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https://www.readbyqxmd.com/read/29216937/-significance-of-peripheral-perfusion-index-in-early-diagnosis-and-goal-directed-therapy-of-septic-shock-patients-a-prospective-single-blind-randomized-controlled-trial
#1
Yuanfeng Shi, Ruihong Yin, Yanli Wang, Jiguang Li, Xiaobing Chen, Yongpeng Xie, Caihong Gu, Xiuzhen Zou, Kexi Liu
OBJECTIVE: To investigate the application of peripheral perfusion index (PPI) in early diagnosis and goal-directed therapy of septic shock, and to provide reference for the early clinical diagnosis and treatment of septic shock. METHODS: A prospective single-blind randomized controlled trial (RCT) was conducted. Adult patients with sepsis admitted to emergency medical department and intensive care unit (ICU) of the First People's Hospital of Lianyungang City in Jiangsu Province from January 2013 to December 2016 were enrolled...
December 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29204871/bone-marrow-mesenchymal-stem-cells-combat-lipopolysaccharide-induced-sepsis-in-rats-via-amendment-of-p38-mapk-signaling-cascade
#2
Omnia S Zaki, Marwa M Safar, Afaf A Ain-Shoka, Laila A Rashed
Sepsis is a systemic inflammatory disorder which often occurs during extremely stressful conditions such as trauma, burn, shock, and infection. This study investigated the curative effects of bone marrow-derived mesenchymal stem cells (BM-MSCs) against hepatic, renal, and pulmonary responses caused by a single administration of lipopolysaccharide (LPS) (10 mg/kg, i.p) in rats. Treatment with BM-MSCs (5 × 105 in 0.1 ml PBS, i.p.) 3 h after LPS antagonized the LPS-induced increment of the liver enzymes (ALT, AST) and kidney functions (BUN, sCr)...
December 4, 2017: Inflammation
https://www.readbyqxmd.com/read/29197350/effect-of-hyperchloremia-on-acute-kidney-injury-in-critically-ill-septic-patients-a-retrospective-cohort-study
#3
Lenar Yessayan, Javier A Neyra, Fabrizio Canepa-Escaro, George Vasquez-Rios, Michael Heung, Jerry Yee
BACKGROUND: Hyperchloremia is common in critically ill septic patients. The impact of hyperchloremia on the incidence of acute kidney injury (AKI) is not well studied. We investigated the association between hyperchloremia and AKI within the first 72 h of intensive care unit (ICU) admission. METHODS: 6490 ICU adult patients admitted with severe sepsis or septic shock were screened for eligibility. Exclusion criteria included: AKI on admission, baseline estimated glomerular filtration rate (eGFR) <15 ml/min/1...
December 2, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/29195914/early-fluid-loading-for-septic-patients-any-safety-limit-needed
#4
REVIEW
Yi-Chun Gong, Jing-Tao Liu, Peng-Lin Ma
Early adequate fluid loading was the corner stone of hemodynamic optimization for sepsis and septic shock. Meanwhile, recent recommended protocol for fluid resuscitation was increasingly debated on hemodynamic stability vs risk of overloading. In recent publications, it was found that a priority was often given to hemodynamic stability rather than organ function alternation in the early fluid resuscitation of sepsis. However, no safety limits were used at all in most of these reports. In this article, the rationality and safety of early aggressive fluid loading for septic patients were discussed...
November 8, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29176794/capillary-refill-time-during-fluid-resuscitation-in-patients-with-sepsis-related-hyperlactatemia-at-the-emergency-department-is-related-to-mortality
#5
Barbara Lara, Luis Enberg, Marcos Ortega, Paula Leon, Cristobal Kripper, Pablo Aguilera, Eduardo Kattan, Ricardo Castro, Jan Bakker, Glenn Hernandez
INTRODUCTION: Acute circulatory dysfunction in patients with sepsis can evolve rapidly into a progressive stage associated with high mortality. Early recognition and adequate resuscitation could improve outcome. However, since the spectrum of clinical presentation is quite variable, signs of hypoperfusion are frequently unrecognized in patients just admitted to the emergency department (ED). Hyperlactatemia is considered a key parameter to disclose tissue hypoxia but it is not universally available and getting timely results can be challenging in low resource settings...
2017: PloS One
https://www.readbyqxmd.com/read/29176402/clinical-outcomes-of-minimized-hydrocortisone-dosage-of-100%C3%A2-mg-day-on-lower-occurrence-of-hyperglycemia-in-septic-shock-patients
#6
Kanchana Ngaosuwan, Kanit Ounchokdee, Thep Chalermchai
BACKGROUND: The current international guideline recommended 200 mg per day of hydrocortisone intravenously to treat septic shock. However, a subsequent study on cortisol metabolism actually showed an increase in cortisol level during sepsis. Hence, the smaller hydrocortisone dose of 100 mg per day might be sufficient and reduce steroid-associated complications. We aimed to compare the clinical outcomes of minimized hydrocortisone dose of 100 mg to the currently recommended dose in the treatment of septic shock patients...
November 15, 2017: Shock
https://www.readbyqxmd.com/read/29172943/tissue-edema-fluid-balance-and-patient-outcomes-in-severe-sepsis-an-organ-systems-review
#7
Will Jaffee, Spencer Hodgins, William T McGee
Severe sepsis and septic shock remain among the deadliest diseases managed in the intensive care unit. Fluid resuscitation has been a mainstay of early treatment, but the deleterious effects of excessive fluid administration leading to tissue edema are becoming clearer. A positive fluid balance at 72 hours is associated with significantly increased mortality, yet ongoing fluid administration beyond a durable increase in cardiac output is common. We review the pathophysiologic and clinical data showing the negative effects of edema on pulmonary, renal, central nervous, hepatic, and cardiovascular systems...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29137585/association-of-positive-fluid-balance-and-mortality-in-sepsis-and-septic-shock-in-an-australian-cohort
#8
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/29133025/perivalvular-mitral-abscess-fistulised-to-the-pericardial-cavity-revealing-staphylococcal-endocarditis
#9
Paul Desaint, Anthony Chauvat, Thomas Garaud, Olivier Andremont, Gaëtan Plantefève, Hervé Mentec, Damien Contou
BACKGROUND: Fistula to the pericardial cavity is a very rare complication of perivalvular abscess during infective endocarditis, with Staphylococcus aureus being the most commonly associated microorganism. METHODS: We report a fatal septic shock due to a mitral endocarditis revealed by a myocardial abscess fistulised toward the pericardial cavity. RESULTS: A 66-year-old female without previous valvular disease was admitted to intensive care for severe sepsis...
October 31, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29132978/intensive-care-in-severe-malaria-report-from-the-task-force-on-tropical-diseases-by-the-world-federation-of-societies-of-intensive-and-critical-care-medicine
#10
REVIEW
Dilip R Karnad, Mohd Basri Mat Nor, Guy A Richards, Tim Baker, Pravin Amin
Severe malaria is common in tropical countries in Africa, Asia, Oceania and South and Central America. It may also occur in travelers returning from endemic areas. Plasmodium falciparum accounts for most cases, although P vivax is increasingly found to cause severe malaria in Asia. Cerebral malaria is common in children in Africa, manifests as coma and seizures, and has a high morbidity and mortality. In other regions, adults may also develop cerebral malaria but neurological sequelae in survivors are rare...
November 8, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29124121/patients-comorbidities-reduce-the-clinical-value-of-emergency-colonoscopy-results-of-a-retrospective-cohort-study
#11
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/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
#12
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/29112081/predictors-prevalence-and-outcomes-of-early-crystalloid-responsiveness-among-initially-hypotensive-patients-with-sepsis-and-septic-shock
#13
Daniel E Leisman, Martin E Doerfler, Sandra M Schneider, Kevin D Masick, Jason A D'Amore, John K D'Angelo
OBJECTIVES: The prevalence of responsiveness to initial fluid challenge among hypotensive sepsis patients is unclear. To avoid fluid overload, and unnecessary treatment, it is important to differentiate these phenotypes. We aimed to 1) determine the proportion of hypotensive sepsis patients sustaining favorable hemodynamic response after initial fluid challenge, 2) determine demographic and clinical risk factors that predicted refractory hypotension, and 3) assess the association between timeliness of fluid resuscitation and refractoriness...
November 3, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29109168/risk-factors-and-outcomes-for-ineffective-empiric-treatment-in-gram-negative-sepsis-stratification-by-onset-of-infection
#14
Scott T Micek, Nicholas Hampton, Marin Kollef
Sepsis and septic shock remain serious infections with reported mortality rates in excess of forty percent. Timely antibiotic therapy in sepsis and septic shock is recognized as an important determinant of outcome. However, the administration of ineffective empiric treatment (IET) (an initial antibiotic regimen that is not active against the identified pathogen(s) based on in vitro susceptibility testing) is associated with excess mortality compared to effective empiric treatment (EET). We examined all hospitalized patients between January 2010 and October 2015 at Barnes-Jewish Hospital with the presence of a sterile site (blood, or pleural, abdominal, cerebrospinal, synovial, and pericardial fluid) culture positive for Gram-negative (GN) bacteria combined with primary or secondary ICD-9-CM codes for severe sepsis (995...
November 6, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29079487/what-is-the-preferred-resuscitation-fluid-for-patients-with-severe-sepsis-and-septic-shock
#15
Michael E Winters, Robert Sherwin, Gary M Vilke, Gabriel Wardi
BACKGROUND: Current guidelines for the management of patients with severe sepsis and septic shock recommend crystalloids as the initial fluid solution of choice in the resuscitation of these patients. In recent years, there have been numerous studies published on the type of fluid used in the resuscitation of patients with sepsis. The primary goal of this article is to determine the preferred intravenous fluid for the resuscitation of patients with severe sepsis and septic shock. METHODS: A MEDLINE literature review was completed to identify studies that investigated the type of resuscitation fluid in the management of patients with severe sepsis and septic shock...
October 24, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29078714/impact-of-a-combination-antibiotic-bag-on-compliance-with-surviving-sepsis-campaign-goals-in-emergency-department-patients-with-severe-sepsis-and-septic-shock
#16
Michael P Lorenzo, Lindsay MacConaghy, Christopher D Miller, Gregory Meola, Luke A Probst, Brian Pratt, Jeff Steele, Robert W Seabury
BACKGROUND: Severe sepsis and septic shock represent common presentations in the emergency department (ED) and have high rates of mortality. Guideline-recommended goals of care have been shown to benefit these patients, but can be difficult to provide. OBJECTIVE: To determine whether the use of a premixed bag consisting of 2 g cefepime and 1 g vancomycin in 1000 mL of normal saline increases the probability of patients receiving Surviving Sepsis Campaign (SSC) recommendations for the initiation of antimicrobials and fluid challenge...
October 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29075932/effect-of-ringers-acetate-in-different-doses-on-plasma-volume-in-rat-models-of-hypovolemia
#17
Svajunas Statkevicius, Attila Frigyesi, Peter Bentzer
BACKGROUND: Even though crystalloids are the first choice for fluid resuscitation in hemodynamically unstable patients, their potency as plasma volume expanders in hypovolemia of different etiologies is largely unknown. The objective of the study was to investigate dose-response curves of a crystalloid in hypovolemia induced by either sepsis or hemorrhagic shock. RESULTS: Rats were randomized to resuscitation with Ringers acetate at a dose 10, 30, 50, 75, or 100 ml/kg at 4 h after induction of sepsis by cecal ligation and puncture (CLP) or 2...
October 26, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29060444/classification-models-to-predict-vasopressor-administration-for-septic-shock-in-the-emergency-department
#18
Varesh Prasad, James C Lynch, Corey L Pasakarnis, Jill E Thorsen, Michael R Filbin, Andrew T Reisner, Thomas Heldt
Optimal management of sepsis and septic shock in the emergency department (ED) involves timely decisions related to intravenous fluid resuscitation and initiation of vasoactive medication support. A decision-support tool trained on electronic health record data, can help improve this complex decision. We retrospectively extracted vital signs, lab measurements, and fluid administration information from 807 patient visits over a two-year period to a major ED. Patients selected for inclusion had a high likelihood of septic shock...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29058589/translational-evidence-for-two-distinct-patterns-of-neuroaxonal-injury-in-sepsis-a-longitudinal-prospective-translational-study
#19
Johannes Ehler, Lucinda K Barrett, Valerie Taylor, Michael Groves, Francesco Scaravilli, Matthias Wittstock, Stephan Kolbaske, Annette Grossmann, Jörg Henschel, Martin Gloger, Tarek Sharshar, Fabrice Chretien, Francoise Gray, Gabriele Nöldge-Schomburg, Mervyn Singer, Martin Sauer, Axel Petzold
BACKGROUND: Brain homeostasis deteriorates in sepsis, giving rise to a mostly reversible sepsis-associated encephalopathy (SAE). Some survivors experience chronic cognitive dysfunction thought to be caused by permanent brain injury. In this study, we investigated neuroaxonal pathology in sepsis. METHODS: We conducted a longitudinal, prospective translational study involving (1) experimental sepsis in an animal model; (2) postmortem studies of brain from patients with sepsis; and (3) a prospective, longitudinal human sepsis cohort study at university laboratory and intensive care units (ICUs)...
October 23, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29028771/mechanisms-of-thrombocytopenia-during-septic-shock-a-multiplex-cluster-analysis-of-endogenous-sepsis-mediators
#20
Alexandre Bedet, Keyvan Razazi, Florence Boissier, Mathieu Surenaud, Sophie Hue, Stéphane Giraudier, Christian Brun-Buisson, Armand Mekontso Dessap
BACKGROUND: Thrombocytopenia is a common feature of sepsis and may involve various mechanisms often related to the inflammatory response. This study aimed at evaluating factors associated with thrombocytopenia during human septic shock. In particular, we used a multiplex analysis to assess the role of endogenous sepsis mediators. METHODS: Prospective, observational study. Thrombocytopenia was defined as an absolute platelet count <100 G/L or a 50% relative decrease in platelet count during the first week of septic shock...
October 12, 2017: Shock
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