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albumin in septic shock

Magnus von Seth, Miklós Lipcsey, Peter Engström, Anders Larsson, Lars Hillered, Enn Maripuu, Charles Widström, Jan Sjölin
Some experimental data suggest that rapid bolus administration of albumin causes less plasma-expanding effects than slow, continuous infusion. To determine whether rapid bolus administration, in comparison with slow infusion, results in greater extravasation of albumin in experimental septic shock we performed a randomized controlled trial with 32 endotoxemic pigs. The animals were monitored and ventilated with standard intensive care equipment and given 10 mL x kg 5% albumin labeled with Technetium-99m, either as a rapid 15-minute bolus (Bolus group, n = 16) or as a 2-hour (h) infusion (Infusion group, n = 16)...
October 5, 2016: Shock
Eric M Fountain, Maggie C Moses, Lawrence P Park, Christopher W Woods, Gowthami M Arepally
Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhea and colitis. The incidence and prognostic significance of thrombocytopenia as related to mode of acquisition (hospital vs. community), NAP1/027 strain, and disease severity has not been examined. We performed a single-institution retrospective analysis of all adult inpatients from 2013 to 2014 diagnosed with CDI during their hospitalization to document the incidence/prevalence of thrombocytopenia and associated outcomes. Severe disease was defined by a composite endpoint of inpatient death, death within 30 days of discharge, presence of septic shock, or need for colectomy during hospitalization...
September 10, 2016: Journal of Thrombosis and Thrombolysis
Min Ho Seo, Minhong Choa, Je Sung You, Hye Sun Lee, Jung Hwa Hong, Yoo Seok Park, Sung Phil Chung, Incheol Park
PURPOSE: The objective of this study was to develop a new nomogram that can predict 28-day mortality in severe sepsis and/or septic shock patients using a combination of several biomarkers that are inexpensive and readily available in most emergency departments, with and without scoring systems. MATERIALS AND METHODS: We enrolled 561 patients who were admitted to an emergency department (ED) and received early goal-directed therapy for severe sepsis or septic shock...
November 2016: Yonsei Medical Journal
William P Parker, Matthew K Tollefson, Courtney N Heins, Kristine T Hanson, Elizabeth B Habermann, Harras B Zaid, Igor Frank, R Houston Thompson, Stephen A Boorjian
OBJECTIVES: To evaluate the incidence, risk factors, and timing of infections following radical cystectomy (RC). METHODS: The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients undergoing RC for bladder cancer from 2006 to 2013. Characteristics including year of surgery, age, sex body mass index, diabetes, smoking, renal function, steroid usage, preoperative albumin, preoperative hematocrit, perioperative blood transfusion (PBT), and operative time were assessed for association with the risk of infection within 30 days of RC using multivariable logistic regression...
August 5, 2016: Urologic Oncology
Min Li, Dong Hao, Tao Wang, Fuquan Gao, Ting Sun, Yan Li, Feng Lu, Xiaoli Liu, Zhencai Hu, Changjun Lyu, Xiaozhi Wang
OBJECTIVE: To explore the variation and clinical value of the degradation of endothelial glycocalyx in the patients with septic shock. METHODS: A prospective case control study was conducted. Patients of 18 years or older diagnosed with septic shock and admitted to Department of Critical Care Medicine of Affiliated Hospital of Binzhou Medical University from June 2014 to May 2015 were enrolled. The levels of degradation products, including hyaluronic acid (HA) and heparin sulfate (HS), at 0, 6, 12, 24, 48 hours were determined, while 20 healthy people were enrolled and served as controls...
August 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Flávia Fonseca Fernandes, Victor Oliveira Alves, Tarquino Erastides Gavilanes Sánchez, Wagner Diniz de Paula, Alfredo Nicodemos Cruz Santana
A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites...
July 11, 2016: Revista do Instituto de Medicina Tropical de São Paulo
Seung J Choi, Eun J Ha, Won K Jhang, Seong J Park
BACKGROUND: We aimed to evaluate the ability of the lactate/albumin ratio to predict mortality in pediatric septic shock patients. METHODS: Retrospective analysis of the medical records of a pediatric intensive care unit. The study cohort comprised 90 pediatric septic shock patients admitted from February 2012 to May 2015. RESULTS: The serum lactate and albumin levels and lactate/albumin ratio were compared between survivors and non-survivors...
July 13, 2016: Minerva Pediatrica
Lauralyn McIntyre, Brian H Rowe, Timothy S Walsh, Alasdair Gray, Yaseen Arabi, Anders Perner, Anthony Gordon, John Marshall, Deborah Cook, Alison Fox-Robichaud, Sean M Bagshaw, Robert Green, Irwin Schweitzer, Alexis Turgeon, Ryan Zarychanski, Shane English, Michaël Chassé, Ian Stiell, Dean Fergusson
OBJECTIVES: Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid administered in early septic shock to inform the design of future septic shock fluid resuscitation trials. METHODS: Using a web-based survey tool, we invited critical care and emergency physicians in Canada, the UK, Scandinavia and Saudi Arabia to complete a self-administered electronic survey...
2016: BMJ Open
Winnie Kwai Yu Chan, Wun Fung Hui
BACKGROUND: High-dose methotrexate therapy (HDMTX) is a common form of chemotherapy used in children with high-grade malignancy such as osteosarcoma. Treatment with HDMTX requires careful monitoring of drug levels with folinic acid (leucovorin) rescue therapy. Toxicity from methotrexate is not uncommon and sometimes causes significant morbidity and mortality. CASE-DIAGNOSIS/TREATMENT: We report an 11-year-old child whose 24-h post-HDMTX serum level was 651.8 μmol/L (recommended level <20 μmol/L), which was complicated by septic shock and progressive renal and liver failure...
October 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Young Hwii Ko, Yoon Seob Ji, Sin-Youl Park, Su Jin Kim, Phil Hyun Song
INTRODUCTION: To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi. MATERIALS AND METHODS: The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model...
March 2016: International Braz J Urol: Official Journal of the Brazilian Society of Urology
A Reum Cho, Tae Hee Lee, Min Ji Park, Sun Hee Oh, Joo Ah Lee, Joo Ho Park, Ki Hyun Ryu, Hoon Sup Koo, Kyung Ho Song, Sun Moon Kim, Kyu Chan Huh, Young Woo Choi, Young Woo Kang
BACKGROUND/AIMS: Pyogenic liver abscess (PLA) is a life-threatening condition, despite advances in diagnostic technology and strategies for treatment. A strong predictor of mortality in this condition is septic shock. This study describes clinical, biochemical, and radiologic features in patients with PLA with or without septic shock, with the intent of describing risk factors for septic shock. METHODS: Of 358 patients with PLA enrolled, 30 suffered septic shock and the remaining 328 did not...
May 25, 2016: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
Elliot Long, Trevor Duke
Sepsis and septic shock are the final common pathway for many decompensated paediatric infections. Fluid resuscitation therapy has been the cornerstone of haemodynamic resuscitation in these children. Good evidence for equivalence between 0.9% saline and 4% albumin, with the relative expense of the latter, has meant that 0.9% saline is currently the most commonly used resuscitation fluid world-wide. Evidence for harm from the chloride load in 0.9% saline has generated interest in balanced solutions as first line resuscitation fluids...
February 2016: Journal of Paediatrics and Child Health
Aijing Luo, Zhuqing Zhong, Qiquan Wan, Qifa Ye
BACKGROUND: Pseudomonas aeruginosa infection remains a life-threatening complication after solid organ transplantation (SOT). We aimed to investigate the distribution and drug susceptibility of pathogens, and clinical characteristics of SOT recipients with Pseudomonas aeruginosa infections. MATERIAL/METHODS: A total of 55 SOT recipients who developed 61 episodes of Pseudomonas aeruginosa infections between January 1, 2003 and July 31, 2015 were retrospectively analyzed...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Nikita Lakomkin, Vasanth Sathiyakumar, Ashley C Dodd, A Alex Jahangir, Paul S Whiting, William T Obremskey, Manish K Sethi
PURPOSE: As US healthcare expenditures continue to rise, there is significant pressure to reduce the cost of inpatient medical services. Studies have estimated that over 70% of routine labs may not yield clinical benefits while adding over $300 in costs per day for every inpatient. Although orthopaedic trauma patients tend to have longer inpatient stays and hip fractures have been associated with significant morbidity, there is a dearth of data examining pre-operative labs in predicting post-operative adverse events in these populations...
June 2016: Injury
Weiwei Jiang, Jie Zhang, Qiming Geng, Xiaoqun Xu, Xiaofeng Lv, Yongwei Chen, Xiang Liu, Weibing Tang
BACKGROUND AND OBJECTIVES: Compared with total parenteral nutrition (TPN), enteral nutrition is more suitable for patients post-operatively. Our aim was to determine the safety and feasibility of early enteral nutrition (EEN) using a jejunum feeding tube in neonates after undergoing a partial gastrectomy. METHODS AND STUDY DESIGN: This was a retrospective review of 46 patients who underwent partial gastrectomies for gastric perforation in our hospital. These patients were categorized into two groups (EEN group [n=24 patients], a jejunal feeding tube was inserted during surgery; and a control group [n=22 patients], a jejunal feeding tube was not placed)...
2016: Asia Pacific Journal of Clinical Nutrition
R V Arun Kumar, Shivakumar M Channabasappa
CONTEXT: Intra-abdominal sepsis following laparotomy for acute abdomen remains still a challenging condition. The understanding of various perioperative risk factors by anesthesiologists are crucial in optimum management these patients. AIMS: The objective of this study is to assess the perioperative risk factors, which predicts the outcome of treatment. SETTINGS AND DESIGN: This retrospective observational study of 603 patients who underwent Laparotomies between March 2012 and March 2015 at our University Medical College...
January 2016: Anesthesia, Essays and Researches
Tatjana Stenzel, Clair Weidgang, Katja Wagner, Florian Wagner, Michael Gröger, Sandra Weber, Bettina Stahl, Ulrich Wachter, Josef Vogt, Enrico Calzia, Stephanie Denk, Michael Georgieff, Markus Huber-Lang, Peter Radermacher, Oscar McCook
Septic shock-related kidney failure is characterized by almost normal morphological appearance upon pathological examination. Endothelial barrier disrupture has been suggested to be of crucial importance for septic shock-induced organ dysfunction. Therefore, in murine resuscitated cecal ligation and puncture (CLP)-induced septic shock, we tested the hypothesis whether there is a direct relationship between the kidney endothelial barrier injury and renal dysfunction. Anesthetized mice underwent CLP, and 15 h later, were anesthetized again and surgically instrumented for a 5-h period of intensive care comprising lung-protective mechanical ventilation, fluid resuscitation, continuous i...
October 2016: Shock
Andre L Holder, Namita Gupta, Elizabeth Lulaj, Miriam Furgiuele, Idaly Hidalgo, Michael P Jones, Tiphany Jolly, Paul Gennis, Adrienne Birnbaum
BACKGROUND: Progression from nonsevere sepsis-i.e., sepsis without organ failure or shock-to severe sepsis or shock among emergency department (ED) patients has been associated with significant mortality. Early recognition in the ED of those who progress to severe sepsis or shock during their hospital course may improve patient outcomes. We sought to identify clinical, demographic, and laboratory parameters that predict progression to severe sepsis, septic shock, or death within 96 h of ED triage among patients with initial presentation of nonsevere sepsis...
December 2016: International Journal of Emergency Medicine
Manuela Ferrario, Alice Cambiaghi, Laura Brunelli, Silvia Giordano, Pietro Caironi, Luca Guatteri, Ferdinando Raimondi, Luciano Gattinoni, Roberto Latini, Serge Masson, Giuseppe Ristagno, Roberta Pastorelli
Septic shock remains a major problem in Intensive Care Unit, with high lethality and high-risk second lines treatments. In this preliminary retrospective investigation we examined plasma metabolome and clinical features in a subset of 20 patients with severe septic shock (SOFA score >8), enrolled in the multicenter Albumin Italian Outcome Sepsis study (ALBIOS, NCT00707122). Our purpose was to evaluate the changes of circulating metabolites in relation to mortality as a pilot study to be extended in a larger cohort...
2016: Scientific Reports
Ronald Chang, John B Holcomb
Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial treatment of sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one that restores intravascular volume while minimizing edema; unfortunately, edema and edema-related complications are common consequences of current resuscitation strategies. Crystalloids are recommended as first-line therapy, but the type of crystalloid is not specified...
July 2016: Shock
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