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https://www.readbyqxmd.com/read/27903001/right-in-front-of-our-eyes-evolution-of-streptococcal-toxic-shock-syndrome-with-ischemic-optic-neuropathy
#1
Salaheldin M Elhamamsy, Mazen O Al-Qadi, Taro Minami, Marguerite Neill
INTRODUCTION: Toxic shock syndrome occurs from dysregulation of host inflammatory responses. Toxin- producing strains of Group A streptococcus cause TSS. Ischemic optic neuropathy rarely complicates septic shock. We present a rare case of streptococcal pharyngitis complicated by septic arthritis and TSS with reversible blindness due to non-arteritic ischemic optic neuropathy. CASE: A 28-year-old man drove to our ED with exudative pharyngitis. A rapid streptococcal test was positive...
December 1, 2016: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/27902530/cardiac-troponin-release-is-associated-with-biomarkers-of-inflammation-and-ventricular-dilatation-during-critical-illness
#2
Marlies Ostermann, Salma Ayis, Emma Tuddenham, Jessica Lo, Katie Lei, John Smith, Barnaby Sanderson, Carl Moran, Paul Collinson, Janet Peacock, Andrew Rhodes, David Treacher
INTRODUCTION: Troponin release is common during critical illness. We hypothesized that there was an association between cardiac troponin T (cTnT) and biomarkers of systemic inflammation and ventricular dilatation. METHODS: In an observational prospective cohort study, we enrolled consecutive adult patients admitted for non-cardiac reasons to the Intensive Care Unit (ICU) in 2 tertiary care centers. We measured cTnT, C-reactive protein (CRP), Interleukin-6 (IL-6), procalcitonin (PCT) and N-terminal pro brain natriuretic peptide (NT-proBNP) daily in the first week, and on alternate days in the second week...
November 29, 2016: Shock
https://www.readbyqxmd.com/read/27891260/intravenous-vitamin-c-administered-as-adjunctive-therapy-for-recurrent-acute-respiratory-distress-syndrome
#3
Amit Bharara, Catherine Grossman, Daniel Grinnan, Aamer Syed, Bernard Fisher, Christine DeWilde, Ramesh Natarajan, Alpha A Berry Fowler
This case report summarizes the first use of intravenous vitamin C employed as an adjunctive interventional agent in the therapy of recurrent acute respiratory distress syndrome (ARDS). The two episodes of ARDS occurred in a young female patient with Cronkhite-Canada syndrome, a rare, sporadically occurring, noninherited disorder that is characterized by extensive gastrointestinal polyposis and malabsorption. Prior to the episodes of sepsis, the patient was receiving nutrition via chronic hyperalimentation administered through a long-standing central venous catheter...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27886982/impact-of-norepinephrine-weight-based-dosing-compared-with-non-weight-based-dosing-in-achieving-time-to-goal-mean-arterial-pressure-in-obese-patients-with-septic-shock
#4
Nina Vadiei, Mitchell J Daley, Manasa S Murthy, Carrie S Shuman
BACKGROUND: Currently, a lack of standardization exists in norepinephrine dosing units, the first-line vasopressor for septic shock. Timely achievement of goal mean arterial pressure (MAP) is dependent on optimal vasopressor dosing. OBJECTIVE: To determine if weight-based dosing (WBD) of norepinephrine leads to earlier time to goal MAP compared with non-WBD in obese patients with septic shock. METHODS: This was a retrospective, multicenter cohort study...
November 24, 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/27879559/angiotensin-ii-in-refractory-septic-shock
#5
Elio Antonucci, Patrick J Gleeson, Filippo Annoni, Sara Agosta, Sergio Orlando, Fabio Silvio Taccone, Dimitrios Velissaris, Sabino Scolletta
Refractory septic shock is defined as persistently low mean arterial blood pressure despite volume resuscitation and titrated vasopressors/inotropes in patients with a proven or suspected infection and concomitant organ dysfunction. Its management typically requires high doses of catecholamines, which can induce significant adverse effects such as ischemia and arrhythmias. Angiotensin II (Ang II), a key product of the renin-angiotensin-aldosterone system (RAAS), is a vasopressor agent that could be used in conjunction with other vasopressors to stabilize critically ill patients during refractory septic shock, and reduce catecholamine requirements...
November 21, 2016: Shock
https://www.readbyqxmd.com/read/27865148/plasma-adrenomedullin-in-critically-ill-patients-with-sepsis-after-major-surgery-a-pilot-study
#6
Tim-Philipp Simon, Lukas Martin, Sabine Doemming, Andreas Humbs, Christian Bruells, Ruedger Kopp, Oliver Hartmann, Joachim Struck, Andreas Bergmann, Gernot Marx, Tobias Schuerholz
PURPOSE: Adrenomedullin is released by different tissues in hypoxia, oxidative stress, and inflammation and is found in general and medical patients and, recently, in sepsis patients in emergency departments. The aim of this study was to evaluate biologically active adrenomedullin that mirrors directly the active peptide levels in plasma of surgical intensive care unit (ICU) patients with sepsis. MATERIALS AND METHODS: In this single-center observational pilot trial, 42 ICU patients with sepsis and 14 patients after major surgery were included after sepsis diagnosis or ICU admission...
October 28, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27851094/1458-consideration-of-race-in-vasopressor-requirements-for-septic-shock
#7
Holly Stallings, Peter Ty, Keith Killu
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27851086/1450-implications-of-statin-use-on-vasopressor-therapy-in-the-setting-of-septic-shock
#8
Chelsey McPheeters, Jennifer Wiedmar, Kyle Weant
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27851022/1386-discontinuation-of-vasopressors-in-septic-shock-patients-weaning-from-norepinephrine-and-vasopressin
#9
James Curtis
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27836304/neutrophil-gelatinase-associated-lipocalin-predicts-myocardial-dysfunction-and-mortality-in-severe-sepsis-and-septic-shock
#10
Biao Wang, Gang Chen, Jia Li, Yuanying Zeng, Yunfu Wu, Xiaoye Yan
BACKGROUND: This study examines the clinical utility of plasma neutrophil gelatinase-associated lipocalin (NGAL) as an indicator of myocardial dysfunction and mortality in severe sepsis and septic shock. METHODS: We designed a prospective cohort study in an intensive care unit, and 53 patients with severe sepsis or septic shock were included. Data were used to determine a relationship between NGAL and the development of myocardial dysfunction and mortality. These associations were determined by the Mann-Whitney test, multiple logistic regression, plotting the receiver operating characteristic (ROC) curve, Kaplan-Meier curves and Spearman test...
November 3, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27823892/practical-considerations-in-sepsis-resuscitation
#11
Brit Long, Alex Koyfman, Katharine L Modisett, Christian J Woods
BACKGROUND: Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment. OBJECTIVE: This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment. DISCUSSION: Early goal-directed therapy revolutionized sepsis management...
November 4, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27816060/septic-shock-with-no-diagnosis-at-24-hours-a-pragmatic-multicenter-prospective-cohort-study
#12
Damien Contou, Damien Roux, Sébastien Jochmans, Rémi Coudroy, Emmanuel Guérot, David Grimaldi, Sylvie Ricome, Eric Maury, Gaëtan Plantefève, Julien Mayaux, Armand Mekontso Dessap, Christian Brun-Buisson, Nicolas de Prost
BACKGROUND: The lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others. METHODS: We conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France...
November 6, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27814989/a-curious-case-of-septic-shock
#13
Arjun Lakshman, Charanpreet Singh, Manphool Singhal, Sanjay Jain, Navneet Sharma, Savita Kumari, Subhash Varma
BACKGROUND: Takayasu arteritis, also known as "pulseless disease," causes proximal occlusion of the lumen of large arteries of the neck and arm, leading to impalpable pulses and "pseudohypotension." This may misdirect the management plan for a patient in the emergency setting if the presence of vascular occlusion is not previously known. CASE REPORT: We describe a young woman who presented to the emergency department (ED) with fever. On evaluation, she had shock, which was not responsive to a fluid bolus...
November 1, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27802854/syphilis-an-atypical-case-of-sepsis-and-multiple-anogenital-lesions-in-secondary-syphilis
#14
Nichole Smith, Sonu Dhillon, John G Cotter, Zohair Ahmed
The incidence of syphilis has historically been cyclical in nature, often in relation to the rise and fall of public health initiatives directed toward eradication along with social attitudes toward sexual practices. The incidence of syphilis has increased by 15% in the last 6 years in the United States, with similar increases worldwide. Herein, we present an atypical case of syphilis presenting with severe septic shock and multiple anogenital lesions in an immunocompetent host. A 22-year-old male with no significant past medical history presented with fevers, chills, sore throat, diaphoresis, and diarrhea...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27788216/selepressin-and-arginine-vasopressin-do-not-display-cardiovascular-risk-in-atherosclerotic-rabbit
#15
Olivier Boucheix, Robert Blakytny, Gerard Haroutunian, Marie Henriksson, Regent Laporte, Stephane Milano, Torsten M Reinheimer
BACKGROUND: Septic shock remains associated with significant mortality rates. Arginine vasopressin (AVP) and analogs with V1A receptor agonist activity are increasingly used to treat fluid-resistant vasodilatory hypotension, including catecholamine-refractory septic shock. Clinical studies have been restricted to healthy volunteers and catecholamine-refractory septic shock patients excluding subjects with cardiac co-morbidities because of presumed safety issues. The novel selective V1A receptor agonist selepressin, with short half-life, has been designed to avoid V2 receptor-related complications and long-term V1A receptor activation...
2016: PloS One
https://www.readbyqxmd.com/read/27787442/temporary-abdominal-closure-for-trauma-and-intra-abdominal-sepsis-different-patients-different-outcomes
#16
Tyler J Loftus, Janeen R Jordan, Chasen A Croft, R Stephen Smith, Philip A Efron, Alicia M Mohr, Frederick A Moore, Scott C Brakenridge
BACKGROUND: Temporary abdominal closure (TAC) following damage control surgery (DCS) for injured patients has been generalized to septic patients. However, direct comparisons between these populations are lacking. We hypothesized that patients with intra-abdominal sepsis would have different resuscitation requirements and lower primary fascial closure rates than trauma patients. STUDY DESIGN: We performed a three year retrospective cohort analysis of patients managed with TAC for trauma (n=77) or intra-abdominal sepsis (n=147)...
October 25, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27787407/vasodilators-in-septic-shock-resuscitation-a-clinical-perspective
#17
Thiago Domingos Corrêa, Roberto Rabello Filho, Murillo Santucci Cesar Assunção, Eliézer Silva, Alexandre Lima
Microcirculatory abnormalities have been shown to be frequent in patients with septic shock despite "normalization" of systemic hemodynamics. Several studies have explored the impact of vasodilator therapy (prostacyclin, inhaled nitric oxide, topic acetylcholine and nitroglycerin) on microcirculation and tissue perfusion, with contradictory findings.In this narrative review, we briefly present the pathophysiological aspects of microcirculatory dysfunction, and depict the evidence supporting the use of vasodilators and other therapeutic interventions (fluid administration, blood transfusion, vasopressors and dobutamine) aiming to improve the microcirculatory flow in septic shock patients...
October 26, 2016: Shock
https://www.readbyqxmd.com/read/27777780/initial-central-venous-pressure-could-be-a-prognostic-marker-for-hemodynamic-improvement-of-polymyxin-b-direct-hemoperfusion-a-retrospective-cohort-study
#18
Hiroyuki Yamada, Tatsuo Tsukamoto, Hiromichi Narumiya, Kazumasa Oda, Satoshi Higaki, Ryoji Iizuka, Motoko Yanagita, Masako Deguchi
BACKGROUND: Direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DHP) could improve the hemodynamic status of septic shock patients. As PMX-DHP is an invasive and costly procedure, it is desirable to estimate the therapeutic effect before performing the therapy. However, it is still unclear when this therapy should be started and what type of sepsis it should be employed for. In this study, we retrospectively examined the clinical effect of patients treated with PMX-DHP by using central venous pressure (CVP)...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27774825/optimum-treatment-of-vasopressor-dependent-distributive-shock
#19
Jean-Louis Vincent, Marc Leone
Distributive shock is associated with decreased systemic vascular resistance and altered oxygen extraction. Septic shock is the most frequent form of distributive shock. In shock states, duration of hypotension is associated with poor outcomes. The speed at which treatment to restore adequate perfusion pressure is initiated is, therefore, important to improve survival. Areas covered: This review presents an overview of the literature related to the management of vasopressor-dependent distributive shock, and in particular the relationship between arterial pressure and organ perfusion and function...
November 7, 2016: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27756870/early-goal-directed-therapy-in-severe-sepsis-and-septic-shock-a-meta-analysis-and-trial-sequential-analysis-of-randomized-controlled-trials
#20
Yao Lu, Han Zhang, Fang Teng, Wen-Jun Xia, Gui-Xiang Sun, Ai-Qing Wen
INTRODUCTION: The Surviving Sepsis Campaign guidelines recommend early goal-directed therapy (EGDT) for the resuscitation of patients with sepsis; however, the recent evidences quickly evolve and convey conflicting results. We performed a meta-analysis to evaluate the effect of EGDT on mortality in adults with severe sepsis and septic shock. METHODS: We searched electronic databases to identify randomized controlled trials that compared EGDT with usual care or lactate-guided therapy in adults with severe sepsis and septic shock...
October 18, 2016: Journal of Intensive Care Medicine
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