The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).

Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study

Cardiogenic shock (CS) is associated with hemodynamic compromise and end-organ hypoperfusion due to a primary cardiac etiology. In addition to vasoactive medications, percutaneous mechanical circulatory support (MCS) devices offer the ability to support the hemodynamics and prevent acute organ failure. Despite the wide array of available MCS devices for CS, there are limited data on the complications from these devices. In this review, we seek to summarize the complications of MCS devices in the contemporary era. Using a systems-based approach, this review covers domains of hematological, neurological, vascular, infectious, mechanical, and miscellaneous complications. These data are intended to provide a balanced narrative and aid in risk–benefit decision-making in this acutely ill population.

/pdf/complications-of-temporary-percutaneous-mechanical-5e7we3tmaa.pdf

Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature.

Septic Cardiomyopathy: From Basics to Management Choices

Cardiogenic shock accounts for ~100,000 annual hospital admissions in the United States. Despite improvements in medical management strategies, in-hospital mortality remains unacceptably high. Multiple mechanical circulatory support devices have been developed with the aim to provide hemodynamic support and to improve outcomes in this population. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the most advanced temporary life support system that is unique in that it provides immediate and complete hemodynamic support as well as concomitant gas exchange. In this review, we discuss the fundamental concepts and hemodynamic aspects of VA-ECMO support in patients with cardiogenic shock of various etiologies. In addition, we review the common indications, contraindications and complications associated with VA-ECMO use.

/pdf/overview-of-veno-arterial-extracorporeal-membrane-2do4s7n5io.pdf

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock.

Introduction:The role of extracorporeal support for patients with septic shock remains unclear.Methods:We conducted a retrospective analysis of our single-centre experience with veno-arterio-venous...

Veno-arterio-venous ECMO for septic cardiomyopathy: a single-centre experience.

Extracorporeal carbon dioxide removal (ECCO2R) is an efficient technique used in the management of hypercapnic respiratory failure. Its application in mechanically ventilated patients has been studied for over 30 years. We describe a case of severe, acute exacerbation of chronic obstructive pulmonary disease (AECOPD) unresponsive to non-invasive ventilation (NIV), where initiation of ECCO2R was used effectively to prevent endotracheal intubation.

https://journals.sagepub.com/doi/pdf/10.1177/175114371401500416

Extracorporeal Carbon Dioxide Removal as an Alternative to Endotracheal Intubation for Non-Invasive Ventilation Failure in Acute Exacerbation of COPD:

In 2010, following the H1N1 swine flu pandemic, 1 five severe respiratory centers were commissioned in England. These were established to provide veno-venous ECMO (extracorporeal membrane oxygenation) for patients with refractory respiratory failure. Moreover, it was a condition set out by the commissioning body that each center would carry out a minimum of 20 cases per year to remain certified. The reality of the situation has proved somewhat different. At Guy's and St Thomas’ NHS foundation Trust (GSTT), the annual number of cases has steadily increased. In 2015, the Trust carried out almost 100 veno-venous ECMO cases. 2 These recent developments in available therapies for patients with refractory respiratory failure or cardiac failure meant that intensive care staff have been exposed to equipment with which they have been hitherto unfamiliar. Clinical perfusion scientists, previously “shackled” to the heart lung machine, have found themselves thrust into clinical, supportive, and educational roles, tea...

The role of the perfusionist outside the OR

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Veno-arterio-venous ECMO for septic cardiomyopathy: a single-centre experience.

Extracorporeal Carbon Dioxide Removal as an Alternative to Endotracheal Intubation for Non-Invasive Ventilation Failure in Acute Exacerbation of COPD:

The role of the perfusionist outside the OR