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Search Results: 1 - 10 of 2084 matches for " Septic shock "
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A New Approach: Chronotherapy in Acute Blood Purification for Septic Shock  [PDF]
Masafumi Yamato, Yusuke Minematsu
Journal of Biosciences and Medicines (JBM) , 2017, DOI: 10.4236/jbm.2017.57004
Abstract: Circadian rhythms are daily oscillations of multiple biological processes. Recently, relationships between circadian rhythms and immune functions have also been described. In a mouse sepsis model, the death rate due to lipopolysaccharide (LPS)-induced endotoxic shock was found to be dependent on LPS administration as determined by circadian time. In humans, a pronounced inflammatory response to endotoxemia differs depending on whether it is daytime or night-time: Levels of tumor necrosis factor-alpha and interleukin-6 were higher during the night. Therefore, it is reasonable to assume that circadian rhythms influence not only organ dysfunction and the prognosis induced by LPS, but also the therapeutic effect of anti-LPS therapy such as Polymyxin-B direct hemoperfusion. We herein postulate the concept that it is important to discuss septic shock treatment in terms of whether or not the treatment is adjusted for the optimal time window as determined by circadian rhythms.
The International Sepsis Forum's controversies in sepsis: corticosteroids should not be routinely used to treat septic shock
Gordon Bernard
Critical Care , 2002, DOI: 10.1186/cc1531
Abstract: The issue of whether to use corticosteroids for treating septic shock has been ongoing for 20 or 30 years. Indeed, there is much clinical and preclinical data that provide ample reasons for using corticosteroids in septic shock. For instance, we know that steroids increase catecholamine-stimulated contractility, vasomotor catecholamine response, and adrenergic receptor density. They also prevent desensitization of β receptors, and they may provide adrenal replacement.The normal cortisol range is 5–24 μg/dl, and during the stress response this rarely goes above 200 μg/dl. During septic shock, classic adrenal insufficiency is rare (0–3% of cases) and cortisol levels can range from 7 to 400 μg/dl. However, 50% of patients have levels below 20 μg/dl [1]. A series of studies has examined the relative adrenal insufficiency that is sometimes seen in septic shock. In one such study [2] patients were stimulated with adrenocorticotrophic hormone (ACTH) and their blood cortisol levels were measured at 0, 30, and 60 min. High mortality (82%) was associated with high baseline cortisol levels that did not respond to ACTH stimulation, whereas low mortality (26%) was associated with low baseline cortisol levels that did respond to ACTH stimulation. The intermediate values correlated with intermediate mortality. This makes perfect sense and is very logical, which is one of the reasons why I think it has been adopted so quickly even though the data are fairly preliminary and have not been reproduced.A recent study examined a cohort of patients with septic shock, separated them according to the presence or absence of relative adrenal insufficiency, randomized them into a placebo-controlled trial of steroid therapy, and then stratified the analysis according to the adrenal insufficiency variable [3]. At the onset, patients were tested for eligibility using ACTH stimulation (although the results of this were not immediately disclosed) and were then randomly assigned to either hydrocorti
Pro/con clinical debate: Is high-volume hemofiltration beneficial in the treatment of septic shock?
Karl Reiter, Rinaldo Bellomo, Claudio Ronco, John A Kellum
Critical Care , 2002, DOI: 10.1186/cc1448
Abstract: You have a 40-year-old male in your intensive care unit who has septic shock as a result of bacterial pneumonia. He is on moderate dose levophed to maintain a systolic pressure of 90 mmHg. Apart from respiratory and cardiovascular failure, he has not developed any other end-organ failure. You feel confident you are giving him the best supportive care possible; however, his septic shock still bothers you. You remember hearing once that HVHF may have a role in this type of patient to rid them of the mediators that cause septic shock and to possibly improve patient outcome, but you are unsure whether you should try it.Karl Reiter, Rinaldo Bellomo and Claudio RoncoThe sepsis syndrome is associated with an overwhelming systemic overflow of pro-inflammatory and anti-inflammatory mediators, leading to generalized endothelial damage, multiple organ failure, and altered cellular immunological responsiveness.The inflammatory network is exaggerated, synergistic, and acts like a cascade. It includes mediators with autocrine and paracrine actions, as well as cellular and intracellular components [1]. Some substances have a pronounced role in the cascade. For instance, there is tumor necrosis factor-α, IL-1β and IL-6 proximally, and there is reactive oxygen species, nitric oxide, and nuclear factor-κB distally, to name but a few. Antagonizing a single mediator has not, however, reduced sepsis mortality in human trials [2].Almost paralleling the surge of pro-inflammatory mediators, there is a rise in anti-inflammatory substances by which a state of immunoparalysis (i.e. 'monocyte hyporesponsiveness') can be induced [3]. As both the pro-inflammatory and anti-inflammatory sides become upregulated and interact together, any intervention favoring one side or the other is hazardous because, without 'on-line' measurements of the inflammatory status, the intervention appears to be blind.Continuous hemofiltration has been used successfully for the treatment of acute renal failure (ARF) fo
The International Sepsis Forum's controversies in sepsis: my initial vasopressor agent in septic shock is norepinephrine rather than dopamine
Vinay K Sharma, R Phillip Dellinger
Critical Care , 2002, DOI: 10.1186/cc1835
Abstract: Norepinephrine and dopamine are the common vasopressor agents used in patients in septic shock who do not respond to fluid resuscitation. Norepinephrine is a potent α1-adrenergic agonist with a weaker but still significant β-adrenergic agonist effect. It increases blood pressure mainly by increasing systemic vascular resistance as a consequence of its vasoconstrictive effects. Dopamine has agonistic effect on a variety of different receptors, depending on the dose used. At doses below 5 μg/kg per min it acts predominantly on dopamine receptors (mainly the vascular D1 receptor); at doses between 5 and 10 μg/kg per min its β-adrenergic agonist effects are dominant; whereas at doses above 10 μg/kg per min its α1-adrenergic agonist action predominates. The American College of Critical Care Medicine and the Society of Critical Care Medicine in 1999 published practice parameters for the hemodynamic management of patients in septic shock [1]; despite 197 listed and ranked references, less than a handful of reports could be categorized as large, prospective, and comparative in determining the best vasopressor with which to raise arterial pressure.Traditionally, the use of norepinephrine in patients with shock has been restricted by the fear of excessive vasoconstriction that may result in end-organ hypoperfusion. In the past it was usually given only when other vasopressor agents failed, and thus such patients would be predicted to have a poor outcome. Recent studies indicate that the fear of deleterious effect was unwarranted and that norepinephrine may have a role as a first-line vasopressor agent in patients with septic shock. There are a number of reasons to consider using norepinephrine first.Norepinephrine-induced increase in blood pressure occurs with little change in the heart rate. This is because the weak β-agonist chronotropic effect of norepinephrine is counterbalanced by an increased venous capacitance constriction effect on the right heart baroreceptors. In a
ACTUALIZACIóN DEL MARCO CONCEPTUAL Y MANEJO DE LA SEPSIS, SEPSIS SEVERA Y SHOCK SéPTICO
GóMEZ RODRíGUEZ,JUAN CARLOS;
Revista Med , 2009,
Abstract: even though sepsis is as old as our immune system, it was not until the xix century that a causality relation between infectious organisms and the infection per se was identified. although great advances have taken place after this, it was not until the last 20 years that a process was initiated to try and diminish the mortality, which surpasses 50% in cases of severe sepsis, becoming the tenth most common cause of death in industrialized countries. the epidemiologic sub registry is marred by deficiencies in the standardization and the definitions of the associated terms: sepsis, severe sepsis and septic shock. the understanding of the physiopathologic mechanisms in the last decade has helped to create diagnostic and therapeutic tools that have produced a highly positive impact, with initiatives created to establish uniformity, to publicize them and to standardize the treatment protocols. this is a discussion and review of the management guidelines, which were recently updated, in an attempt to obtain homogenization of the treatment of sepsis from the emergency room to the intensive care unit and to establish data to evaluate sepsis and the real impact of this ominous process.
Shock séptico en pediatría: un acercamiento a su manejo
Montalván González,Guillermo;
Revista Cubana de Pediatr?-a , 2008,
Abstract: sepsis in the child is an important health problem and it is considered the main cause of death at this age in the world. it also consumes a great deal of health resources. a review of the topic of septic shock in pediatrics and of the possibilities of therapeutic treatment at present was made due to the importance of the diagnosis and early treatment to reduce the mortality from sepsis in childhood.
Evaluación de la microcirculación sublingual en un paciente en shock séptico refractario tratado con hemofiltración de alto volumen
Ruiz B,Carolina; Bruhn C,Alejandro; Hernández P,Glenn; Andresen H,Max;
Revista médica de Chile , 2008, DOI: 10.4067/S0034-98872008000900013
Abstract: microcirculation is severely compromised in sepsis, with a reduction of capillary density and flow impairment. these alterations have important prognostic implications, being more severe in non-survivors to septic shock. today microcirculation may be assessed bedside, non-invasively usingpolarized light videomicroscopy a technique known as sdf (side dark field). we report a 54 year-old man with an extramembranous nephropathy that developed a necrotizing fascitis associated to septic shock, in whom microcirculation was periodically assessed during his management. the patient was treated with buids, vasoactive drugs, antibiotics and was operated for exploration and debridement. as the patient persisted in refractory shock despite treatment, high-volume hemofiltration was started. before hemofiltration the patient had severe microcirculatory alterations that improved during and after the procedure. physiologic endpoints of high-volume hemofiltration in septic shock remain unknown, but it has the capacity to clear in?ammatory mediators. since microcirculatory alterations are in part secondary to these mediators, their removal is beneficia! like other authors, we found no relation between microcirculation and other haemodynamic and perfusión variables.
Early recognition and management of septic shock in children
Paolo Biban,Marcella Gaffuri,Stefania Spaggiari,Federico Zaglia
Pediatric Reports , 2012, DOI: 10.4081/pr.2012.e13
Abstract: Septic shock remains a major cause of morbidity and mortality among children, mainly due to acute haemodynamic compromise and multiple organ failures. In the last decade, international guidelines for the management of septic shock, as well as clinical practice parameters for hemodynamic support of pediatric patients, have been published. Early recognition and aggressive therapy of septic shock, by means of abundant fluid resuscitation, use of catecholamines and other adjuvant drugs, are widely considered of pivotal importance to improve the short and long-term outcome of these patients. The aim of this paper is to summarize the modern approach to septic shock in children, particularly in its very initial phase, when pediatric healthcare providers may be required to intervene in the pre-intensive care unit setting or just on admission in the pediatric intensive care unit.
Pediatric Sepsis Guidelines: summary for resource-limited countries
Khilnani Praveen,Singhi Sunit,Lodha Rakesh,Santhanam Indumathi
Indian Journal of Critical Care Medicine , 2010,
Abstract: Justification: Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa. Process: An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products. Objective: To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India. Recommendations: Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3-5 years as new body of evidence accumulates.
Evaluación de la microcirculación sublingual en un paciente en shock séptico refractario tratado con hemofiltración de alto volumen Evaluation of sublingual microcirculation in septic shock. Report of one patient treated with high volume hemofiltration
Carolina Ruiz B,Alejandro Bruhn C,Glenn Hernández P,Max Andresen H
Revista médica de Chile , 2008,
Abstract: Microcirculation is severely compromised in sepsis, with a reduction of capillary density and flow impairment. These alterations have important prognostic implications, being more severe in non-survivors to septic shock. Today microcirculation may be assessed bedside, non-invasively usingpolarized light videomicroscopy a technique known as SDF (side dark field). We report a 54 year-old man with an extramembranous nephropathy that developed a necrotizing fascitis associated to septic shock, in whom microcirculation was periodically assessed during his management. The patient was treated with Buids, vasoactive drugs, antibiotics and was operated for exploration and debridement. As the patient persisted in refractory shock despite treatment, high-volume hemofiltration was started. Before hemofiltration the patient had severe microcirculatory alterations that improved during and after the procedure. Physiologic endpoints of high-volume hemofiltration in septic shock remain unknown, but it has the capacity to clear in ammatory mediators. Since microcirculatory alterations are in part secondary to these mediators, their removal is beneficia! Like other authors, we found no relation between microcirculation and other haemodynamic and perfusión variables.
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