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corticosteroids in icu

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https://www.readbyqxmd.com/read/28631531/interleukin-1-receptor-antagonist-anakinra-intravenous-immunoglobulin-and-corticosteroids-in-the-management-of-critically-ill-adult-patients-with-hemophagocytic-lymphohistiocytosis
#1
Philipp Wohlfarth, Hermine Agis, Guido A Gualdoni, Johannes Weber, Thomas Staudinger, Peter Schellongowski, Oliver Robak
BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) causes multiple organ dysfunction frequently leading to intensive care unit (ICU) referral and/or death. We report on a series of critically ill adult patients treated with a non-etoposide-based regimen including interleukin 1 antagonist anakinra, intravenous immunoglobulin (IVIG), and/or corticosteroids (CS) for HLH. METHODS: Eight adult (≥18 years) ICU patients having received treatment with anakinra ± IVIG ± CS for HLH between March 2014 and March 2016 at a large tertiary care university hospital (Medical University of Vienna, Vienna, Austria) were retrospectively analyzed...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28619722/corticosteroid-therapy-during-acute-bronchiolitis-in-patients-who-later-develop-asthma
#2
Steven L Shein, Alexandre T Rotta, Richard Speicher, Katherine N Slain, Benjamin Gaston
BACKGROUND AND OBJECTIVE: Meta-analyses show that corticosteroids are not effective in patients with bronchiolitis. However, risk factors for asthma such as eczema or familial atopy prompt some practitioners to prescribe corticosteroids for bronchiolitis. We assessed if corticosteroid prescription is associated with shorter hospitalization for bronchiolitis among patients who later develop asthma. METHODS: The Pediatric Health Information System database was interrogated for patients with bronchiolitis aged <2 years hospitalized between 2006 and 2015...
June 15, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28617807/treatment-with-macrolides-and-glucocorticosteroids-in-severe-community-acquired-pneumonia-a-post-hoc-exploratory-analysis-of-a-randomized-controlled-trial
#3
Adrian Ceccato, Catia Cilloniz, Otavio T Ranzani, Rosario Menendez, Carles Agusti, Albert Gabarrus, Miquel Ferrer, Oriol Sibila, Michael S Niederman, Antoni Torres
BACKGROUND: Systemic corticosteroids have anti-inflammatory effects, whereas macrolides also have immunomodulatory activity in addition to their primary antimicrobial actions. We aimed to evaluate the potential interaction effect between corticosteroids and macrolides on the systemic inflammatory response in patients with severe community-acquired pneumonia to determine if combining these two immunomodulating agents was harmful, or possibly beneficial. METHODS: We performed a post-hoc exploratory analysis of a randomized clinical trial conducted in three tertiary hospitals in Spain...
2017: PloS One
https://www.readbyqxmd.com/read/28615145/early-initiation-of-low-dose-hydrocortisone-treatment-for-septic-shock-in-adults-a-randomized-clinical-trial
#4
Qing-Quan Lv, Xiao-Hua Gu, Qi-Hong Chen, Jiang-Quan Yu, Rui-Qiang Zheng
BACKGROUND: Physiologic dose hydrocortisone is part of the suggested adjuvant therapies for patients with septic shock. However, the association between the corticosteroid therapy and mortality in patients with septic shock is still not clear. Some authors considered that the mortality is related to the time frame between development of septic shock and start of low dose hydrocortisone. Thus we designed a placebo-controlled, randomized clinical trial to assess the importance of early initiation of low dose hydrocortisone for the final outcome...
June 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28598781/health-care-utilisation-before-and-after-intensive-care-unit-admission-in-rheumatoid-arthritis
#5
Ruth Ann Marrie, Carol A Hitchon, Christine A Peschken, Hui Chen, Charles N Bernstein, Allan Garland
OBJECTIVES: We evaluated the incidence of intensive care unit (ICU) admission in a rheumatoid arthritis (RA) population according to health care utilisation and use of immune therapies in the year preceding admission. Also, we compared health care utilisation after ICU admission in persons with and without RA. METHODS: We identified all persons with RA in Manitoba, Canada using population-based administrative data, and controls matched by age, sex, and region of residence...
June 5, 2017: Clinical and Experimental Rheumatology
https://www.readbyqxmd.com/read/28560041/severe-acute-asthma-caused-by-chlamydophila-pneumoniae-infection
#6
Yoshinari Endo, Toshihiro Shirai, Mika Saigusa, Eisuke Mochizuki
Asthma exacerbation is associated with respiratory infections, including those by viruses and atypical bacteria. We herein report a case of severe acute asthma in an adult caused by Chlamydophila pneumoniae (C. pneumoniae) infection. A 39-year-old woman without a history of asthma reported to the emergency department with progressive worsening of cough, shortness of breath, and wheezing with low oxygen saturation. A computed tomography (CT) scan revealed patchy ground-glass opacity and bronchial wall thickening...
July 2017: Respirology Case Reports
https://www.readbyqxmd.com/read/28546381/adjunct-therapies-for-refractory-status-asthmaticus-in-children
#7
Kyle J Rehder
Asthma exacerbation is a common reason for children to present to the emergency department. If primary therapies fail to halt the progression of an asthma flare, status asthmaticus often leads to hospital, and potentially ICU, admission. Following the initial administration of inhaled β agonists and systemic corticosteroids, a wide array of adjunct medical therapies may be used to treat status asthmaticus. Unfortunately, the data supporting the use of these adjunct therapies are often unclear, conflicting, or absent...
June 2017: Respiratory Care
https://www.readbyqxmd.com/read/28527272/-does-corticosteroid-treatment-during-the-pre-and-postnatal-periods-affect-the-neurodevelopmental-outcome-of-premature-newborns
#8
Marita Lardón, José Uberos, Eduardo Narbona
INTRODUCTION: Glucocorticoids, widely used in the perinatal period, may be associated with adverse neurodevelopmental effects. OBJECTIVES: To analyze neurodevelopmental outcomes in a cohort of very low birth weight newborns treated with antenatal and/or postnatal corticosteroids. MATERIALS AND METHODS: This was a prospective cohort study in which we included all very low birth weight babies admitted to the neonatal intensive care unit of a tertiary hospital between 2008 and 2013...
April 1, 2017: Biomédica: Revista del Instituto Nacional de Salud
https://www.readbyqxmd.com/read/28486361/universal-cervical-length-screening-and-antenatal-corticosteroid-timing
#9
Nicole Sahasrabudhe, Catherine Igel, Ghislaine C Echevarria, Peʼer Dar, Diana Wolfe, Peter S Bernstein, Robert Angert, Ashlesha Dayal, Patience Gallagher, Mara Rosner
OBJECTIVE: To evaluate the relationship between universal transvaginal screening for short cervical length in the second trimester and the timing of antenatal corticosteroids. METHODS: We performed a retrospective cohort study of patients with nonanomalous singleton gestations and spontaneous preterm birth between 24 and 34 weeks of gestation after the initiation of a universal transvaginal cervical length screening program between October 2012 and August 2015. Our primary outcome was antenatal corticosteroid administration to a delivery interval of fewer than 7 days...
June 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28444360/role-of-early-onset-neutropenia-in-development-of-candidemia-in-premature-infants
#10
Nermin Ramy, Mohamed Hashim, Heba Abou Hussein, Happy Sawires, Maha Gaafar, Ayat El Maghraby
Background: The aim of the study was to assess the effect of early-onset neutropenia (EON) on the development of candidemia in premature infants and evaluate other risk factors. Materials and Methods: This prospective study was carried out in a neonatal intensive care unit of Cairo University Hospital. Fifty neutropenic premature infants were matched to 50 non-neutropenics. Subjects were then regrouped into candidemics and non-candidemics to study other risk factors such as central venous catheters, mechanical ventilation, parenteral nutrition, drugs as corticosteroids and others...
April 24, 2017: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/28440556/direct-hemoperfusion-with-polymyxin-b-immobilized-fibre-treatment-for-acute-exacerbation-of-interstitial-pneumonia
#11
Haruhiko Furusawa, Makiko Sugiura, Chieko Mitaka, Naohiko Inase
BACKGROUND AND OBJECTIVE: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is recognized as an important cause of mortality. AE has also been reported in patients with other interstitial lung diseases such as idiopathic non-specific interstitial pneumonia (NSIP) and interstitial pneumonia associated with collagen vascular disease (CVD). Current therapies such as high-dose corticosteroid with immunosuppressive agents have provided little benefit for AE. Direct hemoperfusion (DHP) with a polymyxin B-immobilized fibre column (PMX) was originally developed for the treatment of endotoxaemia...
April 25, 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28421191/prospective-multicentre-study-on-the-epidemiology-and-current-therapeutic-management-of-severe-bronchiolitis-in-spain
#12
MULTICENTER STUDY
Jose C Flores-González, Juan Mayordomo-Colunga, Iolanda Jordan, Alicia Miras-Veiga, Cristina Montero-Valladares, Marta Olmedilla-Jodar, Andrés J Alcaraz-Romero, Miren Eizmendi-Bereciartua, Francisco Fernández-Carrión, Carmen Santiago-Gutierrez, Esther Aleo-Luján, Sonia Pérez-Quesada, Cristina Yun-Castilla, Carmen Martín, Álvaro Navarro-Mingorance, Concha Goñi-Orayen
Objective. To determine the epidemiology and therapeutic management of patients with severe acute bronchiolitis (AB) admitted to paediatric intensive care units (PICUs) in Spain. Design. Descriptive, prospective, multicentre study. Setting. Sixteen Spanish PICUs. Patients. Patients with severe AB who required admission to any of the participating PICUs over 1 year. Interventions. Both epidemiological variables and medical treatment received were recorded. Results. A total of 262 patients were recruited; 143 were male (54...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28361121/a-systematic-review-and-meta-analysis-of-the-data-behind-current-recommendations-for-corticosteroids-in-non-hiv-related-pcp-knowing-when-you-are-on-shaky-foundations
#13
Patil Injean, Samantha J Eells, Hoover Wu, Imani McElroy, Aric L Gregson, James A McKinnell
BACKGROUND: Randomized trials show a mortality benefit to adjunctive corticosteroids for human immunodeficiency virus (HIV)-related Pneumocystis jiroveci pneumonia (HIV-PCP). Guidelines for non-HIV PCP (NH-PCP) recommend adjunctive corticosteroids based on expert opinion. We conducted a systematic review and meta-analysis characterizing adjunctive corticosteroids for NH-PCP. METHODS: We searched MEDLINE from 1966 through 2015. Data on clinical outcomes from NH-PCP were extracted with a standardized instrument...
March 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28355466/invasive-mould-infections-in-the-icu-setting-complexities-and-solutions
#14
Matteo Bassetti, Emilio Bouza
Infections caused by filamentous fungi represent a major burden in the ICU. Invasive aspergillosis is emerging in non-neutropenic individuals with predisposing conditions, e.g. corticosteroid treatment, chronic obstructive pulmonary disease, liver cirrhosis, solid organ cancer, HIV infection and transplantation. Diagnosis is challenging because the signs and symptoms are non-specific, and initiation of additional diagnostic examinations is often delayed because clinical suspicion is low. Isolation of an Aspergillus species from the respiratory tract in critically ill patients, and tests such as serum galactomannan, bronchoalveolar lavage 1-3-β-d-glucan and specific PCR should be interpreted with caution...
March 1, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28351838/exposure-to-any-antenatal-corticosteroids-and-outcomes-in-preterm-infants-by-gestational-age-prospective-cohort-study
#15
Colm P Travers, Reese H Clark, Alan R Spitzer, Abhik Das, Thomas J Garite, Waldemar A Carlo
Objective To determine whether exposure to any antenatal corticosteroids is associated with a lower rate of death at each gestational age at which administration is currently recommended.Design Prospective cohort study.Settings 300 participating neonatal intensive care units of the Pediatrix Medical Group in the United States.Participants 117 941 infants 23 0/7 to 34 6/7 weeks' gestational age born between 1 January 2009 and 31 December 2013.Exposure Any antenatal corticosteroids.Main outcomes measures Death or major hospital morbidities analyzed by gestational age and exposure to antenatal corticosteroids with models adjusted for birth weight, sex, mode of delivery, and multiple births...
March 28, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28343176/proactive-approach-at-the-limits-of-viability-improves-the-short-term-outcome-of-neonates-born-after-23-weeks-gestation
#16
Patrik Šimják, Jan Smíšek, Michal Koucký, Tereza Lamberská, Richard Plavka, Zdeněk Hájek
OBJECTIVE: The aim of this single-center study was to identify factors that affect the short-term outcome of newborns delivered around the limits of viability. METHODS: A group of 137 pregnant women who gave birth between 22+0/7 and 25+6/7 weeks of gestation was retrospectively studied. The center supports a proactive approach to infants around the limits of viability. Perinatal and neonatal characteristics were obtained and statistically evaluated. RESULTS: A total of 166 live-born infants were enrolled during a 6-year period; 162 (97...
March 27, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28342389/pilot-randomised-controlled-trial-comparing-the-risk-of-neonatal-respiratory-distress-in-elective-caesarean-section-at-38-weeks-gestation-following-a-course-of-corticosteroids-versus-caesarean-at-39-weeks
#17
Nicolas Sananès, Antoine Koch, Benoît Escande, Germain Aissi, Gabrielle Fritz, Emmanuel Roth, Michèle Weil, Ahmad Bakri, Chantal Bolender, Nicolas Meyer, Christophe Vayssiere, Adrien Gaudineau, Israël Nisand, Romain Favre, Pierre Kuhn, Bruno Langer
INTRODUCTION: The objective of this study was to compare neonatal respiratory morbidity and rate of emergency caesarean section between elective caesarean sections at 38 gestational weeks following a course of corticosteroids and planned caesarean sections at 39 gestational weeks. MATERIAL AND METHODS: This was a multicentre randomised controlled trial. The study was conducted between 2007 and 2013 in level 2 and 3 maternity units in France. A total of 208 women with an indication for elective caesarean section were enrolled and 200 analysed in per-protocol analysis...
May 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28328824/early-use-of-noninvasive-techniques-for-clearing-respiratory-secretions-during-noninvasive-positive-pressure-ventilation-in-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-and-hypercapnic-encephalopathy-a-prospective-cohort-study
#18
Jinrong Wang, Zhaobo Cui, Shuhong Liu, Xiuling Gao, Pan Gao, Yi Shi, Shufen Guo, Peipei Li
Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients.The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28302697/abstention-or-intervention-for-isolated-hypotension-in-the-first-3%C3%A2-days-of-life-in-extremely-preterm-infants-association-with-short-term-outcomes-in-the-epipage-2-cohort-study
#19
Xavier Durrmeyer, Laetitia Marchand-Martin, Raphaël Porcher, Geraldine Gascoin, Jean-Christophe Roze, Laurent Storme, Geraldine Favrais, Pierre-Yves Ancel, Gilles Cambonie
OBJECTIVE: To compare outcomes at hospital discharge for preterm infants born before 29 weeks of gestation who had at least one episode of isolated hypotension during their first 72 hours of life for which they did or did not receive antihypotensive treatment. DESIGN: Etude Epidémiologique sur les Petits Ages Gestationnels 2 (EPIPAGE 2) French national prospective population-based cohort study in 2011. SETTING: 60 neonatal intensive care units...
March 16, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#20
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
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