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https://www.readbyqxmd.com/read/28067711/early-goal-directed-therapy-for-sepsis-a-novel-solution-for-discordant-survival-outcomes-in-clinical-trials
#1
Andre C Kalil, Daniel W Johnson, Steven J Lisco, Junfeng Sun
OBJECTIVES: Early goal-directed therapy has shown discordant survival outcomes in sepsis studies. We aim to find the reasons for this discordance. DESIGN: Random-effects and Bayesian hierarchical analyses. SETTING: Studies that evaluated early goal-directed therapy. SUBJECTS: Patients with severe sepsis and/or septic shock. INTERVENTIONS: Early goal-directed therapy. MEASUREMENTS AND MAIN RESULTS: A total of 19,998 patients were included in the main analysis: 31 observational (n = 15,656) and six randomized (n = 4,342) studies...
January 6, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28052283/the-feasibility-of-conservative-management-for-morbidly-adherent-placenta-accidentally-encountered-after-vaginal-delivery
#2
Ran Cui, Junli Lu, Zhenyu Zhang, Huimin Bai
OBJECTIVE: To evaluate the feasibility of conservative management for patients with morbidly adherent placenta (MAP) accidentally encountered after term vaginal delivery. METHODS: Medical records of patients with MAP who were accidentally encountered after term vaginal delivery and treated in our hospital from January 2009 to December 2015 were retrospectively reviewed. RESULTS: A total of 8 eligible patients were included in this analysis...
January 5, 2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28011233/septic-shock-prediction-for-icu-patients-via-coupled-hmm-walking-on-sequential-contrast-patterns
#3
Shameek Ghosh, Jinyan Li, Longbing Cao, Kotagiri Ramamohanarao
BACKGROUND AND OBJECTIVE: Critical care patient events like sepsis or septic shock in intensive care units (ICUs) are dangerous complications which can cause multiple organ failures and eventual death. Preventive prediction of such events will allow clinicians to stage effective interventions for averting these critical complications. METHODS: It is widely understood that physiological conditions of patients on variables such as blood pressure and heart rate are suggestive to gradual changes over a certain period of time, prior to the occurrence of a septic shock...
December 20, 2016: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/27993196/milk-fat-globule-epidermal-growth-factor-factor-viii-derived-peptide-msp68-is-a-cytoskeletal-immunomodulator-of-neutrophils-that-inhibits-rac1
#4
Louie Hendricks, Monowar Aziz, Weng-Lang Yang, Jeffrey Nicastro, Gene F Coppa, Marc Symons, Ping Wang
BACKGROUND: Prolonged neutrophil infiltration leads to exaggerated inflammation and tissue damage during sepsis. Neutrophil migration requires rearrangement of their cytoskeleton. Milk fat globule-epidermal growth factor-factor VIII-derived short peptide 68 (MSP68) has recently been shown to be beneficial in sepsis-induced tissue injury and mortality. We hypothesize that MSP68 inhibits neutrophil migration by modulating small GTPase Rac1-dependent cytoskeletal rearrangements. METHODS: Bone marrow-derived neutrophils (BMDNs) or whole lung digest isolated neutrophils were isolated from 8 to 10 wk old C57BL/6 mice by Percoll density gradient centrifugation...
February 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/27993157/early-phase-cumulative-hypotension-duration-and-severe-stage-progression-in-oliguric-acute-kidney-injury-with-and-without-sepsis-an-observational-study
#5
Junichi Izawa, Tetsuhisa Kitamura, Taku Iwami, Shigehiko Uchino, Masanori Takinami, John A Kellum, Takashi Kawamura
BACKGROUND: Managing blood pressure in patients with acute kidney injury (AKI) could effectively prevent severe-stage progression. However, the effect of hypotension duration in the early phase of AKI remains poorly understood. This study investigated the association between early-phase cumulative duration of hypotension below threshold mean arterial pressure (MAP) and severe-stage progression of oliguric AKI in critically ill patients, and assessed the difference in association with presence of sepsis...
December 19, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27993148/blood-transfusion-improves-renal-oxygenation-and-renal-function-in-sepsis-induced-acute-kidney-injury-in-rats
#6
Lara Zafrani, Bulent Ergin, Aysegul Kapucu, Can Ince
BACKGROUND: The effects of blood transfusion on renal microcirculation during sepsis are unknown. This study aimed to investigate the effect of blood transfusion on renal microvascular oxygenation and renal function during sepsis-induced acute kidney injury. METHODS: Twenty-seven Wistar albino rats were randomized into four groups: a sham group (n = 6), a lipopolysaccharide (LPS) group (n = 7), a LPS group that received fluid resuscitation (n = 7), and a LPS group that received blood transfusion (n = 7)...
December 20, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27959829/a-model-based-machine-learning-approach-to-probing-autonomic-regulation-from-nonstationary-vital-signs-time-series
#7
Li-Wei Lehman, Roger Mark, Shamim Nemati
Physiological variables, such as heart rate (HR), blood pressure (BP) and respiration (RESP), are tightly regulated and coupled under healthy conditions, and a break-down in the coupling has been associated with aging and disease. We present an approach that incorporates physiological modeling within a switching linear dynamical systems (SLDS) framework to assess the various functional components of the autonomic regulation through transfer function analysis of nonstationary multivariate time series of vital signs...
December 7, 2016: IEEE Journal of Biomedical and Health Informatics
https://www.readbyqxmd.com/read/27931643/microvascular-monitoring-do-global-markers-help
#8
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
#9
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
#10
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...
February 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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...
January 5, 2017: 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
#20
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
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