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Sepsis. Critical Illness

Yanrong Zhu, Ke Wang, Zhiqiang Ma, Dong Liu, Yang Yang, Meng Sun, Aidong Wen, Yuewen Hao, Shanbo Ma, Fang Ren, Zhenlong Xin, Yue Li, Shouyin Di, Juntian Liu
Sepsis-induced brain injury is frequently encountered in critically ill patients with severe systemic infection. Butein (3,4,2',4'-tetrahydroxychalcone) has been demonstrated as the neuro-protective agent via reducing inflammation and oxidative stress on neurons. Moreover, activation of silent information regulator 1 (SIRT1) inhibits apoptosis, oxidation and inflammation thus alleviating sepsis-induced multiorgan injuries. In present study, we show that butein administrated intraperitoneally (10 mg/kg) saved mice from sepsis-induced lethality by increasing 7-day survival rate after cecal ligation and puncture (CLP) surgery...
October 15, 2018: Toxicology and Applied Pharmacology
Juping Ni, Yingjie Sun, Hongping Qu, Aqian Wang, Yunshan Cao, Xiang Li
Patients with catheter-related bloodstream infection (CRBSI) have a poor prognosis. Proadrenomedullin (pro-ADM) has emerged as a valuable marker of sepsis. The potential role of pro-ADM in predicting the prognosis of CRBSI was evaluated. We enrolled 25 CRBSI patients and pro-ADM level was measured within 24 hours after each admission. Survival was assessed after 28 days. Among 25 patients with CRBSI, 14 patients survived. Pro-ADM in survivors was significantly lower than that in non-survivors (3.71 ± 1...
October 2018: Medicine (Baltimore)
Eric Gluck, H Bryant Nguyen, Kishore Yalamanchili, Margaret McCusker, Jaya Madala, Frank A Corvino, Xuelian Zhu, Robert Balk
BACKGROUND: Sepsis management guidelines endorse use of biomarkers to support clinical assessment and treatment decisions in septic patients. The impact of biomarkers on improving patient outcomes remains uncertain. METHODS: Retrospective observational study of adult sepsis discharges between January 1, 2012, and December 31, 2015, from Premier Healthcare Database hospitals. Sepsis was defined by an All Patients Refined Diagnosis-Related Group code of 720 (septicemia and disseminated infections)...
2018: PloS One
Mark Luedde, Martina E Spehlmann, Hans-Joerg Hippe, Sven H Loosen, Sanchari Roy, David Vargas Cardenas, Mihael Vucur, Norbert Frey, Alexander Koch, Tom Luedde, Christian Trautwein, Frank Tacke, Christoph Roderburg
INTRODUCTION: Members of the adipokine family such as resistin, adiponectin and omentin have recently been described as novel biomarkers with a diagnostic and prognostic role in the context of critically ill patients during intensive care unit (ICU) treatment. Kisspeptin represent another member of this family and has been shown to be closely correlated to different members of the adipokine family in manifold diseases. However, its role in critical illness and sepsis is currently unknown...
2018: PloS One
Seham Awad El-Sherbini, Huda Marzouk, Riham El-Sayed, Sarah Hosam-ElDin
OBJECTIVE: This study aimed to study the incidence of stress hyperglycemia in critically ill children and to investigate the etiological basis of the hyperglycemia based on homeostasis model assessment. METHODS: This was a prospective cohort study in one of the pediatric intensive care units of Cairo University, including 60 critically ill children and 21 healthy controls. Serum blood glucose, insulin, and C-peptide levels were measured within 24 hours of admission...
July 2018: Revista Brasileira de Terapia Intensiva
Su-Han Chang, Chiao-Hsuan Hsieh, Yi-Ming Weng, Ming-Shun Hsieh, Zhong Ning Leonard Goh, Hsien-Yi Chen, Tung Chang, Chip-Jin Ng, Joanna Chen-Yeen Seak, Chen-Ken Seak, Chen-June Seak
Background: Renal abscess is a relatively uncommon yet debilitating and potentially fatal disease. There is no clearly defined, objective risk stratification tool available for emergency physicians' and surgeons' use in the emergency department (ED) to quickly determine the appropriate management strategy for these patients, despite early intervention having a beneficial impact on survival outcomes. Objective: This case control study evaluates the performance of Mortality in Emergency Department Sepsis Score (MEDS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting risk of mortality in ED adult patients with renal abscess...
2018: BioMed Research International
Fan Zhang, Olivia Ledue, Maria Jun, Cibelly Goulart, Richard Malley, Ying-Jie Lu
Staphylococcus aureus is a major cause of morbidity and mortality worldwide. S. aureus colonizes 20 to 80% of humans at any one time and causes a variety of illnesses. Strains that are resistant to common antibiotics further complicate management. S. aureus vaccine development has been unsuccessful so far, largely due to the incomplete understanding of the mechanisms of protection against this pathogen. Here, we studied the role of different aspects of adaptive immunity induced by an S. aureus vaccine in protection against S...
October 16, 2018: MBio
Itay Ayalon, Hui Shen, Lauren Williamson, Keith Stringer, Basilia Zingarelli, Jennifer M Kaplan
Severe sepsis and septic shock are the biggest cause of mortality in critically ill patients. Obesity today is one of the world's greatest health challenges. Little is known about the extent of involvement of the white adipose tissue (WAT) in sepsis and how it is being modified by obesity. We sought to explore the involvement of the WAT in sepsis. We hypothesize that sepsis induces browning of the WAT and that obesity alters the response of WAT to sepsis. Six-week-old C57BL/6 mice were randomized to a high-fat diet to induce obesity (obese group) or control diet (nonobese group)...
November 2018: Shock
QiQi Zhou, G Nicholas Verne
In critically ill patients, disruption of intestinal epithelial cell function occurs due to exposure of the epithelium to toxic internal and external inflammatory stimuli, which are key factors that trigger sepsis and multi-organ dysfunction syndrome (MODS). A greater understanding of how trauma and gut failure lead to sepsis and progression to MODS is much needed. In this issue of the JCI, Armacki and colleagues identify mechanisms by which thirty-eight-negative kinase 1 (TNK1) promotes the progression from intestinal apoptosis and gut failure to bacterial translocation, sepsis, and MODS...
October 15, 2018: Journal of Clinical Investigation
Sibtain Ahmed, Imran Siddiqui, Lena Jafri, Madiha Hashmi, Aysha Habib Khan, Farooq Ghani
Background: Sepsis is the leading cause of mortality in critically ill patients. Procalcitonin (PCT) is a promising marker for identification of bacterial sepsis. The aim of this study was to determine the diagnostic accuracy of serum PCT concentration in patients with suspected sepsis admitted to mixed medical-surgical Intensive care unit (ICU). Material and methods: A cross-sectional study conducted at section of Chemical Pathology, Department of Pathology and Laboratory Medicine and ICU...
November 2018: Annals of Medicine and Surgery
Tomoaki Yatabe, Shigeaki Inoue, So Sakamoto, Yuka Sumi, Osamu Nishida, Kei Hayashida, Yoshitaka Hara, Tatsuma Fukuda, Asako Matsushima, Akihisa Matsuda, Hideto Yasuda, Kazuto Yamashita, Moritoki Egi
INTRODUCTION: The benefits and harm caused by anticoagulant treatments for sepsis induced disseminated intravascular coagulation (DIC) remain unclear. Therefore, we performed a network meta-analysis to assess the effect of available anticoagulant treatments on patient mortality, DIC resolution and the incidence of bleeding complication in patients with septic DIC. MATERIALS AND METHODS: We considered all studies from four recent systematic reviews and searched the PubMed, MEDLINE, and Cochrane databases for other studies that investigated anticoagulant treatment for septic DIC using antithrombin, thrombomodulin, heparin, or protease inhibitors in adult critically ill patients...
October 6, 2018: Thrombosis Research
Chun-Yu Chen, Yung-Fong Tsai, Wei-Ju Huang, Shih-Hsin Chang, Tsong-Long Hwang
Critically ill patients have a high risk of sepsis. Various studies have demonstrated that propofol has anti-inflammatory effects that may benefit critically ill patients who require anesthesia. However, the mechanism and therapeutic effect remain incompletely understood. Our previous data suggest that propofol can act as a formyl peptide receptor 1 (FPR1) antagonist. Here, we hypothesize that propofol mitigates sepsis-induced acute lung injury (ALI) by inhibiting mitochondria-derived N-formyl peptide-mediated neutrophil activation...
October 10, 2018: Free Radical Biology & Medicine
Kara Stoudt, Sanjay Chawla
Stress hyperglycemia is the transient increase in blood glucose as a result of complex hormonal changes that occur during critical illness. It has been described in the critically ill for nearly 200 years; patient harm, including increases in morbidity, mortality, and lengths of stay, has been associated with hyperglycemia, hypoglycemia, and glucose variability. However, there remains a contentious debate regarding the optimal glucose ranges for this population, most notably within the past 15 years. Recent landmark clinical trials have dramatically changed the treatment of stress hyperglycemia in the intensive care unit (ICU)...
October 11, 2018: Journal of Intensive Care Medicine
Raphaël Burger, Monia Guidi, Valérie Calpini, Frédéric Lamoth, Laurent Decosterd, Corinne Robatel, Thierry Buclin, Chantal Csajka, Oscar Marchetti
Background: Meropenem plasma concentration above a pathogen's MIC over the whole dosing interval (100% ƒT>MIC) is a determinant of outcome in severe infections. Significant variability of meropenem pharmacokinetics is reported in ICU patients. Objectives: To characterize meropenem pharmacokinetics in variable CLCR or renal replacement therapy and assess the appropriateness of recommended regimens for MIC coverage. Methods: A pharmacokinetic analysis (NONMEM) was conducted with external model validation...
October 9, 2018: Journal of Antimicrobial Chemotherapy
R Phillip Dellinger, Sean M Bagshaw, Massimo Antonelli, Debra M Foster, David J Klein, John C Marshall, Paul M Palevsky, Lawrence S Weisberg, Christa A Schorr, Stephen Trzeciak, Paul M Walker
Importance: Polymyxin B hemoperfusion reduces blood endotoxin levels in sepsis. Endotoxin activity can be measured in blood with a rapid assay. Treating patients with septic shock and elevated endotoxin activity using polymyxin B hemoperfusion may improve clinical outcomes. Objective: To test whether adding polymyxin B hemoperfusion to conventional medical therapy improves survival compared with conventional therapy alone among patients with septic shock and high endotoxin activity...
October 9, 2018: JAMA: the Journal of the American Medical Association
Patrícia Zamberlan, Rubens Feferbaum, Ulysses Doria Filho, Werther Brunow de Carvalho, Artur Figueiredo Delgado
BACKGROUND: Nutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid-upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. METHODS: Data from children aged 2 months-18 years were collected, and bioelectrical impedance was performed to obtain phase angle...
October 10, 2018: Nutrition in Clinical Practice
M Spacek, K Kunze, J Mehrholz
This study describes the course of renal recovery after dialysis in a specific population of chronically critically ill patients with a history of prolonged and complicated treatment in an intensive care unit. This study shows that, in a specialized center, patients can be successfully weaned from dialysis even months after acute kidney injury (AKI). Of the patients who could be recompensated (33%), approximately 20% achieved renal recovery more than 3 months after the start of dialysis. The duration of renal recovery after AKI did not differ between those patients with pre-existing chronic kidney disease (CKD) and those without...
October 9, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Richard J Nies, Carsten Müller, Roman Pfister, Philipp S Binder, Nicole Nosseir, Felix S Nettersheim, Kathrin Kuhr, Martin H J Wiesen, Matthias Kochanek, Guido Michels
Background: Analgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedative drug concentrations (midazolam and sufentanil) might be beneficial to optimize analgosedation and whether drug serum concentrations correlate with the results of subjective (Richmond Agitation-Sedation Scale [RASS]/Ramsay Sedation Scale) and objective (bispectral (BIS) index) monitoring procedures...
2018: Journal of Intensive Care
Giorgia Caspani, Georgina Corbet Burcher, M Elena Garralda, Mehrengise Cooper, Christine M Pierce, Lorraine C Als, Simon Nadel
BACKGROUND: Survivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions. OBJECTIVE: This exploratory study aimed to investigate whether abnormal peripheral blood inflammatory markers measured during paediatric intensive care unit (PICU) admission were associated with psychiatric symptoms after discharge...
October 9, 2018: Evidence-based Mental Health
Jean-Louis Vincent, Wasineenart Mongkolpun
PURPOSE OF REVIEW: Sepsis is a common condition in critically ill patients and associated with high morbidity and mortality. Sepsis is the result of infection by many potential pathogens, including Gram-negative bacteria. There are no specific antisepsis therapies and management relies largely on infection control and organ support, including hemodynamic stabilization. We discuss these key aspects and briefly mention potential immunomodulatory strategies. RECENT FINDINGS: New aspects of sepsis management include the realization that early treatment is important and that fluids and vasopressor agents should be administered simultaneously to insure rapid restoration of an adequate perfusion pressure to limit development and worsening of organ dysfunction...
October 6, 2018: Current Opinion in Infectious Diseases
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