septic shock

Top PDF septic shock:

Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

Mortality Predictors in Renal Transplant Recipients with Severe Sepsis and Septic Shock

Upon ICU admission, 16.4% of the patients had #1 SIRS criterion (Figure 2). The most common SIRS criteria were tachypnea (74.7%) and tachycardia (67.9%). Two or more organ failures were present at admission in 61.5% of patients. Respiratory and hematological dysfunctions occurred more frequently in the non-survivors. Fifty-three patients (27.9%) experienced septic shock within the first 24 hours of ICU admission; however, 96 (50.5%) patients experienced septic shock during their ICU stays. The time for severe sepsis diagnosis was longer in the non-survivors. The patients who developed sepsis in the ward had worse outcomes than those patients in the emergency room (Table 2). The compliance rate with each component of the 6-hour bundle is shown in Table 2. The compliance rate for fluid administration (20 ml/kg crystalloid for hypotension or lactate $36 mg/dl) was higher among the survivors.
Mostrar mais

10 Ler mais

Serum lactate is a useful predictor of death in severe sepsis and septic shock

Serum lactate is a useful predictor of death in severe sepsis and septic shock

Animal models of polymicrobial sepsis suggested that certain organs, particularly the liver and small intestine, may be more sensitive to impaired oxygen delivery (16). Regardless of its exact mechanism of production, patients admitted with a sepsis- related diagnosis and elevated serum lactate levels (greater than 4 mmol/L) had an increased mortality rate (17). Furthermore, mortality rates have decreased in septic patients with higher lactate clearance rates after 6 hours of therapy (18). Serum lactate is a component of prognostic models in severe sepsis and septic shock and concentrations increased in these patients.
Mostrar mais

8 Ler mais

Use of vasopressin in the treatment of refractory septic shock

Use of vasopressin in the treatment of refractory septic shock

in the study. According to hospital policy, vasopressin in only released for the treatment of septic shock in cases that are refractory to norepinephrine, as defined by the attending physician. The patients were identified through a computerized prescription report, and those with a registry of dispensing and administration of vasopressin infusion were included. Data were collected on anthropometric measurements, baseline disease, duration of vasopressor use, presence of organ dysfunction, and complications. Patient data were collected directly from the electronic medical record, and evolution data were recorded until hospital outcome (discharge or death) or for up to 30 days after starting treatment with vasopressin. (18)
Mostrar mais

6 Ler mais

Use of vasopressin in the treatment of refractory septic shock

Use of vasopressin in the treatment of refractory septic shock

27. Mehta S, Granton J, Gordon AC, Cook DJ, Lapinsky S, Newton G, Bandayrel K, Little A, Siau C, Ayers D, Singer J, Lee TC, Walley KR, Storms M, Cooper DJ, Holmes CL, Hebert P, Presneill J, Russell JA; Vasopressin and Septic Shock Trial (VASST) Investigators. Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. Crit Care. 2013;17(3):R117.

6 Ler mais

Use of vasopressin in the treatment of refractory septic shock

Use of vasopressin in the treatment of refractory septic shock

in the study. According to hospital policy, vasopressin in only released for the treatment of septic shock in cases that are refractory to norepinephrine, as defined by the attending physician. The patients were identified through a computerized prescription report, and those with a registry of dispensing and administration of vasopressin infusion were included. Data were collected on anthropometric measurements, baseline disease, duration of vasopressor use, presence of organ dysfunction, and complications. Patient data were collected directly from the electronic medical record, and evolution data were recorded until hospital outcome (discharge or death) or for up to 30 days after starting treatment with vasopressin. (18)
Mostrar mais

6 Ler mais

Use of vasopressin in the treatment of refractory septic shock

Use of vasopressin in the treatment of refractory septic shock

27. Mehta S, Granton J, Gordon AC, Cook DJ, Lapinsky S, Newton G, Bandayrel K, Little A, Siau C, Ayers D, Singer J, Lee TC, Walley KR, Storms M, Cooper DJ, Holmes CL, Hebert P, Presneill J, Russell JA; Vasopressin and Septic Shock Trial (VASST) Investigators. Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. Crit Care. 2013;17(3):R117.

6 Ler mais

Clinical impact of stress dose steroids in patients with septic shock: insights from the PROWESS- Shock trial

Clinical impact of stress dose steroids in patients with septic shock: insights from the PROWESS- Shock trial

In the midst of these conflicting results, two recent obser- vational studies were published [32,33] that brought a little light to these issues [34,35]. The first study from Katsenos et al. [32], showed a potential mortality benefit from early initiation of steroids (in the first 9 hours after vasopressors). However, these results are compromised by several limita- tions, namely the small and asymmetric sample size, the fact that the impact of steroid therapy was not adjusted for clinical severity nor organ dysfunction, and the very high mortality rate at 28 days (almost 70% in patients with late steroid initiation) [34]. The study from Funk et al. [33] was a large retrospective multicenter propensity-matched co- hort study that showed no benefit from low-dose cortico- steroids in septic shock patients either in 30-day mortality
Mostrar mais

10 Ler mais

Interleukin-10 rs2227307 and CXCR2 rs1126579 polymorphisms modulate the predisposition to septic shock

Interleukin-10 rs2227307 and CXCR2 rs1126579 polymorphisms modulate the predisposition to septic shock

Overall, a limitation of this study was the lack of com- prehensive clinical information, such as the causative pathogen, initial infection site and the gap before treat- ment initiation. However, this caveat reveals that the posi- tive genetic markers identified may be useful in assessing septic shock risk even when these data are not yet estab- lished. Nevertheless, we encourage further study aimed at investigating the clinical usefulness of these SNPs in specific infections, which may reveal reliable predictive models. Moreover, considering that some of the patients’ demographic and clinical factors influence sepsis predis- position, it would be interesting to stratify our data to en- hance input score reliability. However, the sample pool we recruited was too small to enable such an approach.
Mostrar mais

9 Ler mais

Perfusion index for assessing microvascular reactivity in septic shock after fluid resuscitation

Perfusion index for assessing microvascular reactivity in septic shock after fluid resuscitation

19. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R; Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165-228.

9 Ler mais

Perfusion index for assessing microvascular reactivity in septic shock after fluid resuscitation

Perfusion index for assessing microvascular reactivity in septic shock after fluid resuscitation

The Shapiro-Wilk test was used to test normalcy of the sample. Nonparametric values were expressed as medians/ interquartile ranges and categorical variables were expressed as percentages. The Mann-Whitney test and Chi-square test were used to determine the significance of the differences in the nonparametric and categorical variables, respectively. Spearman correlation analysis was conducted to determine the relationships between the reactive hyperemia and the clinical-hemodynamic parameters. The statistical program GraphPad Prism 3.02 was used for analyses. The significance level sought was p < 0.05. Because this was the first study in the literature to use this design to evaluate septic shock (time-response analysis using PI), the sample size was not exactly calculated. To minimize this issue, we observed the sample size selected by other similarly designed studies in the literature, which was between 15 and 42 patients per septic group and between 15 and 38 patients in control group. (4,6,7)
Mostrar mais

9 Ler mais

Thirst perception and osmoregulation of vasopressin secretion are altered during recovery from septic shock.

Thirst perception and osmoregulation of vasopressin secretion are altered during recovery from septic shock.

From ICU admission to osmotic challenge included, we recorded criteria for septic shock, the primary source of infection, causal micro-organism and positive blood cultures. We recorded for each day vital signs, arterial blood gas, plasma lactate levels, standard laboratory tests, the administration of catecholamines, sedatives and analgesics, the need for any surgical procedure, renal replacement and mechanical ventilation as well as treatment that might alter AVP secretion. Using these data, the maximum SOFA score, lowest PaO 2 /FiO 2 ratio, duration of shock (i.e. defined as
Mostrar mais

10 Ler mais

Serum estradiol levels predict survival and acute kidney injury in patients with septic shock--a prospective study.

Serum estradiol levels predict survival and acute kidney injury in patients with septic shock--a prospective study.

Associations between the presence of organ dysfunction, including AKI, ARDS, hematologic dysfunction and metabolic acidosis, and serum sex hormone levels are shown in Figure 5. Patients with higher estradiol levels showed increased incidence of AKI (p,0.001) and metabolic acidosis (p = 0.029). Patients with higher progesterone levels showed higher incidence of AKI (P = 0.002), ARDS (p = 0.029), and metabolic acidosis (p = 0.030). Because of the observed close correlation between serum sex hormones and AKI, we further analyzed their predictive values for concomitant AKI. ROC curves of serum sex hormones in predicting the presence of concomitant AKI are shown in Figure 6A. Serum level of estradiol was a good predictor of AKI, with AUCs of 0.788. As shown in Table 3, serum estradiol level was found to be the only independent predictor of the Figure 4. Kaplan-Meier survival curves of pneumonia-related septic shock patients, stratified by day-1 serum sex hormone levels. Patients were categorized into two groups based on the optimal cut-off points of (A) progesterone and (B) estradiol from the ROC curves. Patients were categorized into four groups based on combining (C) progesterone and (D) estradiol optimal cut-off points and high or low Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Statistical significance was tested with the log-rank test.
Mostrar mais

10 Ler mais

How Do I Integrate Hemodynamic Variables When Managing Septic Shock?

How Do I Integrate Hemodynamic Variables When Managing Septic Shock?

The concept of prediction of luid responsiveness has emerged since it has been demonstrated that only 50% of patients with acute circulatory failure respond to luid administration in terms of increase in CO[20] and that luid overload is associated with increased mortality.[21] During the last fifteen years, a number of indices able to predict luid responsiveness at the bedside have been developed. In patients receiving mechanical ventilation, indices based on heart-lung interactions and mainly the respiratory variation of surrogates of stroke volume have been proposed.[22] The general principle is that when the heart is preload responsive, the stroke volume - or a surrogate such as PP - varies markedly over the respira- tory cycle.[22] Accordingly, pulse pressure variation (PPV) was found to predict responsiveness better than cardiac filling pressures in patients with septic shock. [23] A metaanalyse including more than 800 patients showed that the prediction of fluid responsiveness by PPV is excellent in various clinical conditions with a cut- off of 12%.[24] In other words, when PPV is > 12%, CO is likely to increase by more than 15% if luid is infused (luid responsiveness), whereas if PPV is < 12%, no in- crease in CO can be expected from luid infusion (luid unresponsiveness). Recent functional hemodynamic monitoring devices calculate PPV automatically from the arterial pressure curve recording and display its value in real-time on their screen. Other luid responsiveness indi- ces such as stroke volume variation (SVV) can also been calculated and displayed by some advanced hemodynam- ic monitors but they have no superiority over PPV,[25] which has the great advantage to be recorded from a sim- ple arterial catheter. However, the applicability of PPV (or SVV) for predicting luid responsiveness is limited in the intensive care unit since it cannot be used in cases of spontaneous breathing activity, cardiac arrhythmias, low
Mostrar mais

11 Ler mais

Platelet-derived exosomes from septic shock patients induce myocardial dysfunction

Platelet-derived exosomes from septic shock patients induce myocardial dysfunction

We collected blood samples (50 mL) of 55 patients from the Emergency Medicine Intensive Care Unit of Hospital das Clin- icas, University of São Paulo, Brazil, with early (less than 48 hours) diagnosis of septic shock defined according to the cri- teria of the American College of Chest Physicians and the Society of Critical Care Medicine [15]. Twelve healthy volun- teers from our laboratory provided blood samples that served as controls. The study was approved by the institutional ethics and review board, and informed consent was obtained from the patient's next of kin. Animal care and handling of animals in the study were in accordance with guidelines of the National Institutes of Health (Bethesda, MD, USA).
Mostrar mais

10 Ler mais

en 0103 507X rbti 26 02 0193

en 0103 507X rbti 26 02 0193

subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemoiltration. hese rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental efects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemoiltration is a non-conventional hemodynamic support

7 Ler mais

en 0103 507X rbti 28 01 0005

en 0103 507X rbti 28 01 0005

7. Caltabeloti F, Monsel A, Arbelot C, Brisson H, Lu Q, Gu WJ, et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care. 2014;18(3):R91.

3 Ler mais

en 0103 507X rbti 27 02 0092

en 0103 507X rbti 27 02 0092

15. Trzeciak S, Dellinger RP, Parrillo JE, Guglielmi M, Bajaj J, Abate NL, Arnold RC, Colilla S, Zanotti S, Hollenberg SM; Microcirculatory Alterations in Resuscitation and Shock Investigators. Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med. 2007;49(1):88-98, 98.e1-2.

4 Ler mais

en 0103 507X rbti 26 04 0435

en 0103 507X rbti 26 04 0435

2. Joannes-Boyau O, Honoré PM, Perez P, Bagshaw SM, Grand H, Canivet JL, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med. 2013;39(9):1535-46.

3 Ler mais

Clinics  vol.66 número7

Clinics vol.66 número7

Interestingly, these findings are not consistent with our previously published study in 2008 that reported related cases of ARF in autopsies from 1990 to 2000 only; it reported the following associated diseases or complications in descending order: HIV/AIDS (31.4%), BBP (21.8%), sepsis and septic shock (11.7%), liver cirrhosis (11.5%), pulmonary embolism (5.7%), acute myocardial infarction (5.5%), brain stroke (4.6%), tuberculosis (3.6%), cancer (2.3%), chronic kidney failure (1.9%), and leukemia (0.2%). 22

5 Ler mais

Rev. bras. ter. intensiva  vol.23 número2 en a05v23n2

Rev. bras. ter. intensiva vol.23 número2 en a05v23n2

Description of the evidence collecting method he Medline database (www.ncbi.nlm.nih.gov/ pubmed) was searched using the following key words: inappropriate antimicrobial therapy; deescalating antimicrobial therapy; blood culture and sepsis or septic shock; blood culture and collection technique; skin antiseptics and blood cultures; blood culture contamination; skin preparation or skin or venipuncture site disinfection; changing needles and blood cultures; community acquired pneumonia and sputum culture; nosocomial or ventilator- associated pneumonia and sputum culture; lung biopsy or thoracoscopy and pneumonia or pneumonitis; catheter related bloodstream infection; urine culture and bacteriuria and catheter-associated urinary tract infections. his search provided 8,846 articles, of which 115 were selected.
Mostrar mais

11 Ler mais

Show all 610 documents...