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treating septic shock

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https://www.readbyqxmd.com/read/29763385/pyruvate-enriched-resuscitation-for-shock
#1
Robert T Mallet, Albert H Olivencia-Yurvati, Rolf Bünger
This commentary addresses the recent retraction of an article which reported favorable outcomes in septic patients treated with intravenous pyruvate. The retracted report was cited in the authors' recent minireview on the cellular mechanisms and clinical application of pyruvate to improve cardiac performance. Because the retracted article reports pyruvate-enhanced resuscitation of critically ill patients, the authors wish to inform the readership, especially critical care providers, that this particular clinical application of pyruvate is not now supported by robust evidence...
May 2018: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/29761216/low-dose-corticosteroids-for-adult-patients-with-septic-shock-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis
#2
Sofie Louise Rygård, Ethan Butler, Anders Granholm, Morten Hylander Møller, Jeremy Cohen, Simon Finfer, Anders Perner, John Myburgh, Balasubramanian Venkatesh, Anthony Delaney
PURPOSE: To assess the effect of low dose corticosteroids on outcomes in adults with septic shock. METHODS: We systematically reviewed randomised clinical trials (RCTs) comparing low-dose corticosteroids to placebo in adults with septic shock. Trial selection, data abstraction and risk of bias assessment were performed in duplicate. The primary outcome was short-term mortality. Secondary and tertiary outcomes included longer-term mortality, adverse events, quality of life, and duration of shock, mechanical ventilation and ICU stay...
May 14, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29753454/response-of-a-local-hospital-to-a-burn-disaster-contributory-factors-leading-to-zero-mortality-outcomes
#3
Eng-Kean Yeong, Ciaran P O'Boyle, Hui-Fu Huang, Hao-Chih Tai, Yen-Chun Hsu, Shu-Yang Chuang, Yu-Feng Wu, Che-Wei Chang, Tom J Liu, Hong-Shiee Lai
OBJECTIVE: To investigate the outcomes of a local healthcare system in managing a burn mass casualty incident (BMCI). METHODS: Thirty-three victims admitted to the National Taiwan University Hospital within 96h of the explosion were included in the study. Data were recorded on: patient demographics, Baux score, laboratory data, management response, treatment strategies, and outcomes. Case notes from June 27, 2015 to November 2015 were reviewed with a focus on fluid resuscitation, ventilation support, nutrition, infection control, sepsis treatment, and wound closure plan...
May 9, 2018: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29733491/recognition-and-treatment-of-sepsis-in-pregnancy
#4
Anthony M Kendle, Judette Louis
Sepsis that occurs in the context of pregnancy is associated with significant maternal morbidity and mortality. International and multidisciplinary organizations have advocated for expedient diagnosis and initiation of treatment in patients with sepsis. However, the physiologic changes of pregnancy complicate both identification and treatment of maternal sepsis. This article describes a case of a woman presenting with symptoms of sepsis progressing to septic shock. Strategies for identifying and treating women with presumed sepsis are reviewed, and recent data regarding maternal and fetal outcomes are discussed...
May 7, 2018: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/29724988/total-gastric-necrosis-due-to-mucormycosis-a-rare-case-of-gastric-perforation
#5
Salah Termos, Feras Othman, Mohammad Alali, Bader M S Al Bader, Talal Alkhadher, Wael Fathi Hassanaiah, Ali Taqi, Abhijit Sapkal
BACKGROUND Spontaneous gastric perforation is usually a complication of peptic ulcer disease, or a postoperative complication resulting from gastric torsion. Mucormycosis (or zygomycosis) is an uncommon opportunistic fungal infection that is usually seen in immunocompromised patients and is associated with significant morbidity and mortality. This report is of a rare case of spontaneous gastric perforation due to mucormycosis infection. CASE REPORT A 52-year-old woman, with a past medical history of heroin abuse, diabetes mellitus, hypertension, and chronic kidney disease treated by dialysis, presented to the emergency department with cellulitis of the arms...
May 4, 2018: American Journal of Case Reports
https://www.readbyqxmd.com/read/29721239/meningitis-spondylodiscitis-pneumonia-and-septic-shock-with-streptococcus-pneumoniae-in-a-previously-healthy-woman-with-isolated-igg2-igg3-iga-deficiency-and-monoclonal-gammopathy-of-undetermined-significance
#6
Shahin Gaini, David Gudnason, Bjarni Á Steig, Jenny Jónsdóttir Nielsen
A 66 years old Caucasian woman with pneumococcal meningitis was treated and discharged after an uncomplicated course. Five months later she was readmitted with fever and right side abdominal pain and diagnosed with pneumococcal spondylodiscitis. One year later she was treated for a severe chest X-ray confirmed left lobar pneumonia. Two years later she was diagnosed with a pneumococcal pneumonia in her left lung with septic shock. An immune deficiency screen revealed slightly reduced IgA levels, low IgG2 levels, low IgG3 levels and high IgG1 levels...
March 29, 2018: Infectious Disease Reports
https://www.readbyqxmd.com/read/29705974/extreme-hypercalcemia-in-a-kidney-transplant-recipient
#7
Erol Demir, Cagla Karaoglan, Gulcin Yegen, Betul Sair, Halil Yazici, Aydin Turkmen, Mehmet Sukru Sever
Post-transplant hypercalcemia is a major problem in renal transplant recipients, which may negatively affect both graft and patient survival. In this paper, we present a 66-year-old male kidney transplant recipient, who was admitted to our clinic with symptoms of fever, nausea, vomiting and lethargy. Laboratory data showed good renal function; however, a serum calcium level of 22.1 mg/dL. The patient was treated by isotonic saline together with furosemide and methylprednisolone. Because of treatment resistance, subcutaneous calcitonin and ibandronate were added to the treatment protocol as well...
April 28, 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29687277/early-goal-directed-therapy-using-a-physiological-holistic-view-the-andromeda-shock-a-randomized-controlled-trial
#8
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/29686180/chromobacterium-violaceum-the-deadly-sepsis
#9
Guntur Darmawan, R N Yasmin Kusumawardhani, Bachti Alisjahbana, Trinugroho Heri Fadjari
Chromobacterium violaceum is a Gram-negative facultatively anaerobic, oxidase-positive bacterium producing a dark violet antioxidant pigment called violacein. It is an opportunistic pathogen and has an ubiquitous distribution, mainly resides in water and soil of tropical and subtropical regions.An-18-year-old man referred to the emergency room with a 5-day history of progressively worsening swelling of the right cheek. He sought consult and hospitalized at another institution for three days prior this admission; however, his condition deteriorated...
January 2018: Acta Medica Indonesiana
https://www.readbyqxmd.com/read/29678565/simplification-of-first-line-antibacterial-regimen-for-complicated-appendicitis-in-children-was-associated-with-better-adherence-to-guidelines-and-reduced-use-of-antibiotics
#10
Marion Taleb, Nicolas Nardi, Alexis Arnaud, Nathalie Costet, Pierre-Yves Donnio, Charlotte Engrand, Edouard Habonimana, Eric Wodey, Pierre Tattevin
Acute appendicitis in children requires early surgery, and a short course of antibiotics active on Enterobacteriaceae and anaerobes. Although aminoglycoside-containing 3-drug regimen have been used successfully for decades, simpler regimens with similar efficacy are increasingly used. We aimed to evaluate the impact of a switch from the combination of cefotaxime, metronidazole, and gentamicin (regimen 1), to piperacillin-tazobactam (regimen 2), as first-line regimen for complicated acute appendicitis in children...
April 17, 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29675258/livedo-reticularis-a-cutaneous-clue-to-an-underlying-endocrine-crisis
#11
Natasha Shrikrishnapalasuriyar, Mirena Noyvirt, Philip Evans, Bethan Gibson, Elin Foden, Atul Kalhan
A 54-year-old woman was admitted to hospital with a presumed allergic reaction to a single dose of amoxicillin given for a suspected upper respiratory tract infection. She complained of chest tightness although there was no wheeze or stridor. On examination, she was pyrexial, tachycardic, hypertensive and had a diffuse mottled rash on her lower limbs. Her initial investigations showed raised inflammatory markers. She was treated in the intensive care for a presumed anaphylactic reaction with an underlying sepsis...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29661910/myeloid-cell-deficiency-of-p38%C3%AE-p38%C3%AE-protects-against-candidiasis-and-regulates-antifungal-immunity
#12
Dayanira Alsina-Beauchamp, Alejandra Escós, Pilar Fajardo, Diego González-Romero, Ester Díaz-Mora, Ana Risco, Miguel A Martín-Serrano, Carlos Del Fresno, Jorge Dominguez-Andrés, Noelia Aparicio, Rafal Zur, Natalia Shpiro, Gordon D Brown, Carlos Ardavín, Mihai G Netea, Susana Alemany, Juan J Sanz-Ezquerro, Ana Cuenda
Candida albicans is a frequent aetiologic agent of sepsis associated with high mortality in immunocompromised patients. Developing new antifungal therapies is a medical need due to the low efficiency and resistance to current antifungal drugs. Here, we show that p38γ and p38δ regulate the innate immune response to C. albicans We describe a new TAK1-TPL2-MKK1-ERK1/2 pathway in macrophages, which is activated by Dectin-1 engagement and positively regulated by p38γ/p38δ. In mice, p38γ/p38δ deficiency protects against C...
April 16, 2018: EMBO Molecular Medicine
https://www.readbyqxmd.com/read/29649586/nephrotoxicity-of-piperacillin-tazobactam-combined-with-vancomycin-should-it-be-a-concern
#13
Cafer Balcı, Ömrüm Uzun, Mustafa Arıcı, Sibel Aşçıoğlu Hayran, Deniz Yüce, Serhat Ünal
The combination of piperacillin-tazobactam (pip-tazo) and vancomycin provides a wide spectrum of activity against many pathogens acquired in the health-care setting. However, there have been reports of increased potential for nephrotoxicity with this combination. The aim of this study was to evaluate the nephrotoxic effect of pip-tazo plus vancomycin and compare it with that of pip-tazo and vancomycin alone, and meropenem plus vancomycin, another broad-spectrum combination. A total of 402 patients receiving either antimicrobial regimen for more than 48 hours were evaluated retrospectively in a two-year period...
April 9, 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29629219/novel-endoscopic-stent-for-anastomotic-leaks-after-total-gastrectomy-using-an-anchoring-thread-and-fully-covering-thick-membrane-prevention-of-embedding-and-migration
#14
Gum Mo Jung, Seung Hyun Lee, Dae Seong Myung, Wan Sik Lee, Young Eun Joo, Mi Ran Jung, Seong Yeob Ryu, Young Kyu Park, Sung Bum Cho
Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration...
March 2018: Journal of Gastric Cancer
https://www.readbyqxmd.com/read/29623443/pharmacokinetic-and-pharmacodynamic-considerations-of-antibiotics-of-last-resort-in-treating-gram-negative-infections-in-adult-critically-ill-patients
#15
REVIEW
Mojdeh S Heavner, Kimberly C Claeys, Anne M Masich, Jeffrey P Gonzales
PURPOSE OF REVIEW: We provide an overview of antimicrobials that are considered last resort for the treatment of resistant gram-negative infections in adult critically ill patients. The role in therapy, pharmacodynamic (PD) goals, and pharmacokinetic (PK) changes in critical illness for aminoglycosides, polymyxins, tigecycline, fosfomycin, and fluoroquinolones are summarized. RECENT FINDINGS: Altered PK in septic patients in the intensive care unit (ICU) is observed with many of our agents of last resort...
April 5, 2018: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/29623000/lipidomic-profiling-of-plasma-and-erythrocytes-from-septic-patients-reveals-potential-biomarker-candidates
#16
Giovana Colozza Mecatti, Marcia Cristina Fernandes Messias, Rafaela Maria Sant'Anna Paiola, Célio Fernando Figueiredo Angolini, Ildenize Barbosa da Silva Cunha, Marcos Nogueira Eberlin, Patricia de Oliveira Carvalho
Background: Sepsis remains the primary cause of death from infection, despite advances in modern medicine. The identification of reliable diagnostic biomarkers for the early detection of this disease is critical and may reduce the mortality rate as it could allow early treatment. The purpose of this study was to describe the changes in the plasma and red cells blood lipidome profiling of patients diagnosed with sepsis and septic shock with the aim to identify potentially useful metabolic markers...
2018: Biomarker Insights
https://www.readbyqxmd.com/read/29619923/clinical-presentation-management-and-prognosis-of-patients-with-cardiac-sarcoidosis
#17
Muzhda Ghanizada, Kasper Rossing, Henning Bundgaard, Finn Gustafsson
INTRODUCTION: The course and prognosis of cardiac sarcoidosis (CS) are sparsely described. The purpose of this study was to assess the clinical presentation, treatment response and prognosis for patients with CS. METHODS: This was a single-centre retrospective study of patients with CS from 2006 to 2016. A total of 197 patients with a sarcoidosis diagnosis were screened, and 17 patients (mean age 46.9 years, 59% men) were diagnosed with CS based on Japanese Ministry of Health and Welfare criteria; 53% were diagnosed by a positive MRI, 29% by endomyocardial biopsy...
April 2018: Danish Medical Journal
https://www.readbyqxmd.com/read/29619807/-recommendations-for-the-care-of-patients-with-community-acquired-pneumonia-in-the-emergency-department
#18
A Julián-Jiménez, I Adán Valero, A Beteta López, L M Cano Martín, O Fernández Rodríguez, R Rubio Díaz, M A Sepúlveda Berrocal, J González Del Castillo, F J Candel González
The incidence of community-acquired pneumonia (CAP) ranges from 2-15 cases / 1,000 inhabitants / year, being higher in those older than 65 years and in patients with high co-morbidity. Around 75% of all CAP diagnosed are treated in the Emergency Department (ED). The CAP represents the main cause for sepsis and septic shock in ED, and the most frequent cause of death and admission to the Intensive Care Unit (ICU) due to infectious disease. Overall mortality is 10-14% according to age and associated risk factors...
April 2018: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/29600824/prospective-open-label-trial-of-early-concomitant-vasopressin-and-norepinephrine-therapy-versus-initial-norepinephrine-monotherapy-in-septic-shock
#19
Drayton A Hammond, Oktawia A Clem, Jacob T Painter, Kelsey McCain, Julia Cullen, Amy L Brotherton, Krishna Kakkera, Divyan Chopra, Nikhil Meena
PURPOSE: Delays in achieving target mean arterial pressure (MAP) have been associated with increased morbidity and mortality in patients with septic shock. This trial was conducted to test the hypothesis that early, concomitant treatment with vasopressin and norepinephrine reduces the time to achieve and maintain target MAP compared to initial norepinephrine monotherapy. METHODS: A single-center, prospective, open-label trial was conducted in patients with septic shock between November 2015 and June 2016 at a medical intensive care unit in an academic medical center...
March 30, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29596106/recombinant-human-soluble-thrombomodulin-contributes-to-reduced-mortality-in-sepsis-patients-with-severe-respiratory-failure-a-retrospective-observational-study-using-a-multicenter-dataset
#20
Shodai Yoshihiro, Masaaki Sakuraya, Mineji Hayakawa, Kota Ono, Akira Hirata, Akihiro Takaba, Natsuki Kawamura, Toru Tsutsui, Kenichi Yoshida, Yoshihiro Hashimoto
BACKGROUND: Recombinant human soluble thrombomodulin (rhTM) is a novel class therapeutic agent for managing disseminated intravascular coagulation. The progression of severe respiratory failure may be related to intra-alveolar coagulation/fibrinolytic disorders. We aimed to determine the efficacy of rhTM in treating sepsis patients with severe respiratory failure. METHODS: We performed a retrospective observational study using an existing dataset collected from 42 intensive care units (ICUs) in Japan...
March 28, 2018: Shock
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