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https://www.readbyqxmd.com/read/29450521/early-resuscitation-for-adults-with-sepsis-in-a-low-income-country-reply
#1
Matthew W Semler, Ben Andrews, Gordon R Bernard
No abstract text is available yet for this article.
February 13, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29450518/early-resuscitation-for-adults-with-sepsis-in-a-low-income-country
#2
Wagner Luis Nedel, Caroline Deutschendorf
No abstract text is available yet for this article.
February 13, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29447407/the-feasibility-of-venovenous-ecmo-at-role-2-facilities-in-austere-military-environments
#3
Mohamed A T Mohamed, Tareq Maraqa, Matthew D Bacchetta, Michael McShane, Kenneth L Wilson
Introduction: Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been gaining use to bridge the recovery from acute respiratory distress syndrome (ARDS) refractory to conventional treatment. However, these interventions are often limited to higher echelons of military care. We present a case of lung salvage from severe ARDS in an Afghani soldier with VV-ECMO at a Role-2 (R2) facility in an austere military environment in Afghanistan. Case: A 25-year-old Afghani soldier presented to an R2 facility with blast lung injury and multiple penetrating injuries following an explosion...
February 13, 2018: Military Medicine
https://www.readbyqxmd.com/read/29446811/nosocomial-infections-current-situation-in-a-resuscitation-unit
#4
Ahlem Trifi, Sami Abdellatif, Mouna Oueslati, Meriem Zribi, Foued Daly, Rochdi Nasri, Rahma Mannai, Chadlia Fandri, Salah Ben Lakhal
BACKGROUND: The nosocomial infection (NI) is defined as an infection that is not present or incubating on admission in establishment of care. It can be caused by the patient's germs, care personnel or hospital environment. Multidrug resistant (MDR) bacteria are particularly common in intensive care units that lead to a serious infections and increase morbidity, mortality and cost of care. PURPOSE: To identify the epidemiological characteristics of NI, the predisposing factors, the antimicrobial sensitivity pattern of isolated bacteria and the impact on morbidity and mortality...
March 2017: La Tunisie Médicale
https://www.readbyqxmd.com/read/29444696/bedside-analysis-of-the-sublingual-microvascular-glycocalyx-in-the-emergency-room-and-intensive-care-unit-the-glyconurse-study
#5
Alexandros Rovas, Alexander-Henrik Lukasz, Hans Vink, Marc Urban, Jan Sackarnd, Hermann Pavenstädt, Philipp Kümpers
BACKGROUND: Deterioration of the endothelial glycocalyx (eGC), a protective carbohydrate-rich layer lining the luminal surface of the endothelium, plays a key role in vascular barrier dysfunction and eventually organ-failure in systemic inflammatory response syndrome and sepsis. Early detection of glycocalyx damage could thus become an important goal in critical care. This study was designed to determine the feasibility and reproducibility of quantitative, real-time glycocalyx measurements performed at bedside in the emergency room (ER) and intensive care unit (ICU)...
February 14, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29444562/fluid-resuscitation-during-early-sepsis-a-need-for-individualization
#6
Mathieu Jozwiak, Olfa Hamzaoui, Xavier Monnet, Jean-Louis Teboul
The prognosis of septic shock is tightly linked to the earliness of both appropriate antibiotic therapy and early hemodynamic resuscitation. This latter is essentially based on fluid and vasopressors administration. The step-by-step strategy, called "early goal-directed therapy" (EGDT) developed in 2001 and endorsed by the Surviving Sepsis Campaign (SSC) between 2004 and 2016 is no longer recommended. Indeed, recent multicenter randomized clinical trials showed no reduction in all-cause mortality, duration of organ support and in-hospital length of stay with EGDT in comparison with standard care...
February 14, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29438568/haemodynamic-assessment-and-support-in-sepsis-and-septic-shock-in-resource-limited-settings
#7
David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W Dünser, Arjen M Dondorp, Marcus J Schultz
Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking. Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind...
February 9, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/29433878/the-effect-of-resident-involvement-on-bariatric-surgical-outcomes-an-acs-nsqip-analysis
#8
Ivy N Haskins, Jihad Kudsi, Kathleen Hayes, Richard L Amdur, Paul P Lin, Khashayar Vaziri
BACKGROUND: Surgical residency training programs in the United States are modeled on the principle of graduated responsibility. Residents are given greater responsibility and autonomy in the operating room and during perioperative care as they gain surgical skills and progress through their training. The impact of this method of surgical training on patient outcomes remains unknown. The purpose of this study is to compare early patient morbidity and mortality after bariatric surgery in cases with and without resident participation using the American College of Surgeons National Surgical Quality Improvement Program database...
March 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29432347/lactate-level-versus-lactate-clearance-for-predicting-mortality-in-patients-with-septic-shock-defined-by-sepsis-3
#9
Seung Mok Ryoo, JungBok Lee, Yoon-Seon Lee, Jae Ho Lee, Kyoung Soo Lim, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Won Young Kim
OBJECTIVES: This study aimed to compare the prognostic value of lactate level and lactate clearance at 6 hours after septic shock recognition. And, we performed it to determine lactate kinetics in the Sepsis-3 defined septic shock. DESIGN: This retrospective study was performed from a prospective septic shock registry. SETTINGS: This study was performed at single urban tertiary center. And, all patients were treated with protocol-driven resuscitation bundle therapy between 2010 and 2016...
February 9, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29430228/routine-treatment-resistant-clostridium-difficile-infection-during-recovery-from-myxedema
#10
Jan K Adamski, Björn B Jäschke, Raija S Uusitalo-Seppälä, Kalle V J Moilanen, Antti V Pehkonen, Wojciech Weigl
Development of the extreme form of hypothyroidism defined as myxedema is very rare. Acute symptoms and their management have been described in detail previously. However, not much attention has been devoted to therapeutic challenges that are faced in the recovery phase of the treatment, especially pertaining to the gastrointestinal system. The link between myxedema and the appearance of severe Clostridium difficile infection (CDI) has not been established so far. A 61-year-old woman with no significant medical record was admitted to hospital because of infected heel pressure and thyroid dysfunction...
September 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/29396757/epidemiology-of-open-tibia-fractures-in-a-population-based-database-update-on-current-risk-factors-and-clinical-implications
#11
Christian David Weber, Frank Hildebrand, Philipp Kobbe, Rolf Lefering, Richard M Sellei, Hans-Christoph Pape
BACKGROUND: Open tibia fractures usually occur in high-energy mechanisms and are commonly associated with multiple traumas. The purposes of this study were to define the epidemiology of open tibia fractures in severely injured patients and to evaluate risk factors for major complications. METHODS: A cohort from a nationwide population-based prospective database was analyzed (TraumaRegister DGU®). Inclusion criteria were: (1) open or closed tibia fracture, (2) Injury Severity Score (ISS) ≥ 16 points, (3) age ≥ 16 years, and (4) survival until primary admission...
February 2, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29394150/pediatric-sepsis-update-how-are-children-different
#12
Bryanna M Emr, Alicia M Alcamo, Joseph A Carcillo, Rajesh K Aneja, Kevin P Mollen
BACKGROUND: Although there are some commonalities between pediatric and adult sepsis, there are important differences in pathophysiology, clinical presentation, and therapeutic approaches. The recognition and diagnosis of sepsis is a significant challenge in pediatric patients as vital sign aberrations and examination findings are often subtle as compared to those observed in adults. Gaps in knowledge that have been studied in depth in adult sepsis are still being investigated in pediatric patients such as best practices in ventilation, invasive monitoring, and resuscitation...
February 2, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29378423/receipt-of-vasopressors-is-positively-associated-with-the-length-of-the-actively-dying-process-in-hospitalization
#13
Hsiao-Chen Chou, Hsien-Liang Huang, Chiang-Yi Chen, Chuan-Lan Wang, Chin-Chung Shu, Nin-Chieh Hsu, Yu-Feng Lin, Jin-Shing Chen, Wang-Huei Sheng
BACKGROUND: End-of-life care is important in general hospitalization care. However, the clinical impact of using vasopressors on the length of the actively dying process is still controversial. METHODS: We reviewed patients who were hospitalized in general wards and died before discharge. We classified the patients into 2 groups: those who received vasopressors (RVs) and those who did not receive vasopressors (NRV). We analyzed the factors associated with the length of hospital stay (LOS) and the length of the actively dying process...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29374921/-effects-of-cardiac-support-on-delayed-resuscitation-in-extensively-burned-patients-with-shock
#14
R Xiao, Y S Huang, G A Lin, S A Yuan, D S Hu
Objective: To explore the effects of cardiac support on delayed resuscitation in extensively burned patients with shock. Methods: Clinical data of 62 extensively burned patients with shock on admission, admitted to the 159th Hospital of PLA (hereinafter referred to as our hospital) from January 2012 to January 2017, were retrospectively analyzed. They were divided into cardiac support group ( n =35) and control group ( n =27) according to the use of deslanoside and ulinastatin. All patients were treated with routine fluid resuscitation based on the formula of the Third Military Medical University till post injury hour (PIH) 48...
January 20, 2018: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
https://www.readbyqxmd.com/read/29374076/pad4-deficiency-leads-to-decreased-organ-dysfunction-and-improved-survival-in-a-dual-insult-model-of-hemorrhagic-shock-and-sepsis
#15
Bethany M Biron, Chun-Shiang Chung, Yaping Chen, Zachary Wilson, Eleanor A Fallon, Jonathan S Reichner, Alfred Ayala
Indirect acute respiratory distress syndrome (iARDS) is caused by a nonpulmonary inflammatory process resulting from insults such as nonpulmonary sepsis. Neutrophils are thought to play a significant role in mediating ARDS, with the development of iARDS being characterized by dysregulation and recruitment of activated neutrophils into the lung. Recently, a novel mechanism of microbial killing by neutrophils was identified through the formation of neutrophil extracellular traps (NETs). NETs are composed of large webs of decondensed chromatin released from activated neutrophils into the extracellular space; they are regulated by the enzyme peptidylarginine deiminase 4 (PAD4) through mediation of chromatin decondensation via citrullination of target histones...
January 26, 2018: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/29369056/prompt-administration-of-antibiotics-and-fluids-in-the-treatment-of-sepsis-a-murine-trial
#16
Anthony J Lewis, John E Griepentrog, Xianghong Zhang, Derek C Angus, Christopher W Seymour, Matthew R Rosengart
OBJECTIVES: Sepsis, the acute organ dysfunction caused by a dysregulated host response to infection, poses a serious public health burden. Current management includes early detection, initiation of antibiotics and fluids, and source control as necessary. Although observational data suggest that delays of even a few hours in the initiation of antibiotics or IV fluids is associated with survival, these findings are controversial. There are no randomized data in humans, and prior animal studies studied time from experimental manipulation, not from the onset of clinical features of sepsis...
January 23, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29356599/early-goal-directed-therapy-the-history-and-ongoing-impact-on-management-of-severe-sepsis-and-septic-shock
#17
Asher Weisberg, Pauline Park, Jill R Cherry-Bukowiec
The use of early goal-directed therapy (EGDT) for the management of severe sepsis and septic shock, a practice put forth by Dr. Rivers et al. in 2001, ushered in a new era of targeted sepsis therapy. After its publication, several further studies helped validate the protocolized approach to sepsis management, ultimately leading to its incorporation into the Surviving Sepsis Campaign guidelines. Since that time, however, a trio of large multi-center randomized controlled trials have taken place to evaluate the efficacy of EGDT when compared with usual care and have demonstrated that strict adherence to the entirety of the original EGDT protocol is unnecessary for improved outcomes...
January 22, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29355160/predictive-factors-of-management-outcome-in-adult-patients-with-mechanical-intestinal-obstruction
#18
Adebambo Olalekan Bankole, Adedapo Olumide Osinowo, Adedoyin Adekunle Adesanya
BACKGROUND: Mechanical intestinal obstruction (MIO) is a common and potentially fatal surgical emergency, which constitutes about 20% of all admissions to the surgical emergency departments. OBJECTIVE: To determine the predictive factors of morbidity and mortality in patients undergoing treatment for MIO at our tertiary hospital. PATIENTS AND METHODS: This was a prospective study of consecutive patients, 18 years and above, that presented with features of MIO during a 1-year period (May 2014 to April 2015)...
October 2017: Nigerian Postgraduate Medical Journal
https://www.readbyqxmd.com/read/29353273/metabolomics-in-sepsis-and-its-impact-on-public-health
#19
Nikolaos Evangelatos, Pia Bauer, Matthias Reumann, Kapaettu Satyamoorthy, Hans Lehrach, Angela Brand
Sepsis, with its often devastating consequences for patients and their families, remains a major public health concern that poses an increasing financial burden. Early resuscitation together with the elucidation of the biological pathways and pathophysiological mechanisms with the use of "-omics" technologies have started changing the clinical and research landscape in sepsis. Metabolomics (i.e., the study of the metabolome), an "-omics" technology further down in the "-omics" cascade between the genome and the phenome, could be particularly fruitful in sepsis research with the potential to alter the clinical practice...
January 19, 2018: Public Health Genomics
https://www.readbyqxmd.com/read/29352339/effect-of-time-to-operation-on-value-of-care-in-acute-care-surgery
#20
Tyler J Loftus, Martin D Rosenthal, Chasen A Croft, R Stephen Smith, Philip A Efron, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
BACKGROUND: As reimbursement models evolve, there is increasing emphasis on maximizing value-based care for inpatient conditions. We hypothesized that longer intervals between admission and surgery would be associated with worse outcomes and increased costs for acute care surgery patients, and that these associations would be strongest among patients with high-risk conditions. METHODS: We performed a 5-year retrospective analysis of three risk cohorts: appendectomy (low-risk for morbidity and mortality, n = 618), urgent hernia repair (intermediate-risk, n = 80), and laparotomy for intra-abdominal sepsis with temporary abdominal closure (sTAC; high-risk, n = 102)...
January 19, 2018: World Journal of Surgery
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