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Ventilation, sepsis

Jennifer Rickard, Christian Ngarambe, Leonard Ndayizeye, Blair Smart, Robert Riviello, Jean Paul Majyambere
BACKGROUND: Management of critically ill patients is challenging in a low-resource setting. In Rwanda, peritonitis is a common surgical condition where patients often present late, with advanced disease. We aim to describe critical care management of patients with peritonitis in Rwanda. METHODS: Data were collected at a tertiary referral hospital in Rwanda on patients undergoing operation for peritonitis over a 6-month period. Data included epidemiology, hospital course and outcomes...
March 19, 2018: World Journal of Surgery
Olivier Nardi, Elizabeth Zavala, Claude Martin, Serafim Nanas, Thomas Scheeren, Andrea Polito, Xavi Borrat, Djillali Annane
OBJECTIVE: Evaluation of the ratio of oxyhaemoglobin to total haemoglobin in skeletal muscle (StO2 ) using near-infrared spectroscopy may aid in the monitoring of patients with sepsis. This study assessed the benefits and risks of targeting StO2 in adults with severe sepsis or septic shock. DESIGN: A European randomised controlled trial was performed on two parallel groups. SETTING: Five intensive care units (ICU) in France, Greece, Spain and Germany were used for the study...
March 19, 2018: BMJ Open
Eashaa Kumar, Michael T McCurdy, Christian A Koch, Abdurrahman Hamadah, Tibor Fülöp, Kamel A Gharaibeh
Unexplained hypotension in the intensive care unit is commonly attributed to volume depletion, cardiorespiratory failure, sepsis, or relative adrenal insufficiency. In these acute conditions, thyroid hormone levels measured in blood, serum or plasma are often altered and solely attributed to critical illness. We report a series of 3 critically ill patients with prolonged respiratory failure, suppressed mental status and unexplained hypotension. Thyroid stimulating hormone levels ranged from normal to mildly elevated (2...
March 2018: American Journal of the Medical Sciences
Shannon M Fernando, Douglas P Barnaby, Christophe L Herry, E John Gallagher, Nathan I Shapiro, Andrew J E Seely
BACKGROUND: Early emergency department (ED) identification of septic patients at risk of deterioration is critical. Lactate is associated with 28-day mortality in admitted patients, but little evidence exists on its use in predicting short-term deterioration. OBJECTIVE: Our aim was to determine the role of initial serum lactate for prediction of short-term deterioration in stable ED patients with suspected sepsis. METHODS: We conducted a prospective cohort study of adult ED sepsis patients...
March 13, 2018: Journal of Emergency Medicine
Konstadinos Plestis, Oleg Orlov, Vishal N Shah, Joshua Wong, Matthew Thomas, Alon Aharon, Cinthia Orlov, Georgia Panagopoulos, Scott Goldman
OBJECTIVES: Minimally invasive aortic valve replacement (MIAVR) can be technically demanding and may lead to prolonged operative time. We evaluated the intraoperative and postoperative patient outcomes following implementation of 2 facilitating technologies (FT) in MIAVR: the Cor-Knot titanium fastener and Custodiol-histidine-tryptophan-ketoglutarate solution. METHODS: A total of 299 patients underwent MIAVR from 2008 to 2016; 172 (57.5%) patients were included in the FT group and 127 (42...
March 14, 2018: Interactive Cardiovascular and Thoracic Surgery
Jaime Fernández-Sarmiento, Joseph A Carcillo, Claudia M Salinas, Edgar F Galvis, Paula A López, Andrés Jagua-Gualdrón
OBJECTIVES: To evaluate adherence to the sepsis bundle before and after an educational strategy and its impact on hospital stay. DESIGN: A prospective, analytic, before-and-after study of children with severe sepsis and septic shock who presented to the emergency department. SETTING: Carried out from January to December 2014 in the emergency department of a quaternary care hospital. PATIENTS: Of a total of 19,836 children who presented to the emergency department, 4,383 had an infectious pathology, with 203 of these showing severe sepsis and septic shock (124 pre intervention, and 79 post intervention)...
March 14, 2018: Pediatric Critical Care Medicine
Yan-Ting Song, Yong-Qin Wang, Yue-Hua Zhao, Hai-Ling Zhu, Qian Liu, Xiao Zhang, Yi-Wen Gao, Wei-Ye Zhang, Yu-Tong Sang
OBJECTIVE: To study the risk factors for elevated serum total bile acid (TBA) in preterm infants. METHODS: A retrospective analysis was performed for the clinical data of 216 preterm infants who were admitted to the neonatal intensive care unit. According to the presence or absence of elevated TBA (TBA >24.8 μmol/L), the preterm infants were divided into elevated TBA group with 53 infants and non-elevated TBA group with 163 infants. A univariate analysis and an unconditional multivariate logistic regression analysis were used to investigate the risk factors for elevated TBA...
March 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Elliot Long, Trevor Duke, Ed Oakley, Adam O'Brien, Bennett Sheridan, Franz E Babl
OBJECTIVE: The intent of fluid bolus therapy (FBT) is to increase cardiac output and tissue perfusion, yet only 50% of septic children are fluid responsive. We evaluated respiratory variation of inferior vena cava (IVC) diameter as a predictor of fluid responsiveness. METHODS: A prospective observational study in the ED of The Royal Children's Hospital, Melbourne, Australia. Patients were spontaneously ventilating children treated with FBT for sepsis-induced acute circulatory failure...
March 8, 2018: Emergency Medicine Australasia: EMA
Dean B Percy, Candace Haddock, Vivian Ma, Amie Nowak, Julia Panczuk, Sonia Butterworth
OBJECTIVE: The purpose of this study was to describe outcomes and resource utilization in patients treated with twice-weekly silver impregnated (SI) nanocrystalline dressings for initial non-operative management of giant omphalocele (GO). METHODS: A retrospective review of patients with GO treated with SI dressings was undertaken. Clinical parameters, cost, and complications were recorded. RESULTS: Five patients with GO were treated with SI dressings between 2014 and 2016...
February 8, 2018: Journal of Pediatric Surgery
Nianfang Lu, Li Jiang, Bo Zhu, Wenyong Han, Yingqi Zhao, Yuntao Shi, Fashuang Guo, Xiuming Xi
OBJECTIVE: To explore the accuracy of fluid responsiveness assessment by variability of peripheral arterial peak velocity and variability of inferior vena cava diameter (ΔIVC) in patients with septic shock. METHODS: A prospective study was conducted. The patients with septic shock undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Beijing Electric Power Hospital from January 2016 to December 2017 were enrolled. According to sepsis bundles of septic shock, volume expansion (VE) was conducted...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Christopher J Miller, Bruce A Doepker, Andrew N Springer, Matthew C Exline, Gary Phillips, Claire V Murphy
BACKGROUND: Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock. METHODS: A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed...
January 1, 2018: Journal of Intensive Care Medicine
Fabrizio Poletti, Claudio Coccino, Davide Monolo, Paolo Crespi, Giorgio Ciccioli, Giuseppe Cordio, Giovanni Seveso, Stefano De Servi
PURPOSE: Patients admitted to cardiac intensive care unit need administration of drugs intravenously often in concomitance of therapeutic techniques such as non-invasive ventilation, continuous renal replacement therapy and intra-aortic balloon counterpulsation. Therefore, the insertion of central venous catheters provides a reliable access for delivering medications, laboratory testing and hemodynamic monitoring, but it is associated with the risk of important complications. In our study, we tested the efficacy and safety of peripherally inserted central catheters to manage cardiac intensive care...
March 1, 2018: Journal of Vascular Access
Jingyi Wu, Zhen Wang, Tao Wang, Tao Yu, Jing Yuan, Qingling Zhang, Weihua Lu, Xia Zhang
BACKGROUND: Prompt, accurate, and noninvasive prediction of fluid responsiveness is still lacking in intensive care unit. This study is to investigate the value of the Doppler ultrasound evaluation of variation in brachial artery peak velocity (VVpeakbrach ) and passive leg raising (PLR)-induced changes in the brachial artery peak velocity (ΔVpeakPLR ) in predicting the fluid responsiveness in mechanically ventilated patients with severe sepsis or septic shock. METHODS: A prospective study was conducted involving 62 patients...
April 2018: Journal of Surgical Research
Navpreet K Dhillon, Joshua Tseng, Galinos Barmparas, Megan Y Harada, Ara Ko, Eric J T Smith, Gretchen M Thomsen, Eric J Ley
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States, especially in the elderly, who have the highest rates of TBI-related hospitalizations and deaths among all age groups. Sepsis is one of many risk factors that is associated with higher mortality and longer length of hospital stay in this population partially due to the immunosuppressive effects of TBI. The significance of early indicators of infection, such as a positive blood, sputum, or urine culture, is not well described...
April 2018: Journal of Surgical Research
Wei Li, Xianfen Cheng, Linying Guo, Hongri Li, Chunrong Sun, Xiaodai Cui, Qi Zhang, Guowei Song
We assessed the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and community-acquired pneumonia (CAP) among Chinese children.This observational study examined children aged 3 days to 14 years (n = 1582) from the Capital Institute of Pediatrics in 2009 to 2011. There were 797 children in the CAP group and 785 controls. The CAP group was divided into 2 groups: a pneumonia group and pneumonia-induced sepsis group. The serum 25(OH)D level was estimated using micro whole blood chemiluminescence...
January 2018: Medicine (Baltimore)
Ehsan Akbari, Saeed Safari, Hamidreza Hatamabadi
INTRODUCTION: The debate on replacing coagulation factors and its effect on the final outcome of the patients with acute traumatic coagulopathy (ATC) in need of transfusion is still ongoing. Therefore, the present study is designed with the aim of comparing the outcome of patients with acute traumatic coagulopathies receiving fibrinogen and fresh frozen plasma (FFP). METHODS: In this quasi-experimental randomized controlled study, patients with severe blunt trauma (ISS>16) and in need of packed cells transfusion were divided into 3 groups of receiving fibrinogen, receiving FFP, and control, and their final outcome was compared...
February 22, 2018: American Journal of Emergency Medicine
Hitoshi Yamamura, Yu Kawazoe, Kyohei Miyamoto, Tomonori Yamamoto, Yoshinori Ohta, Takeshi Morimoto
Background: Use of high-dose norepinephrine is thought to have an immunosuppressive action that increases mortality. This study aimed to evaluate the correlation between norepinephrine dosage and prognosis of patients with septic shock. Methods: This study was a nested cohort of the DExmedetomidine for Sepsis in Intensive Care Unit Randomized Evaluation (DESIRE) trial. We evaluated 112 patients with septic shock and an initial Sequential Organ Failure Assessment Cardiovascular (SOFA-C) category score > 2 and initial lactate level > 2 mmol/L...
2018: Journal of Intensive Care
Azra Bihorac, Tezcan Ozrazgat-Baslanti, Ashkan Ebadi, Amir Motaei, Mohcine Madkour, Panagote M Pardalos, Gloria Lipori, William R Hogan, Philip A Efron, Frederick Moore, Lyle L Moldawer, Daisy Zhe Wang, Charles E Hobson, Parisa Rashidi, Xiaolin Li, Petar Momcilovic
MINI: In a single-center cohort of 51,457 adult surgical patients, we have developed and validated an automated machine-learning algorithm that uses existing clinical data in electronic health records to forecast the risk for major complications and death after any type of surgery with high sensitivity and high specificity. OBJECTIVE: To accurately calculate the risk for postoperative complications and death after surgery in the preoperative period using machine-learning modeling of clinical data...
February 27, 2018: Annals of Surgery
A Lodha, N Brown, A Soraisham, H Amin, S Tang, N Singhal
Objectives: To compare short- and long-term neurodevelopmental outcomes at 3 years of corrected age of preterm infants cared for by 24-hour in-house staff neonatologists and those cared for by staff neonatologists during daytime only. Methods: Retrospective analysis of prospectively collected follow-up data on all nonanomalous preterm infants from 1998 to 2004 excluding year 2001 as a washout period. Infants were divided into two groups based on care provided by staff neonatologists: 24-hour in-house coverage (24-hour coverage 1998-2000) and daytime coverage (day coverage 2002-2004)...
August 2017: Paediatrics & Child Health
Gail Otulakowski, Doreen Engelberts, Martin Post, Claire Masterson, Brian P Kavanagh
BACKGROUND: Lower tidal volumes are increasingly used in acute respiratory distress syndrome, but mortality has changed little in the last 20 yr. Therefore, in addition to ventilator settings, it is important to target molecular mediators of injury. Sepsis and other inflammatory states increase circulating concentrations of Gas6, a ligand for the antiinflammatory receptor Axl, and of a soluble decoy form of Axl. We investigated the effects of lung stretch on Axl signaling. METHODS: We used a mouse model of early injury from high tidal volume and assessed the effects of inhibiting Axl on in vivo lung injury (using an antagonist R428, n = 4/group)...
February 23, 2018: Anesthesiology
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