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Severe sepsis, septic shock

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https://www.readbyqxmd.com/read/28213737/associations-among-left-ventricular-systolic-function-tachycardia-and-cardiac-preload-in-septic-patients
#1
Michael J Lanspa, Sajid Shahul, Andrew Hersh, Emily L Wilson, Troy D Olsen, Eliotte L Hirshberg, Colin K Grissom, Samuel M Brown
BACKGROUND: In sepsis, tachycardia may indicate low preload, adrenergic stimulation, or both. Adrenergic overstimulation is associated with septic cardiomyopathy. We sought to determine whether tachycardia was associated with left ventricular longitudinal strain, a measure of cardiac dysfunction. We hypothesized an association would primarily exist in patients with high preload. METHODS: We prospectively observed septic patients admitted to three study ICUs, who underwent early transthoracic echocardiography...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28210888/double-carbapenem-combination-as-salvage-therapy-for-untreatable-infections-by-kpc-2-producing-klebsiella-pneumoniae
#2
M Souli, I Karaiskos, A Masgala, L Galani, E Barmpouti, H Giamarellou
We report our experience using the double-carbapenem combination as salvage therapy for patients with untreatable infections caused by KPC-2- producing Klebsiella pneumoniae. A total of 27 patients in two institutions in Athens, Greece suffering from complicated urinary tract infections (16) with or without secondary bacteraemia (four and 12 respectively), primary (six) or catheter-related bloodstream infections (two), HAP or VAP (two) and external ventricular drainage infection (one) were treated exclusively with ertapenem and high-dose prolonged infusion meropenem because in-vitro active antimicrobials were unavailable (19) or failed (four) or were contraindicated (six)...
February 16, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28207922/mass-spectrometry-for-the-discovery-of-biomarkers-of-sepsis
#3
REVIEW
Katelyn R Ludwig, Amanda B Hummon
Sepsis is a serious medical condition that occurs in 30% of patients in intensive care units (ICUs). Early detection of sepsis is key to prevent its progression to severe sepsis and septic shock, which can cause organ failure and death. Diagnostic criteria for sepsis are nonspecific and hinder a timely diagnosis in patients. Therefore, there is currently a large effort to detect biomarkers that can aid physicians in the diagnosis and prognosis of sepsis. Mass spectrometry is often the method of choice to detect metabolomic and proteomic changes that occur during sepsis progression...
February 16, 2017: Molecular BioSystems
https://www.readbyqxmd.com/read/28207566/the-new-sepsis-definition-limitations-and-contribution-to-research-and-diagnosis-of-sepsis
#4
Franck Verdonk, Alice Blet, Alexandre Mebazaa
PURPOSE OF REVIEW: Based on recent clinical, epidemiological, and pathophysiological data, a third international consensus conference was carried out to define new criteria of sepsis in February 2016. This review presents the different items of this new definition, their limitations and their contribution to research and diagnosis of sepsis, in comparison with the previous definitions. RECENT FINDINGS: Incidence, management, and pathophysiological knowledge of sepsis have improved over the past 20 years...
February 15, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28207287/thiamine-as-a-renal-protective-agent-in-septic-shock-a-secondary-analysis-of-a-randomized-double-blind-placebo-controlled-trial
#5
Ari Moskowitz, Lars W Andersen, Michael N Cocchi, Mathias Karlsson, Parth V Patel, Michael W Donnino
RATIONALE: Acute kidney injury (AKI) is common in patients with sepsis and has been associated with high mortality rates. The provision of thiamine to septic patients may reduce the incidence and severity of sepsis-related AKI and thereby prevent renal failure requiring renal replacement therapy (RRT). OBJECTIVES: To test the hypothesis that thiamine supplementation mitigates kidney injury in septic shock. METHODS: This was a secondary analysis of a single-center, randomized, double-blind trial comparing thiamine to placebo in patients with septic shock...
February 16, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28190441/neurologic-complications-of-sepsis
#6
E Schmutzhard, B Pfausler
Over the past decades, the incidence of sepsis and resultant neurologic sequelae has increased, both in industrialized and low- or middle-income countries, by approximately 5% per year. Up to 300 patients per 100 000 population per year are reported to suffer from sepsis, severe sepsis, and septic shock. Mortality is up to 30%, depending on the precision of diagnostic criteria. The increasing incidence of sepsis is partially explained by demographic changes in society, with aging, increasing numbers of immunocompromised patients, dissemination of multiresistant pathogens, and greater availability of supportive medical care in both industrialized and middle-income countries...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28188577/sofa-score-in-septic-patients-incremental-prognostic-value-over-age-comorbidities-and-parameters-of-sepsis-severity
#7
Francesca Innocenti, Camilla Tozzi, Chiara Donnini, Eleonora De Villa, Alberto Conti, Maurizio Zanobetti, Riccardo Pini
Several widely used scoring systems for septic patients have been validated in an ICU setting, and may not be appropriate for other settings like Emergency Departments (ED) or High-Dependency Units (HDU), where a relevant number of these patients are managed. The purpose of this study is to find reliable tools for prognostic assessment of septic patients managed in an ED-HDU. In 742 patients diagnosed with sepsis/severe sepsis/septic shock, not-intubated, admitted in ED between June 2008 and April 2016, SOFA, qSOFA, PIRO, MEWS, Charlson Comorbidity Index, MEDS, and APACHE II were calculated at ED admission (T0); SOFA and MEWS were also calculated after 24 h of ED-High-Dependency Unit stay (T1)...
February 10, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28185230/superior-accuracy-of-mid-regional-proadrenomedullin-for-mortality-prediction-in-sepsis-with-varying-levels-of-illness-severity
#8
David Andaluz-Ojeda, H Bryant Nguyen, Nicolas Meunier-Beillard, Ramón Cicuéndez, Jean-Pierre Quenot, Dolores Calvo, Auguste Dargent, Esther Zarca, Cristina Andrés, Leonor Nogales, Jose María Eiros, Eduardo Tamayo, Francisco Gandía, Jesús F Bermejo-Martín, Pierre Emmanuel Charles
BACKGROUND: The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity has not been explored. In this work, we examined the ability of mid-regional proadrenomedullin (MR-proADM) in predicting mortality in sepsis patients with different degrees of organ failure, compared to that of procalcitonin, C-reactive protein and lactate. METHODS: This was a two-centre prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to the ICU...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28178155/complement-mediated-thrombotic-microangiopathy-secondary-to-sepsis-induced-disseminated-intravascular-coagulation-successfully-treated-with-eculizumab-a-case-report
#9
Tomohiro Abe, Akira Sasaki, Taichiro Ueda, Yoshitaka Miyakawa, Hidenobu Ochiai
Secondary thrombotic microangiopathies (TMAs) are induced by several underlying conditions; most are resolved by treating background disease. Eculizumab is a human monoclonal antibody that blocks the final stage of the complement system and effectively treats atypical hemolytic uremic syndrome (aHUS). In this report, we present a patient with TMA secondary to sepsis- induced coagulopathy, who was successfully treated with eculizumab.A 44-year-old woman, who had no special medical history or familial history of TMAs, was admitted on suspicion of septic shock...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28178007/role-of-skin-biopsies-in-the-diagnosis-of-hemophagocytic-lymphohistiocytosis
#10
Aileen Santos-Arroyo, Julián Barrera-Llaurador, Julio E Sánchez, Rafael Martín-García, Jorge L Sánchez
This is a report of a 15-year-old female who presented with a skin eruption and clinical features consistent with severe sepsis and septic shock. A diagnosis of acquired hemophagocytic lymphohistiocytosis (HLH) was made and confirmed by bone marrow analysis. Skin biopsy showed hemophagocytosis and CD163-positive staining of macrophages. We briefly review the clinical, histologic, and laboratory findings of hemophagocytic lymphohistiocytosis in addition to the potential role of skin biopsies in this condition...
January 26, 2017: American Journal of Dermatopathology
https://www.readbyqxmd.com/read/28169944/increased-time-to-initial-antimicrobial-administration-is-associated-with-progression-to-septic-shock-in-severe-sepsis-patients
#11
Bristol B Whiles, Amanda S Deis, Steven Q Simpson
OBJECTIVES: To determine if time to initial antimicrobial is associated with progression of severe sepsis to septic shock. DESIGN: Retrospective cohort. SETTING: Six hundred fifty-six bed urban academic medical center. PATIENTS: Emergency department patients greater than or equal to 18 years old with severe sepsis and/or septic shock and antimicrobial administration within 24 hours. Patients with shock on presentation were excluded...
February 6, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28166112/endogenous-thrombin-potential-as-marker-of-procoagulant-response-that-can-be-useful-in-early-stage-of-sepsis
#12
Dunja Mihajlovic, Snezana Brkic, Dajana Lendak, Aleksandra Novakov Mikic, Biljana Draskovic, Gorana Mitic
Sepsis is associated with complex procoagulant and anticoagulant changes that modify inflammatory response. Identification of coagulation markers that can differentiate useful procoagulant response from adverse alteration of clotting mechanism in patient with sepsis. In total, 150 patients who fulfilled criteria for diagnosis of sepsis were included in this study. Patients were categorized in two groups according to sepsis severity in the first 24 h from intensive care unit admission: sepsis and septic shock...
February 3, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28165586/efficacy-of-postoperative-polymyxin-b-hemoperfusion-in-secondary-peritonitis-patients-with-septic-shock-a-propensity-matched-analysis
#13
Kuo-Ching Yuan, Shang-Yu Wang, Ming-Chin Yu, Yu-Pao Hsu, Heng-Chih Pan, Yung-Chang Chen
INTRODUCTION: Severe sepsis and septic shock is still a challenge. Polymyxin B hemoperfusion (PMX) is a device designed to remove circulating endotoxin by adsorption, which is reported to improve treatment outcomes. This study aimed to further verify the efficacy of PMX on postoperative, peritonitis, septic shock patients. METHODS: This study prospectively analyzed 20 of 155 patients who presented with postoperative septic shock and were treated with PMX in a single institute during the period March 2013 to September 2014 (Clinical Trial Protocol number: ChiCTR-ONC-16008160)...
February 4, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28165033/micheliolide-provides-protection-of-mice-against-staphylococcus-aureus-and-mrsa-infection-by-down-regulating-inflammatory-response
#14
Xinru Jiang, Yuli Wang, Yifei Qin, Weigang He, Adel Benlahrech, Qingwen Zhang, Xin Jiang, Zhenhui Lu, Guang Ji, Yuejuan Zheng
A major obstacle to therapy in intensive care units is sepsis caused by severe infection. In recent years gram-positive (G(+)) bacteria, most commonly staphylococci, are thought to be the main pathogens. Micheliolide (MCL) was demonstrated to provide a therapeutic role in rheumatoid arthritis, inflammatory intestinal disease, colitis-associated cancer, and lipopolysaccharide (LPS, the main component of G(-) bacterial cell wall) induced septic shock. We proved here that MCL played an anti-inflammatory role in Staphylococcus aureus (S...
February 6, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28163944/immune-reconstitution-inflammatory-syndrome-opening-pandora-s-box
#15
Mariana Meireles, Conceição Souto Moura, Margarida França
One of the purposes of antiretroviral therapy (ART) is to restore the immune system. However, it can sometimes lead to an aberrant inflammatory response and paradoxical clinical worsening known as the immune reconstitution inflammatory syndrome (IRIS). We describe a 23-year-old male, HIV1 infected with a rapid progression phenotype, who started ART with TCD4+ of 53 cells/mm(3) (3,3%) and HIV RNA = 890000 copies/mL (6 log). Four weeks later he was admitted to the intensive care unit with severe sepsis...
2017: Case Reports in Infectious Diseases
https://www.readbyqxmd.com/read/28158885/breaking-bad-delirium-methamphetamine-and-boric-acid-toxicity-with-hallucinations-and-pseudosepsis
#16
Kayla Johnson, Joanna L Stollings, E Wesley Ely
OBJECTIVES: A 30-year-old patient presented with hallucinations and profound shock. He was initially misdiagnosed as having severe sepsis; once ingestions were considered, he was diagnosed as potentially having arsenic toxicity. SUMMARY: The clinical story reveals many instructional lessons that could aid in the evaluation and management of future patients. This man presented with large amounts of blue crystals around his nose and lips from inhaling and eating boric acid (an ant poison) so he could, as he put it, kill the ants "pouring into my mouth and nose and up into my brain...
February 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28153504/effect-of-omega-3-polyunsaturated-fatty-acids-derived-from-fish-oil-in-major-burn-patients-a-prospective-randomized-controlled-pilot-trial
#17
Serrana Tihista, Estrella Echavarría
BACKGROUND & AIMS: The burn patient is the clearest example of prolonged inflammatory response. Various nutrients, particularly omega-3 polyunsaturated fatty acids (ω-3 PUFAs), have been demonstrated as attenuating the inflammatory response, and reduce infectious complications. In absence of definitive evidence in major burns the study aimed at investigating the effect particularly on infectious complications of enteral nutrition enriched with ω-3 PUFAs. METHOD: Prospectively randomized controlled trial...
January 16, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28152345/the-burden-of-invasive-infections-in-critically-ill-indigenous-children-in-australia
#18
Justyna A Ostrowski, Graeme MacLaren, Janet Alexander, Penny Stewart, Sheena Gune, Joshua R Francis, Subodh Ganu, Marino Festa, Simon J Erickson, Lahn Straney, Luregn J Schlapbach
OBJECTIVES: To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia. DESIGN: Retrospective multi-centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data. PARTICIPANTS: All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 - 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset...
February 6, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28149822/a-profile-of-metabolic-acidosis-in-patients-with-sepsis-in-an-intensive-care-unit-setting
#19
Kartik Ganesh, R N Sharma, Jaicob Varghese, M G K Pillai
CONTEXT: Metabolic acidosis is frequently found in patients with severe sepsis. An understanding of types of acidosis in sepsis and their evolution over the course of treatment may give us insight into the behavior of acid-base balance in these patients. AIMS: To describe at Intensive Care Unit (ICU) admission and over the first 5 days the composition of metabolic acidosis in patients with sepsis and to evaluate and compare acidosis patterns in survivors and nonsurvivors...
October 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28149560/glucose-insulin-potassium-correlates-with-hemodynamic-improvement-in-patients-with-septic-myocardial-dysfunction
#20
Won-Young Kim, Moon Seong Baek, Young Shin Kim, Jarim Seo, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
BACKGROUND: Glucose-insulin-potassium (GIK) demonstrates a cardioprotective effect by providing metabolic support and anti-inflammatory action, and may be useful in septic myocardial depression. The aim of this study was to examine the relationship between GIK and hemodynamic outcomes in septic shock patients with myocardial depression. METHODS: Between October 2012 and March 2014, 45 patients in the intensive care unit who fulfilled the criteria for severe sepsis/septic shock and were treated with GIK were recruited...
December 2016: Journal of Thoracic Disease
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