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https://www.readbyqxmd.com/read/29336676/vasopressors-in-sepsis
#1
Kristin P Colling, Kaysie L Banton, Greg J Beilman
BACKGROUND: Sepsis accounts for 10% of intensive care unit admissions and significant healthcare costs. Although the mortality rate from sepsis has been decreasing with better critical care, early identification of septic patients, and prompt interventions, the mortality rate remains 20%-30%. METHOD: Review of the English-language literature. RESULTS: Norepinephrine is the first-line vasopressor in shock and is associated with a lower mortality rate as well as fewer adverse effects...
January 16, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29315472/early-prognostic-factors-in-septic-shock-cancer-patients-a-prospective-study-with-a-proteomic-approach
#2
D Mokart, C Saillard, C Zemmour, M Bisbal, A Sannini, L Chow-Chine, J-P Brun, M Faucher, J-M Boher, Y Toiron, C Chabannon, J-P Borg, A Gonçalves, L Camoin
BACKGROUND: Organ failures are the main prognostic factors in septic shock. The aim was to assess classical clinico-biological parameters evaluating organ dysfunctions at intensive care unit admission, combined with proteomics, on day-30 mortality in critically ill onco-hematology patients admitted to the intensive care unit for septic shock. METHODS: This was a prospective monocenter cohort study. Clinico-biological parameters were collected at admission. Plasma proteomics analyses were performed, including protein profiling using isobaric Tag for Relative and Absolute Quantification (iTRAQ) and subsequent validation by ELISA...
January 7, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29315332/clinical-profile-and-outcomes-of-acute-cardiorenal-syndrome-type-5-in-sepsis-an-eight-year-cohort-study
#3
Saraschandra Vallabhajosyula, Ankit Sakhuja, Jeffrey B Geske, Mukesh Kumar, Rahul Kashyap, Kianoush Kashani, Jacob C Jentzer
BACKGROUND: To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients with severe sepsis and septic shock. METHODS: Historical cohort study of all adult patients with severe sepsis and septic shock admitted to the intensive care units (ICU) at Mayo Clinic Rochester from January 1, 2007 through December 31, 2014. Patients with prior renal or cardiac dysfunction were excluded. Patients were divided into groups with and without cardiorenal syndrome type-5...
2018: PloS One
https://www.readbyqxmd.com/read/29282149/the-effect-of-angiotensin-ii-on-blood-pressure-in-patients-with-circulatory-shock-a-structured-review-of-the-literature
#4
Laurence W Busse, Michael T McCurdy, Osman Ali, Anna Hall, Huaizhen Chen, Marlies Ostermann
BACKGROUND: Circulatory shock is a common syndrome with a high mortality and limited therapeutic options. Despite its discovery and use in clinical and experimental settings more than a half-century ago, angiotensin II (Ang II) has only been recently evaluated as a vasopressor in distributive shock. We examined existing literature for associations between Ang II and the resolution of circulatory shock. METHODS: We searched PubMed, MEDLINE, Ovid, and Embase to identify all English literature accounts of intravenous Ang II in humans for the treatment of shock (systolic blood pressure [SBP] ≤ 90 mmHg or a mean arterial pressure [MAP] ≤ 65 mmHg), and hand-searched the references of extracted papers for further studies meeting inclusion criteria...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29260272/pooled-analysis-of-higher-versus-lower-blood-pressure-targets-for-vasopressor-therapy-septic-and-vasodilatory-shock
#5
REVIEW
François Lamontagne, Andrew G Day, Maureen O Meade, Deborah J Cook, Gordon H Guyatt, Mathieu Hylands, Peter Radermacher, Jean-Marie Chrétien, Nicolas Beaudoin, Paul Hébert, Frédérick D'Aragon, Ferhat Meziani, Pierre Asfar
PURPOSE: Guidelines for shock recommend mean arterial pressure (MAP) targets for vasopressor therapy of at least 65 mmHg and, until recently, suggested that patients with underlying chronic hypertension and atherosclerosis may benefit from higher targets. We conducted an individual patient-data meta-analysis of recent trials to determine if patient variables modify the effect of different MAP targets. METHODS: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials of higher versus lower blood pressure targets for vasopressor therapy in adult patients in shock (until November 2017)...
December 19, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/29260067/severe-bilateral-optic-nerve-and-retinal-hypoperfusion-in-a-patient-with-acute-respiratory-distress-syndrome-and-septic-shock
#6
Wei Gui, Erika Tanaka Friesen, Laura Bonelli, Ye Elaine Wang, Anthony C Arnold
Purpose: To report a case of bilateral central retinal artery occlusion with both anterior and posterior ischemic optic neuropathy. Observations: A 65-year-old Caucasian woman presented with acute respiratory distress syndrome and septic shock. After treatment with vasopressors and prolonged prone positioning, she was noted to be bilaterally completely blind on hospitalization day 12. Evaluation revealed evidence of bilateral central retinal artery occlusion and bilateral ischemic optic neuropathy...
June 2017: American Journal of Ophthalmology Case Reports
https://www.readbyqxmd.com/read/29251709/benchmarking-clinical-outcomes-and-the-immunocatabolic-phenotype-of-chronic-critical-illness-after-sepsis-in-surgical-intensive-care-unit-patients
#7
Julie A Stortz, Juan C Mira, Steven L Raymond, Tyler J Loftus, Tezcan Ozrazgat-Baslanti, Zhongkai Wang, Gabriela L Ghita, Christiaan Leeuwenburgh, Mark S Segal, Azra Bihorac, Babette A Brumback, Alicia M Mohr, Philip A Efron, Lyle L Moldawer, Frederick A Moore, Scott C Brakenridge
BACKGROUND: A growing number of patients survive sepsis but remain chronically critically ill. We sought to define clinical outcomes and incidence of chronic critical illness (CCI) after sepsis and to determine whether selected biomarkers of inflammation, immunosuppression, and catabolism differ between these patients and those that rapidly recover (RAP). METHODS: This three-year prospective observational cohort study (NCT02276417) evaluated 145 surgical intensive care unit patients with sepsis for the development of CCI (≥14 days of ICU resource utilization with persistent organ dysfunction)...
December 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29240642/body-mass-s-impact-on-response-to-fixed-dose-vasopressin-in-patients-with-septic-shock
#8
Heather Torbic, Gretchen L Sacha, Seth R Bauer, Simon W Lam
INTRODUCTION: The effect of patient weight and body mass index (BMI) on hemodynamic response to vasoactive medications is not fully understood. In titratable vasopressors, this effect is less likely a concern due to the ability to titrate dose to response, however, with the use of fixed-dose vasopressin, patient weight and BMI may impact response. METHODS: This was a single center, retrospective cohort of patients who received fixed-dose vasopressin for septic shock for ≥6 hours with concomitant catecholamines in the medical, surgical, or neurosciences intensive care unit (ICU) at a tertiary care center...
December 13, 2017: Shock
https://www.readbyqxmd.com/read/29216937/-significance-of-peripheral-perfusion-index-in-early-diagnosis-and-goal-directed-therapy-of-septic-shock-patients-a-prospective-single-blind-randomized-controlled-trial
#9
Yuanfeng Shi, Ruihong Yin, Yanli Wang, Jiguang Li, Xiaobing Chen, Yongpeng Xie, Caihong Gu, Xiuzhen Zou, Kexi Liu
OBJECTIVE: To investigate the application of peripheral perfusion index (PPI) in early diagnosis and goal-directed therapy of septic shock, and to provide reference for the early clinical diagnosis and treatment of septic shock. METHODS: A prospective single-blind randomized controlled trial (RCT) was conducted. Adult patients with sepsis admitted to emergency medical department and intensive care unit (ICU) of the First People's Hospital of Lianyungang City in Jiangsu Province from January 2013 to December 2016 were enrolled...
December 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29210058/development-and-internal-validation-of-the-simplified-mortality-score-for-the-intensive-care-unit-sms-icu
#10
A Granholm, A Perner, M Krag, P B Hjortrup, N Haase, L B Holst, S Marker, M O Collet, A K G Jensen, M H Møller
BACKGROUND: Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). METHODS: We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016...
December 6, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29198069/does-metformin-exposure-before-icu-stay-have-any-impact-on-patients-outcome-a-retrospective-cohort-study-of-diabetic-patients
#11
Sebastien Jochmans, Jean-Emmanuel Alphonsine, Jonathan Chelly, Ly Van Phach Vong, Oumar Sy, Nathalie Rolin, Olivier Ellrodt, Mehran Monchi, Christophe Vinsonneau
BACKGROUND: Impact of metformin exposure before ICU stay remains controversial. Metformin is thought to induce lactic acidosis and haemodynamic instability but may reduce ICU mortality. We evaluated its influence on outcome in diabetic patients admitted in the ICU and then compared two different populations based on the presence of septic shock. METHODS: We conducted a retrospective cohort study in a 24-bed French ICU between October 2010 and December 2013, including all ICU-admitted diabetic patients...
December 2, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29179699/gastrointestinal-tuberculosis-following-renal-transplantation-accompanied-with-septic-shock-and-acute-respiratory-distress-syndrome-a-survival-case-presentation
#12
Andrea Cikova, Diana Vavrincova-Yaghi, Peter Vavrinec, Anna Dobisova, Andrea Gebhardtova, Zora Flassikova, Mark A Seelen, Robert H Henning, Aktham Yaghi
BACKGROUND: Post-transplant tuberculosis (PTTB) is a serious opportunistic infection in renal graft recipients with a 30-70 fold higher incidence compared to the general population. PTTB occurs most frequently within the first years after transplantation, manifesting as pulmonary or disseminated TB. Gastrointestinal TB (GITB) is a rare and potentially lethal manifestation of PTTB and may show delayed onset in renal transplant recipients due to the use of lower doses of immunosuppressants...
November 28, 2017: BMC Gastroenterology
https://www.readbyqxmd.com/read/29178943/high-volume-hemofiltration-in-adult-burn-patients-with-septic-shock-and-acute-kidney-injury-a-multicenter-randomized-controlled-trial
#13
Kevin K Chung, Elsa C Coates, David J Smith, Rachel A Karlnoski, William L Hickerson, Angela L Arnold-Ross, Michael J Mosier, Marcia Halerz, Amy M Sprague, Robert F Mullins, Daniel M Caruso, Marlene Albrecht, Brett D Arnoldo, Agnes M Burris, Sandra L Taylor, Steven E Wolf
BACKGROUND: Sepsis and septic shock occur commonly in severe burns. Acute kidney injury (AKI) is also common and often results as a consequence of sepsis. Mortality is unacceptably high in burn patients who develop AKI requiring renal replacement therapy and is presumed to be even higher when combined with septic shock. We hypothesized that high-volume hemofiltration (HVHF) as a blood purification technique would be beneficial in this population. METHODS: We conducted a multicenter, prospective, randomized, controlled clinical trial to evaluate the impact of HVHF on the hemodynamic profile of burn patients with septic shock and AKI involving seven burn centers in the United States...
November 25, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29176374/intraoperative-vasoplegia-methylene-blue-to-the-rescue
#14
Sharon L McCartney, Lorent Duce, Kamrouz Ghadimi
PURPOSE OF REVIEW: To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). RECENT FINDINGS: Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of nitric oxide, while inhibiting activation of soluble guanylyl cyclase and preventing vasodilation...
February 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29163498/cytokine-profiles-of-severe-influenza-virus-related-complications-in-children
#15
Andrew Fiore-Gartland, Angela Panoskaltsis-Mortari, Anna A Agan, Anushay J Mistry, Paul G Thomas, Michael A Matthay, Tomer Hertz, Adrienne G Randolph
Rationale: Effective immunomodulatory therapies for children with life-threatening "cytokine storm" triggered by acute influenza infection are lacking. Understanding the immune profiles of children progressing to severe lung injury and/or septic shock could provide insight into pathogenesis. Objectives: To compare the endotracheal and serum cytokine profiles of children with influenza-related critical illness and to identify their associations with severe influenza-associated complications...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/29163354/diabetes-and-sepsis-risk-recurrence-and-ruination
#16
REVIEW
Lynn M Frydrych, Fatemeh Fattahi, Katherine He, Peter A Ward, Matthew J Delano
Sepsis develops when an infection surpasses local tissue containment. A series of dysregulated physiological responses are generated, leading to organ dysfunction and a 10% mortality risk. When patients with sepsis demonstrate elevated serum lactates and require vasopressor therapy to maintain adequate blood pressure in the absence of hypovolemia, they are in septic shock with an in-hospital mortality rate >40%. With improvements in intensive care treatment strategies, overall sepsis mortality has diminished to ~20% at 30 days; however, mortality continues to steadily climb after recovery from the acute event...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/29158076/microcirculation-and-red-cell-transfusion-in-patients-with-sepsis
#17
REVIEW
Øystein Wendelbo, Tor Hervig, Oddbjørn Haugen, Jerard Seghatchian, Håkon Reikvam
Early identification of sepsis followed by diagnostic blood cultures and prompt administration of appropriate intravenous antibiotics covering all likely pathogen remains the corner stone in the initial management of sepsis. Source control, obtained by harvesting microbiological cultures and removal or drainage of the infected foci, is mandatory. However, optimization of hemodynamically unstable patients including volume support supplemented with vasopressor, inotropic and transfusion of red blood cells (RBCs) in case of persistent hypoperfusion have the potential to reduce morbidity and mortality...
November 10, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29149941/pathophysiology-of-septic-shock
#18
REVIEW
James A Russell, Barret Rush, John Boyd
Fundamental features of septic shock are vasodilation, increased permeability, hypovolemia, and ventricular dysfunction. Vasodilation owing to increased nitric oxide and prostaglandins is treated with vasopressors (norepinephrine first). Increased permeability relates to several pathways (Slit/Robo4, vascular endothelial growth factor, angiopoietin 1 and 2/Tie2 pathway, sphingosine-1-phosphate, and heparin-binding protein), some of which are targets for therapies. Hypovolemia is common and crystalloid is recommended for fluid resuscitation...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29142375/the-effects-of-atorvastatin-on-inflammatory-responses-and-mortality-in-septic-shock-a-single-center-randomized-controlled-trial
#19
Ratender Kumar Singh, Vikas Agarwal, Arvind Kumar Baronia, Sudeep Kumar, Banani Poddar, Afzal Azim
Aim of the Study: Pleiotropic effect of statins can modulate inflammation in septic shock. We tested the hypothesis whether statins can reduce mortality in septic shock. Patients and Methods: We conducted a randomized double-blinded trial with treatment (40 mg dose of atorvastatin for 7 days) and control (placebo) arm in adult septic shock patients admitted to the Intensive Care Unit. Primary (28-day mortality) and secondary (vasopressor-, ventilation-, and renal replacement therapy-free days) outcomes, with lipid profile and adverse effects, were documented...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29137585/association-of-positive-fluid-balance-and-mortality-in-sepsis-and-septic-shock-in-an-australian-cohort
#20
M G Pittard, S J Huang, A S McLean, S R Orde
In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours...
November 2017: Anaesthesia and Intensive Care
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