Chinese Expert Consensus on Early Prevention and Intervention of Sepsis

Sepsis is currently a major problem and challenge facing the medical community.With rapid development and progress of modern medicine,researchers have put more and more attention on sepsis;meanwhile,the morbidity and mortality of sepsis remains high despite great efforts from experts in various fields.According to updated guidelines,sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.Infection is the initial step of sepsis progression,and development from infection to sepsis is a complex pathophysiological process,including pathogen invasion,cytokine release,capillary leakage,microcirculation dysfunction,etc.which finally leads to organ metabolic disorders and functional failure.According to the latest recommended international guidelines of Sepsis 3.0,the presence of infection and SOFA score≥2 are considered as the diagnostic criteria for sepsis,and the"rescue"measures mainly focus on reversal of organ dysfunction.However,despite nearly two decades of efforts,the"Save Sepsis Campaign"has not achieved satisfactory results.Emergency medicine is the frontier subject of acute and severe illness which treats patients with acute infections at the earliest.If at this stage,physicians can predict the possibility of sepsis progression from demographic characteristics,localize the pathogen and infection,detect the inflammatory storms by tests of cytokines and evaluate the severity of the infection with more effective clinical scoring system,and then take effective measures to prevent infection from developing into sepsis in high-risk patients,the morbidity and mortality of sepsis in patients with acute infection will be greatly reduced.Based on this situation,Chinese emergency medicine experts proposed the concept of"preventing and blocking"sepsis,and launched the nationwide"Preventing Sepsis Campaign in China(PSCC)"nationwide.The main concept is summarized as"three early and two reduces"which includes early detection,early diagnosis and early intervention during the"pre-symptomatic"and"peri-septic"stage in order to reduce the incidence of sepsis and it proposed a new approach for diagnosis and treatment of acute severe infection.This consensus is jointly advocated,discussed and written by four academic associations in the field of emergency medicine and five scholarly publishing organizations.More than 40 experts from fields of emergency medicine,critical care medicine,infectious diseases,pharmacy and laboratory medicine have participated in several rounds of deliberation and finally reached consensus on the criteria of identifying patients with acute infection,taking anti-infective treatments,screening of high-risk patients with sepsis,detection and treatment of inflammatory storm,protection of vascular endothelial cells and the regulation of coagulation function,as well as strategies of liquid support and organ function protection etc.The consensus summarizes the commonly used clinical diagnosis criteria and treatment measures of sepsis both in Western medicine and traditional Chinese medicine for clinicians in order to provide evidence for the diagnosis and treatment of the disease.

Percutaneous nephrolithotomy with X-ray free technique in morbidly obese patients

To the Editor:Percutaneous nephrolithotomy(PNL)constitutes the first-line of treatment for complex and staghorn stones.Performing PNL in morbidly obese patients is challenging because of potential risks and higher morbidity rates.[1]Previous literature has confirmed the safety and feasibility of the surgery under fluoroscopy.However,the efficiency of total ultrasound(US)-guided access established procedures in morbidly obese patients has not been proved before,with the traditional view holding that obesity is a risk factor that increases the difficulty of accessing the renal collecting system under US.US is sometimes used to reduce radiation exposure in some Western countries,whereas the spread of X-ray-free technique for PNL in China has been lasting for>10 years.This study aims to investigate the feasibility and safety of total US-guided PNL in morbidly obese patients and to highlight the difficulties and problems,which can be encountered and effectively resolved.