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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/29789983/principles-of-fluid-management-and-stewardship-in-septic-shock-it-is-time-to-consider-the-four-d-s-and-the-four-phases-of-fluid-therapy
#2
REVIEW
Manu L N G Malbrain, Niels Van Regenmortel, Bernd Saugel, Brecht De Tavernier, Pieter-Jan Van Gaal, Olivier Joannes-Boyau, Jean-Louis Teboul, Todd W Rice, Monty Mythen, Xavier Monnet
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition...
May 22, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29784051/contributions-of-a-survey-and-retrospective-cohort-study-to-the-planning-of-a-randomised-controlled-trial-of-corticosteroids-in-the-treatment-of-paediatric-septic-shock
#3
Anna Liu, Kusum Menon
BACKGROUND: Randomised controlled trials (RCTs) are challenging to conduct in a paediatric critical-care environment. Background work, including surveys and observational studies, is often used to determine disease estimates, sample sizes and design protocols when planning such RCTs. Our objective was to determine the necessity of performing a survey or a retrospective chart review or both when planning an RCT on corticosteroids in the treatment of paediatric septic shock. METHODS: We compared information on corticosteroid use for moderate to severe paediatric septic shock obtained from a survey of physician beliefs and stated practices with that obtained from a retrospective cohort study...
May 21, 2018: Trials
https://www.readbyqxmd.com/read/29779703/idiopathic-systemic-capillary-leak-syndrome-presenting-as-septic-shock-a-case-report
#4
Eamon P Raith, Joshua F Ihle, Jennifer Jamieson, Anna Kalff, Julian Bosco
BACKGROUND: Idiopathic capillary leak syndrome (Clarkson's Disease) is a rare angiopathy with a heterogenous phenotype that may present as distributive shock refractory to resuscitative management. OBJECTIVE: We report a case of idiopathic systemic capillary leak syndrome presenting as septic shock. METHODS: Structured case report and review of the literature. RESULTS: A 27-year old man admitted to our institution with coryzal symptoms rapidly deteriorated with presumed sepsis, leading to intensive care unit admission...
May 17, 2018: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/29763894/the-understanding-and-management-of-organism-toxicity-in-septic-shock
#5
Kelly Roveran Genga, Tadanaga Shimada, John H Boyd, Keith R Walley, James A Russell
The toxicity caused by different organisms in septic shock is substantially complex and characterized by an intricate pathogenicity that involves several systems and pathways. Immune cells' pattern recognition receptors initiate the host response to pathogens after the recognition of pathogen-associated molecular patterns. In essence, the subsequent activation of downstream pathways may progress to infection resolution or to a dysregulated host response that represents the hallmark of organ injury in septic shock...
May 15, 2018: Journal of Innate Immunity
https://www.readbyqxmd.com/read/29761216/low-dose-corticosteroids-for-adult-patients-with-septic-shock-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis
#6
Sofie Louise Rygård, Ethan Butler, Anders Granholm, Morten Hylander Møller, Jeremy Cohen, Simon Finfer, Anders Perner, John Myburgh, Balasubramanian Venkatesh, Anthony Delaney
PURPOSE: To assess the effect of low dose corticosteroids on outcomes in adults with septic shock. METHODS: We systematically reviewed randomised clinical trials (RCTs) comparing low-dose corticosteroids to placebo in adults with septic shock. Trial selection, data abstraction and risk of bias assessment were performed in duplicate. The primary outcome was short-term mortality. Secondary and tertiary outcomes included longer-term mortality, adverse events, quality of life, and duration of shock, mechanical ventilation and ICU stay...
May 14, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29753517/liberal-versus-restrictive-intravenous-fluid-therapy-for-early-septic-shock-rationale-for-a-randomized-trial
#7
Wesley H Self, Matthew W Semler, Rinaldo Bellomo, Samuel M Brown, Bennett P deBoisblanc, Matthew C Exline, Adit A Ginde, Colin K Grissom, David R Janz, Alan E Jones, Kathleen D Liu, Stephen P J Macdonald, Chadwick D Miller, Pauline K Park, Lora A Reineck, Todd W Rice, Jay S Steingrub, Daniel Talmor, Donald M Yealy, Ivor S Douglas, Nathan I Shapiro
Prompt intravenous fluid therapy is a fundamental treatment for patients with septic shock. However, the optimal approach for administering intravenous fluid in septic shock resuscitation is unknown. Two competing strategies are emerging: a liberal fluids approach, consisting of a larger volume of initial fluid (50 to 75 mL/kg [4 to 6 L in an 80-kg adult] during the first 6 hours) and later use of vasopressors, versus a restrictive fluids approach, consisting of a smaller volume of initial fluid (≤30 mL/kg [≤2 to 3 L]), with earlier reliance on vasopressor infusions to maintain blood pressure and perfusion...
May 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29753504/extracorporeal-life-support-for-adults-with-refractory-septic-shock
#8
Sun Kyun Ro, Wan Kee Kim, Ju Yong Lim, Jae Suk Yoo, Sang-Bum Hong, Joon Bum Kim
OBJECTIVE: Although the use of extracorporeal membrane oxygenation (ECMO) in shock patients is increasing worldwide, studies concerning this treatment for adult septic shock are limited. This study aimed to analyze the outcome of venoarterial ECMO in adult patients with septic shock refractory to conventional treatment. METHODS: A total of 71 consecutive patients who presented with septic shock and underwent venoarterial ECMO were reviewed. Clinical parameters were compared between survivors and nonsurvivors...
April 7, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29753454/response-of-a-local-hospital-to-a-burn-disaster-contributory-factors-leading-to-zero-mortality-outcomes
#9
Eng-Kean Yeong, Ciaran P O'Boyle, Hui-Fu Huang, Hao-Chih Tai, Yen-Chun Hsu, Shu-Yang Chuang, Yu-Feng Wu, Che-Wei Chang, Tom J Liu, Hong-Shiee Lai
OBJECTIVE: To investigate the outcomes of a local healthcare system in managing a burn mass casualty incident (BMCI). METHODS: Thirty-three victims admitted to the National Taiwan University Hospital within 96h of the explosion were included in the study. Data were recorded on: patient demographics, Baux score, laboratory data, management response, treatment strategies, and outcomes. Case notes from June 27, 2015 to November 2015 were reviewed with a focus on fluid resuscitation, ventilation support, nutrition, infection control, sepsis treatment, and wound closure plan...
May 9, 2018: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29742211/antibiotic-therapy-in-ventilator-associated-tracheobronchitis-a-literature-review
#10
Abel Eduardo Alves, José Manuel Pereira
The concept of ventilator-associated tracheobronchitis is controversial; its definition is not unanimously accepted and often overlaps with ventilator-associated pneumonia. Ventilator-associated tracheobronchitis has an incidence similar to that of ventilator-associated pneumonia, with a high prevalence of isolated multiresistant agents, resulting in an increase in the time of mechanical ventilation and hospitalization but without an impact on mortality. The performance of quantitative cultures may allow better diagnostic definition of tracheobronchitis associated with mechanical ventilation, possibly avoiding the overdiagnosis of this condition...
March 2018: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29740793/immune-checkpoint-receptors-homeostatic-regulators-of-immunity
#11
REVIEW
Antonio Riva, Shilpa Chokshi
Alcoholic liver disease (ALD) is an escalating global problem accounting for more than 3 million deaths annually. Bacterial infections are diagnosed in 25-47% of hospitalized patients with cirrhosis and represent the most important trigger for acute decompensation, multi-organ failure, septic shock and death. Current guidelines recommend intensive antibiotic therapy, but this has led to the emergence of multi-drug resistant bacteria, which are associated with increased morbidity and mortality rates. As such, there is a pressing need to explore new paradigms for anti-infective therapy and host-directed immunomodulatory therapies are a promising approach...
May 8, 2018: Hepatology International
https://www.readbyqxmd.com/read/29733491/recognition-and-treatment-of-sepsis-in-pregnancy
#12
Anthony M Kendle, Judette Louis
Sepsis that occurs in the context of pregnancy is associated with significant maternal morbidity and mortality. International and multidisciplinary organizations have advocated for expedient diagnosis and initiation of treatment in patients with sepsis. However, the physiologic changes of pregnancy complicate both identification and treatment of maternal sepsis. This article describes a case of a woman presenting with symptoms of sepsis progressing to septic shock. Strategies for identifying and treating women with presumed sepsis are reviewed, and recent data regarding maternal and fetal outcomes are discussed...
May 7, 2018: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/29732423/predicting-critical-care-unit-level-complications-after-long-segment-fusion-procedures-for-adult-spinal-deformity
#13
Rafael De la Garza-Ramos, Jonathan Nakhla, Yaroslav Gelfand, Murray Echt, Aleka N Scoco, Merritt D Kinon, Reza Yassari
Background: To identify predictive factors for critical care unit-level complications (CCU complication) after long-segment fusion procedures for adult spinal deformity (ASD). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database [2010-2014] was reviewed. Only adult patients who underwent fusion of 7 or more spinal levels for ASD were included. CCU complications included intraoperative arrest/infarction, ventilation >48 hours, pulmonary embolism, renal failure requiring dialysis, cardiac arrest, myocardial infarction, unplanned intubation, septic shock, stroke, coma, or new neurological deficit...
March 2018: Journal of Spine Surgery (Hong Kong)
https://www.readbyqxmd.com/read/29726824/advances-in-the-management-of-pediatric-septic-shock-old-questions-new-answers
#14
Javed Ismail, M Jayashree
Septic shock in children is associated with high mortality, especially in developing countries. Management includes early recognition, timely antibiotics, aggressive fluid resuscitation, and appropriate vasoactive therapy, to achieve the therapeutic end points. The evidence at each step in management has evolved over the past decade with a paradigm shift in emphasis from a 'protocolized care' to an 'individualized physiology-based care'. This shift mirrors the general trend one observes in critical care with respect to various treatment modalities i...
April 15, 2018: Indian Pediatrics
https://www.readbyqxmd.com/read/29722636/recent-advances-in-nanomedicine-for-sepsis-treatment
#15
Simseok A Yuk, Diego A Sanchez-Rodriguez, Michael D Tsifansky, Yoon Yeo
Sepsis and septic shock are life-threating conditions, which form a continuum of the body's response to overwhelming infection. The current treatment consists of fluid and metabolic resuscitation, hemodynamic and end-organ support, and timely initiation of antibiotics. However, these measures may be ineffective and the sepsis-related mortality toll remains substantial; therefore, an urgent need exists for new therapies. Recently, several nanoparticle (NP) systems have shown excellent protective effects against sepsis in preclinical models, suggesting a potential utility in the management of sepsis and septic shock...
May 1, 2018: Therapeutic Delivery
https://www.readbyqxmd.com/read/29719812/peripheral-t-cell-lymphoma-not-otherwise-specified-ptcl-nos-presenting-as-an-endobronchial-lesion-case-report-and-literature-review
#16
Takuto Sueyasu, Kazunori Tobino, Masanobu Okahisa, Kojin Murakami, Yuki Goto, Miyuki Munechika, Kohei Yoshimine, Saori Nishizawa, Yuki Ko, Yuki Yoshimatsu, Mina Asaji, Kosuke Tsuruno, Hiromi Ide, Hiroyuki Miyajima
Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) is a rare entity of lymphoma. We herein report an even rarer case of a 68-year-old male with PTCL-NOS presenting as an endobronchial lesion, and review previously published cases in the literature. Initially, he was referred to our hospital for further investigation of the right upper lobe consolidation on chest radiograph. Computed tomography and 18F-fludeoxyglucose positron emission tomography revealed a right hilar mass with obstruction of the main bronchus and submandibular, right axillary and mediastinal lymphadenopathy...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29715258/comparison-of-sepsis-3-criteria-versus-sirs-criteria-in-screening-patients-for-sepsis-in-the-emergency-department
#17
Brian W Gilbert, Lanae Faires, Amber Meister, Joel Huffman, Rebecca K Faber
The objective of our study was to assess the percentage of patients who met qSOFA criteria, SIRS criteria, both, or none of either criterion and received an International Classification of Diseases, Tenth Revision (ICD-10) code for sepsis after admission from the emergency department (ED). This was a single-center retrospective chart review of medical patients admitted through the ED. Patients were included if they were older than 18 years, were admitted to an inpatient unit through the ED, and received antibiotics within 48 hr of admission...
April 2018: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29706238/-a-fatal-septic-shock-due-to-capnocytophaga-canimorsus-and-review-of-literature
#18
G Vignon, P Combeau, J Violette, A-S Cognée, S Méglio, F Carrère, P Aucher, F Lellouche
INTRODUCTION: Capnocytophaga canimorsus is a Gram-negative bacterium present in normal dogs and cats mouths. It can be responsible for septic shocks after dog or cat bite, especially in asplenic patients. CASE REPORT: We report here a case of C. canimorsus infection rapidly presenting as a multiple organ dysfonction syndrome in an immunocompetent 54 years old patient, who lives near a dog, without any sign of bite. The evolution was a rapidly fatal fulminant septic shock...
April 26, 2018: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/29703972/critically-ill-allogenic-hsct-patients-in-the-intensive-care-unit-a-systematic-review-and-meta-analysis-of-prognostic-factors-of-mortality
#19
Colombe Saillard, Michael Darmon, Magali Bisbal, Antoine Sannini, Laurent Chow-Chine, Marion Faucher, Etienne Lengline, Norbert Vey, Didier Blaise, Elie Azoulay, Djamel Mokart
Outcome of patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) has improved. To investigate if this improvement can be transposed to the ICU setting, we conducted a systematic review and meta-analysis to assess short-term mortality of critically ill allo-HSCT patients admitted to the ICU and to identify prognostic factors of mortality. Public-domain electronic databases, including Medline via PubMed and the Cochrane Library were searched. All full-text articles written-English studies published from 2006 to 2016, including allo-HSCT adults transferred to the ICU were included...
April 27, 2018: Bone Marrow Transplantation
https://www.readbyqxmd.com/read/29697421/a-case-report-and-literature-review-of-scrub-typhus-with-acute-abdomen-and-septic-shock-in-a-child-the-role-of-leukocytoclastic-vasculitis-and-granulysin
#20
Po-Hsiung Chang, Yu-Pin Cheng, Po-Sheng Chang, Chiao-Wei Lo, Lung-Huang Lin, Chin-Fang Lu, Wen-Hung Chung
Scrub typhus is becoming a clinically important cause of acute undifferentiated febrile illness in Taiwan. The incubation period is between 6 and 21 days after exposure. It is transmitted by chiggers (larva of trombiculid mite) in long grasses and in dirt-floor homes, with infection characterized by a flu-like illness of fever, headache, and myalgia lasting approximately 1 week. It has various systemic manifestations, including GI symptoms. In some, the illness progresses to multiorgan dysfunction syndrome and death...
April 24, 2018: American Journal of Dermatopathology
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