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Critical care sepsis

Ewa A Woźnica, Małgorzata Inglot, Ryszard K Woźnica, Lidia Łysenko
Despite continuous progress in medicine, sepsis remains the main cause of deaths in the intensive care unit. Liver failure complicating sepsis/septic shock has a significant impact on mortality in this group of patients. The pathophysiology of sepsis-associated liver dysfunction is very complicated and still not well understood. According to the Surviving Sepsis Campaign (SSC) Guidelines, the diagnosis of liver dysfunction during sepsis is based on the increase in bilirubin concentration >2 mg/dL and the occurrence of coagulation disorders with INR > 1...
March 20, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Jennifer Rickard, Christian Ngarambe, Leonard Ndayizeye, Blair Smart, Robert Riviello, Jean Paul Majyambere
BACKGROUND: Management of critically ill patients is challenging in a low-resource setting. In Rwanda, peritonitis is a common surgical condition where patients often present late, with advanced disease. We aim to describe critical care management of patients with peritonitis in Rwanda. METHODS: Data were collected at a tertiary referral hospital in Rwanda on patients undergoing operation for peritonitis over a 6-month period. Data included epidemiology, hospital course and outcomes...
March 19, 2018: World Journal of Surgery
Adrien Koeltz, Stephane Lastere, Sylvain Jean-Baptiste
During the 2014-2015 chikungunya outbreak in French Polynesia, 64 patients with confirmed chikungunya virus infection were admitted into intensive care. Sixty-three were nonpregnant adults; 11 had an atypical form, 21 had severe sepsis or septic shock, and 18 died. These findings indicate that critical illness frequently complicates the course of chikungunya virus infection.
April 2018: Emerging Infectious Diseases
Eashaa Kumar, Michael T McCurdy, Christian A Koch, Abdurrahman Hamadah, Tibor Fülöp, Kamel A Gharaibeh
Unexplained hypotension in the intensive care unit is commonly attributed to volume depletion, cardiorespiratory failure, sepsis, or relative adrenal insufficiency. In these acute conditions, thyroid hormone levels measured in blood, serum or plasma are often altered and solely attributed to critical illness. We report a series of 3 critically ill patients with prolonged respiratory failure, suppressed mental status and unexplained hypotension. Thyroid stimulating hormone levels ranged from normal to mildly elevated (2...
March 2018: American Journal of the Medical Sciences
Alice G Vassiliou, Anastasia Kotanidou, Zafeiria Mastora, Carlo Tascini, Gianluigi Cardinali, Stylianos E Orfanos
INTRODUCTION: A soluble (s) form of the endothelial protein C receptor (EPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in the septic process is under investigation. This study determined the frequencies of EPCR haplotypes H1 and H3 to investigate possible associations with plasma admission levels of sEPCR in an intensive care unit (ICU) cohort of septic patients. METHODS: Three polymorphisms in the EPCR gene were genotyped in 239 Caucasian critically ill patients, and their plasma sEPCR levels were also measured at the time of admission to the ICU...
March 2018: Infectious Diseases and Therapy
Shannon M Fernando, Douglas P Barnaby, Christophe L Herry, E John Gallagher, Nathan I Shapiro, Andrew J E Seely
BACKGROUND: Early emergency department (ED) identification of septic patients at risk of deterioration is critical. Lactate is associated with 28-day mortality in admitted patients, but little evidence exists on its use in predicting short-term deterioration. OBJECTIVE: Our aim was to determine the role of initial serum lactate for prediction of short-term deterioration in stable ED patients with suspected sepsis. METHODS: We conducted a prospective cohort study of adult ED sepsis patients...
March 13, 2018: Journal of Emergency Medicine
Florian Lamping, Thomas Jack, Nicole Rübsamen, Michael Sasse, Philipp Beerbaum, Rafael T Mikolajczyk, Martin Boehne, André Karch
BACKGROUND: Since early antimicrobial therapy is mandatory in septic patients, immediate diagnosis and distinction from non-infectious SIRS is essential but hampered by the similarity of symptoms between both entities. We aimed to develop a diagnostic model for differentiation of sepsis and non-infectious SIRS in critically ill children based on routinely available parameters (baseline characteristics, clinical/laboratory parameters, technical/medical support). METHODS: This is a secondary analysis of a randomized controlled trial conducted at a German tertiary-care pediatric intensive care unit (PICU)...
March 15, 2018: BMC Pediatrics
Maureen Campion, Gail Scully
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections...
January 1, 2018: Journal of Intensive Care Medicine
Katherine Murphy, Tim Cooksley, Phil Haji-Michael
Background: There has been a significant increase in the number of patients presenting with cancer related emergencies and potentially requiring critical care admission. Aim: To analyse the short and long term outcomes of patients with solid tumours requiring unplanned medical admission to a specialist cancer intensive care unit (ICU). Design: An unplanned cohort study. Methods: A retrospective analysis of patients admitted to a United Kingdom specialist tertiary oncology CCU between September 2009 and September 2015...
March 9, 2018: QJM: Monthly Journal of the Association of Physicians
Jouha Min, Maria Nothing, Ben Coble, Hui Zheng, Jongmin Park, Hyungsoon Im, Georg F Weber, Cesar M Castro, Filip K Swirski, Ralph Weissleder, Hakho Lee
Sepsis is an often fatal condition that arises when the immune response to an infection causes widespread systemic organ injury. A critical unmet need in combating sepsis is the lack of accurate early biomarkers that produce actionable results in busy clinical settings. Here, we report the development of a point-of-care platform for rapid sepsis detection. Termed IBS (integrated biosensor for sepsis), our approach leverages i) the newly-found pathophysiological role of cytokine interleukin-3 (IL-3) in early sepsis, and ii) a hybrid magneto-electrochemical sensor for IL-3 detection...
March 13, 2018: ACS Nano
Tuna Demirdal, Pinar Sen, Salih Atakan Nemli
Background and Aims: Several biomarkers are used in the diagnosis of bacteremia. Procalcitonin (PCT) is more specific than other biomarkers in differentiating bacterial and nonbacterial inflammation. It was aimed to evaluate the diagnostic and prognostic value of PCT in bacteremic patients in Intensive Care Unit (ICU). Materials and Methods: A total of 156 patients diagnosed with noninfectious systemic inflammatory response syndrome, sepsis, and severe sepsis/septic shock in ICU between December 2014 and July 2015 were evaluated in this prospective cohort study...
February 2018: Indian Journal of Critical Care Medicine
Christopher J Miller, Bruce A Doepker, Andrew N Springer, Matthew C Exline, Gary Phillips, Claire V Murphy
BACKGROUND: Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock. METHODS: A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed...
January 1, 2018: Journal of Intensive Care Medicine
John Rene Labib, Sally Kamal Ibrahem, Hala Mohamed Sleem, Mohamed M Ismail, Shaimaa A M Abd El Fatah, Marwa Rashad Salem, Amaal A Abdelaal, Hadeel Al-Hanafi
Early identification of acute lung injury (ALI) in pediatric patients at risk of mortality is important for improving outcome.Assessment of soluble form of receptor for advanced glycation end products (sRAGE) as a valid biomarker for diagnosis of ALI among critically ill, pediatric patients in addition to correlating levels of sRAGE and different outcomes of those patients.A Hospital-based case-control study was conducted in pediatric intensive care units (PICUs) at Cairo University Hospital, along a period of 6 months...
March 2018: Medicine (Baltimore)
Timothy D Girard, Jennifer L Thompson, Pratik P Pandharipande, Nathan E Brummel, James C Jackson, Mayur B Patel, Christopher G Hughes, Rameela Chandrasekhar, Brenda T Pun, Leanne M Boehm, Mark R Elstad, Richard B Goodman, Gordon R Bernard, Robert S Dittus, E W Ely
BACKGROUND: Delirium during critical illness results from numerous insults, which might be interconnected and yet individually contribute to long-term cognitive impairment. We sought to describe the prevalence and duration of clinical phenotypes of delirium (ie, phenotypes defined by clinical risk factors) and to understand associations between these clinical phenotypes and severity of subsequent long-term cognitive impairment. METHODS: In this multicentre, prospective cohort study, we included adult (≥18 years) medical or surgical ICU patients with respiratory failure, shock, or both as part of two parallel studies: the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors (BRAIN-ICU) study, and the Delirium and Dementia in Veterans Surviving ICU Care (MIND-ICU) study...
March 2018: Lancet Respiratory Medicine
Lvlin Chen, Tiangui Li, Fang Fang, Yu Zhang, Andrew Faramand
BACKGROUND: Hyperglycemia is prevalent in patients in the pediatric intensive care unit. The purpose of this study was to describe the benefits and risks of tight glucose control (TGC) in critically ill children. METHODS: A systemic review and meta-analysis of the literature was carried out on randomized controlled trials of TGC in critically ill children admitted to the pediatric intensive care unit. The databases searched were Medline, Embase, and CENTRAL databases until May 1, 2017...
March 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
Chun Cao, Tao Gao, Yan Cheng, Minhua Cheng, Ting Su, Fengchan Xi, Cuili Wu, Wenkui Yu
Hypercatabolism plays a critical role in the pathogenesis of post-critical care debility in critical patients. Central nervous system may exerte a critical role in the regulation of hypercatabolism. However, little is known about the exact mechanisms of the central role. Here, we reported that actived hypothalamic AMP-activated protein kinase (AMPK)-induced autophagy modulated the expression of POMC to ameliorate hypercatabolism in septic rats. Firstly, rats were i.c.v. injected with the lentiviral vector containing shRNA against POMC...
February 26, 2018: Biochemical and Biophysical Research Communications
Silvia Forni, Giulio Toccafondi, Bruno Viaggi, Maddalena Grazzini, Sara D'Arienzo, Fabrizio Gemmi, Andrea Vannucci, Giorgio Tulli
Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorganisms. Antimicrobial stewardship (AS) is a coordinated intervention designed to improve the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen, dose, duration of therapy and route of administration. AS programs have proved effective in reducing antimicrobial resistance, inappropriate antimicrobial use and in improving patient outcomes. Recently developed rapid diagnostic technologies in microbiology (RDTM) allows a faster and etiological diagnosis of infection and a reduction in the use of unnecessary empirical therapies...
February 2018: Recenti Progressi in Medicina
F J Kranenburg, S A Willems, S Le Cessie, P J Marang-van de Mheen, J G van der Bom, M S Arbous
BACKGROUND AND OBJECTIVES: Most guidelines recommend a restrictive transfusion trigger of 7 g/dl. It is unclear whether this resulted in more uniform transfusion practices. The primary objective was to uncover the extent of variation in transfusion decisions within four scenarios of critically ill patients among critical care physicians in the Netherlands. MATERIALS AND METHODS: An online survey comprising four different hypothetical clinical scenarios was sent to all members of the Dutch Society of Intensive Care...
February 23, 2018: Vox Sanguinis
Laura S Peterson, Cecilia Gállego Suárez, Hannah E Segaloff, Cameron Griffin, Emily T Martin, Folafoluwa O Odetola, Kanakadurga Singer
OBJECTIVE: To evaluate the effect of overweight and obesity on outcomes and resource use among patients with sepsis in the pediatric intensive care unit (PICU). DESIGN: Retrospective analysis of clinical characteristics, resource use, and mortality among children 0 to 20 years of age admitted to the C.S. MottChildren's Hospital PICU (University of Michigan) between January 2009 and December 2015, with a diagnostic code for sepsis at admission (based on International Classification of Diseases, Ninth Revision- Clinical Modification codes) and with weight and height measurements at PICU admission...
January 1, 2018: Journal of Intensive Care Medicine
Heitor Pons Leite, Lúcio Flávio Peixoto de Lima, José Augusto de A C Taddei, Ângela Tavares Paes
OBJECTIVE: To test the hypothesis that low blood thiamine concentrations in malnourished critically ill children are associated with higher risk of 30-d mortality. METHODS: Prospective cohort study in 202 consecutively admitted children who had whole blood thiamine concentrations assessed on admission and on days 5 and 10 of intensive care unit (ICU) stay. The primary outcome variable was 30-d mortality. Mean blood thiamine concentrations within the first 10 d of ICU stay, age, sex, malnutrition, C-reactive protein concentration, Pediatric Index of Mortality 2 score, and severe sepsis/septic shock were the main potential exposure variables for outcome...
April 2018: Nutrition
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