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https://www.readbyqxmd.com/read/28710027/admission-lactate-predicts-poor-prognosis-independently-of-the-crb-curb-65-scores-in-community-acquired-pneumonia
#1
Frederik S Frenzen, Ulrike Kutschan, Nils Meiswinkel, Bernhard Schulte-Hubbert, Santiago Ewig, Martin Kolditz
OBJECTIVES: Community-acquired pneumonia (CAP) is associated with a high risk of respiratory failure or septic organ dysfunction. Lactate is an established early marker of prognosis and sepsis severity, but few data exist in patients with CAP. METHODS: We performed a retrospective cohort study of consecutive adult CAP patients without treatment restrictions or direct ICU admission. Lactate was measured as point of care test within the capillary admission blood gas analysis and its prognostic value was compared to the CRB/CURB-65 criteria by multivariate and ROC curve analysis...
July 11, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28701197/a-case-of-bowel-perforation-due-to-traumatic-hernia-at-a-pelvic-fracture-site-a-case-report-and-review-of-the-literature
#2
Ryota Tanaka, Hisashi Nagahara, Kiyoshi Maeda, Hiroshi Ohtani, Masatsune Shibutani, Tatsuro Tamura, Tetsuro Ikeya, Kenji Sugano, Yasuhito Iseki, Katsunobu Sakurai, Sadaaki Yamazoe, Kenjiro Kimura, Takahiro Toyokawa, Ryosuke Amano, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Kosei Hirakawa, Masaichi Ohira
BACKGROUND: Common complications of pelvic fractures include visceral injury, large-volume hemorrhage, genitourinary injury, rectal injury, and pulmonary embolism. On the other hand, traumatic hernia is a rare complication, especially in association with pelvic fractures. We report a case of bowel perforation due to traumatic hernia at a pelvic fracture site. CASE PRESENTATION: A 65-year-old female was presented at our hospital for further examination and treatment of ileus...
July 12, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28687209/new-sepsis-and-septic-shock-definitions-clinical-implications-and-controversies
#3
REVIEW
Chanu Rhee, Michael Klompas
New sepsis definitions shift emphasis from the systemic inflammatory response syndrome to organ dysfunction, quantified using the Sequential Organ Failure Assessment (SOFA) score. The new definitions also propose Quick SOFA criteria to rapidly identify potentially infected patients at risk for poor outcomes. Diagnosing septic shock requires vasopressor dependence and increased lactate levels. Strengths of these definitions include their simplicity and clear association with adverse outcomes. However, their utility in identifying patients with serious infections before frank sepsis ensues remains to be seen...
July 5, 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28683810/effect-of-dextran-70-on-outcome-in-severe-sepsis-a-propensity-score-matching-study
#4
Peter Bentzer, Marcus Broman, Thomas Kander
BACKGROUND: Albumin may be beneficial in patients with septic shock but availability is limited and cost is high. The objective of the present study was to investigate if the use of dextran-70 in addition to albumin and crystalloids influences organ failure or mortality in patients with severe sepsis or septic shock. METHODS: Patients with severe sepsis or septic shock (n = 778) admitted to a university hospital intensive care unit (ICU) between 2007 and 2015 that received dextran-70 during resuscitation were propensity score matched to controls at a 1 to 1 ratio...
July 6, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28680609/hydrocortisone-therapy-in-a-cat-with-vasopressor-refractory-septic-shock-and-suspected-critical-illness-related-corticosteroid-insufficiency
#5
Simone R R Pisano, Judith Howard, Horst Posthaus, Alan Kovacevic, Ivayla D Yozova
A 27-month-old female cat was presented with septic peritonitis secondary to a ruptured pyometra and subsequent pyothorax. Vasopressor-refractory septic shock led to a suspicion of critical illness-related corticosteroid insufficiency, successfully treated with intravenous hydrocortisone. Previous megestrol acetate administration may have played a role in the development of adrenocortical dysfunction.
July 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/28679413/double-carbapenem-as-a-rescue-strategy-for-the-treatment-of-severe-carbapenemase-producing-klebsiella-pneumoniae-infections-a-two-center-matched-case-control-study
#6
Gennaro De Pascale, Gennaro Martucci, Luca Montini, Giovanna Panarello, Salvatore Lucio Cutuli, Daniele Di Carlo, Valentina Di Gravio, Roberta Di Stefano, Guido Capitanio, Maria Sole Vallecoccia, Piera Polidori, Teresa Spanu, Antonio Arcadipane, Massimo Antonelli
BACKGROUND: Recent reports have suggested the efficacy of a double carbapenem (DC) combination, including ertapenem, for the treatment of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) infections. We aimed to evaluate the clinical impact of such a regimen in critically ill patients. METHODS: This case-control (1:2), observational, two-center study involved critically ill adults with a microbiologically documented CR-Kp invasive infection treated with the DC regimen matched with those receiving a standard treatment (ST) (i...
July 5, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28672146/stroke-volume-guided-resuscitation-in-severe-sepsis-and-septic-shock-improves-outcomes
#7
Heath E Latham, Charles D Bengtson, Lewis Satterwhite, Mindy Stites, Dipti P Subramaniam, G John Chen, Steven Q Simpson
To determine whether stroke volume (SV) guided fluid resuscitation in patients with severe sepsis and septic shock alters Intensive Care Unit (ICU) fluid balance and secondary outcomes, this retrospective cohort study evaluated consecutive patients admitted to an ICU with the primary diagnosis of severe sepsis or septic shock. Cohorts were based on fluid resuscitation guided by changes in SV or by usual care (UC). The SV group comprised 100 patients, with 91 patients in the UC group. Net fluid balance for the ICU stay was lower in the SV group (1...
June 28, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28658197/hydrocortisone-therapy-in-catecholamine-resistant-pediatric-septic-shock-a-pragmatic-analysis-of-clinician-practice-and-association-with-outcomes
#8
Blake Nichols, Sherri Kubis, Jennifer Hewlett, Nadir Yehya, Vijay Srinivasan
OBJECTIVES: The 2012 Surviving Sepsis Campaign pediatric guidelines recommend stress dose hydrocortisone in children experiencing catecholamine-dependent septic shock with suspected or proven absolute adrenal insufficiency. We evaluated whether stress dose hydrocortisone therapy in children with catecholamine dependent septic shock correlated with random serum total cortisol levels and was associated with improved outcomes. DESIGN: Retrospective cohort study. SETTING: Non-cardiac PICU...
June 27, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28647651/concomitant-vasopressin-and-hydrocortisone-therapy-on-short-term-hemodynamic-effects-and-vasopressor-requirements-in-refractory-septic-shock
#9
Mitchell S Buckley, Robert MacLaren
PURPOSE: The objective of this study was to evaluate the short-term hemodynamic effects as well as vasopressor requirements with concomitant vasopressin (AVP) and hydrocortisone (HCT) compared to either agent alone in refractory septic shock. MATERIALS AND METHODS: This was a retrospective, cohort study conducted in adult septic shock patients. Patients received continuous infusion AVP at 0.04units/min and/or HCT 200-300mg intravenous daily in divided doses for refractory septic shock...
June 17, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28625256/-comparison-of-effect-of-norepinephrine-and-terlipressin-on-patients-with-ards-combined-with-septic-shock-a-prospective-single-blind-randomized-controlled-trial
#10
Zhi Chen, Ping Zhou, Yuanhua Lu, Chunli Yang
OBJECTIVE: To approach the effect of different vasopressor on hemodynamics, volume responsiveness, fluid volume balance, renal function and prognosis in patients with acute respiratory distress syndrome (ARDS) complicated with septic shock. METHODS: A prospective single-blind randomized controlled trial was conducted. ARDS patients with septic shock admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st, 2015 to May 1st, 2016 were enrolled...
February 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28623891/systolic-blood-pressure-variability-in-patients-with-early-severe-sepsis-or-septic-shock-a-prospective-cohort-study
#11
Yi Tang, Jeff Sorenson, Michael Lanspa, Colin K Grissom, V J Mathews, Samuel M Brown
BACKGROUND: Severe sepsis and septic shock are often lethal syndromes, in which the autonomic nervous system may fail to maintain adequate blood pressure. Heart rate variability has been associated with outcomes in sepsis. Whether systolic blood pressure (SBP) variability is associated with clinical outcomes in septic patients is unknown. The propose of this study is to determine whether variability in SBP correlates with vasopressor independence and mortality among septic patients. METHODS: We prospectively studied patients with severe sepsis or septic shock, admitted to an intensive care unit (ICU) with an arterial catheter...
June 17, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28618919/discontinuation-of-vasopressin-before-norepinephrine-in-the-recovery-phase-of-septic-shock
#12
Drayton A Hammond, Kelsey McCain, Jacob T Painter, Oktawia A Clem, Julia Cullen, Amy L Brotherton, Divyan Chopra, Nikhil Meena
BACKGROUND: Guidance for the discontinuation of vasopressors in the recovery phase of septic shock is limited. Norepinephrine is more easily titrated; however, septic shock is a vasopressin deficient state, which exogenous vasopressin endeavors to resolve. Discontinuation of vasopressin before norepinephrine may result in clinically significant hypotension. METHODS: This retrospective, cohort study compared discontinuation of norepinephrine and vasopressin in medically, critically ill patients in the recovery phase of septic shock from May 2014 to June 2016...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28615145/early-initiation-of-low-dose-hydrocortisone-treatment-for-septic-shock-in-adults-a-randomized-clinical-trial
#13
Qing-Quan Lv, Xiao-Hua Gu, Qi-Hong Chen, Jiang-Quan Yu, Rui-Qiang Zheng
BACKGROUND: Physiologic dose hydrocortisone is part of the suggested adjuvant therapies for patients with septic shock. However, the association between the corticosteroid therapy and mortality in patients with septic shock is still not clear. Some authors considered that the mortality is related to the time frame between development of septic shock and start of low dose hydrocortisone. Thus we designed a placebo-controlled, randomized clinical trial to assess the importance of early initiation of low dose hydrocortisone for the final outcome...
June 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28591965/-predictive-value-of-early-changes-in-sublingual-microcirculation-on-organ-failure-of-patients-with-septic-shock
#14
Xue-Ying Zeng, Xue-Lian Liao, Yan Kang, Yao Chen, Wan-Hong Yin, Liang Zhao
OBJECTIVES: To determine the predictive value of early changes in sublingual microcirculation on organ failure of patients with septic shock. METHODS: Side-streamdark field imaging (SDF) videomicroscopy was performed to assess sublingual microcirculation of 34 adult patients at 0 h, 6 h and 24 h after they were diagnosed with septic shock.The patients were subject to sequential organ failure assessment (SOFA24 h-0 h). The patients with ΔSOFA24 h-0 h≥1 (deteriorated conditions) were compared with those with ΔSOFA24 h-0 h<1 in regard to sublingual microcirculation and the traditional hemodynamic indicators such as heart rate, mean arterial pressure, central venous pressure, urine output and lactate...
July 2016: Sichuan da Xue Xue Bao. Yi Xue Ban, Journal of Sichuan University. Medical Science Edition
https://www.readbyqxmd.com/read/28589286/extracorporeal-cytokine-elimination-as-rescue-therapy-in-refractory-septic-shock-a-prospective-single-center-study
#15
Sigrun Friesecke, Stephanie-Susanne Stecher, Stefan Gross, Stephan B Felix, Axel Nierhaus
Sepsis is the most common cause of death in medical intensive care units (ICU). If sepsis progresses to refractory septic shock, mortality may reach 90-100% despite optimum current therapy. Extracorporeal cytokine adsorption in addition to regular therapy was studied prospectively in refractory septic shock patients on a medical ICU. Refractory shock was defined as increasing vasopressor dose required to maintain mean arterial blood pressure above 65 mmHg or increasing lactate levels despite protocol-guided shock therapy for 6 h...
June 6, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28584432/the-effect-of-high-dose-parenteral-sodium-selenite-in-critically-ill-patients-following-sepsis-a-clinical-and-mechanistic-study
#16
Legese Chelkeba, Arezoo Ahmadi, Mohammad Abdollahi, Atabak Najafi, Mohammad Hosein Ghadimi, Reza Mosaed, Mojtaba Mojtahedzadeh
INTRODUCTION: Severe sepsis and septic shock is characterized by inflammation and oxidative stress. Selenium levels have been reported to be low due to loss or increased requirements during severe sepsis and septic shock. We investigated the effect of high-dose parenteral selenium administration in septic patients. METHODS: A prospective, randomized control clinical trial was performed in septic patients. After randomization, patients in selenium group received high-dose parenteral sodium selenite (2 mg intravenous [IV] bolus followed by 1...
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28584428/a-pilot-randomized-controlled-trial-of-comparison-between-extended-daily-hemodialysis-and-continuous-veno-venous-hemodialysis-in-patients-of-acute-kidney-injury-with-septic-shock
#17
Shakti Bedanta Mishra, Afzal Azim, Narayan Prasad, Ratendra Kumar Singh, Banani Poddar, Mohan Gurjar, Arvind Kumar Baronia
AIM OF STUDY: Acute kidney injury (AKI) is common in patients of septic shock. There is sparse data comparing sustained low-efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT) in patients with septic shock. MATERIALS AND METHODS: This is a prospective randomized study in a 12-bedded medical intensive care unit. After clearance from institute's ethics committee and obtaining informed consent from the relatives, sixty adult patients with septic shock who were to undergo dialysis for AKI were included in the study...
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28561960/acute-respiratory-distress-syndrome-and-septic-shock-in-a-cat-with-disseminated-toxoplasmosis
#18
Natashia A Evans, Julie M Walker, Alison C Manchester, Jonathan F Bach
OBJECTIVE: To describe acute respiratory distress syndrome (ARDS) and septic shock in a cat with disseminated toxoplasmosis. CASE SUMMARY: A 2-year-old neutered male domestic shorthair cat was presented for acute respiratory distress. At the time of presentation it had been receiving cyclosporine for treatment of eosinophilic dermatitis. Thoracic radiographs revealed severe mixed nodular interstitial and alveolar patterns. An endotracheal wash was performed, which confirmed a diagnosis of pulmonary toxoplasmosis...
July 2017: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/28558852/-no-glucocorticoids-for-treatment-of-sepsis-unless%C3%A2
#19
M J A Kamps, D Kiers, P Pickkers
Steroids influence the immune response and blood pressure in patients with septic shock. Many trials have evaluated a putative positive effect of steroids as an adjuvant therapy in patients with sepsis and septic shock, with contradictory outcomes. As a consequence, the use of steroids in sepsis patients varies widely. A recently published randomized clinical trial has demonstrated that treatment with hydrocortisone does not delay or prevent progress to septic shock in patients with sepsis. Based on the current available data, the use of steroids in sepsis should be reserved for those patients who remain severely hemodynamic unstable after fluid resuscitation and vasopressor therapy, or those with a separate indication for steroid therapy...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28542029/the-impact-of-the-sepsis-3-septic-shock-definition-on-previously-defined-septic-shock-patients
#20
Sarah A Sterling, Michael A Puskarich, Andrew F Glass, Faheem Guirgis, Alan E Jones
OBJECTIVE: The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the "old" (1991) criteria of septic shock only. DESIGN: Secondary analysis of two clinical trials of early septic shock resuscitation. SETTING: Large academic emergency departments in the United States...
May 24, 2017: Critical Care Medicine
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