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https://www.readbyqxmd.com/read/29355173/paradigms-of-acute-kidney-injury-in-the-intensive-care-setting
#1
REVIEW
John A Kellum, John R Prowle
Acute kidney injury (AKI) is a heterogeneous clinical syndrome that has multiple aetiologies, variable pathogenesis and diverse outcomes. However, these heterogeneities are not reflected in current approaches to the diagnosis and, to some degree, treatment of AKI. For example, congestive heart failure and dehydration can produce identical changes in serum creatinine level and urine output (parameters that are used to define AKI); however, they differ vastly in their physiological contexts and demand completely opposite treatments...
January 22, 2018: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/29353463/protective-effect-of-a-newly-developed-fucose-deficient-recombinant-antithrombin-against-histone-induced-endothelial-damage
#2
Toshiaki Iba, Tatsuhiko Hirota, Koichi Sato, Isao Nagaoka
Antithrombin is expected to modulate both prothrombotic and proinflammatory reactions in sepsis; vascular endothelium is the primary target. In the present study, we sought to evaluate the protective effects of a newly developed fucose-deficient recombinant antithrombin. Endothelial cells were treated in vitro with histone H4 to induce cellular damage. Low to high doses of either plasma-derived antithrombin or recombinant thrombomodulin were used as treatment interventions. Morphological change, apoptotic rate, cell viability, cell injury, and syndecan-4 level in the medium were evaluated...
January 20, 2018: International Journal of Hematology
https://www.readbyqxmd.com/read/29351144/cardiac-dysfunction-in-critical-illness
#3
Allison Dalton, Sajid Shahul
PURPOSE OF REVIEW: Sepsis and septic shock are prevalent conditions that are likely to increase in prevalence in the future. Given the high mortality and morbidity associated with sepsis and sepsis-induced cardiac dysfunction, we must continue to make advances in knowledge of the complex physiologic interactions and how we may target specific mediators for potential therapeutic options in the future. RECENT FINDINGS: Multiple biomarkers have been discovered, which when assayed in sepsis-induced cardiomyopathy predict morbidity and mortality...
January 17, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29346034/coagulopathy-in-severe-sepsis-interconnectivity-of-coagulation-and-the-immune-system
#4
Jason M Samuels, Hunter B Moore, Ernest E Moore
BACKGROUND: Disseminated intravascular coagulation (DIC) remains a challenging complication of infection with inadequate treatment and significant morbidity and mortality rates. METHODS: Review of the English-language literature. RESULTS: Disseminated intravascular coagulation arises from the immune system's response to microbial invasion, as well as the byproducts of cell death that result from severe sepsis. This response triggers the coagulation system through an interconnected network of cellular and molecular signals, which developed originally as an evolutionary mechanism intended to isolate micro-organisms via fibrin mesh formation...
January 18, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29343993/management-of-disseminated-intravascular-coagulation-current-insights-on-antithrombin-and-thrombomodulin-treatments
#5
REVIEW
Mineji Hayakawa
Sepsis and septic shock are frequently complicated by disseminated intravascular coagulation (DIC), which decreases the survival rate of patients with sepsis. In the past, large international randomized controlled trials (RCTs) using physiological anticoagulants for sepsis-induced DIC were not performed; however, RCTs have been conducted for sepsis and/or septic shock. In these trials, physiological anticoagulants did not show any beneficial effects compared with placebo for the treatment of sepsis and/or septic shock...
2018: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/29342010/the-ever-expanding-saga-of-the-proprotein-convertases-and-their-roles-in-body-homeostasis-emphasis-on-novel-proprotein-convertase-subtilisin-kexin-number-9-functions-and-regulation
#6
Nabil G Seidah, Michel Chrétien, Majambu Mbikay
PURPOSE OF REVIEW: The nine members of the proprotein convertase family play major physiological roles during development and in the adult, and their dysregulation leads to various diseases. The primary objective of this article is to review recent findings on the clinical importance of some of these convertases concentrating mostly on PCSK9, the ninth member of the convertase family. This includes the transcriptional and translational regulation of PCSK9, its ability to enhance the degradation of LDL receptor (LDLR), and the implication of PCSK9 in inflammation and sepsis...
January 15, 2018: Current Opinion in Lipidology
https://www.readbyqxmd.com/read/29334496/oxygen-in-the-critically-ill-friend-or-foe
#7
Elisa Damiani, Abele Donati, Massimo Girardis
PURPOSE OF REVIEW: To examine the potential harmful effects of hyperoxia and summarize the results of most recent clinical studies evaluating oxygen therapy in critically ill patients. RECENT FINDINGS: Excessive oxygen supplementation may have detrimental pulmonary and systemic effects because of enhanced oxidative stress and inflammation. Hyperoxia-induced lung injury includes altered surfactant protein composition, reduced mucociliary clearance and histological damage, resulting in atelectasis, reduced lung compliance and increased risk of infections...
January 12, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29325753/induced-hypothermia-in-patients-with-septic-shock-and-respiratory-failure-cass-a-randomised-controlled-open-label-trial
#8
Theis Skovsgaard Itenov, Maria Egede Johansen, Morten Bestle, Katrin Thormar, Lars Hein, Louise Gyldensted, Anne Lindhardt, Henrik Christensen, Stine Estrup, Henrik Planck Pedersen, Matthew Harmon, Uday Kant Soni, Silvia Perez-Protto, Nicolai Wesche, Ulrik Skram, John Asger Petersen, Thomas Mohr, Tina Waldau, Lone Musaeus Poulsen, Ditte Strange, Nicole P Juffermans, Daniel I Sessler, Else Tønnesen, Kirsten Møller, Dennis Karsten Kristensen, Alessandro Cozzi-Lepri, Jens D Lundgren, Jens-Ulrik Jensen
BACKGROUND: Animal models of serious infection suggest that 24 h of induced hypothermia improves circulatory and respiratory function and reduces mortality. We tested the hypothesis that a reduction of core temperature to 32-34°C attenuates organ dysfunction and reduces mortality in ventilator-dependent patients with septic shock. METHODS: In this randomised, controlled, open-label trial, we recruited patients from ten intensive care units (ICUs) in three countries in Europe and North America...
January 8, 2018: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/29317843/calcium-channel-blockade-and-survival-in-recipients-of-successful-renal-transplant-an-analysis-of-the-favorit-trial-results
#9
Larry A Weinrauch, Jiankang Liu, Brian Claggett, Peter V Finn, Matthew R Weir, John A D'Elia
Introduction: Single-center and observational studies have suggested that calcium channel blocking agents may decrease the expression of sepsis in individual populations. In the renal transplant population, a role for calcium channel blockers in allograft protection and in prevention of sepsis has been postulated. We hypothesized that any important survival benefit or risk related to chronic use of calcium channel blocking agents should be discernable through an analysis of a large database of stable recipients of renal allografts who had enrolled in a large international trial...
2018: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/29310400/clinical-analysis-of-hyperkalemia-after-esophagectomy-a-case-report
#10
Qiang Chen, Wei-Guo Zhang, Shu-Chang Chen
RATIONALE: The occurrence of hyperkalemia after esophagectomy is clinically rare. Patients who underwent esophagectomy often have a serum potassium level due to perioperative reduced intake, fluids loss, consumption and other reasons. These patients often require the artificial administration of potassium. Rapid fluid loss and physiological consumption lead to the deficiency of potassium, even hypokalemia. Patients often require the addition of a large amount of potassium after operation...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29301654/the-additive-effect-of-aging-on-sepsis-induced-cognitive-impairment-and-neuroinflammation
#11
Rodrigo Olivieri, Monique Michels, Bruna Pescador, Pricila Ávila, Mariane Abatti, Luana Cucker, Henrique Burger, Diogo Dominguini, João Quevedo, Felipe Dal-Pizzol
Systemic inflammation is emerging as a significant driver of cognitive decline in the aged and vulnerable brain. In sepsis survivors animals low-grade brain inflammation occurs, suggesting that sepsis is able to induce in microglia a primed-like state. The purpose of this study is to analyze the role of sepsis-induced brain inflammation in the progression of the physiological process of brain aging. Wistar rats 2month-old were subjected to sepsis and 60 and 90days after were submitted to the new object recognition test and brain was removed to the determination of cytokines, myeloperoxidase (MPO) activity, amyloid-beta peptide (Aβ) and immunohistochemistry markers of microglial activation...
January 15, 2018: Journal of Neuroimmunology
https://www.readbyqxmd.com/read/29297363/critical-illness-and-flat-batteries
#12
REVIEW
Mervyn Singer
An exaggerated, dysregulated host response to insults such as infection (i.e. sepsis), trauma and ischaemia-reperfusion injury can result in multiple organ dysfunction and death. While the focus of research in this area has largely centred on inflammation and immunity, a crucial missing link is the precise identification of mechanisms at the organ level that cause this physiological-biochemical failure. Any hypothesis must reconcile this functional organ failure with minimal signs of cell death, availability of oxygen, and (often) minimal early local inflammatory cell infiltrate...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29277590/feasibility-of-a-modified-e-pass-and-possum-system-for-postoperative-risk-assessment-in-patients-with-spinal-disease
#13
Dong Hyun Chun, Do Young Kim, Sun Kyu Choi, Dong Ah Shin, Yoon Ha, Keung Nyun Kim, Do Heum Yoon, Seong Yi
STUDY DESIGN: Retrospective case control study OBJECTIVE: This study aimed to evaluate the feasibility of using Estimation of Physiological Ability and Surgical Stress (E-PASS) and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) systems in patients undergoing spinal surgical procedures. SUMMARY OF BACKGROUND DATA: Degenerative spine disease has increased in incidence in aging societies, as has the number of older adult patients undergoing spinal surgery...
December 22, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29276421/adaptive-returns-of-deficient-systemic-plasma-immunoglobulin-g-levels-as-rehabilitation-biomarker-after-emergency-colectomy-for-fulminant-ulcerative-colitis
#14
Alexander T Hawkins, Jun W Um, Amosy E M'Koma
Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for ulcerative colitis (UC). Emergency colectomies are performed for fulminant colitis (ie, toxic megacolon, profuse bleeding, perforation, or sepsis). The RPC and IPAA involve manipulation of the proximal ileum, which may influence the essential physiological function of gut-associated lymphoid tissues. Circulating plasma immunoglobulin G (p-IgG) deficiency is observed in patients with fulminant UC...
2017: Clinical Medicine Insights. Gastroenterology
https://www.readbyqxmd.com/read/29261568/platelet-drop-and-fibrinolytic-shutdown-in-patients-with-sepsis
#15
Fabrizio Semeraro, Mario Colucci, Pietro Caironi, Serge Masson, Concetta T Ammollo, Roberto Teli, Nicola Semeraro, Michela Magnoli, Giovanni Salati, Michele Isetta, Mauro Panigada, Tommaso Tonetti, Gianni Tognoni, Roberto Latini, Antonio Pesenti, Luciano Gattinoni
OBJECTIVE: Thrombocytopenia is the most common hemostatic disorder during sepsis and is associated with high mortality. We examined whether fibrinolytic changes precede incident thrombocytopenia and predict outcome in patients with severe sepsis. DESIGN: Nested study from the multicenter, randomized, controlled trial on the efficacy of albumin replacement in severe sepsis or septic shock (the Albumin Italian Outcome Sepsis trial). SETTING: Forty ICUs in Italy...
December 19, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29261564/long-term-return-to-functional-baseline-after-mechanical-ventilation-in-the-icu
#16
Michael E Wilson, Amelia Barwise, Katherine J Heise, Theodore O Loftsgard, Mikhail Dziadzko, Andrea Cheville, Abdul Majzoub, Paul J Novotny, Ognjen Gajic, Michelle Biehl
OBJECTIVE: Predictors of long-term functional impairment in acute respiratory failure of all causes are poorly understood. Our objective was to assess the frequency and predictors of long-term functional impairment or death after invasive mechanical ventilation for acute respiratory failure of all causes. DESIGN: Population-based, observational cohort study. SETTING: Eight adult ICUs of a single center. PATIENTS: All adult patients from Olmsted County, Minnesota, without baseline functional impairment who received mechanical ventilation in ICUs for acute respiratory failure of all causes from 2005 through 2009...
December 19, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29260347/apolipoprotein-m-protects-against-lipopolysaccharide-induced-acute-lung-injury-via-sphingosine-1-phosphate-signaling
#17
Bin Zhu, Guang-Hua Luo, Yue-Hua Feng, Miao-Mei Yu, Jun Zhang, Jiang Wei, Chun Yang, Ning Xu, Xiao-Ying Zhang
It had been demonstrated that apolipoprotein M (apoM) is an important carrier of sphingosine-1-phosphate (S1P) in blood, and the S1P has critical roles in the pathogenesis of sepsis-induced acute lung injury (ALI). In the present study, we investigated whether apoM has beneficial effects in a mouse model after lipopolysaccharide (LPS)-induced ALI. Forty-eight mice were divided into two groups: male C57BL/6 wild-type (apoM+/+) group (n = 24) and apoM gene-deficient (apoM-/-) group (n = 24) and then randomly subdivided into four subgroups (n = 6 each) according to different intraperitoneal (i...
December 19, 2017: Inflammation
https://www.readbyqxmd.com/read/29258377/clinical-features-of-kidney-transplant-recipients-admitted-to-the-intensive-care-unit
#18
Flávio Geraldo Rezende Freitas, Fábio Lombardi, Eduardo Souza Pacheco, Tainá Veras de Sandes-Freitas, Laila Almeida Viana, Hélio Tedesco-Silva Junior, José Osmar Medina-Pestana, Antônio Tonete Bafi, Flavia Ribeiro Machado
INTRODUCTION: There is a paucity of data regarding the complications in kidney transplant patients who may require intensive care unit (ICU) management, despite being the most common solid organ transplant worldwide. OBJECTIVE: To identify the main reasons for ICU admission and to determine the factors associated with hospital mortality in kidney transplant recipients. DESIGN: This single-center retrospective cohort study was conducted between September 2013 and June 2014, including all consecutive kidney transplant patients requiring ICU admission...
January 1, 2017: Progress in Transplantation
https://www.readbyqxmd.com/read/29248139/the-macro-and-microcirculation-of-the-kidney
#19
REVIEW
Philippe Guerci, Bulent Ergin, Can Ince
Acute kidney injury (AKI) remains one of the main causes of morbidity and mortality in the intensive care medicine today. Its pathophysiology and progress to chronic kidney disease is still under investigation. In addition, the lack of techniques to adequately monitor renal function and microcirculation at the bedside makes its therapeutic resolution challenging. In this article, we review current concepts related to renal hemodynamics compromise as being the event underlying AKI. In doing so, we discuss the physiology of the renal circulation and the effects of alterations in systemic hemodynamics that lead to renal injury specifically in the context of reperfusion injury and sepsis...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29242524/clinical-implications-of-the-plasma-epha2-receptor-level-in-critically-ill-patients-with-septic-shock
#20
Su Hwan Lee, Ju Hye Shin, Joo Han Song, Ah Young Leem, Moo Suk Park, Young Sam Kim, Joon Chang, Kyung Soo Chung
The Eph/ephrin receptor ligand system is known to play a role in inflammation induced by infection, injury, and inflammatory diseases. The present study aimed to evaluate plasma EphA2 receptor levels in critically ill patients with sepsis. This study was a prospective cohort study evaluating samples and clinical data from the medical intensive care unit (MICU) of a 2000-bed university tertiary referral hospital in South Korea. Positive correlations of the plasma EphA2 receptor level with the acute physiology and chronic health evaluation (APACHE) II score and the sequential organ failure assessment (SOFA) score were observed...
December 14, 2017: Scientific Reports
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