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Lung, sepsis, shock, ventilator

M E Nunnally
Sepsis is as a dysregulated systemic response to infection. Morbidity and mortality of the syndrome are very high worldwide. Recent definitions have redefined criteria for sepsis. The new definition (Sepsis-3) classifies sepsis as infection with organ dysfunction (the old 'severe sepsis'). Septic patients are at risk for secondary injuries, thus aggressive source control, resuscitation, and antibiotic therapy are the mainstays of management. Central to sepsis physiology is vasodilated shock. Many patients respond to i...
December 2016: British Journal of Anaesthesia
Janko Vlaović, Gorazd Voga
A 72-year-old patient was admitted to the medical intensive care unit due to a right-sided, hospital-acquired pneumonia and septic shock with respiratory failure and deterioration of chronic renal failure. During hospitalization the patient required hemodynamic support with norepinephrine and dobutamine, mechanical ventilation and hemodialysis. The patient suffered a non-ST segment elevation myocardial infarction (NSTEMI) and received dual antiplatelet therapy. After 14 days an acute intrapulmonary infiltrate of unknown origin developed, accompanied by fever and a significant increase of the C‑reactive protein (CRP) level...
December 2016: Wiener Klinische Wochenschrift
Elisa Estenssoro, Arnaldo Dubin
Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance...
2016: Medicina
Gianluigi Li Bassi, Joan Daniel Marti, Eli Aguilera Xiol, Talitha Comaru, Francesca De Rosa, Montserrat Rigol, Silvia Terraneo, Mariano Rinaudo, Laia Fernandez, Miguel Ferrer, Antoni Torres
BACKGROUND: Hemoperfusion through a column containing polymyxin B-immobilized fiber (PMX-HP) is beneficial in abdominal sepsis. We assessed the effects of PMX-HP in a model of severe Pseudomonas aeruginosa pneumonia. METHODS: Eighteen pigs with severe P. aeruginosa pneumonia were mechanically ventilated for 76 h. Pigs were randomized to receive standard treatment with fluids and vasoactive drugs, or standard treatment with two 3-h PMX-HP sessions. Antibiotics against P...
December 2016: Annals of Intensive Care
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Jeffrey E Gotts, Michael A Matthay
Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular, cell, and intact organ level...
May 23, 2016: BMJ: British Medical Journal
Won-Young Kim, Sang-Bum Hong
Severe sepsis or septic shock is characterized by an excessive inflammatory response to infectious pathogens. Acute respiratory distress syndrome (ARDS) is a devastating complication of severe sepsis, from which patients have high mortality. Advances in treatment modalities including lung protective ventilation, prone positioning, use of neuromuscular blockade, and extracorporeal membrane oxygenation, have improved the outcome over recent decades, nevertheless, the mortality rate still remains high. Timely treatment of underlying sepsis and early identification of patients at risk of ARDS can help to decrease its development...
April 2016: Tuberculosis and Respiratory Diseases
A Vieillard-Baron, M Matthay, J L Teboul, T Bein, M Schultz, S Magder, J J Marini
RATIONALE: Acute respiratory distress syndrome (ARDS) is frequently associated with hemodynamic instability which appears as the main factor associated with mortality. Shock is driven by pulmonary hypertension, deleterious effects of mechanical ventilation (MV) on right ventricular (RV) function, and associated-sepsis. Hemodynamic effects of ventilation are due to changes in pleural pressure (Ppl) and changes in transpulmonary pressure (TP). TP affects RV afterload, whereas changes in Ppl affect venous return...
May 2016: Intensive Care Medicine
Robert Słotwiński, Agnieszka Sarnecka, Aleksandra Dąbrowska, Katarzyna Kosałka, Ewelina Wachowska, Barbara J Bałan, Marta Jankowska, Teresa Korta, Grzegorz Niewiński, Andrzej Kański, Małgorzata Mikaszewska-Sokolewicz, Mohammad Omidi, Krystyna Majewska, Sylwia M Słotwińska
The aim of this study was an attempt to determine whether the expression of genes involved in innate antibacterial response (TL R2, NOD 1, TRAF6, HMGB 1 and Hsp70) in peripheral blood leukocytes in critically ill patients, may undergo significant changes depending on the severity of the infection and the degree of malnutrition. The study was performed in a group of 128 patients with infections treated in the intensive care and surgical ward. In 103/80.5% of patients, infections had a severe course (sepsis, severe sepsis, septic shock, mechanical ventilation of the lungs)...
2015: Central-European Journal of Immunology
Kim Timmermans, Matthijs Kox, Gert Jan Scheffer, Peter Pickkers
Danger-associated molecular patterns (DAMPs) that are released by injured, threatened, or dead cells, or that originate from the extracellular matrix, influence the immune system. This is of great relevance in critically ill patients, in whom trauma or surgery-related cell damage, hypoxia, ischemia, and infections can result in extensive release of DAMPs. As many patients at the intensive care unit suffer from immune system-related complications, DAMPs could serve as markers for the prognosis of these patients and represent possible therapeutic targets...
February 2016: Shock
Chien-Ho Tsai, Yi-Chun Lai, Shih-Chieh Chang, Cheng-Yu Chang, Wei-Shu Wang, Mei-Kang Yuan
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) with decortication is a major treatment for thoracic empyema in the fibropurulent stage. Compared to open thoracotomy, VATS decortication has similar efficacy but fewer postoperative complications in the treatment of thoracic empyema. The role of VATS decortication in the elderly had rarely been investigated. METHODS: From January 2006 to August 2011, we retrospectively enrolled 33 patients older than 65 years diagnosed as thoracic empyema and treated with VATS decortication...
January 2016: Journal of the Chinese Medical Association: JCMA
François Philippart, Gaëlle Bouroche, Jean-François Timsit, Maité Garrouste-Orgeas, Elie Azoulay, Michael Darmon, Christophe Adrie, Bernard Allaouchiche, Claire Ara-Somohano, Stéphane Ruckly, Anne-Sylvie Dumenil, Bertrand Souweine, Dany Goldgran-Toledano, Lila Bouadma, Benoît Misset
RATIONALE: Experimental studies suggest that intra-abdominal infection (IAI) induces biological alterations that may affect the risk of lung infection. OBJECTIVES: To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP). METHODS: We used data entered into the French prospective multicenter Outcomerea database in 1997-2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included...
2015: PloS One
Liang Qiao, Zhi Liu
OBJECTIVE: To discuss the risk factors of acute respiratory distress syndrome (ARDS) in patients with sepsis in emergency department. METHODS: 312 patients with sepsis admitted to Department of Emergency of China Medical University Affiliated First Hospital were retrospectively analyzed, and they were divided into two groups according to development of ARDS, which was defined according to the Berlin new definition. The age, gender, vital signs, laboratory results, underlying disease, the mortality in emergency department sepsis (MEDS) score and lung injury prediction score (LIPS) were collected...
July 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Gary F Nieman, Louis A Gatto, Jason H T Bates, Nader M Habashi
Trauma, hemorrhagic shock, or sepsis can incite systemic inflammatory response syndrome, which can result in early acute lung injury (EALI). As EALI advances, improperly set mechanical ventilation (MV) can amplify early injury into a secondary ventilator-induced lung injury that invariably develops into overt ARDS. Once established, ARDS is refractory to most therapeutic strategies, which have not been able to lower ARDS mortality below the current unacceptably high 40%. Low tidal volume ventilation is one of the few treatments shown to have a moderate positive impact on ARDS survival, presumably by reducing ventilator-induced lung injury...
December 2015: Chest
Erika P Plata-Menchaca, V M De la Puente-Diaz de Leon, Adriana G Peña-Romero, Eduardo Rivero-Sigarroa
Introduction. Pulmonary hemorrhage secondary to disseminated strongyloidiasis is an unusual, well-recognized entity in immunocompromised patients with autoimmune disease, which is associated with the hyperinfection syndrome, sepsis, and a high mortality rate. Case Presentation. We present a case of a 44-year-old Mexican woman with systemic lupus erythematosus and acute bacterial meningitis who developed pulmonary hemorrhage with acute respiratory failure requiring mechanical ventilation, treated with broad spectrum systemic antibiotics and high dose methylprednisolone, who subsequently developed a characteristic purpuric skin eruption and septic shock and died two days later of refractory hypoxemia caused by massive pulmonary bleeding...
2015: Case Reports in Critical Care
Hendrik J F Helmerhorst, Marie-José Roos-Blom, David J van Westerloo, Evert de Jonge
OBJECTIVE: Oxygen is vital during critical illness, but hyperoxia may harm patients. Our aim was to systematically evaluate the methodology and findings of cohort studies investigating the effects of hyperoxia in critically ill adults. DATA SOURCE: A meta-analysis and meta-regression analysis of cohort studies published between 2008 and 2015 was conducted. Electronic databases of MEDLINE, EMBASE, and Web of Science were systematically searched for the keywords hyperoxia and mortality or outcome...
July 2015: Critical Care Medicine
Cristina Vazquez Guillamet, Rodrigo Vazquez, Scott T Micek, Oleg Ursu, Marin Kollef
OBJECTIVE: To develop and internally validate a prediction rule for the presence of candidemia in patients with severe sepsis and septic shock (candidemia rule) that will fill the gap left by previous rules. To compare the accuracy of the available Candida prediction models. DESIGN: Retrospective cohort study. SETTING: Barnes-Jewish Hospital, St. Louis, Missouri. PATIENTS/SUBJECTS: Two thousand five hundred ninety-seven consecutive patients with a positive blood culture and severe sepsis or septic shock...
August 2015: Journal of Critical Care
S John, C Willam
BACKGROUND: The lungs and kidneys represent the most often affected organs (acute respiratory distress syndrome, ARDS or kidney failure) in multiple organ failure (MOF) due to shock, trauma, or sepsis with a still unacceptable high mortality for both organ failures. PATHOGENESIS AND INTERACTIONS: Although the exact pathophysiological mechanisms of MOF are not completely elucidated, it appears that the lungs and kidneys share several pathophysiologic pathways and have the potential to further harm each other (kidney-lung crosstalk)...
September 2015: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Carmen Pizarro, Dirk Skowasch, Georg Nickenig, Daniel Thomas, Marcel Kaminski
History and clinical findings | A 57-year-old woman with a history of emphysematous COPD GOLD D and homozygotic alpha-1-antitrypsin deficiency presented with aggravated dyspnoea, presyncope and left thoracic chest pain. 12 years previously Stanford type B dissection had been conservatively treated. Examinations | Chest radiograph revealed extended infiltrates of the left lower lobe. Seen together with elevated inflammatory values and the patient´s hemodynamic instability it pointed at a pneumonia-driven septic shock...
January 2015: Deutsche Medizinische Wochenschrift
Muneyuki Takeuchi, Kazuya Tachibana
The mortality rate among patients suffering acute respiratory distress syndrome (ARDS) remains high despite implementation at clinical centers of the lung protective ventilatory strategies recommended by the International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. This suggests that such strategies are still sub-optimal for some ARDS patients. For these patients, tailored use of ventilator settings should be considered, including: further reduction of tidal volumes, administration of neuromuscular blocking agents if the patient's spontaneous breathing is incompatible with mechanical ventilation, and adjusting positive end-expiratory pressure (PEEP) settings based on transpulmonary pressure levels...
2015: Cardiovascular & Hematological Disorders Drug Targets
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