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treating septic shock

Maroua Eid, Olivier Fouquet, Cédric Darreau, Marc Pierrot, Achille Kouatchet, Alain Mercat, Christophe Baufreton
INTRODUCTION: Necrotizing fasciitis represents a life-threatening infectious condition that causes spreading necrotisis of superficial fascia and subcutaneous cellular tissues. We describe the case of a patient diagnosed with septic and toxic shocks leading to multiple organ failure successfully treated with a combination of extracorporeal life support, continuous renal replacement therapy, and a hemoadsorption device. METHODS: A 41-year-old patient presented with necrotizing fasciitis and multi-organ failure...
March 2018: International Journal of Artificial Organs
Prabahs Prasun Giri, Joydeb Roy, Agnisekhar Saha
Aim of the Study: Scrub typhus has been globally recognized as an emerging infectious disease contributing significantly to pyrexia of unknown origin (PUO) and a potential cause of multiorgan dysfunction syndrome (MODS). We studied the incidence of scrub typhus as a cause of pediatric intensive care unit (PICU) admission and MODS in our hospital and its clinical and laboratory characteristics to measure the incidence of MODS caused by scrub typhus. Materials and Methods: This study was done in a pediatric teaching hospital in Kolkata, India...
February 2018: Indian Journal of Critical Care Medicine
Chloe Grace Meyer, Thomas Paul Vacek, Amit Bansal, Ravi Gurujal, Analkumar Parikh
This report illustrates a case of a 42-year-old male with a history of intravenous drug abuse who presented with septic shock. Diagnostic studies, including a transthoracic echocardiogram, chest computed tomography angiography, transesophageal echocardiogram, and blood cultures ultimately revealed Serratia marcescens pulmonic valve infective endocarditis that was treated with intravenous antibiotics. In addition to the rare form of endocarditis and bacterium involved, this case brings into awareness the dynamic nature of the hospital course that requires vigilance in responding to hypotensive episodes for consideration of pulmonary embolism...
January 2018: Journal of Investigative Medicine High Impact Case Reports
P Riera, J Salazar, A Virgili, M Tobeña, A Sebio, P Gallano, A Barnadas, D Páez
AIM: Severe irinotecan-induced toxicity is associated with UGT1A1 polymorphisms. However, some patients develop side-effects despite harbouring a normal UGT1A1 genotype. As CYP3A4 is also an irinotecan-metabolizing enzyme, our study aimed to elucidate the influence of the CYP3A4*20 loss-of-function allele in the toxicity profile of these patients. METHODS: Three-hundred and eight metastatic colorectal cancer patients treated with an irinotecan-containing chemotherapy were studied...
March 5, 2018: British Journal of Clinical Pharmacology
Vincenzo Pota, Maria Beatrice Passavanti, Pasquale Sansone, Maria Caterina Pace, Filomena Peluso, Alfonso Fiorelli, Caterina Aurilio
BACKGROUND: Descending necrotizing mediastinitis is a common and progressive polymicrobial infection involving the neck and chest with a high death rate (10 to 40%). From a microbiological point of view, descending necrotizing mediastinitis is sustained by Gram-positive bacteria (43-62%), anaerobes (46-78%), and, rarely, Gram-negative bacteria. Data collected during the Antibiotic Resistance-Istituto Superiore di Sanità project confirmed that Italy is positioned among the countries with the highest levels of resistance in most pathogenic species under surveillance...
March 3, 2018: Journal of Medical Case Reports
Michail Zografakis-Sfakianakis, Eelco De Bree, Manolis Linardakis, Argyri Messaritaki, Helen Askitopoulou, Alexandra Papaioannou, Panagiotis Aggouridakis
AIM: To determine the value of the Modified Early Warning Score (MEWS) for general ward patients and its potential use as an alarm tool for ward nurses. METHODS: A combined prospective-retrospective observational study was conducted with 153 patients in a university hospital (2013-2014). All patients were admitted to the intensive care unit (ICU) from general wards. Parameters retrospectively studied were 5 MEWS values at 4 hourly intervals, up to 20 hours before ICU admission...
March 1, 2018: International Journal of Nursing Practice
Hitoshi Yamamura, Yu Kawazoe, Kyohei Miyamoto, Tomonori Yamamoto, Yoshinori Ohta, Takeshi Morimoto
Background: Use of high-dose norepinephrine is thought to have an immunosuppressive action that increases mortality. This study aimed to evaluate the correlation between norepinephrine dosage and prognosis of patients with septic shock. Methods: This study was a nested cohort of the DExmedetomidine for Sepsis in Intensive Care Unit Randomized Evaluation (DESIRE) trial. We evaluated 112 patients with septic shock and an initial Sequential Organ Failure Assessment Cardiovascular (SOFA-C) category score > 2 and initial lactate level > 2 mmol/L...
2018: Journal of Intensive Care
Andrew J Hale, Graham M Snyder, John W Ahern, George Eliopoulos, Daniel Ricotta, W Kemper Alston
Bacterial bloodstream infections (BSIs) are a major cause of morbidity and mortality in the United States. Traditionally, BSIs have been managed with intravenous antimicrobials. However, whether intravenous antimicrobials are necessary for the entirety of the treatment course in BSIs, especially for uncomplicated episodes, is a more controversial matter. Patients that are clinically stable, without signs of shock, or have been stabilized after an initial septic presentation, may be appropriate candidates for treatment of BSIs with oral antimicrobials...
February 28, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Caroline Miranda, Ali Mahta, Lee Adam Wheeler, A John Tsiouris, Hooman Kamel
Tension pneumocephalus can lead to rapid neurologic deterioration. We report for the first time its association with aseptic systemic inflammatory response syndrome mimicking septic shock and the efficacy of prompt neurosurgical intervention and critical care support in treating this condition. A 64-year-old man underwent 2-stage olfactory groove meningioma resection. The patient developed altered mental status and gait instability on postoperative day 6. Imaging showed significant pneumocephalus. The patient subsequently developed worsening mental status, respiratory failure, and profound shock requiring multiple vasopressors...
February 2018: Radiology Case Reports
M H Møller, A Granholm, E Junttila, M Haney, A Oscarsson-Tibblin, A Haavind, J H Laake, E Wilkman, K Ö Sverrisson, A Perner
BACKGROUND: Adult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient-important treatment recommendations on this topic. METHODS: This guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock...
February 25, 2018: Acta Anaesthesiologica Scandinavica
Aiko Okubo, Ayumu Nakashima, Shigehiro Doi, Toshinori Ueno, Kensuke Sasaki, Takashi Esaki, Takao Masaki
BACKGROUND: The definition of sepsis was updated to sepsis-3 in February 2016. Currently, direct hemoperfusion therapy using the polymyxin B-immobilized fiber cartridge (PMX-DHP) is widely performed to treat sepsis and septic shock. However, the prognostic factors of PMX-DHPs in patients with sepsis using the new definition are unclear. We retrospectively assessed prognostic factors in patients who had received PMX-DHP therapy for sepsis and septic shock. METHODS: We included 71 patients with severe infection who underwent PMX-DHP treatment from January 2006 to August 2015 in this study...
February 24, 2018: Clinical and Experimental Nephrology
Sandra Bérody, Laurence Heidet, Olivier Gribouval, Jérome Harambat, Patrick Niaudet, Veronique Baudouin, Justine Bacchetta, Bernard Boudaillez, Maud Dehennault, Loïc de Parscau, Olivier Dunand, Hugues Flodrops, Marc Fila, Arnaud Garnier, Ferielle Louillet, Marie-Alice Macher, Adrien May, Elodie Merieau, Françoise Monceaux, Christine Pietrement, Caroline Rousset-Rouvière, Gwenaëlle Roussey, Sophie Taque, Julie Tenenbaum, Tim Ulinski, Rachel Vieux, Ariane Zaloszyc, Vincent Morinière, Rémi Salomon, Olivia Boyer
Background: Recommendations for management of Finnish-type congenital nephrotic syndrome (CNS) followed by many teams include daily albumin infusions, early bilateral nephrectomy, dialysis and transplantation. We aimed to assess the treatment and outcome of patients with CNS in France. Methods: We conducted a nationwide retrospective study on 55 consecutive children born between 2000 and 2014 treated for non-infectious CNS. Results: The estimated cumulative incidence of CNS was 0...
February 20, 2018: Nephrology, Dialysis, Transplantation
Naeemah Ruffin, Chirag V Vasa, Sarah Breakstone, Wayne Axman
We report a case of a 75-year-old Hispanic man treated for septic shock after undergoing surgery for impacted renal stones. He was given vasopressors and later developed symmetrical peripheral gangrene (SPG) on both his feet and left hand. SPG is a serious and rare condition presenting clinically as an acute onset of ischaemia with no vessel occlusion. Vasopressors are identified as a contributing factor in SPG development. The patient ultimately underwent transmetatarsal amputations of both feet and amputation of three digits on his left hand...
February 7, 2018: BMJ Case Reports
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
Sahil Gupta, Chan-Mi Lee, Jia-Feng Wang, Jean Parodo, Song-Hui Jia, Jim Hu, John C Marshall
The brief lifespan of the polymorphonuclear neutrophil (PMN) is regulated through its capacity to undergo apoptosis, a constitutive process that is actively inhibited during sepsis. We sought to define the cellular mechanisms through which Heat Shock Protein 90 (Hsp90) prolongs the survival of inflammatory PMN. We evaluated Hsp90 expression and interaction with client proteins in PMNs from patients with sepsis and in healthy control PMNs treated with LPS (1 μg/mL). Hsp90 activity was inhibited pharmacologically using radicicol (Rad; 1 μM), and Hsp90 transcription was silenced in septic PMN using siRNA...
February 2, 2018: Journal of Leukocyte Biology
Sarath Sujatha-Bhaskar, Reza F Alizadeh, Christina Koh, Colette Inaba, Mehraneh D Jafari, Joseph C Carmichael, Michael J Stamos, Alessio Pigazzi
Emergent colonic disease has traditionally been managed with open procedures. Evaluation of recent trends suggests a shift toward minimally invasive techniques in this disease setting. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2014 was used to examine clinical data from patients who emergently underwent open colectomy (OC) and laparoscopic colectomy (LC). Multivariate regression was utilized to analyze preoperative characteristics and determine risk-adjusted outcomes with intent-to-treat and as-treated approach...
October 1, 2017: American Surgeon
Satoshi Yoshiji, Kimitaka Shibue, Toshihito Fujii, Takeshi Usui, Keisho Hirota, Daisuke Taura, Mayumi Inoue, Masakatsu Sone, Akihiro Yasoda, Nobuya Inagaki
RATIONALE: Unilateral adrenalectomy as part of surgical resection of renal cell carcinoma (RCC) is not thought to increase the risk of chronic adrenal insufficiency, as the contralateral adrenal gland is assumed to be capable of compensating for the lost function of the resected gland. However, recent studies have indicated that adrenalectomy might cause irreversible impairment of the adrenocortical reserve. We describe a case of chronic primary adrenal insufficiency in a 68-year-old man who previously underwent unilateral adrenonephrectomy, which was complicated by severe postoperative adrenal stress that involved cardiopulmonary disturbance and systemic infection...
December 2017: Medicine (Baltimore)
Christian Nusshag, Christian Morath, Martin Zeier, Markus A Weigand, Uta Merle, Thorsten Brenner
RATIONALE: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease entity primarily described in children, but not less relevant in adults. It is characterized by a misdirected activation of the immune system, resulting in an uncontrolled cytokine release from macrophages and cytotoxic T-cells (CTLs). Primary HLH relies on a genetic predisposition, whereas secondary HLH develops in the context of infections, malignancies or autoimmune diseases. However, the awareness and therapeutic knowledge for HLH in adulthood is limited...
December 2017: Medicine (Baltimore)
Roger J Lewis, Derek C Angus, Pierre-François Laterre, Anne Louise Kjølbye, Egbert van der Meulen, Allan Blemings, Todd Graves, James A Russell, Jan E Carlsen, Karsten Jacobsen, Donald M Yealy, Steven M Opal, Nis A Windeløv, Bruno François, Anders Perner, Peter Pickkers, Scott M Berry
Septic shock carries substantial morbidity and mortality. The failure of many promising therapies during late-phase clinical trials prompted calls for alternative trial designs. We describe an innovative trial evaluating selepressin, a novel selective vasopressin V1a receptor agonist, for adults with septic shock. SEPSIS-ACT (Selepressin Evaluation Programme for Sepsis-induced Shock-Adaptive Clinical Trial) is a blinded, randomized, placebo-controlled, two-part, adaptive phase 2b/3 trial, evaluating up to four selepressin dosing strategies...
February 2018: Annals of the American Thoracic Society
Ki Jin Jung, Jae-Hwi Nho, Hyeung-Kyu Cho, Sijohn Hong, Sung Hun Won, Dong-Il Chun, Byungsung Kim
RATIONALE: We present 4 cases of symmetrical peripheral gangrene (SPG) associated with use of inotropic agent to elevate blood pressure. SPG is a relatively rare phenomenon characterized by symmetrical distal ischemic damage that leads to gangrene of 2 or more sites in the absence of large blood vessel obstruction, where vasoconstriction rather than thrombosis is implicated as the underlying pathophysiology. We present 4 SPG cases of the multiple limbs amputation, associated with inevitable use of inotropic agents...
February 2018: Medicine (Baltimore)
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