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Septic shock review

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https://www.readbyqxmd.com/read/100001003/emergency-management-of-sepsis-the-simple-stuff-saves-lives
#1
David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
https://www.readbyqxmd.com/read/28332876/evaluation-and-management-of-adrenal-insufficiency-in-critically-ill-patientsdisease-state-review
#2
Amir H Hamrahian, Maria Fleseriu
Definition of normal adrenal function in critically ill patients remains controversial, despite a large body of literature. Furthermore, evaluation of adrenal function in these patients is complex. A decrease in cortisol breakdown rather than an increase in cortisol production has been suggested as the main contributor to elevated cortisol levels in critically ill patients. The concept of relative adrenal insufficiency has multiple pathophysiological flaws and is not supported by current evidence. Patients with septic shock who are pressor-dependent or refractory to fluid resuscitation should receive a short course of hydrocortisone regardless of their serum cortisol levels or their response to a Cosyntropin stimulation test (CST)...
March 23, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28331537/combined-totally-mini-invasive-approach-in-necrotizing-pancreatitis-a-case-report-and-systematic-literature-review
#3
REVIEW
Luca Sorrentino, Osvaldo Chiara, Massimiliano Mutignani, Fabrizio Sammartano, Paolo Brioschi, Stefania Cimbanassi
BACKGROUND: Currently, both the step-up approach, combining percutaneous drainage (PD) and video-assisted retroperitoneal debridement (VARD), and endoscopic transgastric necrosectomy (ETN) are mini-invasive techniques for infected necrosis in severe acute pancreatitis. A combination of these approaches could maximize the management of necrotizing pancreatitis, conjugating the benefits from both the experiences. However, reporting of this combined strategy is anecdotal. This is the first reported case of severe necrotizing pancreatitis complicated by biliary fistula treated by a combination of ETN, PD, VARD, and endoscopic biliary stenting...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28321079/shewanella-algae-bacteremia-in-an-end-stage-renal-disease-patient-a-case-report-and-review-of-the-literature
#4
Tomoaki Takata, Hiroki Chikumi, Shota Morishita, Shintaro Hamada, Shotaro Hoi, Takuji Iyama, Takeaki Fukui, Tomomitsu Matono, Satoko Fukuda, Chishio Munemura, Hajime Isomoto
A 71-year-old man was admitted because of nausea and abdominal pain. He was receiving an erythropoiesis-stimulating agent for anemia and dysregulated iron metabolism due to stage G5 chronic kidney disease. He had a history of raw fish intake and was diagnosed with infectious enterocolitis, which worsened and led to septic shock. Shewanella putrefaciens grew in the blood culture, but Shewanella algae was identified in a 16S rRNA gene sequence analysis. We herein report a case of S. algae bacteremia believed to have been transmitted orally...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28319910/the-role-of-vasopressin-and-the-vasopressin-type-v1a-receptor-agonist-selepressin-in-septic-shock
#5
REVIEW
Antonio F Saad, Marc O Maybauer
Septic shock remains one of the major causes of morbidity and mortality in the critically ill. Despite early goal therapy and administration of cathecholaminergic agents, up to 30% of patients succumb to the disease. In this manuscript, we first summarize the standard of care of patients with septic shock and current guidelines. We review the physiologic role of vasopressin and its role in septic shock management. We then review the most up-to-date evidence on the potential role of V1a receptor agonists such as Selepressin, in septic shock...
March 15, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28316845/spinal-cord-infarction-in-the-course-of-a-septic-shock-about-one-case-and-review-of-the-literature
#6
P Henin, A Molderez, V Huberlant, H Trine
We report the case of a patient admitted to our intensive care unit in the course of a septic shock, secondary to cholangitis. After rapid hemodynamic stabilization, antibiotherapy, and endoscopic extraction of bile ducts stones, she appeared to have developed flaccid paraplegia. The suspected diagnosis of medullar ischemia was confirmed by typical MRI findings. This case stresses the potential pathogenic role of hypotension in medullar ischemia and the place of magnetic resonance imaging (MRI) as a reliable diagnostic tool...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28304355/the-glyoxalase-system-and-methylglyoxal-derived-carbonyl-stress-in-sepsis-glycotoxic-aspects-of-sepsis-pathophysiology
#7
REVIEW
Thomas Schmoch, Florian Uhle, Benedikt H Siegler, Thomas Fleming, Jakob Morgenstern, Peter P Nawroth, Markus A Weigand, Thorsten Brenner
Sepsis remains one of the leading causes of death in intensive care units. Although sepsis is caused by a viral, fungal or bacterial infection, it is the dysregulated generalized host response that ultimately leads to severe dysfunction of multiple organs and death. The concomitant profound metabolic changes are characterized by hyperglycemia, insulin resistance, and profound transformations of the intracellular energy supply in both peripheral and immune cells. A further hallmark of the early phases of sepsis is a massive formation of reactive oxygen (ROS; e...
March 17, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28299952/n-acetylcysteine-s-role-in-sepsis-and-potential-benefit-in-patients-with-microcirculatory-derangements
#8
Jason Chertoff
OBJECTIVE: To review the data surrounding the utility of N-acetylcysteine (NAC) in sepsis and identify areas needed for additional research. DATA SOURCES: A review of articles describing the mechanisms of action and clinical use of NAC in sepsis. SUMMARY OF REVIEW: Despite many advances in critical care medicine, still as many as 50% of patients with septic shock die. Treatments thus far have focused on resuscitation and restoration of macrocirculatory targets in the early phases of sepsis, with less focus on microcirculatory dysfunction...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28296657/neuroendocrine-derangements-in-early-septic-shock-pharmacotherapy-for-relative-adrenal-and-vasopressin-insufficiency
#9
James W Schurr, Paul M Szumita, Jeremy R DeGrado
Septic shock is a leading cause of mortality in intensive care units throughout the world. While this disease state represents a highly complex pathophysiology involving numerous organ systems, the early approach to care includes adequate hemodynamic support traditionally achieved via infusions of vasoactive medications after adequate fluid resuscitation. Relative adrenal and vasopressin deficiencies are a common feature of septic shock that contribute to impaired hemodynamics. Hydrocortisone and vasopressin are endocrine system hormone analogues that target the acute neuroendocrine imbalance associated with septic shock...
March 14, 2017: Shock
https://www.readbyqxmd.com/read/28289047/are-patients-with-cancer-with-sepsis-and-bacteraemia-at-a-higher-risk-of-mortality-a-retrospective-chart-review-of-patients-presenting-to-a-tertiary-care-centre-in-lebanon
#10
Gilbert Abou Dagher, Christopher El Khuri, Ahel Al-Hajj Chehadeh, Ali Chami, Rana Bachir, Dina Zebian, Ralphe Bou Chebl
OBJECTIVE: Most sepsis studies have looked at the general population. The aim of this study is to report on the characteristics, treatment and hospital mortality of patients with cancer diagnosed with sepsis or septic shock. SETTING: A single-centre retrospective study at a tertiary care centre looking at patients with cancer who presented to our tertiary hospital with sepsis, septic shock or bacteraemia between 2010 and 2015. PARTICIPANTS: 176 patients with cancer were compared with 176 cancer-free controls...
March 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28284298/severe-sepsis-and-septic-shock-trials-process-arise-promise-what-is-optimal-resuscitation
#11
REVIEW
Tiffany M Osborn
Between 2014 and 2015, 3 independent, multicenter, randomized controlled trials evaluated early goal-directed therapy (EGDT) in severe sepsis and septic shock: Protocolized Care for Early Septic Shock (ProCESS) from the United States; Australasian Resuscitation in Sepsis Evaluation (ARISE), and Protocolised Management in Sepsis (ProMISe) in the United Kingdom. All 3 trials confirmed that there was no survival benefit of EGDT compared to usual resuscitation. How should we define usual care for sepsis given these study findings? Furthermore, the definition of sepsis has now been updated...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28279723/physiologic-cryoamputation-in-managing-critically-ill-patients-with-septic-advanced-acute-limb-ischemia
#12
Samuel L Chen, Isabella J Kuo, Nii-Kabu Kabutey, Roy M Fujitani
OBJECTIVES: Certain critically ill patients with advanced acute limb ischemia with a non-viable extremity may be unsuitable for transport to the operating room to undergo definitive amputation. In these unstable patients, rapid regional cryotherapy allows for prompt infectious source control and correction of hemodynamic and metabolic abnormalities, thereby lessening the risk associated with definitive surgical amputation. We describe our refined technique for lower extremity physiologic cryoamputation and review our institutional experience...
March 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28275488/early-management-of-sepsis-with-emphasis-on-early-goal-directed-therapy-ame-evidence-series-002
#13
REVIEW
Zhongheng Zhang, Yucai Hong, Nathan J Smischney, Han-Pin Kuo, Panagiotis Tsirigotis, Jordi Rello, Win Sen Kuan, Christian Jung, Chiara Robba, Fabio Silvio Taccone, Marc Leone, Herbert Spapen, David Grimaldi, Sven Van Poucke, Steven Q Simpson, Patrick M Honore, Stefan Hofer, Pietro Caironi
Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials...
February 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28270040/predictors-of-septic-shock-in-initially-stable-patients-with-pyogenic-liver-abscess
#14
Hyunyoung Cho, Eu Sun Lee, Yoon-Seon Lee, Youn-Jung Kim, Chang Hwan Sohn, Shin Ahn, Dong-Woo Seo, Jae Ho Lee, Won Young Kim, Kyung Soo Lim
OBJECTIVES: The incidence of pyogenic liver abscess (PLA), a life-threatening condition, is increasing worldwide. This study was designed to evaluate clinical features and outcomes in initially stable patients with PLA and to determine the predictors of septic shock. METHODS: The medical records of all adult patients who were hemodynamically stable and diagnosed with PLA in the emergency department from January 2010 to December 2014, inclusive, were reviewed. The primary outcome was septic shock...
May 2017: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/28257752/efficacy-and-safety-of-idelalisib-in-combination-with-ofatumumab-for-previously-treated-chronic-lymphocytic-leukaemia-an-open-label-randomised-phase-3-trial
#15
Jeffrey A Jones, Tadeusz Robak, Jennifer R Brown, Farrukh T Awan, Xavier Badoux, Steven Coutre, Javier Loscertales, Kerry Taylor, Elisabeth Vandenberghe, Malgorzata Wach, Nina Wagner-Johnston, Loic Ysebaert, Lyndah Dreiling, Ronald Dubowy, Guan Xing, Ian W Flinn, Carolyn Owen
BACKGROUND: Idelalisib, a selective inhibitor of PI3Kδ, is approved for the treatment of patients with relapsed chronic lymphocytic leukaemia (CLL) in combination with rituximab. We aimed to assess the efficacy and safety of idelalisib in combination with a second-generation anti-CD20 antibody, ofatumumab, in a similar patient population. METHODS: In this global, open-label, randomised, controlled phase 3 trial, we enrolled patients with relapsed CLL progressing less than 24 months from last therapy...
March 2017: Lancet Haematology
https://www.readbyqxmd.com/read/28251608/adult-t-cell-leukemia-lymphoma-in-a-peruvian-hospital-in-human-t-lymphotropic-virus-type-1-htlv-1-positive-patients
#16
Milton José Max Rodríguez-Zúñiga, Florencio Cortez-Franco, Eberth Qujiano-Gomero
BACKGROUND: Adult T-cell leukemia/lymphoma (ATLL) is an aggressive neoplasm of T-lymphocytes associated with human T-lymphotropic virus type I (HTLV-1) infection. As HTLV-1 is endemic in native ethnics in South America, and its infection leads to several chronic diseases as ATLL with poor prognosis, we aimed to present three ATLL cases and to review current literature. CASE REPORTS: Two cases were from the mountains of Peru, while one was from an endemic harbor of the country...
March 2, 2017: International Journal of Dermatology
https://www.readbyqxmd.com/read/28250986/severe-tuberculosis-requiring-intensive-care-a-descriptive-analysis
#17
Raquel Pacheco Duro, Paulo Figueiredo Dias, Alcina Azevedo Ferreira, Sandra Margarida Xerinda, Carlos Lima Alves, António Carlos Sarmento, Lurdes Campos Dos Santos
Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors. Methods. Retrospective cohort study of all TB patients admitted to the ICU of the Infectious Diseases Department of Centro Hospitalar de São João (Porto, Portugal) between January 2007 and July 2014. Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify risk factors for death...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/28237623/effect-of-underlying-immune-compromise-on-the-manifestations-and-outcomes-of-group-a-streptococcal-bacteremia
#18
Kathleen A Linder, Leen Alkhouli, Mayur Ramesh, George A Alangaden, Carol A Kauffman, Marisa H Miceli
BACKGROUND: Group A streptococcal bloodstream infection is the most common presentation of invasive group A streptococcal disease. We sought to determine the impact of immunosuppression on severity of disease and clinical outcomes. METHODS: This retrospective review of 148 patients with at least one positive blood culture for Streptococcus pyogenes from 1/2003 to 3/2013 compared immunocompromised patients with those with no immunocompromise in regards to development of severe complications and mortality...
February 22, 2017: Journal of Infection
https://www.readbyqxmd.com/read/28221185/antipyretic-therapy-in-critically-ill-septic-patients-a-systematic-review-and-meta-analysis
#19
Anne M Drewry, Enyo A Ablordeppey, Ellen T Murray, Carolyn R T Stoll, Sonya R Izadi, Catherine M Dalton, Angela C Hardi, Susan A Fowler, Brian M Fuller, Graham A Colditz
OBJECTIVE: This meta-analysis aimed to examine the impact of antipyretic therapy on mortality in critically ill septic adults. DATA SOURCES: Literature searches were implemented in Ovid Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, and ClinicalTrials.gov through February 2016. STUDY SELECTION: Inclusion criteria were observational or randomized studies of septic patients, evaluation of antipyretic treatment, mortality reported, and English-language version available...
February 17, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28215930/ultrasound-guided-resuscitative-endovascular-balloon-occlusion-of-the-aorta-in-the-resuscitation-area
#20
Takayuki Ogura, Alan Kawarai Lefor, Mitsunobu Nakamura, Kenji Fujizuka, Kousuke Shiroto, Minoru Nakano
BACKGROUND: In trauma resuscitation with resuscitative endovascular balloon occlusion of the aorta (REBOA), urgent and accurate placement of the catheter in the resuscitation area without fluoroscopy can shorten the time from admission to REBOA, allowing rapid, temporary control of bleeding. DISCUSSION: The experience-based protocol in our center for ultrasound-guided REBOA in the resuscitation area without fluoroscopy is as follows: the femoral artery is punctured and a guidewire inserted; sonography is used to verify that the guidewire is in the abdominal aorta; the position of the balloon is confirmed with ultrasound after estimating the distance to the clavicle, and the pressure in the radial artery and sheath is used to monitor correct positioning; connect the pressure transducer to the catheter sheath for continuous monitoring of the blood pressure in the sheath, and inflate the balloon until the blood pressure tracing at the sheath has disappeared; check the pulse in the left radial artery, and withdraw the catheter slightly if the pulse in the radial artery is not palpable or is decreased (if this pulse is not palpable or decreased, the balloon is in the aortic arch)...
February 17, 2017: Journal of Emergency Medicine
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