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Septic dialysis

Fabio Araujo Motta, Libera Maria Dalla-Costa, Marisol Dominguez Muro, Mariana Nadal Cardoso, Gledson Luiz Picharski, Gregory Jaeger, Marion Burger
OBJECTIVE: To evaluate risk factors associated with death due to bloodstream infection caused by Candida spp. in pediatric patients and evaluate the resistance to the main anti-fungal used in clinical practice. METHODS: This is a cross-sectional, observational, analytical study with retrospective collection that included 65 hospitalized pediatric patients with bloodstream infection by Candida spp. A univariate analysis was performed to estimate the association between the characteristics of the candidemia patients and death...
October 3, 2016: Jornal de Pediatria
Parnandi Bhaskar Rao, Neha Singh, Sumanth Samson
A 56-year-old man on maintenance hemodialysis was admitted to the intensive care unit with septic shock and coagulopathy. As there was a dialysis catheter in the right internal jugular vein, the left internal jugular vein was cannulated with a central venous catheter to initiate vasopressor therapy. A chest X-ray showed formation of a catheter loop inside the left brachiocephalic vein, probably due to hindrance by the dialysis catheter. This report describes the hurdles encountered, repeated cannulation attempts, and serial chest X-ray findings required to obtain acceptable placement of the catheter tip...
October 2016: Korean Journal of Anesthesiology
Aristine Cheng, Hsin-Yun Sun, Mao-Song Tsai, Wen-Je Ko, Pi-Ru Tsai, Fu-Chang Hu, Yee-Chun Chen, Shan-Chwen Chang
BACKGROUND: To identify novel factors associated with the survival of septic adults receiving extracorporeal membrane oxygenation (ECMO) to improve patient selection and outcomes. METHODS: Cases were identified from our ECMO registry from 2001 to 2011 if they were ≥16 years and received ECMO for life-threatening sepsis. RESULTS: A total of 151 adults with a median (25th-75th percentile) age of 51 (37-63) years were analyzed. Pneumonia (50%), myocarditis (20%), and primary bloodstream infections (15%) were the main types of infection, caused by predominantly nonfermentative Gram-negative bacteria (NFGNB) (26%), Enterobacteriaceae (24%), and Gram-positive cocci (21%)...
August 30, 2016: Journal of Thoracic and Cardiovascular Surgery
Mohamed Shokr, Ramanjit Kaur, Kevin Belgrave, Arshad Javed, Mahir Elder, Shaun Cardozo, Luis Afonso, Amir Kaki
Catheter related thrombosis (CRT) is a commonly encountered entity fraught with substantial risk for mortality secondary to various complications including pulmonary embolism (PE), tricuspid regurgitation, endocarditis, right sided heart failure, and cardiogenic and septic shock. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients. Management strategies include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines...
2016: Case Reports in Cardiology
Philip Simon Webb, Abdallah Al-Mohammad
A man aged 73 years with infective endocarditis presented with septic shock and was started on immediate antimicrobial therapy. His blood culture yielded no organism. Subsequently, he developed a severe allergic reaction to prolonged empirical vancomycin therapy. This manifested as fever, widespread maculopapular rash and severe progressive acute kidney injury ultimately requiring dialysis. In the context of eosinophilia, this was determined to be drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome...
August 29, 2016: BMJ Case Reports
Aleksandra Leligdowicz, William A Fischer, Timothy M Uyeki, Thomas E Fletcher, Neill K J Adhikari, Gina Portella, Francois Lamontagne, Christophe Clement, Shevin T Jacob, Lewis Rubinson, Abel Vanderschuren, Jan Hajek, Srinivas Murthy, Mauricio Ferri, Ian Crozier, Elhadj Ibrahima, Marie-Claire Lamah, John S Schieffelin, David Brett-Major, Daniel G Bausch, Nikki Shindo, Adrienne K Chan, Tim O'Dempsey, Sharmistha Mishra, Michael Jacobs, Stuart Dickson, G Marshall Lyon, Robert A Fowler
As of 20 May 2016 there have been 28,646 cases and 11,323 deaths resulting from the West African Ebola virus disease (EVD) outbreak reported to the World Health Organization. There continue to be sporadic flare-ups of EVD cases in West Africa.EVD presentation is nonspecific and characterized initially by onset of fatigue, myalgias, arthralgias, headache, and fever; this is followed several days later by anorexia, nausea, vomiting, diarrhea, and abdominal pain. Anorexia and gastrointestinal losses lead to dehydration, electrolyte abnormalities, and metabolic acidosis, and, in some patients, acute kidney injury...
2016: Critical Care: the Official Journal of the Critical Care Forum
Marina Pieri, Marcus Müller, Anna Mara Scandroglio, Panagiotis Pergantis, Alexandra Kretzschmar, Friedrich Kaufmann, Volkmar Falk, Thomas Krabatsch, Georg Arlt, Marian Kukucka, Evgenij Potapov
Mediastinitis is more frequent in patients with implantable ventricular assist devices (VAD) than in other cardiac surgery patients and carries significant mortality. We report our experience with a stepwise approach including aggressive debridement, jet lavage, vacuum assisted closure (VAC) dressing and finally coverage with well-vascularized and immune active omental flaps in VAD patients with infective mediastinitis.We retrospectively collected and analyzed data of patients with continuous flow VAD who underwent plasty with the omental flap due to mediastinitis at Deutsches Herzzentrum Berlin beween 1 January 2008 and 30 October 2015 ...
July 26, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ghaneh Fananapazir, Christoph Troppmann, Michael T Corwin, Arian M Nikpour, Sima Naderi, Ramit Lamba
PURPOSE: To determine the incidence of acute kidney injury (AKI), need for emergent dialysis, and renal graft loss in patients with kidney transplants, who underwent CT examinations with low-osmolality iodine-based contrast material (IBCM). MATERIALS AND METHODS: Our institutional review board approved this retrospective Health Insurance Portability and Accountability Act compliant study. From January 2005 to April 2015, a total of 224 CT examinations were performed using low-osmolality IBCM in patients with kidney transplants...
July 5, 2016: Abdominal Radiology
Javier A Neyra, Xilong Li, Fabrizio Canepa-Escaro, Beverley Adams-Huet, Robert D Toto, Jerry Yee, S Susan Hedayati
OBJECTIVE: Incident acute kidney injury and prevalent chronic kidney disease are commonly encountered in septic patients. We examined the differential effect of acute kidney injury and chronic kidney disease on the association between cumulative fluid balance and hospital mortality in critically ill septic patients. DESIGN: Retrospective cohort study. SETTING: Urban academic medical center ICU. PATIENTS: ICU adult patients with severe sepsis or septic shock and serum creatinine measured within 3 months prior to and 72 hours of ICU admission...
October 2016: Critical Care Medicine
Winnie Kwai Yu Chan, Wun Fung Hui
BACKGROUND: High-dose methotrexate therapy (HDMTX) is a common form of chemotherapy used in children with high-grade malignancy such as osteosarcoma. Treatment with HDMTX requires careful monitoring of drug levels with folinic acid (leucovorin) rescue therapy. Toxicity from methotrexate is not uncommon and sometimes causes significant morbidity and mortality. CASE-DIAGNOSIS/TREATMENT: We report an 11-year-old child whose 24-h post-HDMTX serum level was 651.8 μmol/L (recommended level <20 μmol/L), which was complicated by septic shock and progressive renal and liver failure...
October 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
S Sen, H Akdam, S B Ozturk, A Soyder
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
Anne-Marie E Sirany, Christopher J Chow, Hiroko Kunitake, Robert D Madoff, David A Rothenberger, Mary R Kwaan
BACKGROUND: More than 450,000 US patients with end-stage renal disease currently dialyze. The risk of morbidity and mortality for these patients after colorectal surgery has been incompletely described. OBJECTIVE: We analyzed the 30-day morbidity and mortality rates of chronic dialysis patients who underwent colorectal surgery. DESIGN: This was a retrospective analysis. SETTINGS: Hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program were included...
July 2016: Diseases of the Colon and Rectum
John I Shin, Aakash Keswani, Andrew J Lovy, Calin S Moucha
BACKGROUND: The modified frailty index (mFI) has been shown to predict adverse outcomes in multiple nonorthopedic surgical specialties. This study aimed to assess whether mFI is a predictor of adverse events in patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Patients who underwent THA and TKA from 2005-2012 were identified in the National Surgical Quality Improvement Program database. mFI was calculated for each patient using 15 variables found in National Surgical Quality Improvement Program...
April 27, 2016: Journal of Arthroplasty
Paul D Weyker, Xosé L Pérez, Kathleen D Liu
Acute kidney injury (AKI) is an abrupt decrease in kidney function that takes place over hours to days. Sepsis is the leading cause of AKI and portends a particularly high morbidity and mortality, although the severity may vary from a transient rise in serum creatinine to end-stage renal disease. With regard to acid-base management in septic AKI, caution should be used with hyperchloremic crystalloid solutions, and dialysis is often used in the setting of severe acidosis. In the future, biomarkers may help clinicians identify AKI earlier and allow for potential interventions before the development of severe AKI...
June 2016: Clinics in Chest Medicine
Asha M Zimmerman, Jayson Marwaha, Hector Nunez, David Harrington, Daithi Heffernan, Sean Monaghan, Charles Adams, Andrew Stephen
BACKGROUND: Recent studies have linked postoperative serum troponin elevation to mortality in a range of different clinical scenarios. To date, there has been no investigation into the significance of preoperative troponin elevation in emergency general surgery (EGS) patients. We define this as preoperative myocardial injury (PMI). We hypothesize that PMI seen in EGS patients may predict postoperative morbidity and mortality. STUDY DESIGN: Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, we performed a retrospective review of all EGS cases between 2008 and 2014...
August 2016: Journal of the American College of Surgeons
Fahad Saleh Alhajjaj, Farooq Pasha
Emphysematous pyelonephritis (EPN) is a rare disease with devastating outcomes in healthy adults. It may affect renal allografts resulting in higher mortality rate, graft loss and permanent dialysis. Presentation is highly variable and non-specific requiring higher degree of suspension. Optimal management of EPN is controversial with recent case reports challenging a previously suggested management pathway. We report a case of a 71-year-old man who presented in septic shock who was diagnosed with EPN in an allograft kidney in the emergency department, treated with antibiotics and medical support but died on the 6th day of presentation...
April 2016: International Journal of Health Sciences
M Cronhjort, P B Hjortrup, L B Holst, E Joelsson-Alm, J Mårtensson, C Svensen, A Perner
BACKGROUND: Several studies have shown an association between a positive fluid balance and increased mortality in patients with septic shock. This may have led to a more restrictive use of intravenous fluids. The association between fluid accumulation and mortality in the setting of a more restrictive use of intravenous fluids, however, is uncertain. We therefore aimed to investigate the association between a cumulative fluid balance 3 days after randomization and 90-day mortality in a recent Nordic multicentre cohort of patients with septic shock...
August 2016: Acta Anaesthesiologica Scandinavica
Yusuke Minematsu, Masafumi Yamato, Yuta Ikemiya, Takahito Ito
BACKGROUND: The most frequent cause of acute kidney injury (AKI) needing renal replacement therapy is sepsis, with the prognosis of patients with septic AKI worse than for other causes of this disease. Recent studies have shown that fibroblast growth factor-23 (FGF-23) levels, one of the phosphaturic and prognostic factors in chronic kidney disease, are also elevated in patients with AKI and correlate with an increased risk of death or a need for dialysis. In addition, FGF-23 was found to inhibit the extra-renal synthesis of 1,25-dihydroxyvitamin D by human monocytes...
2016: Clinical Laboratory
Kent Doi
Kidney injury, including acute kidney injury (AKI) and chronic kidney disease (CKD), has become very common in critically ill patients treated in ICUs. Many epidemiological studies have revealed significant associations of AKI and CKD with poor outcomes of high mortality and medical costs. Although many basic studies have clarified the possible mechanisms of sepsis and septic AKI, translation of the obtained findings to clinical settings has not been successful to date. No specific drug against human sepsis or AKI is currently available...
2016: Journal of Intensive Care
Stephan Harm, Franz Gabor, Jens Hartmann
Endotoxins are the major components of the outer membrane of most Gram-negative bacteria and are one of the main targets in inflammatory diseases. The presence of endotoxins in blood can provoke septic shock in case of pronounced immune response. Here we show in vitro inactivation of endotoxins by polymyxin B (PMB). The inflammatory activity of the LPS-PMB complex in blood was examined in vitro in freshly drawn blood samples. Plasma protein binding of PMB was determined by ultracentrifugation using membranes with different molecular cut-offs, and PMB clearance during dialysis was calculated after in vitro experiments using the AV1000S filter...
May 2016: Innate Immunity
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