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33 papers 25 to 100 followers Articulos muy interesantes en el manejo de shock septico
Yasuyuki Kakihana, Takashi Ito, Mayumi Nakahara, Keiji Yamaguchi, Tomotsugu Yasuda
Sepsis is aggravated by an inappropriate immune response to invading microorganisms, which occasionally leads to multiple organ failure. Several lines of evidence suggest that the ventricular myocardium is depressed during sepsis with features of diastolic dysfunction. Potential candidates responsible for septic cardiomyopathy include pathogen-associated molecular patterns (PAMPs), cytokines, and nitric oxide. Extracellular histones and high-mobility group box 1 that function as endogenous damage-associated molecular patterns (DAMPs) also contribute to the myocardial dysfunction associated with sepsis...
2016: Journal of Intensive Care
Jean-Louis Vincent, Greg S Martin, Mitchell M Levy
No abstract text is available yet for this article.
July 17, 2016: Critical Care: the Official Journal of the Critical Care Forum
Matthew W Semler, Todd W Rice
Sepsis is a common and life-threatening inflammatory response to severe infection treated with antibiotics and fluid resuscitation. Despite the central role of intravenous fluid in sepsis management, fundamental questions regarding which fluid and in what amount remain unanswered. Recent advances in understanding the physiologic response to fluid administration, and large clinical studies examining resuscitation strategies, fluid balance after resuscitation, colloid versus crystalloid solutions, and high- versus low-chloride crystalloids, inform the current approach to sepsis fluid management and suggest areas for future research...
June 2016: Clinics in Chest Medicine
Patrick M Honore, Rita Jacobs, Inne Hendrickx, Sean M Bagshaw, Olivier Joannes-Boyau, Willem Boer, Elisabeth De Waele, Viola Van Gorp, Herbert D Spapen
Sepsis-induced acute kidney injury (SAKI) remains an important challenge in critical care medicine. We reviewed current available evidence on prevention and treatment of SAKI with focus on some recent advances and developments. Prevention of SAKI starts with early and ample fluid resuscitation preferentially with crystalloid solutions. Balanced crystalloids have no proven superior benefit. Renal function can be evaluated by measuring lactate clearance rate, renal Doppler, or central venous oxygenation monitoring...
December 2015: Annals of Intensive Care
Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour, Manu Shankar-Hari, Djillali Annane, Michael Bauer, Rinaldo Bellomo, Gordon R Bernard, Jean-Daniel Chiche, Craig M Coopersmith, Richard S Hotchkiss, Mitchell M Levy, John C Marshall, Greg S Martin, Steven M Opal, Gordon D Rubenfeld, Tom van der Poll, Jean-Louis Vincent, Derek C Angus
IMPORTANCE: Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE: To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS: A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine...
February 23, 2016: JAMA: the Journal of the American Medical Association
Christopher W Seymour, Vincent X Liu, Theodore J Iwashyna, Frank M Brunkhorst, Thomas D Rea, André Scherag, Gordon Rubenfeld, Jeremy M Kahn, Manu Shankar-Hari, Mervyn Singer, Clifford S Deutschman, Gabriel J Escobar, Derek C Angus
IMPORTANCE: The Third International Consensus Definitions Task Force defined sepsis as "life-threatening organ dysfunction due to a dysregulated host response to infection." The performance of clinical criteria for this sepsis definition is unknown. OBJECTIVE: To evaluate the validity of clinical criteria to identify patients with suspected infection who are at risk of sepsis. DESIGN, SETTINGS, AND POPULATION: Among 1.3 million electronic health record encounters from January 1, 2010, to December 31, 2012, at 12 hospitals in southwestern Pennsylvania, we identified those with suspected infection in whom to compare criteria...
February 23, 2016: JAMA: the Journal of the American Medical Association
Kirsi-Maija Kaukonen, Michael Bailey, David Pilcher, D Jamie Cooper, Rinaldo Bellomo
BACKGROUND: The consensus definition of severe sepsis requires suspected or proven infection, organ failure, and signs that meet two or more criteria for the systemic inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and construct validity of this approach. METHODS: We studied data from patients from 172 intensive care units in Australia and New Zealand from 2000 through 2013. We identified patients with infection and organ failure and categorized them according to whether they had signs meeting two or more SIRS criteria (SIRS-positive severe sepsis) or less than two SIRS criteria (SIRS-negative severe sepsis)...
April 23, 2015: New England Journal of Medicine
Jean-Christophe Richard, Frédérique Bayle, Gael Bourdin, Véronique Leray, Sophie Debord, Bertrand Delannoy, Alina Cividjian Stoian, Florent Wallet, Hodane Yonis, Claude Guerin
INTRODUCTION: In septic shock, pulse pressure or cardiac output variation during passive leg raising are preload dependence indices reliable at predicting fluid responsiveness. Therefore, they may help to identify those patients who need intravascular volume expansion, while avoiding unnecessary fluid administration in the other patients. However, whether their use improves septic shock prognosis remains unknown. The aim of this study was to assess the clinical benefits of using preload dependence indices to titrate intravascular fluids during septic shock...
2015: Critical Care: the Official Journal of the Critical Care Forum
David R Janz, Julie A Bastarache, Todd W Rice, Gordon R Bernard, Melissa A Warren, Nancy Wickersham, Gillian Sills, John A Oates, L Jackson Roberts, Lorraine B Ware
OBJECTIVES: This trial evaluated the efficacy of acetaminophen in reducing oxidative injury, as measured by plasma F2-isoprostanes, in adult patients with severe sepsis and detectable plasma cell-free hemoglobin. DESIGN: Single-center, randomized, double-blind, placebo-controlled phase II trial. SETTING: Medical ICU in a tertiary, academic medical center. PATIENTS: Critically ill patients 18 years old or older with severe sepsis and detectable plasma cell-free hemoglobin...
March 2015: Critical Care Medicine
Roberta Capp, Cheryl Lynn Horton, Sukhjit S Takhar, Adit A Ginde, David A Peak, Richard Zane, Keith A Marill
OBJECTIVES: Approximately one in every four patients who present to the emergency department with sepsis progresses to septic shock within 72 hours of arrival. In this study, we describe key patient characteristics present within 4 hours of emergency department arrival that are associated with developing septic shock between 4 and 48 hours of emergency department arrival. DESIGN AND SETTING: This study was a retrospective chart review study of all patients hospitalized from the emergency department with two or more systemic inflammatory response syndrome criteria present within 4 hours of emergency department arrival from September 2010 to February 2011 at two large academic institutions...
May 2015: Critical Care Medicine
Violaine Tolsma, Carole Schwebel, Elie Azoulay, Michael Darmon, Bertrand Souweine, Aurélien Vesin, Dany Goldgran-Toledano, Maxime Lugosi, Samir Jamali, Christine Cheval, Christophe Adrie, Hatem Kallel, Adrien Descorps-Declere, Maïté Garrouste-Orgeas, Lila Bouadma, Jean-François Timsit
OBJECTIVES: This study evaluated the influence of the immune profile on the outcome at day 28 (D28) of patients admitted to the ICU for septic shock or severe sepsis. METHODS: We conducted an observational study using a prospective multicenter database and included all patients admitted to 11 ICUs for severe sepsis or septic shock from January 1997 to August 2011. Seven profiles of immunodeficiency were defined. The prognostic analysis used a competitive risk model (Fine and Gray), in which being alive at ICU or hospital discharge before D28 competed with death...
November 2014: Chest
Diana J Kelm, Jared T Perrin, Rodrigo Cartin-Ceba, Ognjen Gajic, Louis Schenck, Cassie C Kennedy
Early goal-directed therapy (EGDT) consists of early, aggressive fluid resuscitation and is known to improve survival in sepsis. It is unknown how often EGDT leads to subsequent fluid overload and whether post-EGDT fluid overload affects patients' outcomes. Our hypothesis was that patients with sepsis treated with EGDT were at risk for fluid overload and that fluid overload would be associated with adverse outcomes. We conducted a retrospective cohort of 405 consecutive patients admitted with severe sepsis and septic shock to the medical intensive care unit of a tertiary care academic hospital from January 2008 to December 2009...
January 2015: Shock
Chizobam Ani, Siavash Farshidpanah, Amy Bellinghausen Stewart, H Bryant Nguyen
OBJECTIVE: Recent studies have reported decreased overall severe sepsis mortality, but associations with organism trends have not yet been investigated. This study explored organism-specific severe sepsis mortality trends from 1999 to 2008 in a large hospital-based administrative database. DESIGN: Secondary data analysis using the Nationwide Inpatient Sample. SETTING: United States hospitals sampled in the Nationwide Inpatient Sample dataset...
January 2015: Critical Care Medicine
D Bihari, S Prakash, A Bersten
No abstract text is available yet for this article.
September 2014: Anaesthesia and Intensive Care
John R Barton, Baha M Sibai
Pregnancies complicated by severe sepsis and septic shock are associated with increased rates of preterm labor, fetal infection, and preterm delivery. Sepsis onset in pregnancy can be insidious, and patients may appear deceptively well before rapidly deteriorating with the development of septic shock, multiple organ dysfunction syndrome, or death. The outcome and survivability in severe sepsis and septic shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy...
September 2012: Obstetrics and Gynecology
S Goldstein, S Bagshaw, M Cecconi, M Okusa, H Wang, J Kellum, M Mythen, A D Shaw
BACKGROUND: Standard treatment practice for the hypotensive patient with poor tissue perfusion is rapid volume resuscitation; in some scenarios, such as septic shock, this is performed with targeted goal-directed endpoints within 6 h of presentation. As a result, patients often develop significant positive fluid accumulation, which has been associated with poor outcomes above certain thresholds. METHODS: The aim of the current paper is to provide guidance for active pharmacological fluid management in the patient with, or at risk for, clinically significant positive fluid balance from either resuscitation for hypovolaemic shock or acute decompensated heart failure...
November 2014: British Journal of Anaesthesia
Michael Behnes, Thomas Bertsch, Dominic Lepiorz, Siegfried Lang, Frederik Trinkmann, Martina Brueckmann, Martin Borggrefe, Ursula Hoffmann
INTRODUCTION: The aim of this study was to evaluate the diagnostic and prognostic value of presepsin in patients with severe sepsis and septic shock during the first week of ICU treatment. METHODS: In total, 116 patients with suspected severe sepsis or septic shock were included during the first 24 hours of ICU treatment. Blood samples for biomarker measurements of presepsin, procalcitonin (PCT), interleukin 6 (IL-6), C reactive protein (CRP) and white blood cells (WBC) were drawn at days 1, 3 and 8...
2014: Critical Care: the Official Journal of the Critical Care Forum
Catherine Chen, Marin H Kollef
Intravenous fluids (IVFs) represent a basic therapeutic intervention utilized in septic shock. Unfortunately, the optimal method for administering IVFs to maximize patient outcomes is unknown. A meta-analysis of four randomized trials of goal-directed therapy did not demonstrate a significant reduction in mortality (odds ratio 0.609; 95% confidence interval 0.363 to 1.020; P = 0.059), whereas 18 trials with historical controls showed a significant increase in survival (odds ratio 0.580; 95% confidence interval 0...
2014: Critical Care: the Official Journal of the Critical Care Forum
Jason Waechter, Anand Kumar, Stephen E Lapinsky, John Marshall, Peter Dodek, Yaseen Arabi, Joseph E Parrillo, R Phillip Dellinger, Allan Garland
OBJECTIVE: Fluids and vasoactive agents are both used to treat septic shock, but little is known about how they interact or the optimal way to administer them. We sought to determine how hospital mortality was influenced by combined use of these two treatments. DESIGN: Retrospective evaluation using multivariable logistic regression to evaluate the association between hospital mortality and categorical variables representing initiation of vasoactive agents and volumes of IV fluids given 0-1, 1-6, and 6-24 hours after onset, including interactions and adjusting for potential confounders...
October 2014: Critical Care Medicine
Bram Rochwerg, Waleed Alhazzani, Anees Sindi, Diane Heels-Ansdell, Lehana Thabane, Alison Fox-Robichaud, Lawrence Mbuagbaw, Wojciech Szczeklik, Fayez Alshamsi, Sultan Altayyar, Wang-Chun Ip, Guowei Li, Michael Wang, Anna Wludarczyk, Qi Zhou, Gordon H Guyatt, Deborah J Cook, Roman Jaeschke, Djillali Annane
BACKGROUND: Fluid resuscitation is the cornerstone of sepsis treatment. However, whether balanced or unbalanced crystalloids or natural or synthetic colloids confer a survival advantage is unclear. PURPOSE: To examine the effect of different resuscitative fluids on mortality in patients with sepsis. DATA SOURCES: MEDLINE, EMBASE, ACP Journal Club, CINAHL, HealthSTAR, the Allied and Complementary Medicine Database, and the Cochrane Central Register of Controlled Trials through March 2014...
September 2, 2014: Annals of Internal Medicine
2014-09-15 18:59:47
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