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Sepsis

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181 papers 25 to 100 followers
https://www.readbyqxmd.com/read/27908338/fluid-resuscitation-in-severe-sepsis
#1
REVIEW
Rob Loflin, Michael E Winters
Since its original description in 1832, fluid resuscitation has become the cornerstone of early and aggressive treatment of severe sepsis and septic shock. However, questions remain about optimal fluid composition, dose, and rate of administration for critically ill patients. This article reviews pertinent physiology of the circulatory system, pathogenesis of septic shock, and phases of sepsis resuscitation, and then focuses on the type, rate, and amount of fluid administration for severe sepsis and septic shock, so providers can choose the right fluid, for the right patient, at the right time...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27916077/-intestinal-barrier-dysfunction-and-its-related-factors-in-patients-with-sepsis
#2
W Liu, X H Wang, X J Yang, X Y Zhang, W J Qi
Objective: To investigate the relationship between related factors of intestinal barrier dysfunction in patients with sepsis or septic shock and severity of the condition. Methods: A prospective observational study was conducted in 31 sepsis patients, 28 septic shock patients, and 21 postoperative patients without sepsis (control group) who were admitted to intensive care unit (ICU) of General Hospital of Ningxia Medical University between November 2015 and June 2016. Blood samples were collected from the patients within 24 hours following admission to ICU...
November 29, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27885885/septic-encephalopathy-and-septic-encephalitis%C3%A2-%C3%A2
#3
Simone C Tauber, Helmut Eiffert, Wolfgang Brück, Roland Nau
During the last two decades, septic encephalopathy (SE) was recognized as a clinically relevant problem with a high prevalence in patients at admission and during their hospital stay. SE is a condition associated with increased mortality and morbidity such as long-term cognitive impairment. Areas covered: This review illustrates the pathophysiology of sepsis-associated encephalopathy and encephalitis involving blood-brain-barrier dysfunction and neuroinflammation caused by endothelial and microglial activation by endogenous or pathogen-derived compounds, hypoxia by impaired microvascular regulation and septic shock as well as imbalance of neurotransmitters...
December 5, 2016: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#4
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27861258/septic-participation-in-cardiogenic-shock-exposure-to-bacterial-endotoxin
#5
Paula Ramirez, Esther Villarreal, Monica Gordon, María Dolores Gómez, Luis de Hevia, Karla Vacacela, Teresa Gisbert, Adrian Quinzá, Jesús Ruiz, Ricardo Alonso, Juan Bonastre, Jordi Vila
OBJECTIVE: In cardiogenic shock (CS), presence of fever, leukocytosis, relatively low systemic vascular resistances and high serum procalcitonin levels are quite frequent and recurrently involve the search for an infectious complication. We hypothesized that endotoxin exposure in CS could explain this sepsis-like syndrome. DESIGN AND SETTING: Prospective observational study of consecutive CS patients admitted to our intensive care unit (ICU). Patients were followed during the first three days after SC onset...
November 15, 2016: Shock
https://www.readbyqxmd.com/read/27864924/pentraxin-3-in-patients-with-severe-sepsis-or-shock-the-albios-trial
#6
Pietro Caironi, Serge Masson, Tommaso Mauri, Barbara Bottazzi, Roberto Leone, Michela Magnoli, Simona Barlera, Filippo Mamprin, Andrea Fedele, Alberto Mantovani, Gianni Tognoni, Antonio Pesenti, Luciano Gattinoni, Roberto Latini
BACKGROUND: The long pentraxin PTX3 is a key component of the humoral arm of innate immunity related to sepsis severity and mortality. We evaluated the clinical and prognostic significance of circulating PTX3 in the largest cohort ever reported of patients with severe sepsis or septic shock. DESIGN: Plasma PTX3 was measured on days 1, 2 and 7 after randomization of 958 patients to albumin or crystalloids for fluid resuscitation in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial...
November 16, 2016: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/27886576/the-effect-of-early-goal-directed-therapy-for-treatment-of-severe-sepsis-or-septic-shock-a-systemic-review-and-meta-analysis
#7
Sun-Kyung Park, Su Rin Shin, Min Hur, Won Ho Kim, Eun-Ah Oh, Soo Hee Lee
PURPOSE: To assess the effects of early goal-directed therapy (EGDT) on reducing mortality compared with conventional management of severe sepsis or septic shock. MATERIALS AND METHODS: We included a systemic review, using the Medline and EMBASE. Seventeen randomized trials with 5765 patients comparing EGDT with usual care were included. RESULTS: There were no significant differences in mortality between EGDT and control groups (relative risk [RR], 0...
October 30, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27910086/higher-vs-lower-haemoglobin-threshold-for-transfusion-in-septic-shock-subgroup-analyses-of-the-triss-trial
#8
S L Rygård, L B Holst, J Wetterslev, P I Johansson, A Perner
BACKGROUND: Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. METHODS: In post-hoc analyses of the full trial population of 998 patients from the Transfusion Requirements in Septic Shock (TRISS) trial, we investigated the intervention effect on 90-day mortality in patients with severe comorbidity (chronic lung disease, haematological malignancy or metastatic cancer), in patients who had undergone surgery (elective or acute) and in patients with septic shock as defined by the new consensus definition: lactate above 2 mmol/l and the need for vasopressors to maintain a mean arterial pressure above 65 mmHg...
December 2, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27922878/higher-fluid-balance-increases-the-risk-of-death-from-sepsis-results-from-a-large-international-audit
#9
Yasser Sakr, Paolo Nahuel Rubatto Birri, Katarzyna Kotfis, Rahul Nanchal, Bhagyesh Shah, Stefan Kluge, Mary E Schroeder, John C Marshall, Jean-Louis Vincent
OBJECTIVES: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. DESIGN: Observational cohort study. SETTING: Seven hundred and thirty ICUs in 84 countries. PATIENTS: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance...
December 5, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27879559/angiotensin-ii-in-refractory-septic-shock
#10
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/27815588/the-new-sepsis-consensus-definitions-the-good-the-bad-and-the-ugly
#11
EDITORIAL
Charles L Sprung, Roland M H Schein, Robert A Balk
No abstract text is available yet for this article.
December 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27851105/1469-lactate-monitoring-for-severe-sepsis-and-septic-shock-are-all-lactate-measurements-the-same
#12
Kelly Lima, Rachel Caynak, Fabian Lara, Nam Tran
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27798738/fluid-management-in-the-icu-has-the-tide-turned
#13
EDITORIAL
Peter Buhl Hjortrup, Anthony Delaney
No abstract text is available yet for this article.
October 31, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27823892/practical-considerations-in-sepsis-resuscitation
#14
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/27822777/critical-role-of-endogenous-histamine-in-promoting-end-organ-tissue-injury-in-sepsis
#15
Mizuki Hattori, Mitsuaki Yamazaki, Wakana Ohashi, Satoshi Tanaka, Kohshi Hattori, Kenichiro Todoroki, Toshio Fujimori, Hiroshi Ohtsu, Naoyuki Matsuda, Yuichi Hattori
BACKGROUND: Histamine assumes an important role as a major mediator in various pathologic disorders associated with inflammation and immune reactions. However, the involvement of histamine in the pathological conditions and symptoms of sepsis remains entirely unknown. In this study, we establish that histamine is identified as a contributory mediator to promoting the development of organ injury in sepsis. METHODS: Histidine decarboxylase (HDC) gene knockout (HDC(-/-)) mice, histamine H1-/H2-receptor gene-double knockout (H1R(-/-)/H2R(-/-)) mice, and their littermate wild-type (WT) C57BL/6J mice underwent cecal ligation and puncture (CLP) or sham operation...
December 2016: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/27787407/vasodilators-in-septic-shock-resuscitation-a-clinical-perspective
#16
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/27741949/hydrocortisone-treatment-in-early-sepsis-associated-acute-respiratory-distress-syndrome-results-of-a-randomized-controlled-trial
#17
Surat Tongyoo, Chairat Permpikul, Wasineenart Mongkolpun, Veerapong Vattanavanit, Suthipol Udompanturak, Mehmet Kocak, G Umberto Meduri
BACKGROUND: Authors of recent meta-analyses have reported that prolonged glucocorticoid treatment is associated with significant improvements in patients with severe pneumonia or acute respiratory distress syndrome (ARDS) of multifactorial etiology. A prospective randomized trial limited to patients with sepsis-associated ARDS is lacking. The objective of our study was to evaluate the efficacy of hydrocortisone treatment in sepsis-associated ARDS. METHODS: In this double-blind, single-center (Siriraj Hospital, Bangkok), randomized, placebo-controlled trial, we recruited adult patients with severe sepsis within 12 h of their meeting ARDS criteria...
October 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27708007/the-physiology-of-early-goal-directed-therapy-for-sepsis
#18
Lindsay Lief, John Arbo, David A Berlin
In 2001, Rivers and colleagues published a randomized controlled trial of early goal-directed therapy (EGDT) for the treatment of sepsis. More than a decade later, it remains a landmark achievement. The study proved the benefits of early aggressive treatment of sepsis. However, many questions remain about specific aspects of the complex EGDT algorithm. Recently, 3 large trials attempted to replicate these results. None of the studies demonstrated a benefit of an EGDT protocol for sepsis. This review explores the physiologic basis of goal-directed therapy, including the hemodynamic targets and the therapeutic interventions...
October 5, 2016: Journal of Intensive Care Medicine
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
#19
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/27782333/the-immune-system-s-role-in-sepsis-progression-resolution-and-long-term-outcome
#20
REVIEW
Matthew J Delano, Peter A Ward
Sepsis occurs when an infection exceeds local tissue containment and induces a series of dysregulated physiologic responses that result in organ dysfunction. A subset of patients with sepsis progress to septic shock, defined by profound circulatory, cellular, and metabolic abnormalities, and associated with a greater mortality. Historically, sepsis-induced organ dysfunction and lethality were attributed to the complex interplay between the initial inflammatory and later anti-inflammatory responses. With advances in intensive care medicine and goal-directed interventions, early 30-day sepsis mortality has diminished, only to steadily escalate long after "recovery" from acute events...
November 2016: Immunological Reviews
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