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Sepsis. Critical Illness

Ronald H L Li, Fern Tablin
Sepsis is the leading cause of critical illness and mortality in human beings and animals. Neutrophils are the primary effector cells of innate immunity during sepsis. Besides degranulation and phagocytosis, neutrophils also release neutrophil extracellular traps (NETs), composed of cell-free DNA, histones, and antimicrobial proteins. Although NETs have protective roles in the initial stages of sepsis, excessive NET formation has been found to induce thrombosis and multiple organ failure in murine sepsis models...
2018: Frontiers in Veterinary Science
María D Ballesteros Pomar, Elena González Arnaiz
Set of resident microorganisms in our body that are responsible for the absorption of nutrients and the maintenance of health is named microbiota. The microbiota´s role is protective, trophic and metabolic. Different groups of microbiota intestinal name enterotypes, each one of them are in relation to specific dietary habits. The absence of enteral stimulation affects both epithelial and GALT and the development of the microbiota. This situation modifies the immune system´s interaction, with a less competitive exclusion of more pathogenic bacteria, which can promote infections...
April 3, 2018: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
Wei-Dong Zhu, Jia Xu, Mao Zhang, Tie-Ming Zhu, Yun-Hua Zhang, Ke Sun
Acute lung injury (ALI) is a frequent, but severe complication following sepsis in patients with critical illness. The present study aimed to investigate the potential role of microRNA-21 (miR-21) in the regulation of inflammation in the ALI induced by lipopolysaccharide (LPS) in vitro and in vivo . The levels of inflammatory cytokines, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-1β and IL-10, and the level of miR-21 expression were measured in the lungs of LPS-induced ALI rats and NR8383 alveolar macrophages (AMs)...
December 2018: Experimental and Therapeutic Medicine
Jessica J Grahl, Joanna L Stollings, Shayan Rakhit, Anna K Person, Li Wang, Jennifer L Thompson, Pratik P Pandharipande, E Wesley Ely, Mayur B Patel
BACKGROUND: Prior retrospective cross-sectional work has associated antimicrobials with a non-specific phrase: encephalopathy without seizures. The purpose of this study is to determine whether different classes of antimicrobials have differential associations with the daily risk of delirium after critical illness is adjusted for. METHODS: Our study was a nested cohort that enrolled non-neurological critically ill adults from a medical or surgical intensive care unit (ICU) with daily follow-up to 30 days...
December 12, 2018: Critical Care: the Official Journal of the Critical Care Forum
Greg S Martin, Paul Bassett
PURPOSE: Guidelines recommend crystalloids for fluid resuscitation in sepsis/shock and switching to albumin in cases where crystalloids are insufficient. We evaluated hemodynamic response to crystalloids/colloids in critically ill adults. MATERIALS AND METHODS: The primary research question was: "Are crystalloids sufficient for volume replacement in severe indications (intensive care unit [ICU]/critical illness)?" Randomized, controlled trials (RCTs) were identified using PubMed and EMBASE, and screened against predefined inclusion/exclusion criteria...
November 30, 2018: Journal of Critical Care
Lex M van Loon, Johannes G van der Hoeven, Joris Lemson
The administration of β-blockers in patients with sepsis is a trending topic in intensive care medicine since the landmark study by Morelli and colleagues, showing a striking decrease in 28-day mortality compared to standard care. While the available evidence suggests that the use of β-blockers in septic shock is safe, the effects on hemodynamics are controversial. In this paper, we review the effect of β-blockade in septic shock on hemodynamics from animal models to critically ill patients.
December 5, 2018: Journal of Critical Care
Menbeu Sultan, Gelila Mengistu, Finot Debebe, Aklilu Azazh, Indi Trehan
Introduction: Given the scarcity of critical care hospital beds in Africa, emergency centres (ECs) are increasingly charged with caring for critically ill patients for extended periods of time. The objective of this study was to improve the understanding of the nature and outcomes of critically ill patients with prolonged treatment times of more than six hours in two ECs in Addis Ababa, Ethiopia. Methods: This study was conducted over three months in two ECs of urban tertiary care hospitals in Addis Ababa...
December 2018: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Tingting Cheng, Jianwen Bai, Chun-Shiang Chung, Yaping Chen, Eleanor A Fallon, Alfred Ayala
Therapeutic interventions to treat acute lung injury (ALI) remain largely limited to lung-protective strategies, as a real molecular pathophysiologically driven therapeutic intervention has yet to become available. While we have previously documented the expression of HVEM on leukocytes of septic mice and critically ill patients, its functional role in shock/sepsis-induced ALI has not yet been studied. Inasmuch; a murine model of indirect ALI (iALI) was induced by hemorrhagic shock (HEM) followed by cecal ligation and puncture (CLP), septic challenge and HVEM-siRNA or PBS was administrated by intra-tracheal instillation 2 hours after hemorrhage to determine the role of HVEM in the development of experimental iALI...
May 4, 2018: Shock
Tomoko Fujii, Tosiya Sato, Shigehiko Uchino, Kent Doi, Taku Iwami, Takashi Kawamura
PURPOSE: Acute kidney injury (AKI) is common in the intensive care unit (ICU). Selected clinical studies have implied human atrial natriuretic peptide (hANP) improves renal function; however, the treatment effects for AKI are unclear. METHODS: A multicenter prospective observational study in 13 Japanese ICUs. The effects of hANP were estimated by the standardized mortality ratio weighted analyses of generalized linear models using propensity scores. The primary outcome was renal replacement therapy (RRT) or death in the ICU...
December 1, 2018: Journal of Critical Care
Carrie A Kubiak, Kavitha Ranganathan, Niki Matusko, Jon A Jacobson, Stewart C Wang, Pauline K Park, Benjamin L Levi
BACKGROUND: Morphomic studies have demonstrated a correlation between sarcopenia and clinical outcomes in septic patients. However, tendon morphomics has not yet been studied in this context. The purpose of the present study was to evaluate tendon morphology in septic patients through analytic morphomics. We hypothesized that morphomic analyses would reveal concomitant muscle and tendon wasting in sepsis patients. The results of this study may help to implement different rehabilitation modalities for critically ill patients...
February 2019: Journal of Surgical Research
Dino Moretti, Melisa D Ré, Nicolás S Rocchetti, Daniel Horacio Bagilet, Claudio Jesus Settecase, Martin Gonzalo Buncuga, Marta Quaglino
INTRODUCTION: the Nutrition Risk in Critically Ill (NUTRIC) score does not include a variable that objectively estimates protein hypercatabolism (PHC), one of the main metabolic changes experienced by critical patients. OBJECTIVE: to evaluate the correlation of the NUTRIC score with PHC in critically ventilated patients. MATERIALS AND METHODS: prospective, observational study. Mixed ICU. It included ventilated patients ≥ 18 years old, without anuria or chronic renal failure...
October 17, 2018: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
Douglas A Simonetto, Laura Piccolo Serafim, Alice Gallo de Moraes, Ognjen Gajic, Patrick S Kamath
Sepsis in patients with cirrhosis is associated with high mortality. An impaired immune response accounts for the increased infection risk observed in these patients. Hemodynamic and systemic changes suggestive of sepsis may be seen in patients with cirrhosis in the absence of infection, therefore diagnosis and treatment of sepsis may be delayed. The optimal management of the critically-ill septic patient with cirrhosis has not been well established and is generally extrapolated from consensus guidelines and expert recommendations made for management of non-cirrhotic patients with sepsis...
December 5, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Besu F Teshome, Scott Martin Vouri, Nicholas Hampton, Marin H Kollef, Scott T Micek
STUDY OBJECTIVE: Minimizing the duration of broad-spectrum antimicrobial exposure in the critically ill is a commonly used strategy aimed at preventing resistance. Our objective was to correlate the duration of exposure to antipseudomonal β-lactam antibiotics with the development of new resistance in critically ill patients. DESIGN: Single-center, retrospective cohort study. SETTING: A large, academic, tertiary care hospital. PATIENTS: A total of 7118 adults with a discharge diagnosis of severe sepsis or septic shock who received at least 1 dose of cefepime, meropenem, or piperacillin-tazobactam during their hospitalization between 2010 and 2015...
December 3, 2018: Pharmacotherapy
Liliana Clara, Viviana M Rodríguez, Pablo Saúl, Cecilia Domínguez, Mercedes Esteban
Intra-abdominal infections represent a group of intra and retroperitoneal processes, ranging from localized infections to complicated ones, sepsis and septic shock, associated with a significant mortality rate. They are the third most commonly identified cause of sepsis and the second cause of death in the intensive care unit. Although antimicrobial therapy must be started as soon as possible, especially in critically ill patients, the source control procedure is highly relevant. On account of the importance of this subject, members of the Argentine Society of Infectious Diseases (SADI) and intensive care specialists joined to develop recommendations on diagnosis, treatment, and prevention of intra-abdominal infections...
2018: Medicina
Stephanie A K Angarita, Sergio Duarte, Tara A Russell, Piotr Ruchala, Irmina A Elliott, Julian P Whitelegge, Ali Zarrinpar
BACKGROUND: Loss of intestinal barrier integrity plays a fundamental role in the pathogenesis of various gastrointestinal diseases and is implicated in the onset of sepsis and multiple organ failure. An array of methods to assess different aspects of intestinal barrier function suffers from lack of sensitivity, prolonged periods of specimen collection, or high expense. We have developed a technique to measure the concentration of the food dye FD&C Blue #1 from blood and sought to assess its utility in measuring intestinal barrier function in humans...
January 2019: Journal of Surgical Research
Tyler J Loftus, Juan C Mira, Julie A Stortz, Tezcan Ozrazgat-Baslanti, Gabriella L Ghita, Zhongkai Wang, Babette A Brumback, Ricardo F Ungaro, Azra Bihorac, Christiaan Leeuwenburgh, Frederick A Moore, Lyle L Moldawer, Scott C Brakenridge, Philip A Efron, Alicia M Mohr
BACKGROUND: Associations among inflammatory cytokines, erythropoietin, and anemia in critically ill septic patients remain unclear. This study tested the hypothesis that elevated inflammatory cytokines and decreased erythropoietin would be associated with iron-restricted anemia while accounting for operative blood loss, phlebotomy blood loss, and red blood cell (RBC) transfusion volume. METHODS: Prospective observational cohort study of 42 critically ill septic patients...
November 27, 2018: Journal of Trauma and Acute Care Surgery
Charlene M T Robertson, Karin T Bork, Gerda Tawfik, Gwen Y Bond, Leonora Hendson, Irina A Dinu, Elham Khodayari Moez, Ivan M Rebeyka, Gonzalo Garcia Guerra, Ari R Joffe
OBJECTIVE: To reduce bilateral delayed-onset progressive sensory permanent hearing loss using a systems-wide quality improvement project with adherence to best practice for the administration of furosemide. DESIGN: Prospective cohort study with regular audiologic follow-up assessment of survivors both before and after a 2007-2008 quality improvement practice change. SETTING: The referral center in Western Canada for complex cardiac surgery, with comprehensive multidisciplinary follow-up by the Complex Pediatric Therapies Follow-up Program...
November 26, 2018: Pediatric Critical Care Medicine
M Vasco, S Pandya, D Van Dyk, D G Bishop, R Wise, R A Dyer
Maternal critical care reflects interdisciplinary care in any hospital area according to the severity of illness of the pregnant woman. The admission rate to intensive care units is below 1% (0.08-0.76%) of deliveries in high-income countries, and ranges from 0.13% to 4.6% in low middle-income countries. Mortality in these patients is high and varies from 0% to 4.9% of admissions in high-income countries, and from 2% to 43.6% in low middle-income countries. Obstetric haemorrhage, sepsis, preeclampsia, human immunodeficiency virus complications and tropical diseases are the main reasons for intensive care unit admission in low middle-income countries...
September 29, 2018: International Journal of Obstetric Anesthesia
Emmanuel Dudoignon, Alexandre Alanio, James Anstey, François Depret, Maxime Coutrot, Alexandre Fratani, Marion Jully, Alexandru Cupaciu, Maïté Chaussard, Haikel Oueslati, Axelle Ferry, Mourad Benyamina, Christian de Tymowski, David Boccara, Kevin Serror, Marc Chaouat, Maurice Mimoun, Matthieu Lafaurie, Blandine Denis, Maud Gits-Muselli, Stephane Bretagne, Alexandre Mebazaa, Matthieu Legrand, Sabri Soussi
BACKGROUND: Patients with extensive burns are at risk of developing candidemia. OBJECTIVES: To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. PATIENTS AND METHODS: Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonization and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonization index)...
November 27, 2018: Mycoses
Kevin J Downes, Julie C Fitzgerald, Emily Schriver, Craig L K Boge, Michael E Russo, Scott L Weiss, Fran Balamuth, Sherri E Kubis, Pam Tolomeo, Warren B Bilker, Jennifer H Han, Ebbing Lautenbach, Susan E Coffin, Jeffrey S Gerber
Background: Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods: We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours...
November 22, 2018: Journal of the Pediatric Infectious Diseases Society
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