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Septic shock

Johan Mårtensson, Anthony C Gordon
No abstract text is available yet for this article.
July 13, 2018: Intensive Care Medicine
Yu Wang, Changsong Shi, Zhongwen Yang, Fengmin Chen, Li Gao
PURPOSE: Low vitamin D blood levels are related to many clinical outcomes in children with critically illness. However, the relationship of it and septic shock has not been systematically analyzed. The objective of this review was to evaluate the effect of vitamin D on septic shock and predict if vitamin D administration can improve prognosis of it. MATERIALS AND METHODS: Online databases were searched up to June 1st, 2017 for studies on the relation of vitamin D deficiency (VDD) and clinical outcomes on septic shock in children with critical illness...
July 13, 2018: European Journal of Clinical Nutrition
José Santiago Ibañez-Cabellos, Carmen Aguado, Daniel Pérez-Cremades, José Luis García-Giménez, Carlos Bueno-Betí, Eva M García-López, Carlos Romá-Mateo, Susana Novella, Carlos Hermenegildo, Federico V Pallardó
Circulating histones have been proposed as targets for therapy in sepsis and hyperinflammatory symptoms. However, the proposed strategies have failed in clinical trials. Although different mechanisms for histone-related cytotoxicity are being explored, those mediated by circulating histones are not fully understood. Extracellular histones induce endothelial cell death, thereby contributing to the pathogenesis of complex diseases such as sepsis and septic shock. Therefore, the comprehension of cellular responses triggered by histones is capital to design effective therapeutic strategies...
July 10, 2018: Biochimica et Biophysica Acta
Paul E Marik
Glucocorticoids have been used as adjunctive therapy in patients with sepsis and septic shock for more than four decades. The rationale for the use of glucocorticoids is that this class of drugs downregulates the proinflammatory response and limits the anti-inflammatory response while preserving innate immunity. Between 1976 and 2017, 22 randomised placebo-controlled trials have been published evaluating the benefit of glucocorticoids in patients with community-acquired pneumonia, sepsis, and septic shock. These studies produced conflicting results...
July 10, 2018: Lancet Respiratory Medicine
Heather Peluso, Marwan S Abougergi, Julie Caffrey
OBJECTIVE: To study the relationship between insurance provider and important outcomes among patients with burn injury. METHODS: Adults with burn injury were selected from the National Inpatient Sample. The primary outcome was inpatient mortality. Secondary outcomes were morbidity (septic shock and prolonged mechanical ventilation (PMV)), treatment metrics (time to surgery and parenteral or enteral nutrition (P/E-nutrition)) and resource utilization (length of stay (LOS) and total hospitalization costs and charges)...
July 11, 2018: Burns: Journal of the International Society for Burn Injuries
Maite Antonio, Carlota Gudiol, Cristina Royo-Cebrecos, Sara Grillo, Carmen Ardanuy, Jordi Carratalà
PURPOSE: To assess the etiology, clinical features and outcomes of bacteremia in older patients with solid tumors. METHODS: All episodes of bacteremia in hospitalized patients with solid tumors were prospectively collected. Patients aged ≥70 years were compared to patients aged <70 years. Risk factors for case-fatality rates in older patients were identified. RESULTS: We compared 217 episodes of bacteremia involving older patients and 525 occurring in younger patients...
July 10, 2018: Journal of Geriatric Oncology
Yuki Maruchi, Masanobu Tsuda, Hisatake Mori, Nobuyoshi Takenaka, Takayoshi Gocho, Muhammad A Huq, Naoshi Takeyama
BACKGROUND: Recent studies have suggested that excessive formation of neutrophil extracellular traps (NETs) plays a critical role in the pathogenesis of sepsis. Although elevation of the plasma level of cell-free DNA (cf-DNA) has been reported in sepsis patients, there has been little direct measurement of circulating free NETs such as myeloperoxidase-conjugated DNA (MPO-DNA). The objectives of this study were to detect NETs in the bloodstream of patients with septic shock, and to assess the correlations of circulating NET levels with organ dysfunction, disease severity, and mortality...
July 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
Matthias Kochanek, Boris Böll
Sepsis and septic shock are common diseases with high mortality rates. Although volume therapy has been a central component of sepsis therapy for decades, the choice of optimal fluid and fluid intake is unclear. This paper summarizes findings on pathophysiology, clinical trial results, and current recommendations for optimal volume and fluid management in sepsis.
July 2018: Deutsche Medizinische Wochenschrift
Tomoya Hirose, Hiroshi Ogura, Hiroki Takahashi, Masahiro Ojima, Kang Jinkoo, Youhei Nakamura, Takashi Kojima, Takeshi Shimazu
Background: C1 inhibitor (C1-INH), which belongs to the superfamily of serine protease inhibitors, regulates the complement system and also the plasma kallikrein-kinin, fibrinolytic, and coagulation systems. The biologic activities of C1-INH can be divided into the regulation of vascular permeability and anti-inflammatory functions. The objective of this study was to clarify the serial change of C1-INH in patients with sepsis and evaluate the relationship with the shock severity. Methods: This was a single-center, prospective, observational study...
2018: Journal of Intensive Care
Romain Jouffroy, Anastasia Saade, Jean Pierre Tourtier, Papa Gueye, Emmanuel Bloch-Laine, Patrick Ecollan, Pierre Carli, Benoît Vivien
OBJECTIVES: The early identification of septic shock patients at high risk of poor outcome is essential to early initiate optimal treatments and to decide on hospital admission. Biomarkers are often used to evaluate the severity. In prehospital settings, the availability of biomarkers, such as lactate, is restricted. In this context, clinical tools such as skin mottling score (SMS) and capillary refill time (CRT) are more suitable. In this study, we describe prehospital SMS and CRT's ability to predict mortality of patients with septic shock initially cared in the prehospital setting by a mobile intensive care unit...
July 6, 2018: American Journal of Emergency Medicine
Edward E Conway
Sepsis is the body's systemic response to infection and is a serious health care concern that affects neonatal, pediatric, and adult populations worldwide. Severe sepsis (sepsis that has progressed to cellular dysfunction and organ damage or evidence of hypoperfusion) and septic shock (sepsis with persistent hypotension despite adequate fluid resuscitation) are still associated with high mortality rates despite improvements in the management of infectious processes. The cellular processes that occur as a result of the inflammatory response in sepsis, including impaired perfusion and microcirculatory coagulation, can lead to organ system dysfunction...
July 1, 2018: Pediatric Annals
Jean-Philippe Auger, Dominic Dolbec, David Roy, Mariela Segura, Marcelo Gottschalk
Streptococcus suis serotype 2 is an important porcine bacterial pathogen and zoonotic agent responsible for sudden death, septic shock, and meningitis. However, serotype 2 strains are heterogeneous, composed of a multitude of sequence types (STs) whose distribution greatly varies worldwide. Of the virulence factors presently described for S. suis, the capsular polysaccharide (CPS) is a critical factor implicated in a multitude of functions, including in impairment of phagocytosis and innate immune cell activation by masking underlying bacterial components...
2018: PloS One
María Cecilia Yubini, Caterina Contreras, Gonzalo Díaz, María Alejandra Cerda, Dannette Guíñez, Nicole Rogers, Francisco Silva, Rodrigo Cornejo
Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress...
February 2018: Revista Médica de Chile
Daniel L Davenport, Walker R Ueland, Shyanie Kumar, Margaret Plymale, Andrew C Bernard, J Scott Roth
BACKGROUND: We compared 30-day outcomes in patients undergoing emergent open and laparoscopic repair of perforated peptic ulcers in a large multicenter cohort. METHODS: Prospectively obtained data in the American College of Surgeons National Surgical Quality Improvement Program public use files from 2010 to 2016 were reviewed. Perioperative risks and outcomes were compared in unmatched and propensity-matched groups using parametric/non-parametric statistical tests as appropriate...
July 11, 2018: Surgical Endoscopy
Ingo Schmidt
Background: A devasting course of Iliopsoas Muscle (IPM) abscess remains a challenging therapeutic problem. Methods: A 69-year-old polymorbid male had a history of multiple carcinomas and presented with advanced stage of septic shock due to a right IPM abscess which communicated with the right hip joint and subsequently led to septic hip arthritis accompanied with post-infectious right gluteal deep soft tissue necroses. Management of surgical treatment included abscess revision, coverage with the use of Long Head Biceps Femoris Muscle (LHBFM) 180° turnover flap, and creating a Girdlestone resection-arthroplasty...
2018: Open Orthopaedics Journal
Dominik J Kaczmarek, Jacob Nattermann, Christian P Strassburg, Tobias J Weismüller
INTRODUCTION: Pancreatic fluid collection (PFC) is a common complication of acute pancreatitis. Endoscopic ultrasound (EUS)-guided drainage, which is often followed by direct endoscopic necrosectomy (DEN), has become the primary approach to treat PFC, including pancreatic pseudocysts (PP) and walled-off necrosis (WON). We aimed to determine retrospectively the short- and long-term results of patients treated in our endoscopy unit and to identify parameters that are associated with treatment efficacy and outcome...
July 11, 2018: Zentralblatt Für Chirurgie
Wenjun Deng, Shan Zhu, Ling Zeng, Jiao Liu, Rui Kang, Minghua Yang, Lizhi Cao, Haichao Wang, Timothy R Billiar, Jianxin Jiang, Min Xie, Daolin Tang
Sepsis and septic shock are associated with life-threatening organ dysfunction caused by an impaired host response to infections. Although circadian clock disturbance impairs the early inflammatory response, its impact on post-septic immunosuppression remains poorly elucidated. Here, we show that Bmal1, a core circadian clock gene, plays a role in the regulation of host immune responses in experimental sepsis. Mechanistically, Bmal1 deficiency in macrophages increases PKM2 expression and lactate production, which is required for expression of the immune checkpoint protein PD-L1 in a STAT1-dependent manner...
July 10, 2018: Cell Reports
Peng Lan, Shuo-Jia Wang, Qiu-Cheng Shi, Ying Fu, Qing-Ye Xu, Tao Chen, Yun-Xian Yu, Kong-Han Pan, Ling Lin, Jian-Cang Zhou, Yun-Song Yu
Cirrhotic patients with infection are prone to develop sepsis or even septic shock rendering poorer prognosis. However, few methods are available to predict the prognosis of cirrhotic patients with infection although there are some scoring systems can be used to predict general patients with cirrhosis. Therefore, we aimed to explore the predictive value of scoring systems in determining the outcome of critically ill cirrhotic patients with suspected infection.This was a retrospective cohort study based on a single-center database...
July 2018: Medicine (Baltimore)
Gwenola Allain-Jeannic, Nicolas Traversier, Olivier Belmonte, Dorothée Valance, Sarah Bekkar, Nicolas Allou, Jerome Allyn
RATIONALE: Very few cases of secondary peritonitis caused by Streptococcus pneumoniae have been described in the literature, and they have been found to occur mostly in patients with predisposing factors. Here, we report the case of an elderly patient who developed pneumococcal peritonitis secondary to perforation of gastroduodenal ulcer. PATIENT CONCERNS: An 82-year-old man was admitted to intensive care unit (ICU) for septic shock with cardiac impairment 1 day after arriving in the Emergency Department...
July 2018: Medicine (Baltimore)
Igor Alexandre Côrtes Menezes, Cláudio Leinig Pereira da Cunha, Hipólito Carraro Júnior, Alain Marcio Luy
OBJECTIVE: Microcirculation disturbances are implicated in the prognosis of septic shock. Microvascular hyporesponsiveness can be assessed by an oximetry-derived perfusion index and reactive hyperemia. Using this perfusion index, we investigated reactive hyperemia and its relationship with peripheral perfusion and clinical-hemodynamic parameters in septic shock. METHODS: Eighty-two patients were evaluated: 47 with septic shock and 35 controls. Tests were performed within 24 hours after admission...
April 2018: Revista Brasileira de Terapia Intensiva
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