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Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021.

Laura Evans, Andrew Rhodes, Waleed Alhazzani, Massimo Antonelli, Craig M Coopersmith, Craig French, Flávia R Machado, Lauralyn Mcintyre, Marlies Ostermann, Hallie C Prescott, Christa Schorr, Steven Simpson, W Joost Wiersinga, Fayez Alshamsi, Derek C Angus, Yaseen Arabi, Luciano Azevedo, Richard Beale, Gregory Beilman, Emilie Belley-Cote, Lisa Burry, Maurizio Cecconi, John Centofanti, Angel Coz Yataco, Jan De Waele, R Phillip Dellinger, Kent Doi, Bin Du, Elisa Estenssoro, Ricard Ferrer, Charles Gomersall, Carol Hodgson, Morten Hylander Møller, Theodore Iwashyna, Shevin Jacob, Ruth Kleinpell, Michael Klompas, Younsuck Koh, Anand Kumar, Arthur Kwizera, Suzana Lobo, Henry Masur, Steven McGloughlin, Sangeeta Mehta, Yatin Mehta, Mervyn Mer, Mark Nunnally, Simon Oczkowski, Tiffany Osborn, Elizabeth Papathanassoglou, Anders Perner, Michael Puskarich, Jason Roberts, William Schweickert, Maureen Seckel, Jonathan Sevransky, Charles L Sprung, Tobias Welte, Janice Zimmerman, Mitchell Levy,

Crit Care Med (Critical care medicine)
[2021, 49(11):1974-1982]

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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.

Laura Evans, Andrew Rhodes, Waleed Alhazzani, Massimo Antonelli, Craig M Coopersmith, Craig French, Flávia R Machado, Lauralyn Mcintyre, Marlies Ostermann, Hallie C Prescott, Christa Schorr, Steven Simpson, W Joost Wiersinga, Fayez Alshamsi, Derek C Angus, Yaseen Arabi, Luciano Azevedo, Richard Beale, Gregory Beilman, Emilie Belley-Cote, Lisa Burry, Maurizio Cecconi, John Centofanti, Angel Coz Yataco, Jan De Waele, R Phillip Dellinger, Kent Doi, Bin Du, Elisa Estenssoro, Ricard Ferrer, Charles Gomersall, Carol Hodgson, Morten Hylander Møller, Theodore Iwashyna, Shevin Jacob, Ruth Kleinpell, Michael Klompas, Younsuck Koh, Anand Kumar, Arthur Kwizera, Suzana Lobo, Henry Masur, Steven McGloughlin, Sangeeta Mehta, Yatin Mehta, Mervyn Mer, Mark Nunnally, Simon Oczkowski, Tiffany Osborn, Elizabeth Papathanassoglou, Anders Perner, Michael Puskarich, Jason Roberts, William Schweickert, Maureen Seckel, Jonathan Sevransky, Charles L Sprung, Tobias Welte, Janice Zimmerman, Mitchell Levy,

Crit Care Med (Critical care medicine)
[2021, 49(11):e1063-e1143]

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A Research Agenda for Precision Medicine in Sepsis and Acute Respiratory Distress Syndrome: An Official American Thoracic Society Research Statement.

Faraaz Ali Shah, Nuala J Meyer, Derek C Angus, Rana Awdish, Élie Azoulay, Carolyn S Calfee, Gilles Clermont, Anthony C Gordon, Arthur Kwizera, Aleksandra Leligdowicz, John C Marshall, Carmen Mikacenic, Pratik Sinha, Balasubramanian Venkatesh, Hector R Wong, Fernando G Zampieri, Sachin Yende,

<b>Background:</b> Precision medicine focuses on the identification of therapeutic strategies that are effective for a group of patients based on similar unifying characteristics. The recent success of precision medicine in non-critical care settings has resulted from the confluence of large clinical and biospecimen repositories, innovative bioinformatics, and novel trial designs. ... Read more >>

Am J Respir Crit Care Med (American journal of respiratory and critical care medicine)
[2021, 204(8):891-901]

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Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.

Laura Evans, Andrew Rhodes, Waleed Alhazzani, Massimo Antonelli, Craig M Coopersmith, Craig French, Flávia R Machado, Lauralyn Mcintyre, Marlies Ostermann, Hallie C Prescott, Christa Schorr, Steven Simpson, W Joost Wiersinga, Fayez Alshamsi, Derek C Angus, Yaseen Arabi, Luciano Azevedo, Richard Beale, Gregory Beilman, Emilie Belley-Cote, Lisa Burry, Maurizio Cecconi, John Centofanti, Angel Coz Yataco, Jan De Waele, R Phillip Dellinger, Kent Doi, Bin Du, Elisa Estenssoro, Ricard Ferrer, Charles Gomersall, Carol Hodgson, Morten Hylander Møller, Theodore Iwashyna, Shevin Jacob, Ruth Kleinpell, Michael Klompas, Younsuck Koh, Anand Kumar, Arthur Kwizera, Suzana Lobo, Henry Masur, Steven McGloughlin, Sangeeta Mehta, Yatin Mehta, Mervyn Mer, Mark Nunnally, Simon Oczkowski, Tiffany Osborn, Elizabeth Papathanassoglou, Anders Perner, Michael Puskarich, Jason Roberts, William Schweickert, Maureen Seckel, Jonathan Sevransky, Charles L Sprung, Tobias Welte, Janice Zimmerman, Mitchell Levy,

Intensive Care Med (Intensive care medicine)
[2021, :]

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Safety and Efficacy of Hydroxychloroquine for Treatment of Non-Severe COVID-19 in Adults in Uganda: A Randomized Open Label Phase II Clinical Trial

Pauline Byakika-Kibwika, Christine Sekaggya-Wiltshire, Jerome Roy Semakula, Jane Nakibuuka, Joseph Musaazi, James Kayima, Cornelius Sendagire, David Meya, Bruce Kirenga, Sarah Nanzigu, Arthur Kwizera, Fred Nakwagala, Ivan Kisuule, Misaki Wayengera, Henry Mwebesa, Moses Kamya, William Bazeyo,

<h4>Background: </h4> Several repurposed drugs such as hydroxychloroquine (HCQ) have been investigated for treatment of COVID-19, but none was confirmed to be efficacious. While in vitro studies have demonstrated antiviral properties of HCQ, data from clinical trials were conflicting regarding its benefit for COVID-19 treatment. Drugs that limit viral replication ... Read more >>

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A living WHO guideline on drugs to prevent covid-19.

François Lamontagne, Thomas Agoritsas, Reed Siemieniuk, Bram Rochwerg, Jessica Bartoszko, Lisa Askie, Helen Macdonald, Wagdy Amin, Frederique Jacquerioz Bausch, Erlina Burhan, Maurizio Cecconi, Duncan Chanda, Vu Quoc Dat, Bin Du, Heike Geduld, Patrick Gee, Harley Nerina, Madiha Hashimi, Beverley J Hunt, Sushil Kabra, Seema Kanda, Leticia Kawano-Dourado, Yae-Jean Kim, Niranjan Kissoon, Arthur Kwizera, Yee-Sin Leo, Imelda Mahaka, Hela Manai, Greta Mino, Emmanuel Nsutebu, Natalia Pshenichnaya, Nida Qadir, Shalini Sri Ranganathan, Saniya Sabzwari, Rohit Sarin, Michael Sharland, Yinzhong Shen, Joao Paulo Souza, Miriam Stegemann, Sebastian Ugarte, Sridhar Venkatapuram, Dubula Vuyiseka, Jacobus Preller, Romina Brignardello-Petersen, Elena Kum, Anila Qasim, Dena Zeraatkar, Andrew Owen, Gordon Guyatt, Lyubov Lytvyn, Janet Diaz, Per Olav Vandvik, Michael Jacobs,

<h4>Clinical question</h4>What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on ... Read more >>

BMJ (BMJ (Clinical research ed.))
[2021, 372:n526]

Cited: 13 times

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COVID-19: a heavy toll on health-care workers.

Sangeeta Mehta, Flavia Machado, Arthur Kwizera, Laurent Papazian, Marc Moss, Élie Azoulay, Margaret Herridge,

Lancet Respir Med (The Lancet. Respiratory medicine)
[2021, 9(3):226-228]

Cited: 34 times

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The prevalence, incidence and mortality associated with intra-abdominal hypertension among patients in intensive care units of a low-income country: a cohort study

Phiona Nansubuga, Arthur Kavuma Mwanje, Samuel Kizito, Daniel Obua, Cornelius Sendagire, Arthur Kwizera,

Background : Intra-abdominal hypertension (IAH) is sustained increase in intra-abdominal pressure (IAP) ≥12 mmHg in adults and ≥10 mmHg in children. IAH has been noted to be associated with increased morbidity and mortality among critically ill patients. Measurement of IAP is common among at risk patients in the developed world. ... Read more >>

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Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality.

Arthur Kwizera, Jane Nakibuuka, Lydia Nakiyingi, Cornelius Sendagire, Janat Tumukunde, Catherine Katabira, Ronald Ssenyonga, Noah Kiwanuka, David Patrick Kateete, Moses Joloba, Daphne Kabatoro, Diana Atwine, Charlotte Summers,

<h4>Introduction</h4>Limited data exist on the epidemiology of acute hypoxaemic respiratory failure (AHRF) in low-income countries (LICs). We sought to determine the prevalence of AHRF in critically ill adult patients admitted to a Ugandan tertiary referral hospital; determine clinical and treatment characteristics as well as assess factors associated with mortality.<h4>Materials and ... Read more >>

BMJ Open Respir Res (BMJ open respiratory research)
[2020, 7(1):]

Cited: 2 times

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A living WHO guideline on drugs for covid-19.

Bram Rochwerg, Arnav Agarwal, Reed Ac Siemieniuk, Thomas Agoritsas, François Lamontagne, Lisa Askie, Lyubov Lytvyn, Yee-Sin Leo, Helen Macdonald, Linan Zeng, Wagdy Amin, Erlina Burhan, Frederique Jacquerioz Bausch, Carolyn S Calfee, Maurizio Cecconi, Duncan Chanda, Bin Du, Heike Geduld, Patrick Gee, Nerina Harley, Madiha Hashimi, Beverly Hunt, Sushil K Kabra, Seema Kanda, Leticia Kawano-Dourado, Yae-Jean Kim, Niranjan Kissoon, Arthur Kwizera, Imelda Mahaka, Hela Manai, Greta Mino, Emmanuel Nsutebu, Jacobus Preller, Natalia Pshenichnaya, Nida Qadir, Saniya Sabzwari, Rohit Sarin, Manu Shankar-Hari, Michael Sharland, Yinzhong Shen, Shalini Sri Ranganathan, Joao P Souza, Miriam Stegemann, An De Sutter, Sebastian Ugarte, Sridhar Venkatapuram, Vu Quoc Dat, Dubula Vuyiseka, Ananda Wijewickrama, Brittany Maguire, Dena Zeraatkar, Jessica J Bartoszko, Long Ge, Romina Brignardello-Petersen, Andrew Owen, Gordon Guyatt, Janet Diaz, Michael Jacobs, Per Olav Vandvik,

<h4>Clinical question</h4>What is the role of drugs in the treatment of patients with covid-19?<h4>New recommendation</h4>Pre-prints of four randomised trials (from a larger adaptive randomised master protocol) among patients with non-severe illness, and the RECOVERY trial among severe and critically ill patients, triggered this guideline update. This resulted in a conditional ... Read more >>

BMJ (BMJ (Clinical research ed.))
[2020, 370:m3379]

Cited: 131 times

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Remdesivir for severe covid-19: a clinical practice guideline.

Bram Rochwerg, Arnav Agarwal, Linan Zeng, Yee-Sin Leo, John Adabie Appiah, Thomas Agoritsas, Jessica Bartoszko, Romina Brignardello-Petersen, Begum Ergan, Long Ge, Heike Geduld, Hayley B Gershengorn, Hela Manai, Minhua Huang, François Lamontagne, Seema Kanda, Leticia Kawano-Dourado, Linda Kurian, Arthur Kwizera, Srinivas Murthy, Nida Qadir, Reed Siemieniuk, Maria Asuncion Silvestre, Per Olav Vandvik, Zhikang Ye, Dena Zeraatkar, Gordon Guyatt,

<h4>Clinical question</h4>What is the role of remdesivir in the treatment of severe covid-19? This guideline was triggered by the ACTT-1 trial published in the <i>New England Journal of Medicine</i> on 22 May 2020.<h4>Current practice</h4>Remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19. After rapid market approval ... Read more >>

BMJ (BMJ (Clinical research ed.))
[2020, 370:m2924]

Cited: 32 times

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Estimating the Effect and Cost-Effectiveness of Facemasks in Reducing the Spread of the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) in Uganda

Betty Nannyonga, Rhoda Wanyenze, Pontiano Kaleebu, John Ssenkusu, Tom Lutalo, Fredrick Edward Makumbi, Arthur Kwizera, Pauline Byakika, Willford Kirungi, Henry Kyobe Bosa, Vincent Ssembatya, Henry Mwebesa, Diana Atwine, Jane Ruth Aceng, Yonas Tegegn Woldermariam, ,

Evidence that face masks provide effective protection against respiratory infections in the community is scarce. However, face masks are widely used by health workers as part of droplet precautions when caring for patients with respiratory infections. It would therefore be reasonable to suggest that consistent widespread use of face masks ... Read more >>

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Current Challenges in the Management of Sepsis in ICUs in Resource-Poor Settings and Suggestions for the Future

Marcus J. Schultz, Martin W. Dünser, Arjen M. Dondorp, Neill K. J. Adhikari, Shivakumar Iyer, Arthur Kwizera, Yoel Lubell, Alfred Papali, Luigi Pisani, Elisabeth D. Riviello, Derek C. Angus, Luciano C. Azevedo, Timothy Baker, Janet V. Diaz, Emir Festic, Rashan Haniffa, Randeep Jawa, Shevin T. Jacob, Niranjan Kissoon, Rakesh Lodha, Ignacio Martin-Loeches, Ganbold Lundeg, David Misango, Mervyn Mer, Sanjib Mohanty, Srinivas Murthy, Ndidiamaka Musa, Jane Nakibuuka, Ary Serpa Neto, NT Hoang Mai, Binh Nguyen Thien, Rajyabardhan Pattnaik, Jason Phua, Jacobus Preller, Pedro Povoa, Suchitra Ranjit, Daniel Talmor, Jonarthan Thevanayagam, C. Louise Thwaites,

Sepsis is a major cause of critical illness worldwide, especially in resource-poor settings. Intensive care units (ICUs) in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. The aim of this review is to describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics, ... Read more >>

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Infection Management in Patients with Sepsis and Septic Shock in Resource-Limited Settings

C. Louise Thwaites, Ganbold Lundeg, Arjen M. Dondorp, Neill K. J. Adhikari, Jane Nakibuuka, Randeep Jawa, Mervyn Mer, Srinivas Murthy, Marcus J. Schultz, Binh Nguyen Thien, Arthur Kwizera,

Recommendations on the management of infections in patients with sepsis and septic shock are mainly derived from studies on bacterial sepsis in high-income settings and are not necessarily applicable elsewhere due to differences in etiology and diagnostic or treatment capacity. In this chapter, we provide recommendations on infection management in ... Read more >>

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Recognition of Sepsis in Resource-Limited Settings

Arthur Kwizera, Neill K. J. Adhikari, Derek C. Angus, Arjen M. Dondorp, Martin W. Dünser, Emir Festic, Rashan Haniffa, Niranjan Kissoon, Ignacio Martin-Loeches, Ganbold Lundeg,

In this chapter, we summarize recommendations on sepsis recognition, identification of the underlying infection and causative microbiological pathogen, as well as recognition of septic shock in resource-limited settings. Early recognition of sepsis is based on the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA): respiratory rate ≥22 bpm, systolic blood pressure ... Read more >>

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Core Elements of General Supportive Care for Patients with Sepsis and Septic Shock in Resource-Limited Settings

Mervyn Mer, Marcus J. Schultz, Neill K. J. Adhikari, Arthur Kwizera, Sanjib Mohanty, Arjen M. Dondorp, Ary Serpa Neto, Jacobus Preller,

In this chapter, we outline important elements for the general supportive care for patients with sepsis in resource-limited settings. We discuss the use of corticosteroids, sedation, neuromuscular blocking agents, deep venous thrombosis (DVT) prophylaxis, gastric ulcer prevention, glucose control, enteral feeding, renal replacement therapy, and initial fluid resuscitation. Low-dose corticosteroids ... Read more >>

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The inability to walk unassisted at hospital admission as a valuable triage tool to predict hospital mortality in Rwandese patients with suspected infection.

Arthur Kwizera, Olivier Urayeneza, Pierre Mujyarugamba, Jens Meier, Andrew J Patterson, Lori Harmon, Joseph C Farmer, Martin W Dünser, ,

OBJECTIVE:To assess the value of the inability to walk unassisted to predict hospital mortality in patients with suspected infection in a resource-limited setting. METHODS:This is a post hoc study of a prospective trial performed in rural Rwanda. Patients hospitalized because of a suspected acute infection and who were able to ... Read more >>

PLoS One (PloS one)
[2020, 15(2):e0228966]

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Intra-operative low-dose ketamine does not reduce the cost of post-operative pain management after surgery: a randomized controlled trial in a low-income country.

Luca Ragazzoni, Arthur Kwizera, Marta Caviglia, Moran Bodas, Jeffrey Michael Franc, Hannington Ssemmanda, Alba Ripoll-Gallardo, Francesco Della-Corte, Annet Alenyo-Ngabirano,

Background:In developing countries, post-operative pain remains underestimated and undertreated due to economic constraints, lack of awareness and limited resources. In contrast, ketamine is an effective, readily available, easy to use and inexpensive drug frequently used in poor settings. Objectives:The aim of this study was to explore the overall reduction in ... Read more >>

Afr Health Sci (African health sciences)
[2019, 19(4):3127-3135]

Cited: 1 time

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Assessment of the current capacity of intensive care units in Uganda; A descriptive study.

Patience Atumanya, Cornelius Sendagire, Agnes Wabule, John Mukisa, Lameck Ssemogerere, Arthur Kwizera, Peter K Agaba,

<h4>Purpose</h4>To describe the organizational characteristics of functional ICUs in Uganda.<h4>Methods</h4>A descriptive survey of 12 ICUs in Uganda; ICU organisation, structure, staffing, and support facilities. A functional ICU was defined as one that admitted critically ill patients and had the ability to provide mechanical ventilation. ICUs were selected based on information ... Read more >>

J Crit Care (Journal of critical care)
[2020, 55:95-99]

Cited: 8 times

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Hand Colonization with Gram-Negative Organisms of Healthcare Workers Accessing the Cardiac Intensive Care Unit: A Cross-Sectional Study at the Uganda Heart Institute.

Lameck Ssemogerere, Cornelius Sendagire, Ceaser Mbabazi, Yvonne Namungoma, Anna Noland Oketayot, Judith Namuyonga, Cephas Mijumbi, Ritah Nkwine, Moses Othin, Michael Oketcho, John Paul Magala, Peter Lwabi, Arthur Kwizera, Martin W Dünser, Christine Florence Najjuka,

Background:Hands of healthcare workers (HCWs) are vehicles for pathogens responsible for healthcare-associated infections (HAIs). Following the identification of Gram-negative organisms (GNOs) in all cases of HAIs in the cardiac intensive care unit (ICU), we sought to determine the burden of hand colonization with GNOs among healthcare workers who access the ... Read more >>

Crit Care Res Pract (Critical care research and practice)
[2019, 2019:6081954]

Cited: 1 time

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A Machine Learning-Based Triage Tool for Children With Acute Infection in a Low Resource Setting.

Arthur Kwizera, Niranjan Kissoon, Ndidiamaka Musa, Olivier Urayeneza, Pierre Mujyarugamba, Andrew J Patterson, Lori Harmon, Joseph C Farmer, Martin W Dünser, Jens Meier, ,

OBJECTIVES:To deploy machine learning tools (random forests) to develop a model that reliably predicts hospital mortality in children with acute infections residing in low- and middle-income countries, using age and other variables collected at hospital admission. DESIGN:Post hoc analysis of a single-center, prospective, before-and-after feasibility trial. SETTING:Rural district hospital in ... Read more >>

Pediatr Crit Care Med (Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies)
[2019, 20(12):e524-e530]

Cited: 2 times

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Association between CD4 T cell counts and the immune status among adult critically ill HIV-negative patients in intensive care units in Uganda

Arthur Kavuma Mwanje, Joseph Ejoku, Lameck Ssemogerere, Clare Lubulwa, Christine Namata, Arthur Kwizera, Agnes Wabule, Erasmus Okello, Samuel Kizito, Aggrey Lubikire, Cornelius Sendagire, Irene Andia Biraro,

Background : Cluster of differentiation 4 (CD4) T cells play a central role in regulation of adaptive T cell-mediated immune responses. Low CD4 T cell counts are not routinely reported as a marker of immune deficiency among HIV-negative individuals, as is the norm among their HIV positive counterparts. Despite evidence ... Read more >>

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Association between CD4 T cell counts and the immune status among adult critically ill HIV-negative patients in intensive care units in Uganda.

Arthur Kavuma Mwanje, Joseph Ejoku, Lameck Ssemogerere, Clare Lubulwa, Christine Namata, Arthur Kwizera, Agnes Wabule, Erasmus Okello, Samuel Kizito, Aggrey Lubikire, Cornelius Sendagire, Irene Andia Biraro,

<b>Background</b>: Cluster of differentiation 4 (CD4) T cells play a central role in regulation of adaptive T cell-mediated immune responses. Low CD4 T cell counts are not routinely reported as a marker of immune deficiency among HIV-negative individuals, as is the norm among their HIV positive counterparts. Despite evidence of ... Read more >>

AAS Open Res (AAS open research)
[2019, 2:2]

Cited: 1 time

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World Health Organization Surgical Safety Checklist: Compliance and Associated Surgical Outcomes in Uganda's Referral Hospitals.

Elizabeth N Igaga, Cornelius Sendagire, Samuel Kizito, Daniel Obua, Arthur Kwizera,

<h4>Background</h4>A pilot study on the World Health Organization (WHO) Surgical Safety Checklist (SSC) showed a reduction in both major complications and mortality of surgical patients. Compliance with this checklist varies around the world. We aimed to determine the extent of compliance with the WHO SSC and its association with surgical ... Read more >>

Anesth Analg (Anesthesia and analgesia)
[2018, 127(6):1427-1433]

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Increasing Evidence-Based Interventions in Patients with Acute Infections in a Resource-Limited Setting: A Before-and-After Feasibility Trial in Gitwe, Rwanda.

Olivier Urayeneza, Pierre Mujyarugamba, Zacharie Rukemba, Vincent Nyiringabo, Polyphile Ntihinyurwa, John I Baelani, Arthur Kwizera, Danstan Bagenda, Mervyn Mer, Ndidiamaka Musa, Julia T Hoffman, Ashok Mudgapalli, Austin M Porter, Niranjan Kissoon, Hanno Ulmer, Lori A Harmon, Joseph C Farmer, Martin W Dünser, Andrew J Patterson, ,

<h4>Objective</h4>To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections.<h4>Design</h4>Single-center, prospective, before-and-after feasibility trial.<h4>Setting</h4>Emergency department of a sub-Saharan African district hospital.<h4>Patients</h4>Patients > 28 days of life admitted to the study hospital for an acute infection.<h4>Interventions</h4>The ... Read more >>

Crit Care Med (Critical care medicine)
[2018, 46(8):1357-1366]

Cited: 2 times

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