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https://www.readbyqxmd.com/read/29151002/management-of-arrhythmia-in-sepsis-and-septic-shock
#1
Martin Balik, Vojtech Matousek, Michal Maly, Tomas Brozek
The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of a sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when a sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents...
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29150856/defining-sepsis-on-the-wards-results-of-a-multi-centre-point-prevalence-study-comparing-two-sepsis-definitions
#2
T Szakmany, R Pugh, M Kopczynska, R M Lundin, B Sharif, P Morgan, G Ellis, J Abreu, S Kulikouskaya, K Bashir, L Galloway, H Al-Hassan, T Grother, P McNulty, S T Seal, A Cains, M Vreugdenhil, M Abdimalik, N Dennehey, G Evans, J Whitaker, E Beasant, C Hall, M Lazarou, C V Vanderpump, K Harding, L Duffy, A Guerrier Sadler, R Keeling, C Banks, S W Y Ng, S Y Heng, D Thomas, E W Puw, I Otahal, C Battle, O Minik, R A Lyons, J E Hall
Our aim was to prospectively determine the predictive capabilities of SEPSIS-1 and SEPSIS-3 definitions in the emergency departments and general wards. Patients with National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled over a 24-h period in 13 Welsh hospitals. The primary outcome measure was mortality within 30 days. Out of the 5422 patients screened, 431 fulfilled inclusion criteria and 380 (88%) were recruited. Using the SEPSIS-1 definition, 212 patients had sepsis...
November 17, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29150768/toe-web-intertrigo-in-kaposi-s-sarcoma-patients-a-microbiological-study-in-a-large-cohort-of-patients
#3
G Nazzaro, A Tourlaki, B Scoppio, A Restelli, A Grancini, L Brambilla
Kaposi 's sarcoma (KS) is a rare multifocal angioproliferative disease associated with human herpes virus 8 (HHV-8) infection, characterized by cutaneous nodules or plaques especially on the lower limbs. Some skin modifications, such as chronic lymphedema, plantar hyperkeratosis and interdigital desquamation, may be associated with consequent impairment of the local immunosurveillance and increased risk of some bacterial or mycotic infections. With the objective of evaluating if bacterial or mycotic infections in KS patients are supported by different microorganisms compared to control patients, we performed an observational retrospective study, comparing positive cultural swabs of interdigital intertrigo of KS patients with positive cultural swabs of interdigital intertrigo of patients admitted to our dermatologic unit during the last 10 years...
November 17, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/29150444/toll-like-receptor-4-induced-ryanodine-receptor-2-oxidation-and-sarcoplasmic-reticulum-ca2-leakage-promote-cardiac-contractile-dysfunction-in-sepsis
#4
Jie Yang, Rui Zhang, Xin Jiang, Jingzhang Lv, Ying Li, Hongyu Ye, Wenjuan Liu, Gang Wang, Cuicui Zhang, Na Zheng, Ming Dong, Yan Wang, Peiya Chen, Kumar Santosh, Yong Jiang, Jie Liu
Studies suggest the potential role of sarcoplasmic reticulum (SR) Ca2+ leak in cardiac contractile dysfunction in sepsis. However, direct supporting evidence is lacking, and the mechanisms underlying this SR leak are poorly understood. Here, we investigated the changes in cardiac Ca2+ handling and contraction in LPS-treated rat cardiomyocytes and a mouse model of polymicrobial sepsis produced by cecal ligation and puncture (CLP). LPS decreased the systolic Ca2+ transient and myocyte contraction, as well as SR Ca2+ content...
November 17, 2017: Journal of Biological Chemistry
https://www.readbyqxmd.com/read/29150122/neonatal-sepsis-secondary-to-chorioamnionitis-by-actinomyces-neuii-in-a-25-weeks-pregnant-woman
#5
Patricia Giron de Velasco-Sada, Helena Peinado, María Pilar Romero-Gómez
No abstract text is available yet for this article.
November 14, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/29149975/clinical-outcomes-of-living-liver-transplantation-according-to-the-presence-of-sarcopenia-as-defined-by-skeletal-muscle-mass-hand-grip-and-gait-speed
#6
N Harimoto, T Yoshizumi, T Izumi, T Motomura, N Harada, S Itoh, T Ikegami, H Uchiyama, Y Soejima, A Nishie, T Kamishima, R Kusaba, K Shirabe, Y Maehara
BACKGROUND: Sarcopenia is an independent predictor of death after living-donor liver transplantation (LDLT). However, the ability of the Asian Working Group for Sarcopenia criteria for sarcopenia (defined as reduced skeletal muscle mass plus low muscle strength) to predict surgical outcomes in patients who have undergone LDLT has not been determined. METHODS: This study prospectively enrolled 366 patients who underwent LDLT at Kyushu University Hospital. Skeletal muscle area (determined by computed tomography), hand-grip strength, and gait speed were measured in 102 patients before LDLT...
November 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29149961/practice-variation-in-the-immediate-postoperative-care-of-pediatric-kidney-transplantation-a-national-survey
#7
S Abu-Sultaneh, M J Hobson, A C Wilson, W C Goggins, M E Nitu, R Lutfi
INTRODUCTION: Advances in organ allocation, surgical technique, immunosuppression, and long-term follow-up have led to a significant improvement in kidney transplant outcomes. Although there are clear recommendations for several aspects of kidney transplant management, there are no pediatric-specific guidelines for immediate postoperative care. The aim of this survey is to examine practice variations in the immediate postoperative care of pediatric kidney transplant patients. METHODS: We surveyed medical directors of Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)-affiliated pediatric intensive care units regarding center-specific immediate postoperative management of pediatric kidney transplantation...
November 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29149945/caring-for-sepsis-patients-an-update
#8
EDITORIAL
Manu Shankar-Hari, Mervyn Singer
No abstract text is available yet for this article.
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149944/management-of-sepsis-induced-immunosuppression
#9
REVIEW
Fabienne Venet, Thomas Rimmelé, Guillaume Monneret
It is now well established that profound immunosuppression develops within a few days after sepsis onset in patients. This should be considered additional organ failure because it is associated with increased rate of nosocomial infections, mortality, and long-term complications, thus constituting the rationale for immunomodulation in patients. Nevertheless, the demonstration of the efficacy of such therapeutic strategy in improving deleterious outcomes in sepsis remains to be made. Results from clinical trials based on interleukin 7 and granulocyte macrophage colony-stimulating factor immunoadjuvant therapies in septic shock patients are expected for 2018...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149943/endocrine-and-metabolic-alterations-in-sepsis-and-implications-for-treatment
#10
REVIEW
Catherine Ingels, Jan Gunst, Greet Van den Berghe
Sepsis induces profound neuroendocrine and metabolic alterations. During the acute phase, the neuroendocrine changes are directed toward restoration of homeostasis, and also limit unnecessary energy consumption in the setting of restricted nutrient availability. Such changes are probably adaptive. In patients not recovering quickly, a prolonged critically ill phase may ensue, with different neuroendocrine changes, which may represent a maladaptive response. Whether stress hyperglycemia should be aggressively treated or tolerated remains a matter of debate...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149942/mechanisms-of-organ-dysfunction-in-sepsis
#11
REVIEW
Rachel Pool, Hernando Gomez, John A Kellum
Sepsis-associated organ dysfunction involves multiple responses to inflammation, including endothelial and microvascular dysfunction, immune and autonomic dysregulation, and cellular metabolic reprogramming. The effect of targeting these mechanistic pathways on short- and long-term outcomes depends highly on the timing of therapeutic intervention. Furthermore, there is a need to understand the adaptive or maladaptive character of these mechanisms, to discover phase-specific biomarkers to guide therapy, and to conceptualize these mechanisms in terms of resistance and tolerance...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149940/immune-activation-in-sepsis
#12
REVIEW
Andrew Conway-Morris, Julie Wilson, Manu Shankar-Hari
Sepsis is caused by a dysregulated host response to infection. Immune responses determine the characteristics of sepsis. The body's protection against infection involves danger signal surveillance and recognition from nonself, effector functions in response to sensing danger signals, homeostatic regulation, and generation of immunologic memory. During sepsis, the immune system is activated by pathogen-associated and host-derived molecular patterns. Detecting these molecular patterns generates multisystem responses...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149939/improving-long-term-outcomes-after-sepsis
#13
REVIEW
Hallie C Prescott, Deena Kelly Costa
Although acute survival from sepsis has improved in recent years, a large fraction of sepsis survivors experience poor long-term outcomes. In particular, sepsis survivors have high rates of weakness, cognitive impairment, hospital readmission, and late death. To improve long-term outcomes, in-hospital care should focus on early, effective treatment of sepsis; minimization of delirium, distress, and immobility; and preparing patients for hospital discharge. In the posthospital setting, medical care should focus on addressing new disability and preventing medical deterioration, providing a sustained period out of the hospital to allow for recovery...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149938/novel-interventions-what-s-new-and-the-future
#14
REVIEW
Jean-Louis Vincent, David Grimaldi
Despite decades of sepsis research, no specific therapies for sepsis have emerged and current management still relies on source control, antibiotics, and organ support. With improved understanding of sepsis pathophysiology and the development of new techniques to enable better characterization of patients with sepsis, clinical trials are beginning to better target new interventions at those patients most likely to respond. This article discusses advances in sepsis therapeutics designed to improve endothelial cell function, purify the blood to help restore immune homeostasis, and provide immunostimulation for patients with immune exhaustion...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149937/personalizing-sepsis-care
#15
REVIEW
Mervyn Singer
Sepsis describes a broad-based syndrome covering many infectious agents, affecting various sites in patients of differing age, gender, and comorbidity and resulting in varying degrees and combinations of organ dysfunction. Protocolized care with rigid goals may suit populations, assuming the evidence-lite recommendations are beneficial, but not necessarily individual patients. A personalized approach to management is rational and preferable. Other than clinical heterogeneity, a range of biological signatures exist in sepsis, and these fluctuate over the disease course...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149936/epidemiology-and-outcomes
#16
REVIEW
Bourke Tillmann, Hannah Wunsch
Sepsis is a global public health concern. Internationally it contributes to more than 5 million deaths annually. Although rates are variable between countries, over the past 40 years reported incidence has continued to increase. Aside from potential differences in patient populations, the variation in reported rates also reflects differences in identification strategies, access to health care, and awareness of the diagnosis. Factors such as age, sex, socioeconomic status, comorbid disease, and type and site of infection impact the development of and outcomes from sepsis...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149935/biomarkers-in-sepsis
#17
REVIEW
Tjitske S R van Engelen, Willem Joost Wiersinga, Brendon P Scicluna, Tom van der Poll
A biomarker is a characteristic by which a (patho)physiologic process can be identified. Biomarkers can be of diagnostic value (to discriminate infection from noninfectious conditions or to determine the causative pathogen), of prognostic value (assigning risk profiles and predict outcome), and in the future may be of theranostic value (aid in selection and monitoring of therapy). Systems biology provides a promising tool for the discovery of novel biomarkers. Biomarkers can be the key to personalized targeted treatment in the future clinical management of sepsis...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149934/common-sense-approach-to-managing-sepsis
#18
REVIEW
Anders Perner, Lars B Holst, Nicolai Haase, Peter B Hjortrup, Morten H Møller
Sepsis results in many deaths, prolonged suffering among survivors and relatives, and high use of resources both in developed and developing countries. The updated Surviving Sepsis Campaign guidelines should aid clinicians in improving the identification and management of these patients, but many uncertainties remain because most of the guidance is based on low-quality evidence. This article discusses how to use some of the specific items of the guidelines together with a common-sense approach to aid clinical management of patients with sepsis while trying to balance the potential benefit and harm of the items...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149933/nutrition-therapy-in-sepsis
#19
REVIEW
Paul E Wischmeyer
Sepsis is characterized by early massive catabolism, lean body mass (LBM) loss, and escalating hypermetabolism persisting for months to years. Early enteral nutrition should attempt to correct micronutrient/vitamin deficiencies, deliver adequate protein and moderated nonprotein calories, as well-nourished patients can generate reasonable endogenous energy. After resuscitation, increasing protein/calories are needed to attenuate LBM loss and promote recovery. Malnutrition screening is essential, and parenteral nutrition can be safely added when enteral nutrition is failing based on preillness malnutrition...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29149932/sepsis-definitions-a-work-in-progress
#20
REVIEW
John C Marshall
The word, sepsis, dates back more than 2 millennia but has, over the past 2 centuries, come to be applied first to the clinical state evoked by invasive infection and, more recently, to describe the syndrome resulting from the host response to infection. Further refinements embodied in the recently published Sepsis-3 definition underline the concept of a dysregulated immune response resulting in potentially modifiable life-threatening organ dysfunction. This review summarizes the evolution and limitations of efforts to characterize a common and complex disorder...
January 2018: Critical Care Clinics
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