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Id Subject Object Predicate Lexical cue
T1 0-25 Sentence denotes Sepsis Care Pathway 2019.
T1 0-25 Sentence denotes Sepsis Care Pathway 2019.
T2 26-37 Sentence denotes Background:
T2 26-37 Sentence denotes Background:
T3 38-185 Sentence denotes Sepsis, a medical emergency and life-threatening disorder, results from abnormal host response to infection that leads to acute organ dysfunction1.
T3 38-185 Sentence denotes Sepsis, a medical emergency and life-threatening disorder, results from abnormal host response to infection that leads to acute organ dysfunction1.
T4 186-332 Sentence denotes Sepsis is a major killer across all ages and countries and remains the most common cause of admission and death in the Intensive Care Unit (ICU)2.
T4 186-332 Sentence denotes Sepsis is a major killer across all ages and countries and remains the most common cause of admission and death in the Intensive Care Unit (ICU)2.
T5 333-433 Sentence denotes The true incidence remains elusive and estimates of the global burden of sepsis remain a wild guess.
T5 333-433 Sentence denotes The true incidence remains elusive and estimates of the global burden of sepsis remain a wild guess.
T6 434-522 Sentence denotes One study suggested over 19 million cases and 5 million sepsis-related deaths annually3.
T6 434-522 Sentence denotes One study suggested over 19 million cases and 5 million sepsis-related deaths annually3.
T7 523-693 Sentence denotes Addressing the challenge, the World Health Assembly of the World Health Organisation (WHO) passed a resolution on better prevention, diagnosis, and management of sepsis4.
T7 523-693 Sentence denotes Addressing the challenge, the World Health Assembly of the World Health Organisation (WHO) passed a resolution on better prevention, diagnosis, and management of sepsis4.
T8 694-729 Sentence denotes Current state of sepsis guidelines:
T8 694-729 Sentence denotes Current state of sepsis guidelines:
T9 730-814 Sentence denotes Despite thousands of articles and hundreds of trials, sepsis remains a major killer.
T9 730-814 Sentence denotes Despite thousands of articles and hundreds of trials, sepsis remains a major killer.
T10 815-975 Sentence denotes The cornerstones of sepsis care remain early recognition, adoption of a systematic evidence-based bundle of care, and timely escalation to higher level of care.
T10 815-975 Sentence denotes The cornerstones of sepsis care remain early recognition, adoption of a systematic evidence-based bundle of care, and timely escalation to higher level of care.
T11 976-1212 Sentence denotes The bundle approach has been advocated since 2004 but underwent major modifications in subsequent years with more emphasis on the time-critical nature of sepsis and need to restore physiological variables within one hour of recognition.
T11 976-1212 Sentence denotes The bundle approach has been advocated since 2004 but underwent major modifications in subsequent years with more emphasis on the time-critical nature of sepsis and need to restore physiological variables within one hour of recognition.
T12 1213-1295 Sentence denotes A shift from a three and six-hour bundle to one-hour bundle has been recommended5.
T12 1213-1295 Sentence denotes A shift from a three and six-hour bundle to one-hour bundle has been recommended5.
T13 1296-1375 Sentence denotes This single hour approach has been faced with an outcry and been challenged6-8.
T13 1296-1375 Sentence denotes This single hour approach has been faced with an outcry and been challenged6-8.
T14 1376-1400 Sentence denotes One size never fits all:
T14 1376-1400 Sentence denotes One size never fits all:
T15 1401-1487 Sentence denotes Over several decades, the individual components of the sepsis bundle have not changed.
T15 1401-1487 Sentence denotes Over several decades, the individual components of the sepsis bundle have not changed.
T16 1488-1670 Sentence denotes Encountering a patient with suspected sepsis, one should measure lactate, obtain blood cultures, swiftly administer broad spectrum antimicrobials and fluids, and infuse vasopressors.
T16 1488-1670 Sentence denotes Encountering a patient with suspected sepsis, one should measure lactate, obtain blood cultures, swiftly administer broad spectrum antimicrobials and fluids, and infuse vasopressors.
T17 1671-1734 Sentence denotes A critical question arises: should we do this for all patients?
T17 1671-1734 Sentence denotes A critical question arises: should we do this for all patients?
T18 1735-1827 Sentence denotes Sepsis is not septic shock and guidelines did not make distinctive recommendations for each.
T18 1735-1827 Sentence denotes Sepsis is not septic shock and guidelines did not make distinctive recommendations for each.
T19 1828-1917 Sentence denotes Septic patients will present differently with some having more subtle signs and symptoms.
T19 1828-1917 Sentence denotes Septic patients will present differently with some having more subtle signs and symptoms.
T20 1918-2063 Sentence denotes Phenotypically, we do not know which patient with infection will develop a dysregulated host response and will succumb to sepsis and/or shock6-8.
T20 1918-2063 Sentence denotes Phenotypically, we do not know which patient with infection will develop a dysregulated host response and will succumb to sepsis and/or shock6-8.
T21 2064-2231 Sentence denotes The existing bundle lacks high quality evidence to support its recommendations and a blanket implementation for all patients with 'suspected' sepsis could be harmful7.
T21 2064-2231 Sentence denotes The existing bundle lacks high quality evidence to support its recommendations and a blanket implementation for all patients with 'suspected' sepsis could be harmful7.
T22 2232-2358 Sentence denotes Indeed, a significant reduction of sepsis and septic shock in Australia and New Zealand was observed in a bundle-free region8.
T22 2232-2358 Sentence denotes Indeed, a significant reduction of sepsis and septic shock in Australia and New Zealand was observed in a bundle-free region8.
T23 2359-2396 Sentence denotes Emergency Department (ED) challenges:
T23 2359-2396 Sentence denotes Emergency Department (ED) challenges:
T24 2397-2446 Sentence denotes Upon arrival in the ED, patients will be triaged.
T24 2397-2446 Sentence denotes Upon arrival in the ED, patients will be triaged.
T25 2447-2468 Sentence denotes This is 'time zero'5.
T25 2447-2468 Sentence denotes This is 'time zero'5.
T26 2469-2578 Sentence denotes Those with hypotension and hypoperfusion will be easily recognised and at most need to receive emergent care.
T26 2469-2578 Sentence denotes Those with hypotension and hypoperfusion will be easily recognised and at most need to receive emergent care.
T27 2579-2669 Sentence denotes Sepsis, per se, may not manifest clear cut signs and expertise to identify it is required.
T27 2579-2669 Sentence denotes Sepsis, per se, may not manifest clear cut signs and expertise to identify it is required.
T28 2670-2832 Sentence denotes Those with non-specific symptoms may trigger an early warning scoring system and receive unnecessary antimicrobials and a large volume of intravenous (IV) fluids.
T28 2670-2832 Sentence denotes Those with non-specific symptoms may trigger an early warning scoring system and receive unnecessary antimicrobials and a large volume of intravenous (IV) fluids.
T29 2833-2889 Sentence denotes Both therapies are not without significant side effects.
T29 2833-2889 Sentence denotes Both therapies are not without significant side effects.
T30 2890-3021 Sentence denotes Putting pressure on ED physicians to implement the 60-minute bundle without individualisation of care puts our patients at risk6-8.
T30 2890-3021 Sentence denotes Putting pressure on ED physicians to implement the 60-minute bundle without individualisation of care puts our patients at risk6-8.
T31 3022-3044 Sentence denotes Diagnostic challenges:
T31 3022-3044 Sentence denotes Diagnostic challenges:
T32 3045-3194 Sentence denotes Given the heterogenous nature and diverse pathobiological pathways, sepsis diagnosis can be challenging and both over and under-treatment can result.
T32 3045-3194 Sentence denotes Given the heterogenous nature and diverse pathobiological pathways, sepsis diagnosis can be challenging and both over and under-treatment can result.
T33 3195-3331 Sentence denotes Established biomarkers such as procalcitonin and C-reactive protein lack specificity to rule out infection as the cause of inflammation.
T33 3195-3331 Sentence denotes Established biomarkers such as procalcitonin and C-reactive protein lack specificity to rule out infection as the cause of inflammation.
T34 3332-3466 Sentence denotes Currently, no laboratory test or biomarker helps predict which patients with infection or inflammation will develop organ dysfunction.
T34 3332-3466 Sentence denotes Currently, no laboratory test or biomarker helps predict which patients with infection or inflammation will develop organ dysfunction.
T35 3467-3520 Sentence denotes A dire need for a specific sepsis biomarker exists10.
T35 3467-3520 Sentence denotes A dire need for a specific sepsis biomarker exists10.
T36 3521-3675 Sentence denotes Modern molecular-based technologies are evolving and utilise polymerase chain reaction (PCR), nanotechnology, and microfluidics for point-of-care testing.
T36 3521-3675 Sentence denotes Modern molecular-based technologies are evolving and utilise polymerase chain reaction (PCR), nanotechnology, and microfluidics for point-of-care testing.
T37 3676-3768 Sentence denotes Some devices identify causative microorganisms and their sensitivity in less than an hour10.
T37 3676-3768 Sentence denotes Some devices identify causative microorganisms and their sensitivity in less than an hour10.
T38 3769-3791 Sentence denotes The bundle components:
T38 3769-3791 Sentence denotes The bundle components:
T39 3792-3863 Sentence denotes Catecholamines along with IV fluids are indicated to restore perfusion.
T39 3792-3863 Sentence denotes Catecholamines along with IV fluids are indicated to restore perfusion.
T40 3864-3936 Sentence denotes However, inadvertent side effects may arise, especially at higher doses.
T40 3864-3936 Sentence denotes However, inadvertent side effects may arise, especially at higher doses.
T41 3937-4063 Sentence denotes Anti-adrenergic ß-blockers improve cardiac performance, enhance receptor responsiveness, and possess anti-inflammatory action.
T41 3937-4063 Sentence denotes Anti-adrenergic ß-blockers improve cardiac performance, enhance receptor responsiveness, and possess anti-inflammatory action.
T42 4064-4114 Sentence denotes All are desirable in patients with septic shock11.
T42 4064-4114 Sentence denotes All are desirable in patients with septic shock11.
T43 4115-4207 Sentence denotes One randomised trial showed beneficial and protective effects of ß-blockers in septic shock.
T43 4115-4207 Sentence denotes One randomised trial showed beneficial and protective effects of ß-blockers in septic shock.
T44 4208-4351 Sentence denotes Rapidly acting titratable agents should be used in conjunction with appropriate hemodynamic monitoring and after adequate volume resuscitation.
T44 4208-4351 Sentence denotes Rapidly acting titratable agents should be used in conjunction with appropriate hemodynamic monitoring and after adequate volume resuscitation.
T45 4352-4462 Sentence denotes There is no consensus on target heart rate but an arbitrary cut off of 80-95 beats per minute is reasonable11.
T45 4352-4462 Sentence denotes There is no consensus on target heart rate but an arbitrary cut off of 80-95 beats per minute is reasonable11.
T46 4463-4523 Sentence denotes Fluid resuscitation is the cornerstone of sepsis management.
T46 4463-4523 Sentence denotes Fluid resuscitation is the cornerstone of sepsis management.
T47 4524-4585 Sentence denotes There is also compelling evidence that too much fluid is bad.
T47 4524-4585 Sentence denotes There is also compelling evidence that too much fluid is bad.
T48 4586-4643 Sentence denotes Starch-based colloids should not be used in septic shock.
T48 4586-4643 Sentence denotes Starch-based colloids should not be used in septic shock.
T49 4644-4751 Sentence denotes Albumin is an alternative when large volumes are required but is not appropriate in traumatic brain injury.
T49 4644-4751 Sentence denotes Albumin is an alternative when large volumes are required but is not appropriate in traumatic brain injury.
T50 4752-4868 Sentence denotes Balanced, less chloride and less acidic crystalloids are safer for the kidneys and are preferred over normal saline.
T50 4752-4868 Sentence denotes Balanced, less chloride and less acidic crystalloids are safer for the kidneys and are preferred over normal saline.
T51 4869-5057 Sentence denotes Doses of IV fluids should be tailored to the patient's condition and a 30 ml/kg recommendation should be reviewed.12 Effective sepsis management requires adequate dosing of antimicrobials.
T51 4869-5057 Sentence denotes Doses of IV fluids should be tailored to the patient's condition and a 30 ml/kg recommendation should be reviewed.12 Effective sepsis management requires adequate dosing of antimicrobials.
T52 5058-5158 Sentence denotes Significant alteration of pharmacokinetics and pharmacodynamics is characteristic of septic shock13.
T52 5058-5158 Sentence denotes Significant alteration of pharmacokinetics and pharmacodynamics is characteristic of septic shock13.
T53 5159-5306 Sentence denotes Accurate and effective dosing is challenging particularly in patients with multiple comorbidities and those receiving extracorporeal organ support.
T53 5159-5306 Sentence denotes Accurate and effective dosing is challenging particularly in patients with multiple comorbidities and those receiving extracorporeal organ support.
T54 5307-5445 Sentence denotes Underdosing results in treatment failure, whilst overdosing leads to toxicity and the risk of developing multi-drug resistant organisms13.
T54 5307-5445 Sentence denotes Underdosing results in treatment failure, whilst overdosing leads to toxicity and the risk of developing multi-drug resistant organisms13.
T55 5446-5557 Sentence denotes An individualised approach supported by therapeutic drug monitoring is suggested to ensure clinical efficacy13.
T55 5446-5557 Sentence denotes An individualised approach supported by therapeutic drug monitoring is suggested to ensure clinical efficacy13.
T56 5558-5574 Sentence denotes Sepsis research:
T56 5558-5574 Sentence denotes Sepsis research:
T57 5575-5619 Sentence denotes The search for a cure for sepsis is ongoing.
T57 5575-5619 Sentence denotes The search for a cure for sepsis is ongoing.
T58 5620-5770 Sentence denotes A large prospective, randomised two-arm, parallel group study aims to recruit over 200 patients with septic shock across critical care units in Qatar.
T58 5620-5770 Sentence denotes A large prospective, randomised two-arm, parallel group study aims to recruit over 200 patients with septic shock across critical care units in Qatar.
T59 5771-5892 Sentence denotes Evaluation of Hydrocortisone, Vitamin C, and Thiamine (HYVITS) examines the safety and efficacy of this triple therapy14.
T59 5771-5892 Sentence denotes Evaluation of Hydrocortisone, Vitamin C, and Thiamine (HYVITS) examines the safety and efficacy of this triple therapy14.
T60 5893-5921 Sentence denotes Sepsis in the young patient:
T60 5893-5921 Sentence denotes Sepsis in the young patient:
T61 5922-5969 Sentence denotes Children are particularly vulnerable to sepsis.
T61 5922-5969 Sentence denotes Children are particularly vulnerable to sepsis.
T62 5970-6029 Sentence denotes 1 in 6 children admitted with septic shock to ICU will die.
T62 5970-6029 Sentence denotes 1 in 6 children admitted with septic shock to ICU will die.
T63 6030-6190 Sentence denotes As the majority of paediatric sepsis cases are community acquired, there is a strong need to raise awareness both for families and primary healthcare providers.
T63 6030-6190 Sentence denotes As the majority of paediatric sepsis cases are community acquired, there is a strong need to raise awareness both for families and primary healthcare providers.
T64 6191-6269 Sentence denotes Akin to adults, a bundle-approach to paediatric sepsis is strongly encouraged.
T64 6191-6269 Sentence denotes Akin to adults, a bundle-approach to paediatric sepsis is strongly encouraged.
T65 6270-6334 Sentence denotes National programs for paediatric sepsis have been established15.
T65 6270-6334 Sentence denotes National programs for paediatric sepsis have been established15.
T66 6335-6455 Sentence denotes The Qatar paediatric multidisciplinary sepsis program was established under the umbrella of the adult programme in 2017.
T66 6335-6455 Sentence denotes The Qatar paediatric multidisciplinary sepsis program was established under the umbrella of the adult programme in 2017.
T67 6456-6585 Sentence denotes A structured and standardised approach to sepsis across all neonate and paediatric facilities has been developed and implemented.
T67 6456-6585 Sentence denotes A structured and standardised approach to sepsis across all neonate and paediatric facilities has been developed and implemented.
T68 6586-6705 Sentence denotes Improvement in timely sepsis recognition and administration of antimicrobials within the golden hour has been observed.
T68 6586-6705 Sentence denotes Improvement in timely sepsis recognition and administration of antimicrobials within the golden hour has been observed.
T69 6706-6802 Sentence denotes The program aims to achieve a 95% compliance to the paediatric sepsis bundle by the end of 2019.
T69 6706-6802 Sentence denotes The program aims to achieve a 95% compliance to the paediatric sepsis bundle by the end of 2019.
T70 6803-6927 Sentence denotes A screening tool and order set have been put in place and are presented in this special issue of Qatar Medical Journal16,17.
T70 6803-6927 Sentence denotes A screening tool and order set have been put in place and are presented in this special issue of Qatar Medical Journal16,17.
T71 6928-6945 Sentence denotes Obstetric sepsis:
T71 6928-6945 Sentence denotes Obstetric sepsis:
T72 6946-6999 Sentence denotes Pregnancy and childbirth are risk factors for sepsis.
T72 6946-6999 Sentence denotes Pregnancy and childbirth are risk factors for sepsis.
T73 7000-7065 Sentence denotes Multi-organ failure and death can result from puerperal sepsis18.
T73 7000-7065 Sentence denotes Multi-organ failure and death can result from puerperal sepsis18.
T74 7066-7139 Sentence denotes Sepsis is the direct and leading cause of maternal mortality in the UK19.
T74 7066-7139 Sentence denotes Sepsis is the direct and leading cause of maternal mortality in the UK19.
T75 7140-7208 Sentence denotes Attention to maternal sepsis with a tailored approach is encouraged.
T75 7140-7208 Sentence denotes Attention to maternal sepsis with a tailored approach is encouraged.
T76 7209-7336 Sentence denotes The Qatar National Sepsis Program developed a sepsis care pathway for pregnant women and during their early post-partum period.
T76 7209-7336 Sentence denotes The Qatar National Sepsis Program developed a sepsis care pathway for pregnant women and during their early post-partum period.
T77 7337-7379 Sentence denotes Challenges in low socioeconomic societies:
T77 7337-7379 Sentence denotes Challenges in low socioeconomic societies:
T78 7380-7496 Sentence denotes A broader, national -or better yet- a global approach to further sepsis management and outcome should be considered.
T78 7380-7496 Sentence denotes A broader, national -or better yet- a global approach to further sepsis management and outcome should be considered.
T79 7497-7553 Sentence denotes There are a number of significant challenges to address.
T79 7497-7553 Sentence denotes There are a number of significant challenges to address.
T80 7554-7699 Sentence denotes One such challenge is the inconsistency of the operational definition and diagnostic approaches for sepsis including coding and documentation1,3.
T80 7554-7699 Sentence denotes One such challenge is the inconsistency of the operational definition and diagnostic approaches for sepsis including coding and documentation1,3.
T81 7700-7779 Sentence denotes Significant deficiencies in healthcare systems have been highlighted by sepsis.
T81 7700-7779 Sentence denotes Significant deficiencies in healthcare systems have been highlighted by sepsis.
T82 7780-7837 Sentence denotes This is most obvious in medium- and low-income countries.
T82 7780-7837 Sentence denotes This is most obvious in medium- and low-income countries.
T83 7838-7962 Sentence denotes A major limitation to effective sepsis management is inadequate medical staffing and poor knowledge and awareness of sepsis.
T83 7838-7962 Sentence denotes A major limitation to effective sepsis management is inadequate medical staffing and poor knowledge and awareness of sepsis.
T84 7963-8010 Sentence denotes Both have a negative impact on sepsis outcome3.
T84 7963-8010 Sentence denotes Both have a negative impact on sepsis outcome3.
T85 8011-8096 Sentence denotes Poor medical facilities in many countries pose significant challenges to sepsis care.
T85 8011-8096 Sentence denotes Poor medical facilities in many countries pose significant challenges to sepsis care.
T86 8097-8217 Sentence denotes Lack of critical care capacity - a global phenomenon - has been linked to poor outcome of sepsis cases and septic shock.
T86 8097-8217 Sentence denotes Lack of critical care capacity - a global phenomenon - has been linked to poor outcome of sepsis cases and septic shock.
T87 8218-8342 Sentence denotes This could be attributed to provision of suboptimal critical care, monitoring and critical interventions outside of the ICU.
T87 8218-8342 Sentence denotes This could be attributed to provision of suboptimal critical care, monitoring and critical interventions outside of the ICU.
T88 8343-8512 Sentence denotes ICU availability is subject to inconsistency and inequity.2,3 Lack of adequate surgical capacity to accomplish timely source control adversely affects sepsis management.
T88 8343-8512 Sentence denotes ICU availability is subject to inconsistency and inequity.2,3 Lack of adequate surgical capacity to accomplish timely source control adversely affects sepsis management.
T89 8513-8700 Sentence denotes This, unfortunately, in medium- and low-income countries, is accompanied by inadequate medical supplies, diagnostic capacity, and manpower which increases sepsis mortality and morbidity3.
T89 8513-8700 Sentence denotes This, unfortunately, in medium- and low-income countries, is accompanied by inadequate medical supplies, diagnostic capacity, and manpower which increases sepsis mortality and morbidity3.
T90 8701-8717 Sentence denotes Global concerns:
T90 8701-8717 Sentence denotes Global concerns:
T91 8718-8762 Sentence denotes Antimicrobials are critical for sepsis care.
T91 8718-8762 Sentence denotes Antimicrobials are critical for sepsis care.
T92 8763-8929 Sentence denotes A global concern is the development of multi-drug resistant organisms and the lack of novel antimicrobials and this adds pressure on those caring for septic patients.
T92 8763-8929 Sentence denotes A global concern is the development of multi-drug resistant organisms and the lack of novel antimicrobials and this adds pressure on those caring for septic patients.
T93 8930-8998 Sentence denotes Effective antimicrobials should be utilised to eradicate infections.
T93 8930-8998 Sentence denotes Effective antimicrobials should be utilised to eradicate infections.
T94 8999-9153 Sentence denotes Misuse, inadequacy, inferior agents, and lack of timely access to effective and affordable agents significantly hinders patient's recovery from sepsis2,3.
T94 8999-9153 Sentence denotes Misuse, inadequacy, inferior agents, and lack of timely access to effective and affordable agents significantly hinders patient's recovery from sepsis2,3.
T95 9154-9334 Sentence denotes Optimum sepsis outcome mandates attention to acute sepsis complications (e.g. acute renal or respiratory failure) as well as addressing post-discharge complications and disability.
T95 9154-9334 Sentence denotes Optimum sepsis outcome mandates attention to acute sepsis complications (e.g. acute renal or respiratory failure) as well as addressing post-discharge complications and disability.
T96 9335-9396 Sentence denotes These challenging issues remain poorly studied or addressed3.
T96 9335-9396 Sentence denotes These challenging issues remain poorly studied or addressed3.
T97 9397-9408 Sentence denotes Conclusion:
T97 9397-9408 Sentence denotes Conclusion:
T98 9409-9466 Sentence denotes Sepsis and septic shock are major global health concerns.
T98 9409-9466 Sentence denotes Sepsis and septic shock are major global health concerns.
T99 9467-9589 Sentence denotes Progress has been achieved in understanding this life-threatening syndrome at a biological, metabolic, and cellular level.
T99 9467-9589 Sentence denotes Progress has been achieved in understanding this life-threatening syndrome at a biological, metabolic, and cellular level.
T100 9590-9643 Sentence denotes Efforts should be coordinated to improve sepsis care.
T100 9590-9643 Sentence denotes Efforts should be coordinated to improve sepsis care.
T101 9644-9761 Sentence denotes Better and more accurate diagnostics are needed and governments are encouraged to invest in sepsis research and care.
T101 9644-9761 Sentence denotes Better and more accurate diagnostics are needed and governments are encouraged to invest in sepsis research and care.
T102 9762-9833 Sentence denotes More integrated, inclusive, and focused research is desperately needed.
T102 9762-9833 Sentence denotes More integrated, inclusive, and focused research is desperately needed.
T103 9834-9954 Sentence denotes Public education and increased awareness among primary healthcare providers are also critical to improve sepsis outcome.
T103 9834-9954 Sentence denotes Public education and increased awareness among primary healthcare providers are also critical to improve sepsis outcome.