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Sepsis. Critical Illness

Bruno Viaggi, Daniele Poole, Omar Tujjar, Silvia Marchiani, Agostino Ognibene, Stefano Finazzi
Biomarkers are widely used to confirm the presence of infection. However, it would be of the greatest importance to predict in advance the occurrence or worsening of organ dysfunction in infected patients allowing timely antibiotic escalation. This study investigates the ability of procalcitonin (PCT) and MR-proADM to predict the transition to sepsis in infected patients. The study was conducted in a neurointensive care unit over a three-month period. We included both patients with and without infection to investigate the specificity of organ dysfunction prediction in infected patients...
2018: PloS One
Puneet Khanna, Ravinder Kumar Pandey, Chandralekha Chandralekha, Ankur Sharma, Neha Pangasa
Background and Objectives: Pain assessment of nonverbal, critically ill patients continues to present a challenge in Intensive Care Unit (ICU). The Critical-Care Pain Observation Tool (CPOT) rates critically ill patients' pain based on clinical observation. In the present study, the accuracy of CPOT was compared with physiological indicators of pain in mechanically ventilated, critically ill patients. Methods: This quantitative prospective observational study was conducted to assess pain in the critically ill, mechanically ventilated patients in comparison to physiologic indicators such as blood pressure and heart rate...
July 2018: Saudi Journal of Anaesthesia
Hai Peng Yan, Miao Li, Xiu Lan Lu, Yi Min Zhu, Wen-Xian Ou-Yang, Zheng Hui Xiao, Jun Qiu, Shuang Jie Li
BACKGROUND: The mortality rate due to severe sepsis is approximately 30-60%. Sepsis readily progresses to septic shock and multiple organ dysfunction, representing a significant problem in the pediatric intensive care unit (PICU). The aim of this study was to explore the value of plasma mitochondrial DNA (mtDNA) for early diagnosis and prognosis in children with sepsis. METHODS: A total of 123 children with sepsis who were hospitalized in the Hunan Children's Hospital PICU from July 2013 to December 2014 were divided into the general sepsis group (n = 70) and severe sepsis group (n = 53) based on diagnostic standards...
August 9, 2018: BMC Pediatrics
Yong-Gang Wang, Jian-Cang Zhou, Kang-Song Wu
Objective This study was performed to explore the characteristics and outcomes of patients with sepsis accompanied by active cancer who were admitted to the intensive care unit (ICU). Methods The baseline characteristics, infection profiles, and outcomes of patients with sepsis were retrospectively analyzed according to the presence of concomitant active cancer. The association between concomitant active cancer and 28-day mortality was explored. Results Of 23,956 patients with sepsis, 1574 (6.6%) had concomitant active cancer...
August 8, 2018: Journal of International Medical Research
Alejandro Donoso, Daniela Arriagada
La fiebre es un signo frecuente en el niño críticamente enfermo durante su estadía en la unidad de cuidados intensivos, y debe ser entendida como una respuesta biológica evolutiva, de carácter adaptativo normal del huésped al estrés fisiológico. Es el resultado de una compleja respuesta a estímulos pirogénicos, resultando en la generación de citocinas y prostaglandinas. Los mecanismos moleculares implicados en el inicio de la fiebre aún no están totalmente precisados, originando dificultades en el conocimiento de los procesos fisiopatológicos exactos involucrados y, por ende, necesarios para elaborar una adecuada y específica estrategia terapéutica...
2018: Boletín Médico del Hospital Infantil de México
Philip Yang, Perry Formanek, Steven Scaglione, Majid Afshar
AIM: Prior randomized controlled trials of acute respiratory distress syndrome (ARDS) excluded critically ill patients with cirrhosis. Data regarding risk factors for ARDS development and outcomes from ARDS in patients with cirrhosis are scarce. We sought to characterize outcomes from ARDS in patients with cirrhosis. METHODS: An observational cohort of patients with cirrhosis admitted to an intensive care unit (ICU) at a high-volume liver transplant center between January 1, 2012 and December 31, 2014 were reviewed...
August 7, 2018: Hepatology Research: the Official Journal of the Japan Society of Hepatology
V Fuhrmann, P Tariparast
Liver-lung interactions are common in daily clinical practice. However, frequently they are not the focus of clinical attention. For example, 10% of patients with acute-on-chronic liver failure and more than 30% of patients with advanced stages of acute-on-chronic liver failure suffer from respiratory failure. Conversely, up to 20% of critically ill patients develop secondary liver failure as a consequence of cardiopulmonary diseases or sepsis during their stay in the intensive care unit. This article provides an overview of clinically relevant liver-lung interactions, consecutively acquired pulmonary and hepatic diseases and the therapeutic implications...
August 6, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Cécile Aubron, Andrew W J Flint, Yves Ozier, Zoe McQuilten
BACKGROUND: Platelets (PLTs) are usually stored for up to 5 days prior to transfusion, although in some blood services the storage period is extended to 7 days. During storage, changes occur in both PLT and storage medium, which may lead to PLT activation and dysfunction. The clinical significance of these changes remains uncertain. METHODS: We performed a systematic review to assess the association between PLT storage time and clinical or transfusion outcomes in patients receiving allogeneic PLT transfusion...
August 5, 2018: Critical Care: the Official Journal of the Critical Care Forum
Esther Peters, Massimo Antonelli, Xavier Wittebole, Rahul Nanchal, Bruno François, Yasser Sakr, Jean-Louis Vincent, Peter Pickkers
BACKGROUND: Acute kidney injury (AKI) is a common complication of critical illness and is associated with worse outcomes. However, the influence of deterioration or improvement in renal function on clinical outcomes is unclear. Using a large international database, we evaluated the prevalence and evolution of AKI over a 7-day period and its effects on clinical outcomes in septic and non-septic critically ill patients worldwide. METHODS: From the 10,069 adult intensive care unit (ICU) patients in the Intensive Care Over Nations database, all those with creatinine and urine output data were included in this substudy...
August 3, 2018: Critical Care: the Official Journal of the Critical Care Forum
Tao Yang, Zhiqiang Li, Li Jiang, Xiuming Xi
BACKGROUND: The association between corticosteroid use and intensive care unit (ICU)-acquired weakness remains unclear. We evaluated the relationship between corticosteroid use and ICU-acquired weakness in critically ill adult patients. METHODS: The PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Cumulative Index of Nursing and Allied Health Literature databases were searched from database inception until October 10, 2017. Two authors independently screened the titles/abstracts and reviewed full-text articles...
August 3, 2018: Critical Care: the Official Journal of the Critical Care Forum
Amanda B Hassinger, Stacey L Valentine
OBJECTIVES: Observational studies have shown that fluid overload is independently associated with increased morbidity in critically ill children, especially with respiratory pathology. It is unknown if recent evidence has influenced clinical practice. We sought to describe current IV fluid management in pediatric acute respiratory distress syndrome. DESIGN: Multinational, cross-sectional electronic survey. SETTING: Pediatric Acute Lung Injury and Sepsis Investigators Network...
August 2, 2018: Pediatric Critical Care Medicine
Jorge Echeverri, Alejandra Molano
Del 6 al 23% de los pacientes con lesión renal aguda (LRA) en unidades de cuidados intensivos (UCI) requieren apoyo renal, siendo la terapia continua una modalidad de alta frecuencia de uso en el paciente críticamente enfermo. Si bien el objetivo general de las terapias de reemplazo renal continuo (TRRC) es restablecer el equilibrio hídrico y ácido-base, junto con la eliminación de toxinas urémicas e inflamatorias relacionadas con la pérdida de depuración renal y la disfunción multiorgánica; reconocemos como efecto colateral la depuración (K) no deseado de moléculas y sustancias deseadas en la recuperación del paciente crítico, como pueden ser antimicrobianos y nutrientes...
2018: Gaceta Médica de México
Sharon R Lewis, Michael W Pritchard, David Jw Evans, Andrew R Butler, Phil Alderson, Andrew F Smith, Ian Roberts
BACKGROUND: Critically ill people may lose fluid because of serious conditions, infections (e.g. sepsis), trauma, or burns, and need additional fluids urgently to prevent dehydration or kidney failure. Colloid or crystalloid solutions may be used for this purpose. Crystalloids have small molecules, are cheap, easy to use, and provide immediate fluid resuscitation, but may increase oedema. Colloids have larger molecules, cost more, and may provide swifter volume expansion in the intravascular space, but may induce allergic reactions, blood clotting disorders, and kidney failure...
August 3, 2018: Cochrane Database of Systematic Reviews
Anna Hall, Siobhan Crichton, Matt Varrier, Danielle E Bear, Marlies Ostermann
BACKGROUND: Soluble urokinase-type plasminogen activator receptor (suPAR) has emerged as a new sepsis biomarker. It is not known whether suPAR has a role in critically ill patients with severe acute kidney injury (AKI). METHODS: Our main aims were to describe serial serum suPAR concentrations in patients with severe AKI, to investigate a potential association between suPAR and C-reactive protein (CRP), and to compare suPAR and CRP as diagnostic markers of infection in patients with AKI...
August 2, 2018: BMC Nephrology
Jae C Chang
: Hemostasis is the most important protective mechanism for human survival following harmful vascular damage caused by internal disease or external injury. Physiological mechanism of hemostasis is partially understood. Hemostasis can be initiated by either intravascular injury or external bodily injury involving two different levels of damage [i.e., limited to the endothelium or combined with extravascular tissue (EVT)]. In intravascular injury, traumatic damage limited to local endothelium typically is of no consequence, but disease-induced endothelial damage associated with systemic endothelial injury seen in sepsis and other critical illnesses could cause generalized 'endotheliopathy'...
July 30, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Stefan Kluge, Geraldine de Heer, Dominik Jarczak, Axel Nierhaus, Valentin Fuhrmann
Severe hyperlactaemia in intensive care patients is most often due to underlying sepsis or septic, cardiogenic or haemorrhagic shock. Hyperlactaemia is an independent predictor of death in various groups of critically ill patients. With serum lactate values > 10 mmol/l 80 % of the patients die in intensive care, and if the severe lactic acidosis persists for 48 hours, all patients die. Increased lactate levels require immediate diagnostic work-up and classification. The new sepsis definition requires a serum lactate > 2 mmol/l for septic shock with adequate volume substitution and vasopressor administration in order to achieve a mean arterial pressure in persistent hypotension ≥ 65 mmHg...
August 2018: Deutsche Medizinische Wochenschrift
J Zhang, C-J Wang, X-M Tang, Y-K Wei
OBJECTIVE: Acute kidney injury (AKI) is common in critically ill patients, and sepsis patients with AKI had a higher mortality rate. The aim of the present study was to determine the potential value of urinary miR-26b in the diagnosis of sepsis-associated AKI. PATIENTS AND METHODS: Urinary samples were collected from a cohort of 155 sepsis patients (68 AKI patients and 87 non-AKI patients) and 57 patients with non-infectious systemic inflammatory response syndrome (SIRS)...
July 2018: European Review for Medical and Pharmacological Sciences
Marisa Tucci, Jacques Lacroix, Dean Fergusson, Allan Doctor, Paul Hébert, Robert A Berg, Jaime Caro, Cassandra D Josephson, Stéphane Leteurtre, Kusum Menon, Kenneth Schechtman, Marie E Steiner, Alexis F Turgeon, Lucy Clayton, Tina Bockelmann, Philip C Spinella
BACKGROUND: The "Age of Blood in Children in Pediatric Intensive Care Unit" (ABC PICU) study is a randomized controlled trial (RCT) that aims to determine if red blood cell (RBC) unit storage age affects outcomes in critically ill children. While RBCs can be stored for up to 42 days in additive solutions, their efficacy and safety after long-term storage have been challenged. Preclinical and clinical observational evidence suggests loss of efficacy and lack of safety of older RBC units, especially in more vulnerable populations such as critically ill children...
July 28, 2018: Trials
Rishikesan Kamaleswaran, Oguz Akbilgic, Madhura A Hallman, Alina N West, Robert L Davis, Samir H Shah
OBJECTIVES: We used artificial intelligence to develop a novel algorithm using physiomarkers to predict the onset of severe sepsis in critically ill children. DESIGN: Observational cohort study. SETTING: PICU. PATIENTS: Children age between 6 and 18 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Continuous minute-by-minute physiologic data were available for a total of 493 critically ill children admitted to a tertiary care PICU over an 8-month period, 20 of whom developed severe sepsis...
July 26, 2018: Pediatric Critical Care Medicine
A F Peschka, S Kaestle, F Seidel, L Weidhase, M Bernhard, A Gries, S Petros
BACKGROUND: Hyperlactatemia is associated with increased mortality. Possible differences between patients directly admitted via the emergency department to the intensive care unit (ICU) and inpatient transfers to the ICU have not yet been investigated. MATERIALS AND METHODS: In this retrospective analysis, characteristics and outcomes between critically ill medical inpatient transfers and direct admissions with hyperlactatemia on ICU admission, defined as a blood lactate >2 mmol/l, were compared...
July 26, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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