Name: assessment of dependence in activities of daily living among older patients in an acute care unit
Uploaded: 2020-09-30T13:00:00
Description: Watch this Scientific Journal Video about Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit at JoVE.com

波尔多大学和波尔多大学医院支持这一出版物。

该议定书已获波尔多大学医院人类研究伦理委员会批准。
注意：本节中描述的协议涉及使用 Katz ADL 评估 ADL 依赖性。评估的六项活动于上文第十八条所述。Katz ADL 在波尔多大学医院接受和出院时，所有 75 岁患者，即所有急性老年医学病房的患者进行住院治疗。老年病住院病人的患有多种合并症，建议工作人员评估所有此类患者。从理论上讲，Katz ADL 可以给?...

<ol>
	<li>Jin, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiovascular+Health+Is+Associated+With+Disability+Among+Older+Community+Dwelling+Men+and+Women.">Cardiovascular Health Is Associated With Disability Among Older Community Dwelling Men and Women.</a> Journal of Aging and Health. 31 (8), 1339-1352 (2019).</li><li>Mograbi, D. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+dementia,+depression+and+awareness+on+activities+of+daily+living+in+a+sample+from+a+middle-income+country.">The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country.</a> Int J Geriatr Psychiatry. 33 (6), 807-813 (2018).</li><li>Sauvaget, C., Yamada, M., Fujiwara, S., Sasaki, H., Mimori, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dementia+as+a+predictor+of+functional+disability:+a+four-year+follow-up+study.">Dementia as a predictor of functional disability: a four-year follow-up study.</a> Gerontology. 48 (4), 226-233 (2002).</li><li>Jacobs, J. M., Hammerman-Rozenberg, R., Maaravi, Y., Cohen, A., Stessman, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+visual+impairment+on+health,+function+and+mortality.">The impact of visual impairment on health, function and mortality.</a> Aging Clinical and Experimental Research. 17 (4), 281-286 (2005).</li><li>Lyu, W., Wolinsky, F. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Onset+of+ADL+Difficulties+and+Changes+in+Health-Related+Quality+of+Life.">The Onset of ADL Difficulties and Changes in Health-Related Quality of Life.</a> Health and Quality of Life Outcomes. 15 (1), 217 (2017).</li><li>Keeler, E., Guralnik, J. M., Tian, H., Wallace, R. B., Reuben, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+functional+status+on+life+expectancy+in+older+persons.">The impact of functional status on life expectancy in older persons.</a> The Journals of Gerontology Series A Biological Sciences and Medical Sciences. 65 (7), 727-733 (2010).</li><li>van Lier, L. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictors+of+Societal+Costs+of+Older+Care-Dependent+Adults+Living+in+the+Community+in+11+European+Countries.">Predictors of Societal Costs of Older Care-Dependent Adults Living in the Community in 11 European Countries.</a> Health Services Insights. 12, 1178632918820947 (2019).</li><li>Gill, T. M., Allore, H. G., Gahbauer, E. A., Murphy, T. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Change+in+disability+after+hospitalization+or+restricted+activity+in+older+persons.">Change in disability after hospitalization or restricted activity in older persons.</a> JAMA. 304 (17), 1919-1928 (2010).</li><li>Chodos, A. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hospitalization-Associated+Disability+in+Adults+Admitted+to+a+Safety-Net+Hospital.">Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital.</a> Journal of General Internal Medicine. 30 (12), 1765-1772 (2015).</li><li>Gill, T. M., Gahbauer, E. A., Han, L., Allore, H. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+intervening+hospital+admissions+on+trajectories+of+disability+in+the+last+year+of+life:+prospective+cohort+study+of+older+people.">The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people.</a> BMJ. 350, 2361 (2015).</li><li>Boyd, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recovery+of+activities+of+daily+living+in+older+adults+after+hospitalization+for+acute+medical+illness.">Recovery of activities of daily living in older adults after hospitalization for acute medical illness.</a> Journal of the American Geriatrics Society. 56 (12), 2171-2179 (2008).</li><li>Blanc-Bisson, C., Dechamps, A., Gouspillou, G., Dehail, P., Bourdel-Marchasson, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomized+controlled+trial+on+early+physiotherapy+intervention+versus+usual+care+in+acute+care+unit+for+elderly:+potential+benefits+in+light+of+dietary+intakes.">A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes.</a> The journal of nutrition, health &amp; aging. 12 (6), 395-399 (2008).</li><li>Martinez-Velilla, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Exercise+Intervention+on+Functional+Decline+in+Very+Elderly+Patients+During+Acute+Hospitalization:+A+Randomized+Clinical+Trial.">Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial.</a> JAMA Internal Medicine. 179 (1), 28-36 (2019).</li><li>Bourdel-Marchasson, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Muscle+phosphocreatine+post-exercise+recovery+rate+is+related+to+functional+evaluation+in+hospitalized+and+community-living+older+people.">Muscle phosphocreatine post-exercise recovery rate is related to functional evaluation in hospitalized and community-living older people.</a> The journal of nutrition, health &amp; aging. 11 (3), 215-221 (2007).</li><li>Katz, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+self-maintenance:+activities+of+daily+living,+mobility,+and+instrumental+activities+of+daily+living.">Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living.</a> Journal of the American Geriatrics Society. 31 (12), 721-727 (1983).</li><li>Katz, S., Downs, T. D., Cash, H. R., Grotz, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Progress+in+development+of+the+index+of+ADL.">Progress in development of the index of ADL.</a> Gerontologist. 10 (1), 20-30 (1970).</li><li>Ciesla, J. R., Shi, L., Stoskopf, C. H., Samuels, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+Katz's+Activities+of+Daily+Living+Scale+when+used+in+telephone+interviews.">Reliability of Katz's Activities of Daily Living Scale when used in telephone interviews.</a> Evaluation &amp; the Health Professions. 16 (2), 190-203 (1993).</li><li>Carvalho, T., Polachinido Valle, A., Ferrari Jacinto, A., Ferreira de S&#225; Mayoral, V., Fortes Villas Boas, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+hospitalization+on+the+functional+capacity+of+the+elderly:+A+cohort+study.">Impact of hospitalization on the functional capacity of the elderly: A cohort study.</a> Revista Brasileira de Geriatria e Gerontologia. 21, 134-142 (2018).</li><li>Mahoney, F. I., Barthel, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+Evaluation:+The+Barthel+Index.">Functional Evaluation: The Barthel Index.</a> Maryland Medicine Journal. 14, 61-65 (1965).</li><li>Peres, K., Verret, C., Alioum, A., Barberger-Gateau, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+disablement+process:+factors+associated+with+progression+of+disability+and+recovery+in+French+elderly+people.">The disablement process: factors associated with progression of disability and recovery in French elderly people.</a> Disability and Rehabilitation. 27 (5), 263-276 (2005).</li><li>Lawton, M. P., Brody, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+older+people:+self-maintaining+and+instrumental+activities+of+daily+living.">Assessment of older people: self-maintaining and instrumental activities of daily living.</a> Gerontologist. 9 (3), 179-186 (1969).</li><li>Barberger-Gateau, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Health+measures+correlates+in+a+French+elderly+community+population:+the+PAQUID+study.">Health measures correlates in a French elderly community population: the PAQUID study.</a> Journal of Gerontology. 47 (2), 88-95 (1992).</li></ol>

该协议并非适合所有情况 我们的协议是为因急性医疗问题住院的患者设计的。然而，其他工具，如巴特尔指数，应该用于康复中心。原始 Katz ADL 秤仅以 7 分刻度（0+6 的分数）对功能能力进行评分;因此，功能依赖的细微波动可能会被忽视。巴特尔指数通常与Katz ADL相当，它产生加权和汇总分数。Barthel 指数还评估了 Katz ADL 量表中包含的六项活动，但存在以下几个差异：肠和膀胱控?...

医疗问题可能导致老年人失去功能独立性，使他们在没有他人帮助的情况下无法开展日常生活活动。这种独立性的丧失，往往由心血管合并症1、认知障碍,2、3和2视力障碍4导致，影响患者生活质量5和预期寿命6，并增加医疗成本7。功能独立性可能逐渐恶化，或完全丧失，更严重的合并症（认知障碍，心力衰竭等）。在急性医疗问题（如中风、心肌梗塞、下肢骨折或胸部感染）期间，它也可能会恶化。在70至80岁的病人中，约有30%和80岁以上的病人中，有60%在9至10岁住院期间，会丧失独立性。患者可以恢复在急性医疗问题之前所享有的功能独立性，或者尽管治疗得当，功能可能持续。
人们普遍认为，在急性医疗问题住院期间维持或恢复功能独立的治疗，如果尽快启动，是最有效的。住院期间的体育锻炼可改善中短期12、13,的功能。在住院人群中，ADL测量的评分与肌肉氧化能力和肌肉功能1有关。因此，在住院早期评估患者的功能独立性是一个优先事项;然后，此评估应与患者住院前的 ADL 独立性水平（基线）进行比较。医疗，特别是护理，旨在恢复任何丧失独立性或维持现有水平。这需要可靠和可重复的评估方法;为此目的最常用的衡量标准是日常生活活动中的卡茨独立性指数（Katz ADL）。
Katz ADL 于 1970 年开发，它允许评估患者独立执行基本 ADL 的能力15，,16。该秤衡量患者在六项活动中的独立性：洗澡、穿衣、上厕所、转移、节制和喂养。每个活动得分为 0 或 1，其中 0 的分数表示对另一个人的依赖，1 表示独立性。卡茨 ADL 总分 6 表示完全独立，4 分中等依赖，分数 2 或更少的严重依赖。
多年来，Katz ADL 在评估老年人功能状况方面已被证明是有用的。首先，Katz ADL 评估执行非常简单，涉及询问患者或家庭成员有关患者执行六项 ADL 活动的能力，或直接观察患者执行这些活动的能力 17。此外，在急性医疗问题期间，Katz ADL 指数对健康状况的主要变化（但对轻微变化）很敏感。因此，此工具是评估急性医疗问题对患者功能状态的影响的理想之选，无论其慢性疾病如何。
当在急性医疗问题的第一天开始康复时，有必要确定患者功能衰退的程度。为此，我们建议在住院前通过面谈评估每位患者的功能状态，并在住院后的第一天内通过观察评估执行ADL的能力。这两项评估可指导早期预防和康复措施，同时制定急性事件护理计划。这些措施促进功能独立性恢复的有效性可以通过反复的ADL评估来监测，直到放电。

<table>
	<tbody>
		<tr>
			<td>Clothing and underwear</td>
			<td>Any</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Hospital Bathroom with toilet</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Meal Tray</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Medical Bed</td>
			<td>Any</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Medical Chair</td>
			<td>Any</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Papers</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Pens</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Table Bed</td>
			<td>Any</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

assessment of dependence in activities of daily living among older patients in an acute care unit

在严重的医疗问题中，老年人可能会失去功能独立性。ADL 天平用于评估这种独立性损失。最简单、最方便的ADL量表是Katz指数，它测量了六个ADL：洗澡、穿衣、上厕所、转移、节制和喂食。ADL 分数较低表示功能独立性损失较大。急性医疗问题（基线）之前的ADL评分通过询问患者或护理人员进行估计，然后将该分数与入院时的分数进行比较。应从入院到出院对ADL评分进行监测，以便及早发现功能独立性的变化。在住院前和住院期间识别任何功能独立性损失，可向护理人员提供有关短期死亡风险和并发症的风险以及住院后预后的信息。

在这里，我们考虑两个完成协议后的示例案例：一个在放电时完全恢复 ADL 函数的基线级别，另一个在未恢复或部分恢复的情况下。
使用 ADL 函数的基线级别释放 在这组患者中，有两个 ADL 功能轨迹是可能的， 如图 1 所示：在整个住院期间保持 ADL 评分的患者（轨迹 A）和住院时得分低于基线的患者，但通过出院恢复其基线功能水平的患者...

Watch this Scientific Journal Video about Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit at JoVE.com

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

在严重的医疗问题期间，老年人可能会失去日常生活活动的独立性。对基线ADL和ADL入院的评估可以指导个性化的治疗计划，旨在预防诺索体依赖，并确保更好的功能结果。

急性护理科老年患者日常生活活动依赖性评价

During an acute medical problem, older people may lose functional independence. ADL scales are used to assess this loss of independence. The simplest and ...

我们的协议使得评估老年患者在急性医疗发作住院期间功能独立性的演变成为可能。ADL 分数可重现、易于使用，并可用于在早期阶段加入作为功能独立性的丧失，以便对康复护理计划进行调整。要评估洗澡，询问患者如何洗澡，以及是否需要有人帮助他们洗澡。如果是这样，询问他们身体的哪个部位需要帮助，并注意他们是独立还是依赖沐浴活动。询问患者是否可以单独穿衣服和脱衣服，以及是否可以毫无帮助地将衣服从壁橱中拿出来。然后询问他们是否需要帮助，穿上袜子或其他衣服和注意，他们是独立的还是依赖穿衣活动。询问患者是否在家无辅助的情况下上厕所，是否可以坐下来从马桶中站起来，根据需要安排衣服，并在没有帮助的情况下清洁生殖器区域。然后注意它们是独立的还是依赖的。要评估转移，询问患者是否可以在没有人工帮助的情况下从床到椅子、椅子移动到床上，并注意他们是独立的还是依赖转移的。然后询问患者是否完全自我控制排尿和排便，以及是否可以使用尿导管或尿布没有帮助。注意患者是独立还是依赖节制。最后，询问患者是否在没有帮助的情况下进食，以及他们是否能够切肉或打开酸奶容器的盖子，并注意他们是独立还是依赖喂养活动。然后确定 ADL 分数的所有活动的分数总和。在住院的第一天，给病人一个淋浴。如果他们觉得能够带一个，陪他们到浴室，并检查他们是否可以自己洗。如果患者觉得不能这样做，请提出在床上或盆中清洗。在观察患者是否可以单独呼吸或是否需要身体某些部位的指导或帮助后，请注意他们是独立还是依赖洗澡。在住院的第一天，建议病人穿好衣服，要求他们从衣橱里挑选衣服，然后穿上衣服。如果病人有困难，帮助他们穿好衣服。在晚上，遵循相同的程序，但适用于脱衣服。然后注意患者是独立还是依赖穿衣。在住院的最初几天，检查病人是否可以独自上厕所，坐在马桶上，从马桶里站起来，整理衣服，清洁生殖器区域。请注意患者是独立还是依赖上厕所。评估是否需要通孔或床板，并注意患者是独立还是依赖性。在住院的第一天，请患者从床到椅子，从椅子转移到床，提供机械转移辅助，并帮助他们进行必要的转移。注意患者是独立患者还是依赖者进行转接。在医院的第一餐中，观察患者是否可以单独食用，包括切肉和打开酸奶容器的盖子，如有必要，应提供帮助。注意患者是独立还是依赖饮食。然后求和所有活动的分数，以确定 ADL 分数。在这组具有有利ADL依赖轨迹的患者中，有两个ADL功能轨迹是可能的。在整个住院期间保持ADL评分的患者和住院时得分低于基线的患者，但通过出院恢复了其基线功能水平。当患者的基线ADL功能在出院后分别有83.8%或67%的机会维持一个月和一年时，患者就出院了。两组患者的死亡率为17.8%在这组患有不利ADL依赖性轨迹的患者中，确定了三种类型的病例。住院时保持基线独立性，但在住院期间出现恶化，但此后没有完全独立的患者、住院前失去基线独立性并在住院期间没有恢复基线独立性的患者，以及住院前和住院期间表现出独立性恶化且未完全恢复独立的患者。在ADL新残疾或额外残疾的患者中，33.5%在出院后第一个月内恢复了ADL功能的基线水平，30.1%的患者在出院后的第一年内恢复了对ADL功能的基线水平。这些患者的一年死亡率为41.3%。最重要的是要记住，为了使协议有效，住院期间必须定期注意分数。我们的协议允许我们确定那些应该按原样优先接受康复治疗的患者，以便尽快启动他们的计划。

Research

Education

JoVE Core

JoVE Journal

Nursing

Medicine

Unit 1

Introduction to Nursing

SCIENTISTS IN ACTION

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

过期的CO 2测量气管插管或自主呼吸的病人从急诊科

Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth ...

科研

医学

Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects

驾驶模拟诊所：测试视觉与视野缺损的患者在日常活动中的探索行为

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily ...

Collecting Saliva and Measuring Salivary Cortisol and Alpha-amylase in Frail Community Residing Older Adults via Family Caregivers

Salivary measures have emerged in bio-behavioral research  that are easy-to-collect, minimally invasive, and relatively inexpensive  biologic markers of ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

时空步态参数的患者和老年人的临床评估

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

老年人艾滋病感染者健身游戏平衡改善，流动性和可改善虚弱的几个问题

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is ...

A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers

一种使用加速度计量化上肢表现在日常生活的方法

A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. ...

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

应用 Pupillometry 和伤害性屈曲反射的可行性研究--通气 ICU 患者的客观伤害评估

The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and ...

Using a Chemical Biopsy for Graft Quality Assessment

使用化学活检进行移植质量评估

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated ...

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

重症监护病房型装置在猪模型急性呼吸窘迫综合征中的卤化剂递送

Acute respiratory distress syndrome (ARDS) is a common cause of hypoxemic respiratory failure and death in critically ill patients, and there is an urgent ...

A Reproducible Intensive Care Unit-Oriented Endotoxin Model in Rats

一种可重复的重症监护病房导向内毒素模型在大鼠中的应用

Sepsis and septic shock remain the leading cause of death in intensive care units. Despite significant improvements in sepsis management, mortality still ...