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Fluid therapy in shock

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https://www.readbyqxmd.com/read/29756704/cerebrospinal-fluid-shunt-associated-infections-in-pediatrics-analysis-of-the-epidemiology-and-mortality-risk-factors
#1
Soledad González, Mirta Carbonaro, Ana G Fedullo, María I Sormani, María Del C Ceinos, Roberto González, María T Rosanova
INTRODUCTION: Infections are the most common complications of ventricular cerebrospinal fluid shunts. The objective of this study was to describe the clinical, microbiological, and evolutionary characteristics of children with ventricular cerebrospinal fluid shunt-associated infections and analyze the risk factors for mortality. POPULATION AND METHODS: Descriptive, retrospective study carried out at Hospital "Prof. Dr. Juan P. Garrahan" in the Autonomous City of Buenos Aires...
June 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29753517/liberal-versus-restrictive-intravenous-fluid-therapy-for-early-septic-shock-rationale-for-a-randomized-trial
#2
Wesley H Self, Matthew W Semler, Rinaldo Bellomo, Samuel M Brown, Bennett P deBoisblanc, Matthew C Exline, Adit A Ginde, Colin K Grissom, David R Janz, Alan E Jones, Kathleen D Liu, Stephen P J Macdonald, Chadwick D Miller, Pauline K Park, Lora A Reineck, Todd W Rice, Jay S Steingrub, Daniel Talmor, Donald M Yealy, Ivor S Douglas, Nathan I Shapiro
Prompt intravenous fluid therapy is a fundamental treatment for patients with septic shock. However, the optimal approach for administering intravenous fluid in septic shock resuscitation is unknown. Two competing strategies are emerging: a liberal fluids approach, consisting of a larger volume of initial fluid (50 to 75 mL/kg [4 to 6 L in an 80-kg adult] during the first 6 hours) and later use of vasopressors, versus a restrictive fluids approach, consisting of a smaller volume of initial fluid (≤30 mL/kg [≤2 to 3 L]), with earlier reliance on vasopressor infusions to maintain blood pressure and perfusion...
May 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29744563/diagnostic-workup-etiologies-and-management-of-acute-right-ventricle-failure-a-state-of-the-art-paper
#3
REVIEW
Antoine Vieillard-Baron, R Naeije, F Haddad, H J Bogaard, T M Bull, N Fletcher, T Lahm, S Magder, S Orde, G Schmidt, M R Pinsky
INTRODUCTION: This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically ill patients. It is based on a large review of previously published articles in the field, as well as the expertise of the authors. RESULTS: The authors propose the ten key points and directions for future research in the field. RV failure (RVF) is frequent in the ICU, magnified by the frequent need for positive pressure ventilation...
May 9, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29740065/comparison-of-first-line-and-second-line-terlipressin-versus-sole-norepinephrine-in-fulminant-ovine-septic-shock
#4
Tim G Kampmeier, Philip H Arnemann, Michael Hessler, Laura M Seidel, Karsten Becker, Andrea Morelli, Sebastian W Rehberg, Christian Ertmer
The Surviving Sepsis Guidelines suggest the use of vasopressin in case of catecholamine-refractory septic shock. Terlipressin (TP) as a V1 -selective AVP analogue is a potential alternative, though data regarding the first-line administration in septic shock are scarce. The present study explored and compared the effects of first-line vs. second-line infusion of TP or sole norepinephrine regarding organ function, fluid and norepinephrine requirements and survival in fulminant ovine septic shock. Peritoneal sepsis was induced in 23 ewes after laparotomy and faecal withdrawal from the caecum...
May 8, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29736359/clinical-significance-of-candida-in-an-intraoperative-peritoneal-specimen-with-perforation-peritonitis-an-institutional-perspective
#5
Jagannath Pramod, Chellappa Vijayakumar, Krishnamachari Srinivasan, Nanda Kishore Maroju, Nagarajan Raj Kumar, Gopal Balasubramaniyan
Introduction Fungal infection of the peritoneum has become more common in recent years, the most common cause of which is Candida. Candida peritonitis is considered as a severe disease and is regarded as an independent risk factor for mortality in postoperative peritonitis. This study was planned to find out the clinical significance of Candida isolation on the outcome of the patients with peritonitis in terms of morbidity and mortality. Methods This prospective study included consecutive patients admitted and operated for secondary peritonitis over a two-year period in a tertiary care hospital in South India...
March 5, 2018: Curēus
https://www.readbyqxmd.com/read/29728116/implications-for-paediatric-shock-management-in-resource-limited-settings-a-perspective-from-the-feast-trial
#6
Kirsty Anne Houston, Elizabeth C George, Kathryn Maitland
BACKGROUND: Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty...
May 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29726824/advances-in-the-management-of-pediatric-septic-shock-old-questions-new-answers
#7
Javed Ismail, M Jayashree
Septic shock in children is associated with high mortality, especially in developing countries. Management includes early recognition, timely antibiotics, aggressive fluid resuscitation, and appropriate vasoactive therapy, to achieve the therapeutic end points. The evidence at each step in management has evolved over the past decade with a paradigm shift in emphasis from a 'protocolized care' to an 'individualized physiology-based care'. This shift mirrors the general trend one observes in critical care with respect to various treatment modalities i...
April 15, 2018: Indian Pediatrics
https://www.readbyqxmd.com/read/29722636/recent-advances-in-nanomedicine-for-sepsis-treatment
#8
Simseok A Yuk, Diego A Sanchez-Rodriguez, Michael D Tsifansky, Yoon Yeo
Sepsis and septic shock are life-threating conditions, which form a continuum of the body's response to overwhelming infection. The current treatment consists of fluid and metabolic resuscitation, hemodynamic and end-organ support, and timely initiation of antibiotics. However, these measures may be ineffective and the sepsis-related mortality toll remains substantial; therefore, an urgent need exists for new therapies. Recently, several nanoparticle (NP) systems have shown excellent protective effects against sepsis in preclinical models, suggesting a potential utility in the management of sepsis and septic shock...
May 1, 2018: Therapeutic Delivery
https://www.readbyqxmd.com/read/29696105/cumulative-positive-fluid-balance-is-a-risk-factor-for-acute-kidney-injury-and-requirement-for-renal-replacement-therapy-after-liver-transplantation
#9
Liana Codes, Ygor Gomes de Souza, Ricardo Azevedo Cruz D'Oliveira, Jorge Luiz Andrade Bastos, Paulo Lisboa Bittencourt
AIM: To analyze whether fluid overload is an independent risk factor of adverse outcomes after liver transplantation (LT). METHODS: One hundred and twenty-one patients submitted to LT were retrospectively evaluated. Data regarding perioperative and postoperative variables previously associated with adverse outcomes after LT were reviewed. Cumulative fluid balance (FB) in the first 12 h and 4 d after surgery were compared with major adverse outcomes after LT. RESULTS: Most of the patients were submitted to a liberal approach of fluid administration with a mean cumulative FB over 5 L and 10 L, respectively, in the first 12 h and 4 d after LT...
April 24, 2018: World Journal of Transplantation
https://www.readbyqxmd.com/read/29687277/early-goal-directed-therapy-using-a-physiological-holistic-view-the-andromeda-shock-a-randomized-controlled-trial
#10
Glenn Hernández, Alexandre Biasi Cavalcanti, Gustavo Ospina-Tascón, Fernando Godinho Zampieri, Arnaldo Dubin, F Javier Hurtado, Gilberto Friedman, Ricardo Castro, Leyla Alegría, Maurizio Cecconi, Jean-Louis Teboul, Jan Bakker
BACKGROUND: Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction and death. Lactate-targeted resuscitation is the gold-standard under current guidelines, although it has several pitfalls including that non-hypoxic sources of lactate might predominate in an unknown proportion of patients. Peripheral perfusion-targeted resuscitation might provide a real-time response to increases in flow that could lead to a more timely decision to stop resuscitation, thus avoiding fluid overload and the risks of over-resuscitation...
April 23, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29685859/shock-wave-induced-permeabilization-of-mammalian-cells
#11
REVIEW
Luz M López-Marín, Ana Leonor Rivera, Francisco Fernández, Achim M Loske
Controlled permeabilization of mammalian cell membranes is fundamental to develop gene and cell therapies based on macromolecular cargo delivery, a process that emerged against an increasing number of health afflictions, including genetic disorders, cancer and infections. Viral vectors have been successfully used for macromolecular delivery; however, they may have unpredictable side effects and have been limited to life-threatening cases. Thus, several chemical and physical methods have been explored to introduce drugs, vaccines, and nucleic acids into cells...
March 21, 2018: Physics of Life Reviews
https://www.readbyqxmd.com/read/29683753/fluid-therapy-and-shock-an-integrative-literature-review
#12
Joana Silva, Luís Gonçalves, Patrícia Pontífice Sousa
BACKGROUND: shock refers to a physiological situation that puts life at risk. Its early identification and the timely institution of therapeutic measures can avoid death. Despite the frequent administration of fluid therapy as a treatment for shock, the type and dose of fluids to be delivered remain undetermined. AIM: to determine the type of fluids to be administered and the type of approach to be performed in the different types of shock. METHOD: integrative literature review...
April 26, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29680980/when-a-cure-becomes-the-pathology-mechanical-bowel-obstruction-due-to-herbal-pharmacobezoar-a-case-report-with-review-of-literature
#13
Saurabh Gandhi, Eham Arora, Ajay Bhandarwar, Arun Patil, Amol Wagh, Shubham Gupta
Bezoars are intra-luminal concretions of ingested material which accumulate within the bowel. They are termed pharmacobezoars when the constituent material is drugs. We report a 64-year-old female with abdominal pain and obstipation for 3 days. Patient had completed anti-tuberculous combination therapy for suspected abdominal tuberculosis 25 years ago. She exhibited features of shock with a right iliac fossa lump. Abdominal X-ray displayed multiple air-fluid levels with densely cluttered radio-opacities in the right lower quadrant...
April 21, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29668565/the-effects-of-genetic-3-mercaptopyruvate-sulfurtransferase-deficiency-in-murine-traumatic-hemorrhagic-shock
#14
Michael Gröger, Martin Wepler, Ulrich Wachter, Tamara Merz, Oscar McCook, Sandra Kress, Britta Lukaschewski, Sebastian Hafner, Markus Huber-Lang, Enrico Calzia, Michael Georgieff, Noriyuki Nagahara, Csaba Szabó, Peter Radermacher, Clair Hartmann
INTRODUCTION: Hemorrhagic shock is a major cause of death after trauma. An additional blunt chest trauma independently contributes to mortality upon the development of an acute lung injury (ALI) by aggravating pathophysiological consequences of hemorrhagic shock. The maintenance of hydrogen sulfide availability is known to play an important role during hemorrhage and ALI. We therefore tested the impact of a genetic 3-mercaptopyruvate sulfurtransferase mutation (Δ3-MST) in a resuscitated murine model of traumatic-hemorrhagic shock...
April 17, 2018: Shock
https://www.readbyqxmd.com/read/29657372/targeted-interventions-in-critically-ill-children-with-severe-dengue
#15
Suchitra Ranjit, Gokul Ramanathan, Balasubramaniam Ramakrishnan, Niranjan Kissoon
Background: The World Health Organization guidelines provide suggestions on early recognition and treatment of severe dengue (SD); however, mortality in this group can be high and is related both to disease severity and the treatment complications. Subjects and Methods: In this prospective observational study, we report our results where standard therapy (ST) was enhanced by Intensive Care Unit (ICU) supportive measures that have proven beneficial in other conditions that share similar pathophysiology of capillary leak and fluid overload...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29626019/diagnosis-and-management-of-sepsis
#16
Tom Evans
Sepsis is a common condition with high morbidity and mortality. Although many patients may require critical care, this article considers the features of sepsis that are of most relevance to acute general physicians. Recently updated definitions of sepsis and septic shock have been proposed which better identify patients who are likely to have a poor outcome, and therefore give an opportunity to escalate care. Despite these advances, there is still no molecular signature able to diagnose sepsis. Pathogenesis is complex, with many immune and non-immune mediators involved...
March 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/29617940/intraosseous-versus-intravenous-access-in-pediatric-septic-shock-patients-admitted-to-alexandria-university-pediatric-intensive-care-unit
#17
Ahmed A El-Nawawy, Omneya M Omar, Mona Khalil
The cornerstone of emergency management of sepsis is early, goal-directed therapy. The purpose of this study was to evaluate the effect of intraosseous (IO) vs. intravenous (IV) access for resuscitation of patients with septic shock admitted to pediatric intensive care unit. This prospective interventional randomized clinical trial study was conducted on 60 patients with septic shock who need rapid administration of fluids and drugs; 30 cases were randomly chosen for IO vascular access, while the other 30 were selected for IV access...
April 1, 2018: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/29602841/effect-of-levosimendan-on-mortality-in-severe-sepsis-and-septic-shock-a-meta-analysis-of-randomised-trials
#18
Wei Chang, Jian-Feng Xie, Jing-Yuan Xu, Yi Yang
OBJECTIVE: We aim to synthesise up-to-date randomised trials to investigate the effects of levosimendan on mortality and clinical outcomes in severe sepsis and septic shock. METHODS: A collection of databases including PubMed, EMBASE, Cochrane Central Register and Web of Science were searched updated to August 2017. Randomised trials were included when they pertain to the use of levosimendan in severe sepsis or septic shock compared with any category of inotropes, or as an adjunct to standard therapy with mortality reported...
March 30, 2018: BMJ Open
https://www.readbyqxmd.com/read/29569847/review-article-sepsis-in-the-emergency-department-part-3-treatment
#19
REVIEW
Julian M Williams, Gerben Keijzers, Stephen Pj Macdonald, Amith Shetty, John F Fraser
Although comprehensive guidelines for treatment of sepsis exist, current research continues to refine and revise several aspects of management. Imperatives for rapid administration of broad-spectrum antibiotics for all patients with sepsis may not be supported by contemporary data. Many patients may be better served by a more judicious approach allowing consideration of investigation results and evidence-based guidelines. Conventional fluid therapy has been challenged with early evidence supporting balanced, restricted fluid and early vasopressor use...
April 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29553049/the-influence-of-medium-elasticity-on-the-prediction-of-histotripsy-induced-bubble-expansion-and-erythrocyte-viability
#20
Kenneth B Bader
Histotripsy is a form of therapeutic ultrasound that liquefies tissue mechanically via acoustic cavitation. Bubble expansion is paramount in the efficacy of histotripsy therapy, and the cavitation dynamics are strongly influenced by the medium elasticity. In this study, an analytic model to predict histotripsy-induced bubble expansion in a fluid was extended to include the effects of medium elasticity. Good agreement was observed between the predictions of the analytic model and numerical computations utilizing highly nonlinear excitations (shock-scattering histotripsy) and purely tensile pulses (microtripsy)...
March 19, 2018: Physics in Medicine and Biology
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