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https://www.readbyqxmd.com/read/27931643/microvascular-monitoring-do-global-markers-help
#1
REVIEW
Jean-Louis Vincent, Fabio Silvio Taccone
The microcirculation is altered in sepsis, and the degree and persistence of these alterations are associated with outcome. When there are significant alterations of the systemic circulation, as in shock, the microcirculation is always altered. However, sometimes global variables can be restored to normal while the microcirculation remains altered. Monitoring the microcirculation has, therefore, been proposed as a more precise means of assessing the effects of therapy. In this review, we will discuss the limitations of global haemodynamic variables such as mean arterial pressure, cardiac output and mixed venous oxygen saturation as markers of microcirculatory abnormalities...
December 2016: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/27929426/serum-soluble-fms-like-tyrosine-kinase-1-sflt-1-predicts-the-severity-of-acute-pancreatitis
#2
Paulina Dumnicka, Mateusz Sporek, Małgorzata Mazur-Laskowska, Piotr Ceranowicz, Marek Kuźniewski, Ryszard Drożdż, Tadeusz Ambroży, Rafał Olszanecki, Beata Kuśnierz-Cabala
Organ failure is the most important determinant of the severity of acute pancreatitis (AP). Soluble fms-like tyrosine kinase 1 (sFlt-1) is positively associated with organ failure in sepsis. Our aim was to evaluate the diagnostic utility of automated sFlt-1 measurements for early prediction of AP severity. Adult patients (66) with AP were recruited, including 46 with mild (MAP), 15 with moderately-severe (MSAP) and 5 with severe AP (SAP). Serum and urine samples were collected twice. Serum sFlt-1 was measured with automated electrochemiluminescence immunoassay...
December 6, 2016: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/27910086/higher-vs-lower-haemoglobin-threshold-for-transfusion-in-septic-shock-subgroup-analyses-of-the-triss-trial
#3
S L Rygård, L B Holst, J Wetterslev, P I Johansson, A Perner
BACKGROUND: Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. METHODS: In post-hoc analyses of the full trial population of 998 patients from the Transfusion Requirements in Septic Shock (TRISS) trial, we investigated the intervention effect on 90-day mortality in patients with severe comorbidity (chronic lung disease, haematological malignancy or metastatic cancer), in patients who had undergone surgery (elective or acute) and in patients with septic shock as defined by the new consensus definition: lactate above 2 mmol/l and the need for vasopressors to maintain a mean arterial pressure above 65 mmHg...
December 2, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#4
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27852320/a-complex-endeavour-an-ethnographic-study-of-the-implementation-of-the-sepsis-six-clinical-care-bundle
#5
Carolyn Tarrant, Barbara O'Donnell, Graham Martin, Julian Bion, Alison Hunter, Kevin D Rooney
BACKGROUND: Implementation of the 'Sepsis Six' clinical care bundle within an hour of recognition of sepsis is recommended as an approach to reduce mortality in patients with sepsis, but achieving reliable delivery of the bundle has proved challenging. There remains little understanding of the barriers to reliable implementation of bundle components. We examined frontline clinical practice in implementing the Sepsis Six. METHODS: We conducted an ethnographic study in six hospitals participating in the Scottish Patient Safety Programme Sepsis collaborative...
November 16, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27849677/use-of-a-short-acting-%C3%AE-1-blocker-during-endotoxemia-may-reduce-cerebral-tissue-oxygenation-if-haemodynamics-are-depressed-by-a-decrease-in-heart-rate
#6
Tadayoshi Kurita, Shingo Kawashima, Koji Morita, Yoshiki Nakajima
BACKGROUND: A decrease in heart rate (HR) using a short-acting β blocker has potential benefits in sepsis; however, depression of haemodynamics and reduction of cerebral oxygenation may also occur in endotoxemia. METHODS: Seventeen swine were allocated to landiolol or control groups. In the landiolol group, the dose was sequentially changed from 0 to 40 to 200 μg kg min, and stopped. Haemodynamics, blood variables and the cerebral tissue oxygenation index (TOI) were recorded by near infrared spectroscopy at each dose...
November 15, 2016: Shock
https://www.readbyqxmd.com/read/27823892/practical-considerations-in-sepsis-resuscitation
#7
Brit Long, Alex Koyfman, Katharine L Modisett, Christian J Woods
BACKGROUND: Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment. OBJECTIVE: This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment. DISCUSSION: Early goal-directed therapy revolutionized sepsis management...
November 4, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27817009/applicability-of-stroke-volume-variation-in-patients-of-a-general-intensive-care-unit-a-longitudinal-observational-study
#8
Sebastian Mair, Julia Tschirdewahn, Simon Götz, Johanna Frank, Veit Phillip, Benedikt Henschel, Caroline Schultheiss, Ulrich Mayr, Sebastian Noe, Matthias Treiber, Roland M Schmid, Bernd Saugel, Wolfgang Huber
Sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for the applicability of respiratory changes of the arterial curve such as stroke volume variation (SVV) to predict fluid-responsiveness. Furthermore, several secondary limitations including tidal volumes <8 mL/kg and SVV-values within the "gray zone" of 9-13% impair prediction of fluid-responsiveness by SVV. Therefore, we investigated the prevalence of these four conditions in general ICU-patients. This longitudinal observational study analyzed a prospectively maintained haemodynamic database including 4801 transpulmonary thermodilution and pulse contour analysis measurements of 278 patients (APACHE-II 21...
November 5, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27813279/oxygenation-dynamics-of-sepsis-patients-undergoing-far-infrared-intervention-based-on-near-infrared-spectroscopy
#9
Kuei-Hung Chuang, Ming-Lung Chuang, Sung-Kien Sia, Chia-Wei Sun
Near-infrared spectroscopy (NIRS; continuous wave type) is a noninvasive tool for detecting the relative change of oxyhemoglobin and deoxyhemoglobin. To make this change, intervention methods must be applied. This study determined the hemodynamics of 44 healthy participants and 35 patients with sepsis during exposure to FIR as a novel physical intervention approach. Local microcirculation of their brachioradialis was monitored during exposure and recovery through NIRS. The variations in blood flow and microvascular reaction were determined by conducting paired and unpaired t tests...
November 4, 2016: Journal of Biophotonics
https://www.readbyqxmd.com/read/27805796/implementation-of-a-multicenter-performance-improvement-program-for-early-detection-and-treatment-of-severe-sepsis-in-general-medical-surgical-wards
#10
Christa Schorr, Andrew Odden, Laura Evans, Gabriel J Escobar, Snehal Gandhi, Sean Townsend, Mitchell Levy
Sepsis is a leading cause of in-hospital death, and evidence suggests a higher mortality in patients presenting with sepsis on the ward compared to those presenting to the emergency department. Ward patients who develop severe sepsis may have poor outcomes for a variety of reasons, including delayed diagnosis, lack of readily available staffing, and delayed treatment. We report on a multihospital quality improvement program for early detection and treatment of sepsis on general medical-surgical wards. We describe a multipronged approach to improve severe sepsis outcomes using the Institute for Healthcare Improvement's Plan-Do-Study-Act model...
November 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27798314/cerebral-blood-flow-autoregulation-in-sepsis-for-the-intensivist-why-its-monitoring-may-be-the-future-of-individualized-care
#11
Carrie M Goodson, Kathryn Rosenblatt, Lucia Rivera-Lara, Paul Nyquist, Charles W Hogue
Cerebral blood flow (CBF) autoregulation maintains consistent blood flow across a range of blood pressures (BPs). Sepsis is a common cause of systemic hypotension and cerebral dysfunction. Guidelines for BP management in sepsis are based on historical concepts of CBF autoregulation that have now evolved with the availability of more precise technology for its measurement. In this article, we provide a narrative review of methods of monitoring CBF autoregulation, the cerebral effects of sepsis, and the current knowledge of CBF autoregulation in sepsis...
October 25, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27768920/nano-lc-ms-ms-for-the-identification-of-proteins-trapped-in-sorbent-cartridges-used-for-coupled-plasma-filtration-adsorption-treatments-of-healthy-pigs
#12
Donatella Nardiello, Clelia Prattichizzo, Maria Teresa Rocchetti, Loreto Gesualdo, Diego Centonze
A dedicated proteomic approach based on nano-Liquid Chromatography coupled with tandem mass spectrometry in ion trap is proposed for the analysis of proteins trapped in sorbent resin cartridges used to remove inflammatory mediators from blood by coupled plasma filtration adsorption (CPFA). The final purpose of the proposed proteomic approach was to obtain a reference map of plasma proteins trapped in CPFA sorbents used for the extracorporeal blood purification of healthy pigs, with the potential impact to design new bio-filters able to control the inflammatory imbalance under pathological conditions, such as severe sepsis...
October 12, 2016: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/27760303/effects-of-a-human-recombinant-alkaline-phosphatase-on-renal-hemodynamics-oxygenation-and-inflammation-in-two-models-of-acute-kidney-injury
#13
Esther Peters, Bülent Ergin, Asli Kandil, Ebru Gurel-Gurevin, Andrea van Elsas, Rosalinde Masereeuw, Peter Pickkers, Can Ince
Two small clinical trials indicated that administration of bovine intestinal alkaline phosphatase (AP) improves renal function in critically ill patients with sepsis-associated acute kidney injury (AKI), for which the mechanism of action is not completely understood. Here, we investigated the effects of a newly developed human recombinant AP (recAP) on renal oxygenation and hemodynamics and prevention of kidney damage and inflammation in two in vivo AKI models. To induce AKI, male Wistar rats (n=18) were subjected to renal ischemia (30min) and reperfusion (I/R), or sham-operated...
December 15, 2016: Toxicology and Applied Pharmacology
https://www.readbyqxmd.com/read/27759589/influences-of-macrohemodynamic-conditions-on-systemic-microhemodynamic-changes-in-burns
#14
Jochen-Frederick Hernekamp, Florian Neubrech, Tomke Cordts, Volker J Schmidt, Ulrich Kneser, Thomas Kremer
PURPOSE: The clinical course after major burns is characterized by microcirculatory changes and consecutive capillary leakage. However, current clinical monitoring does not properly assess microcirculation, whereas macrohemodynamic changes are continuously evaluated. Here, we assess if macrohemodynamic and microhemodynamic parameters after burn trauma are correlated in a rat model. METHODS: Burn plasma harvested from donor rats 4 hours after thermal injury (30% total body surface area, 100 °C water, 12 seconds) was administered intravenously to healthy animals during 2 hours of intravital microscopy (burn group [BG])...
October 17, 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/27713891/vasoactive-agents-for-the-treatment-of-sepsis
#15
REVIEW
Zhongheng Zhang, Kun Chen
The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine...
September 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27677085/predicting-fluid-responsiveness-using-bedside-ultrasound-measurements-of-the-inferior-vena-cava-and-physician-gestalt-in-the-emergency-department-of-an-urban-public-hospital-in-sub-saharan-africa
#16
Hendry Robert Sawe, Cathryn Haeffele, Juma A Mfinanga, Victor G Mwafongo, Teri A Reynolds
BACKGROUND: Bedside inferior vena cava (IVC) ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI) and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation. METHODS: This was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician's impression of patient volume status and cause of hypotension...
2016: PloS One
https://www.readbyqxmd.com/read/27633962/a-randomized-trial-comparing-terlipressin-and-noradrenaline-in-patients-with-cirrhosis-and-septic-shock
#17
Ashok Choudhury, Chandan K Kedarisetty, Chitranshu Vashishtha, Deepak Saini, Sachin Kumar, Rakhi Maiwall, Manoj K Sharma, Ajeet S Bhadoria, Guresh Kumar, Yogendra K Joshi, Shiv K Sarin
BACKGROUND & AIMS: The choice of vasopressor for treating cirrhosis with septic shock is unclear. While noradrenaline in general is the preferred vasopressor, terlipressin improves microcirculation in addition to vasopressor action in non-cirrhotics. We compared the efficacy and safety of noradrenaline and terlipressin in cirrhotics with septic shock. PATIENTS AND METHODS: Cirrhotics with septic shock underwent open label randomization to receive either terlipressin (n=42) or noradrenaline (n=42) infusion at a titrated dose...
September 16, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/27612852/peripheral-nerve-conduction-abnormalities-precede-morphological-alterations-in-an-experimental-rat-model-of-sepsis
#18
Arisa Miura, Hirofumi Hino, Kazuhide Uchida, Soichiro Inoue, Takeshi Tateda
PURPOSE: The pathological mechanisms of critical illness polyneuropathy (CIP), an acute neuromuscular disorder, remain unknown. In this study, we evaluated nerve and vascular properties that might account for electrophysiological abnormalities, including reduced nerve conduction amplitude, in the early phase of CIP. METHODS: Rats were administered intravenous saline (C-group; n = 31) or lipopolysaccharide (3 mg/kg/day; L-group; n = 30) for 48 h. Subsequently, tracheotomy was performed and sciatic nerves exposed bilaterally...
September 9, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27578513/soluble-suppression-of-tumorigenicity-2-and-echocardiography-in-sepsis
#19
Hyun Suk Yang, Mina Hur, Hanah Kim, Laura Magrini, Rossella Marino, Salvatore Di Somma
Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated...
November 2016: Annals of Laboratory Medicine
https://www.readbyqxmd.com/read/27551277/carbapenem-resistance-in-acinetobacter-baumannii-and-other-acinetobacter-spp-causing-neonatal-sepsis-focus-on-ndm-1-and-its-linkage-to-isaba125
#20
Somdatta Chatterjee, Saswati Datta, Subhasree Roy, Lavanya Ramanan, Anindya Saha, Rajlakshmi Viswanathan, Tapas Som, Sulagna Basu
Carbapenem-resistant determinants and their surrounding genetic structure were studied in Acinetobacter spp. from neonatal sepsis cases collected over 7 years at a tertiary care hospital. Acinetobacter spp. (n = 68) were identified by ARDRA followed by susceptibility tests. Oxacillinases, metallo-β-lactamases (MBLs), extended-spectrum β-lactamases and AmpCs, were detected phenotypically and/or by PCR followed by DNA sequencing. Transconjugants possessing the bla NDM-1(New Delhi metallo-β-lactamase) underwent further analysis for plasmids, integrons and associated genes...
2016: Frontiers in Microbiology
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