D; Nadel S; Schlapbach LJ; Maclaren G; Tissieres P Intensive Care Med 2016[]; 42 (12): 1948-57 PMID27709263show ga Purpose: Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts? definition of paediatric RSS. Methods: We conducted a two-round Delphi study followed by an observational multicentre retrospective study. One hundred and fourteen paediatric intensivists answered a clinical case-based, two-round Delphi survey, identifying clinical items consistent with RSS. Multivariate analysis of these items in a development single-centre cohort (70 patients, 30 % mortality) facilitated development of RSS definitions based on either a bedside or computed severity score. Both scores were subsequently tested in a validation cohort (six centres, 424 patients, 11.6 % mortality). Results: From the Delphi process, the draft definition included evidence of myocardial dysfunction and high blood lactate levels despite high vasopressor treatment. When assessed in the development population, each item was independently associated with the need for extracorporeal life support (ECLS) or death. Resultant bedside and computed septic shock scores had high discriminative power against the need for ECLS or death, with areas under the receiver operating characteristics curve of 0.920 (95 % CI 0.89?0.94), and 0.956 (95 % CI 0.93?0.97), respectively. RSS defined by a bedside score equal to or higher than 2 and a computed score equal to or higher than 3.5 was associated with a significant increase in mortality. Conclusions: This ESPNIC definition of RSS accurately identifies children with the most severe form of septic shock. Electronic supplementary material: The online version of this article (doi:10.1007/s00134-016-4574-2) contains supplementary material, which is available to authorized users. äRefractory septic shock in children: a European Society of Paediatric (epmc).pdf DeepDyve Pubget Overpricing