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https://www.readbyqxmd.com/read/29157918/purpura-fulminans-mechanism-and-management-of-dysregulated-hemostasis
#1
REVIEW
Meaghan E Colling, Pavan K Bendapudi
Purpura fulminans (PF) is a highly thrombotic subtype of disseminated intravascular coagulation that can accompany severe bacterial, and more rarely, viral infections. PF is associated with an extremely high mortality rate, and patients often die of overwhelming multisystemic thrombosis rather than septic shock. Survivors typically experience amputation of involved extremities and significant scarring in affected areas. Despite the devastating clinical course associated with this hemostatic complication of infection, the mechanism of PF remains poorly understood...
October 16, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/29149944/management-of-sepsis-induced-immunosuppression
#2
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/29142375/the-effects-of-atorvastatin-on-inflammatory-responses-and-mortality-in-septic-shock-a-single-center-randomized-controlled-trial
#3
Ratender Kumar Singh, Vikas Agarwal, Arvind Kumar Baronia, Sudeep Kumar, Banani Poddar, Afzal Azim
Aim of the Study: Pleiotropic effect of statins can modulate inflammation in septic shock. We tested the hypothesis whether statins can reduce mortality in septic shock. Patients and Methods: We conducted a randomized double-blinded trial with treatment (40 mg dose of atorvastatin for 7 days) and control (placebo) arm in adult septic shock patients admitted to the Intensive Care Unit. Primary (28-day mortality) and secondary (vasopressor-, ventilation-, and renal replacement therapy-free days) outcomes, with lipid profile and adverse effects, were documented...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29141400/antifungal-treatment-with-echinocandins-a-10-year-clinical-experience
#4
R Poves-Alvarez, B Cano-Hernández, S Balbás-Alvarez, P Román-García, M Heredia-Rodríguez, E Gómez-Sánchez, E Gómez-Pesquera, M Lorenzo-López, B Martínez-Rafael, M F Muñoz-Moreno, J M Eiros, E Tamayo
OBJECTIVE: The number of studies evaluating the use of echinocandins, whether or not its indication meets international guidelines, in clinical practice is limited. The objective of the present study was to determine the use of echinocandins in a tertiary Spanish hospital in 10 years of clinical practice, and to evaluate its impact on prognosis. METHODS: This retrospective study involved adult nonneutropenic ill patients with suspicion of fungal invasion who started treatment with echinocandins between 2006 and 2015...
November 10, 2017: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/29138849/elevated-serum-levels-of-lipoprotein%C3%A2-associated-phospholipase%C3%A2-a2-predict-mortality-rates-in-patients-with-sepsis
#5
Zhongwei Huang, Haiyan Jiang, Xiaohui Cui, Guiwen Liang, Yu Chen, Ting Wang, Zhichao Sun, Lei Qi
Sepsis remains one of the leading contributors to mortality rates in the intensive care unit (ICU) and emergency intensive care unit (EICU). Therefore, any treatments against the agents which produce sepsis in a medical emergency, are welcome. Elevated serum levels of lipoprotein‑associated phospholipase A2 (Lp‑PLA2) have been reported in a small cohort of patients with inflammation. The present study evaluated serum levels of Lp‑PLA2 in patients with sepsis and investigated the role of Lp‑PLA2 in sepsis...
November 13, 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29138652/trauma-a-major-cause-of-death-among-surgical-inpatients-of-a-nigerian-tertiary-hospital
#6
Onyeanunam Ngozi Ekeke, Kelechi Emmanuel Okonta
Introduction: Trauma presents a significant global health burden. Death resulting from trauma remains high in low income countries despite a steady decrease in developed countries. Analysis of the pattern of death will enable intervention to reduce these deaths from trauma in developing countries. This study aims to present the pattern of trauma-related deaths in the surgical wards of University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a retrospective study of all patients who died from trauma during admission into the surgical wards of UPTH from 2007 to 2012...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/29137585/association-of-positive-fluid-balance-and-mortality-in-sepsis-and-septic-shock-in-an-australian-cohort
#7
M G Pittard, S J Huang, A S McLean, S R Orde
In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29133561/outcomes-of-vancomycin-plus-a-%C3%AE-lactam-versus-vancomycin-only-for-the-treatment-of-methicillin-resistant-staphylococcus-aureus-bacteremia
#8
James Truong, John J Veillette, Steve C Forland
The objective of this retrospective study was to compare the rates of treatment failure, which was a composite of clinical and microbiologic failure, of patients receiving vancomycin and a β-lactam to those receiving vancomycin only for MRSA bacteremia. Patients 16 to 89 years of age with MRSA bacteremia admitted to a university-affiliated hospital from January 1(st), 2014 to December 31(st), 2016 were screened for study inclusion. Patients were eligible if they received >48 hours of vancomycin and a β-lactam (combination group) or vancomycin only (standard group) within 48 hours following bacteremia onset...
November 13, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29133071/red-blood-cell-distribution-width-is-associated-with-mortality-in-elderly-patients-with-sepsis
#9
An-Yi Wang, Hon-Ping Ma, Wei-Fong Kao, Shin-Han Tsai, Cheng-Kuei Chang
INTRODUCTION: RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients. METHODS: This was a retrospective cohort study conducted in emergency department intensive care units (ED-ICU) between April 2015 and November 2015...
November 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29128166/right-ventricle-dysfunction-and-pre-implantation-vasopressors-in-refractory-ards-supported-by-vv-ecmo
#10
Chiara Lazzeri, Manuela Bonizzoli, Giovanni Cianchi, Stefano Batacchi, Cristiana Guetti, Morena Cozzolino, Pasquale Bernardo, Adriano Peris
BACKGROUND: Acute respiratory distress syndrome (ARDS) has been shown to be frequently associated with haemodynamic instability requiring the use of vasopressors. To date, there is still some uncertainty in the use of veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) in haemodynamically unstable ARDS patients. METHODS: We therefore assessed whether patients receiving pre ECMO vasopressors had a worse prognosis and, furthermore, we reviewed the factors associated with the use of pre ECMO vasopressors in 92 consecutive patients with refractory ARDS treated with VV-ECMO...
October 31, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29126416/adjunctive-use-of-physostigmine-salicylate-anticholium%C3%A2-in-perioperative-sepsis-and-septic-shock-study-protocol-for-a-randomized-double-blind-placebo-controlled-monocentric-trial-anticholium%C3%A2-per-se
#11
Johannes B Zimmermann, Nadine Pinder, Thomas Bruckner, Monika Lehmann, Johann Motsch, Thorsten Brenner, Torsten Hoppe-Tichy, Stefanie Swoboda, Markus A Weigand, Stefan Hofer
BACKGROUND: Severe sepsis and septic shock remain a major challenge, even in modern intensive care. In Germany, about 68,000 patients die annually because of septic diseases, characterized by a complex systemic inflammatory response. Causal treatment of the underlying infection is essential for successful management of sepsis, but the course can be positively influenced by supportive and adjuvant measures. The cholinergic anti-inflammatory pathway (CAP) represents a new approach to adjunctive therapy of septic diseases and can be pharmacologically activated by the acetylcholinesterase inhibitor physostigmine (Anticholium®)...
November 10, 2017: Trials
https://www.readbyqxmd.com/read/29124867/acute-kidney-injury-in-critically-ill-surgical-patients-epidemiology-risk-factors-and-outcomes
#12
Konlawij Trongtrakul, Chaiwut Sawawiboon, Amanda Y Wang, Anusang Chitsomkasem, Ploynapas Limphunudom, Sathit Kurathong, Surasee Prommoon, Thananda Trakarnvanich, Nattachai Srisawat
AIM: Acute kidney injury (AKI) is one of the most serious complications seen in intensive care units (ICUs). However, its epidemiology, risk factors and clinical outcomes in surgical critically ill patients remains unclear. METHODS: A prospective cohort study was conducted in surgical intensive care unit (ICU) of the university hospital in Bangkok, Thailand. AKI was diagnosed according to the KDIGO 2012 criteria. RESULTS: A total of 189 of the 400 patients enrolled in our study developed AKI (47...
November 10, 2017: Nephrology
https://www.readbyqxmd.com/read/29124121/patients-comorbidities-reduce-the-clinical-value-of-emergency-colonoscopy-results-of-a-retrospective-cohort-study
#13
Cristiano Cremone, Anouk Esch, Charlotte Gagniere, Alessandro Fugazza, Faria Mesli, Michael Levy, Aurelien Amiot, Alexis Laurent, Yann LeBaleur, Francois Hemery, Nicolas De'Angelis, Francesco Brunetti, Iradj Sobhani
Background and study aims:  Urgent endoscopy is often used to diagnose and sometimes treat acute upper gastrointestinal syndromes (hemorrhage, toxic ingestion, and occlusion). However, its suitability concerning the management of lower gastrointestinal conditions in emergency circumstances is controversial. Patients and methods:  We studied the role of emergency colonoscopy in diagnosis and treatment of all consecutive patients presenting with acute lower gastrointestinal symptoms referred to our hospital on an emergency basis...
November 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/29123906/two-cases-with-intra-aortic-balloon-pumping-use-for-severe-septic-cardiomyopathy
#14
Taro Hiromi, Chiaki Toida, Takashi Muguruma, Katsutaka Hashiba, Tomoki Doi, Kyota Nakamura, Naoto Morimura
Cases: Septic cardiomyopathy is defined as a reversible left ventricular systolic dysfunction. Patients with severe septic cardiomyopathy have a high mortality rate, even if they receive conventional therapy. For those patients, previous reports showed intra-aortic balloon pump (IABP) efficacy. We report two rare cases with IABP introduction leading them to drastic improvement, and survival from severe septic cardiomyopathy. Case 1 is a 78-year-old woman diagnosed with renal calculus pyelonephritis, septic shock, and septic cardiomyopathy...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29123903/early-evaluation-of-severity-in-patients-with-severe-sepsis-a-comparison-with-septic-shock-subgroup-analysis-of-the-japanese-association-for-acute-medicine-sepsis-registry-jaam-sr
#15
Takehiko Tarui, Yoshihiro Yamaguchi, Koichiro Suzuki, Ryosuke Tsuruta, Hiroto Ikeda, Hiroshi Ogura, Shigeki Kushimoto, Joji Kotani, Shin-Ichiro Shiraishi, Yasushi Suzuki, Kiyotsugu Takuma, Naoshi Takeyama, Seitaro Fujishima, Toshihiko Mayumi, Yasuo Miki, Norio Yamashita, Naoki Aikawa, Satoshi Gando
Aim: The purpose of this subgroup analysis of a Japanese multicenter registry, the Japanese Association for Acute Medicine Sepsis Registry Advanced (JAAM-SR-Advanced), was to identify early outcome indicators for severe sepsis that are useful and more objective than "septic shock." Methods: Among 624 patients with severe sepsis registered in JAAM-SR-Advanced, 554 with valid serum lactate data were retrospectively studied. Hypotension before and after fluid resuscitation and the highest lactate values over the initial 24 h were compared for their ability to predict in-hospital mortality...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29123901/respiratory-extracorporeal-membrane-oxygenation-for-severe-sepsis-and-septic-shock-in-adults-a-propensity-score-analysis-in-a-multicenter-retrospective-observational-study
#16
Shuhei Takauji, Mineji Hayakawa, Kota Ono, Hiroshi Makise
Aim: This multicenter retrospective observational study aimed to evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) support for septic patients with severe respiratory failure using propensity score analyses. Methods: The data of severe sepsis patients from 42 intensive care units between January 2011 and December 2013 were retrospectively collected. Propensity score matching analyses were undertaken for severe respiratory failure patients with/without veno-venous ECMO support...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29122896/persistent-bacteraemia-caused-by-staphylococcus-aureus-in-the-gall-bladder
#17
Alexander Tin Han Yu, Tony Cun, Esther Benamu, Cybele Renault
Staphylococcus aureusbacteraemia (SAB) remains a complex disease with a high associated morbidity and mortality, especially when it is able to establish an occult nidus safe from antimicrobial eradication. Without rapid identification and intervention, the nidus can cause persistent relapse of disease, morbidity and mortality. Having a high clinical suspicion for the foci of occult S. aureus is important, and awareness of potential sites of infection is critical and can be life-saving.We present a unique case of a 65-year-old man with end-stage renal disease receiving haemodialysis who developed septic shock from SAB...
November 8, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29122697/early-administration-of-appropriate-antimicrobial-agent-to-improve-the-outcome-of-carbapenem-resistant-acinetobacter-baumannii-complex-bacteremic-pneumonia
#18
Seong Yeon Park, Eun Jung Lee, Tark Kim, Shi Nae Yu, Ki-Ho Park, Mi Suk Lee, Se Yoon Park, Min Hyok Jeon, Tae Hyong Kim, Eun Ju Choo
BACKGROUND: Carbapenem resistant Acinetobacter baumannii complex (CRABC) is an emerging pathogen that causes bloodstream infections and nosocomial pneumonia. This study aimed to describe the severe infection associated with CRABC bacteremic pneumonia and to investigate risk factors for 28-day mortality. METHODS: All patients ≥18 years of age with a CRABC bacteremic pneumonia were enrolled retrospectively at five teaching hospitals in South Korea. Empirical antimicrobial therapy was defined as appropriate if administration of at least one antimicrobial agent, to which the causative pathogen was susceptible, more than 48 hours, within 5 days of the onset of bacteremia...
November 6, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29121301/tissue-doppler-assessment-of-diastolic-function-and-relationship-with-mortality-in-critically-ill-septic-patients-a-systematic-review-and-meta-analysis
#19
F Sanfilippo, C Corredor, A Arcadipane, G Landesberg, A Vieillard-Baron, M Cecconi, N Fletcher
Background: Myocardial dysfunction may contribute to circulatory failure in sepsis. There is growing evidence of an association between left ventricular diastolic dysfunction (LVDD) and mortality in septic patients. Utilizing echocardiography, we know that tissue Doppler imaging (TDI) variables e' and E/e' are reliable predictors of LVDD and are useful measurements to estimate left ventricular (LV) filling pressures. Methods: We conducted a systematic review and meta-analysis to investigate the association of e' and E/e' with mortality of patients with severe sepsis or septic shock...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29121281/epidemiology-of-sepsis-and-septic-shock-in-critical-care-units-comparison-between-sepsis-2-and-sepsis-3-populations-using-a-national-critical-care-database
#20
M Shankar-Hari, D A Harrison, G D Rubenfeld, K Rowan
Background: New sepsis and septic shock definitions could change the epidemiology of sepsis because of differences in criteria. We therefore compared the sepsis populations identified by the old and new definitions. Methods: We used a high-quality, national, intensive care unit (ICU) database of 654 918 consecutive admissions to 189 adult ICUs in England, from January 2011 to December 2015. Primary outcome was acute hospital mortality. We compared old (Sepsis-2) and new (Sepsis-3) incidence, outcomes, trends in outcomes, and predictive validity of sepsis and septic shock populations...
October 1, 2017: British Journal of Anaesthesia
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