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    The Role of NIGMS P50 Sponsored Team Science in Our Understanding of Multiple Organ Failure.
    J Trauma Acute Care Surg 2017 May 22. Epub 2017 May 22.
    University of Florida University of Colorado University of Pittsburg University of Pittsburg University of Colorado University of Florida.
    The history of the National Institute of General Medical Sciences (NIGMS) Research Centers in Peri-operative Sciences (RCIPS) is the history of clinical, translational and basic science research into the etiology and treatment of posttraumatic multiple organ failure (MOF). Born out of the activism of trauma and burn surgeons after the Viet Nam war, the P50 trauma research centers have been a nidus of research advances in the field, and the training of future academic physician-scientists in the fields of trauma, burns, sepsis and critical illness. For over 40 years, research conducted under the aegis of this funding program has led to numerous contributions at both the bedside and at the bench. Read More

    Continuous hemoadsorption with a cytokine adsorber during sepsis - a review of the literature.
    Int J Artif Organs 2017 May 19. Epub 2017 May 19.
    Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle - Germany.
    Sepsis is a well-recognized healthcare issue worldwide, ultimately resulting in significant mortality, morbidity and resource utilization during and after critical illness. In its most severe form, sepsis causes multi-organ dysfunction that produces a state of critical illness characterized by severe immune dysfunction and catabolism. Sepsis induces the activation of complement factor via 3 pathways and the release of inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin-1beta (IL-1β), resulting in a systemic inflammatory response. Read More

    Purpura fulminans mimicking toxic epidermal necrolysis - additional value of 16S rRNA sequencing and skin biopsy.
    Neth J Med 2017 May;75(4):165-168
    Department of Intensive Care medicine, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
    Both purpura fulminans and toxic epidermal necrolysis (TEN) are rare and life-threatening disorders with a high mortality. We present a case of suspected rapidly progressive, severe pneumococcal sepsis-induced purpura fulminans complicated by multiple organ failure, severe epidermolysis and cutaneous necrosis. We show the diagnostic challenge to differentiate between purpura fulminans and TEN, as the extensive epidermolysis in purpura fulminans may mimic TEN and we highlight the additional value of repeated skin biopsies and 16S rRNA gene sequencing. Read More

    Metabolic Inflammatory Complex in Sepsis: Septic Cachexia as a Novel Potential Therapeutic Target.
    Shock 2017 May 17. Epub 2017 May 17.
    Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129.
    Despite several decades of focused investigation, sepsis remains a major cause of mortality in critically ill patients. Advancements in intensive care have enabled more patients to survive the acute phase of sepsis than previously, but a growing number of them progress to chronic critical illness. The failure of previous randomized clinical trials of anti-inflammatory agents to show any pro-survival benefit in septic patients underscores current thought that simple anti-inflammatory strategies are ineffective because the inhibitory effect of anti-inflammatory agents undermines the immune response to pathogens. Read More

    Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness.
    J Vis Exp 2017 May 2(123). Epub 2017 May 2.
    Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven;
    This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce sepsis with the use of a central venous line for fluids, drugs and nutrient administration to mimic the human clinical setting. Critically ill patients require intensive medical support in order to survive. Read More

    Coenzyme Q10 improves the survival, mesenteric perfusion, organs and vessel functions in septic rats.
    Biomed Pharmacother 2017 May 11;91:912-919. Epub 2017 May 11.
    Department of Pharmacology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
    Background: Coenzyme Q10 (CoQ10) is a naturally occurring, lipid-soluble antioxidant and an essential electron carrier in the mitochondrial respiratory chain. In sepsis, CoQ10 deficiency induced by mitochondrial failure can lead to hypoxia, hypoperfusion, oxidative organ damage and finally death. We aimed to investigate the effects of CoQ10 on survival, mesenteric artery blood flow (MABF), vascular reactivity, oxidative and inflammatory injuries in cecal ligation and puncture (CLP)-induced sepsis. Read More

    Time course of blood lactate levels, inflammation, and mitochondrial function in experimental sepsis.
    Crit Care 2017 May 12;21(1):105. Epub 2017 May 12.
    Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
    Background: A decrease in blood lactate levels (Lac) >10% during the first hours of resuscitation in sepsis is associated with better outcomes, but the mechanisms are unclear. Our objective was to investigate the relationship between the time course of Lac, inflammatory response, and mitochondrial respiration during experimental sepsis.

    Methods: Original data from two previously published studies were reanalyzed. Read More

    Interleukin-22 Prevents Microbial Dysbiosis and Promotes Intestinal Barrier Regeneration Following Acute Injury.
    Shock 2017 May 11. Epub 2017 May 11.
    *Alcohol Research Program †Burn & Shock Trauma Research Institute ‡Department of Surgery §Department of Microbiology and Immunology ||Integrative Cell Biology Program ¶Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL, USA **Laboratory of Liver Diseases, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA.
    Intestine barrier disruption and bacterial translocation can contribute to sepsis and multiple organ failure- leading causes of mortality in burn-injured patients. Additionally, findings suggest ethanol (alcohol) intoxication at the time of injury worsens symptoms associated with burn injury. We have previously shown that interleukin-22 (IL-22) protects from intestinal leakiness and prevents overgrowth of Gram-negative bacteria following ethanol and burn injury, but how IL-22 mediates these effects has not been established. Read More

    Platelet desialylation is a novel mechanism and a therapeutic target in thrombocytopenia during sepsis: an open-label, multicenter, randomized controlled trial.
    J Hematol Oncol 2017 May 11;10(1):104. Epub 2017 May 11.
    Department of Hematology, Qilu Hospital, Shandong University, Jinan, 250012, China.
    Background: Studies in murine models suggested that platelet desialylation was an important mechanism of thrombocytopenia during sepsis.

    Methods: First, we performed a prospective, multicenter, observational study that enrolled septic patients with or without thrombocytopenia to determine the association between platelet desialylation and thrombocytopenia in patients with sepsis, severe sepsis, and septic shock. Gender- and age-matched healthy adults were selected as normal controls in analysis of the platelet desialylation levels (study I). Read More

    Lethal pulmonary hemorrhage syndrome due to Leptospira infection transmitted by pet rat.
    IDCases 2017 28;8:84-86. Epub 2017 Apr 28.
    Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany.
    Human infection with Leptospira interrogans can be life-threatening. Multiple organ involvement frequently presents with liver and kidney failure, less commonly including severe hemolysis and pulmonary hemorrhage syndrome. Here, we present a fulminant case of leptospirosis presenting with hemolysis and pulmonary hemorrhage. Read More

    Chronic Critical Illness from Sepsis Is Associated with an Enhanced TCR Response.
    J Immunol 2017 May 8. Epub 2017 May 8.
    Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany;
    Sepsis is characterized by a disproportionate host response to infection that often culminates in multiple organ failure. Current concepts invoke a deregulated immune reaction involving features of hyperinflammation, as well as protracted immune suppression. However, owing to the scarcity of human data, the precise origin of a long-term suppression of adaptive immunity remains doubtful. Read More

    Levosimendan mitigates coagulopathy and organ dysfunction in rats with endotoxemia.
    J Chin Med Assoc 2017 May 3. Epub 2017 May 3.
    Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Pharmacology, Taipei Medical University, Taipei, Taiwan, ROC.
    Background: In patients with severe sepsis, pro-inflammatory cytokines and subsequent activation of tissue factors trigger a cascade of events that lead to coagulation dysfunction and multiple organ failure. It has been shown that levosimendan has protective effects against tissue injury caused by endotoxin. The purpose of this study was to evaluate the effects of levosimendan on consumptive coagulopathy and organ dysfunction in an endotoxemic animal model induced by lipopolysaccharide (LPS). Read More

    Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy.
    Endocrinol Diabetes Metab Case Rep 2017 31;2017. Epub 2017 Mar 31.
    Division of Nephrology, Kosin University College of Medicine, BusanRepublic of Korea.
    Summary: Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF). A 22-year-old female patient with a 10-year history of Graves' disease was transferred to our emergency department (ED). Read More

    Emergent laparotomy and temporary abdominal closure for the cirrhotic patient.
    J Surg Res 2017 Apr 11;210:108-114. Epub 2016 Nov 11.
    Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida Health, Gainesville, Florida. Electronic address:
    Background: Temporary abdominal closure (TAC) may be performed for cirrhotic patients undergoing emergent laparotomy. The effects of cirrhosis on physiologic parameters, resuscitation requirements, and outcomes following TAC are unknown. We hypothesized that cirrhotic TAC patients would have different resuscitation requirements and worse outcomes than noncirrhotic patients. Read More

    A novel paradigm links mitochondrial dysfunction with muscle stem cell impairment in sepsis.
    Biochim Biophys Acta 2017 Apr 26. Epub 2017 Apr 26.
    Department of Developmental and Stem Cell Biology, Institut Pasteur, Stem Cells and Development, 75724 cedex15, Paris, France; Team Stability of Nuclear and Mitochondrial DNA, CNRS UMR 3525 and UMR 3738, 75724 cedex15, Paris, France. Electronic address:
    Sepsis is an acute systemic inflammatory response of the body to microbial infection and a life threatening condition associated with multiple organ failure. Survivors may display long-term disability with muscle weakness that remains poorly understood. Recent data suggest that long-term myopathy in sepsis survivors is due to failure of skeletal muscle stem cells (satellite cells) to regenerate the muscle. Read More

    Comparison of the clinical characteristics and prognosis of primary versus secondary acute gastrointestinal injury in critically ill patients.
    J Intensive Care 2017 20;5:26. Epub 2017 Apr 20.
    ICU, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, China.
    Background: This prospective study compared clinical characteristics and prognosis between primary (P) and secondary (S) acute gastrointestinal injury (AGI) (P-AGI)/(S-AGI) in critically ill patients.

    Methods: This was a prospective, single-center observational study. Patients were included if they had been hospitalized for at least 72 h before the AGI diagnosis. Read More

    Sepsis and Septic Shock: Current Treatment Strategies and New Approaches.
    Eurasian J Med 2017 Feb;49(1):53-58
    Department of Pharmacology, Atatürk University School of Medicine, Erzurum, Turkey.
    Sepsis is a complex condition characterized by the simultaneous activation of inflammation and coagulation in response to microbial insult. These events manifest as systemic inflammatory response syndrome or sepsis symptoms through the release of proinflammatory cytokines, procoagulants, and adhesion molecules from immune cells and/or damaged endothelium. Today, sepsis is a severe multisystem disease with difficult treatments for its manifestations and high mortality rates. Read More

    Acute kidney injury after burn.
    Burns 2017 Apr 12. Epub 2017 Apr 12.
    University of Texas Southwestern Medical Center, Department of Surgery, Division of Burn, Trauma, and Critical Care, Dallas, TX, USA. Electronic address:
    Acute kidney injury (AKI) is a common and morbid complication after severe burn, with an incidence and mortality as high as 30% and 80%, respectively. AKI is a broad clinical condition with many etiologies, which makes definition and diagnosis challenging. The most recent Kidney Disease: Improving Global Outcomes (KDIGO) consensus guidelines defined stage and severity of AKI based on changes of serum creatinine and urine output (UOP) across time. Read More

    The effect of a novel minimally invasive strategy for infected necrotizing pancreatitis.
    Surg Endosc 2017 Apr 14. Epub 2017 Apr 14.
    Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China.
    Background: Step-up approach consisting of multiple minimally invasive techniques has gradually become the mainstream for managing infected pancreatic necrosis (IPN). In the present study, we aimed to compare the safety and efficacy of a novel four-step approach and the conventional approach in managing IPN.

    Methods: According to the treatment strategy, consecutive patients fulfilling the inclusion criteria were put into two time intervals to conduct a before-and-after comparison: the conventional group (2010-2011) and the novel four-step group (2012-2013). Read More

    Sepsis-3 on the Block: What Does It Mean for Preclinical Sepsis Modeling?
    Shock 2017 May;47(5):658-660
    *Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria †The William Harvey Research Institute, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK ‡Boston University School of Medicine, Boston, Massachusetts.
    To effectively improve outcomes of septic patients, we first need to elucidate the multifaceted pathogenesis of sepsis syndromes and related inflammatory conditions. In fulfillment of such needs, in February 2016, new definitions for sepsis and septic shock were published under the acronym Sepsis-3. Although aimed at the clinical area, Sepsis-3 will have an inevitable influence upon the field of translational research as well. Read More

    Three Hypothetical Inflammation Pathobiology Phenotypes and Pediatric Sepsis-Induced Multiple Organ Failure Outcome.
    Pediatr Crit Care Med 2017 Apr 13. Epub 2017 Apr 13.
    1Department of Critical Care Medicine, Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, PA. 2Department of Pediatrics, Nationwide Children's Hospital and Ohio State University, Columbus, OH. 3Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX. 4Department of Pediatrics, University of Utah, Salt Lake City, UT. 5Department of Medicine, George Washington University Hospital, Washington, DC.
    Objectives: We hypothesize that three inflammation pathobiology phenotypes are associated with increased inflammation, proclivity to develop features of macrophage activation syndrome, and multiple organ failure-related death in pediatric severe sepsis.

    Design: Prospective cohort study comparing children with severe sepsis and any of three phenotypes: 1) immunoparalysis-associated multiple organ failure (whole blood ex vivo tumor necrosis factor response to endotoxin < 200 pg/mL), 2) thrombocytopenia-associated multiple organ failure (new onset thrombocytopenia with acute kidney injury and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 activity < 57%), and/or 3) sequential multiple organ failure with hepatobiliary dysfunction (respiratory distress followed by liver dysfunction with soluble Fas ligand > 200 pg/mL), to those without any of these phenotypes.

    Setting: Tertiary children's hospital PICU. Read More

    A Prospective Study of Acute Kidney Injury According to KDIGO Definition and its Mortality Predictors.
    J Assoc Physicians India 2016 Dec;64(12):22-28
    Registrar, Department of Medicine (MICU), Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra.
    Background: Acute kidney injury is no longer considered to be an innocent bystander merely reflecting co-existent pathologies but an independent risk factor for mortality in the ICU.

    Aims And Objectives: To study clinical profile and correlation of patients with acute kidney injury (AKI) according to KDIGO definition with respect to incidence, outcome and different causes of AKI in critical care unit.

    Study Design And Setting: It is a prospective observational study; and was carried out in the ICU of a tertiary care, teaching, public hospital. Read More

    Less invasive management of deep neck infection and descending necrotizing mediastinitis: A single-center retrospective study.
    Medicine (Baltimore) 2017 Apr;96(15):e6590
    Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
    By a 7-year retrospective review, we reported our experience in management of descending necrotizing mediastinitis (DNM) and deep neck infection (DNI). A retrospective design was used to reveal the clinical characteristics of DNI and DNM. The clinical outcome was analyzed to validate less invasive management. Read More

    Innate Immune Function and Organ Failure Recovery in Adults With Sepsis.
    J Intensive Care Med 2017 Jan 1:885066617701903. Epub 2017 Jan 1.
    1 Department of Pediatrics, Section of Pediatric Critical Care, University of Colorado School of Medicine, Aurora, CO, USA.
    Purpose: Sepsis stimulates pro- and anti-inflammatory immune responses. The innate immune response is critical to organ injury repair. We tested for an association between innate immune function and organ function recovery in a prospective cohort of immune-competent adults with sepsis. Read More

    Efficacy of polymyxin B-immobilized fiber hemoperfusion for patients with septic shock caused by Gram-negative bacillus infection.
    PLoS One 2017 30;12(3):e0173633. Epub 2017 Mar 30.
    Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
    Septic shock-associated mortality in intensive care units (ICUs) remains high, with reported rates ranging 30-50%. In particular, Gram-negative bacilli (GNB), which induce significant inflammation and consequent multiple organ failure, are the etiological bacterial agent in 40% of severe sepsis cases. Hemoperfusion using polymyxin B-immobilized fiber (PMX), which adsorbs endotoxin, is expected to reduce the inflammatory sepsis cascade due to GNB. Read More

    Hemoadsorption by CytoSorb in septic patients: a case series.
    Crit Care 2017 Mar 27;21(1):74. Epub 2017 Mar 27.
    Department of Anaesthesiology and Intensive Care Medicine, Klinikum, Emden, Germany.
    Background: Septic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks of sepsis is the excessive release of cytokines and other inflammatory mediators causing refractory hypotension, tissue damage, metabolic acidosis and ultimately multiple organ failure. In this context, cytokine reduction by hemoadsorption represents a new concept for blood purification, developed to attenuate the overwhelming systemic levels of pro-inflammatory and anti-inflammatory mediators released in the early phase of sepsis. Read More

    C-terminal proendothelin-1 (CT-proET-1) is associated with organ failure and predicts mortality in critically ill patients.
    J Intensive Care 2017 20;5:25. Epub 2017 Mar 20.
    Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
    Background: Endothelin 1 (ET-1) is a strong vasoconstrictor, which is involved in inflammation and reduced tissue perfusion. C-terminal proendothelin-1 (CT-proET-1) is the stable circulating precursor protein of ET-1. We hypothesized that CT-proET-1, reflecting ET-1 activation, is involved in the pathogenesis of critical illness and associated with its prognosis. Read More

    Delta neutrophil index is an independent predictor of mortality in septic acute kidney injury patients treated with continuous renal replacement therapy.
    BMC Nephrol 2017 Mar 20;18(1):94. Epub 2017 Mar 20.
    Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
    Background: Delta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocytes in acute infection, has been reported as a useful marker for predicting mortality in patients with sepsis. The aim of this study was to evaluate the prognostic value of DNI in predicting mortality in septic acute kidney injury (S-AKI) patients treated with continuous renal replacement therapy (CRRT).

    Method: This is a retrospective analysis of consecutively CRRT treated patients. Read More

    Capillary leak syndrome: etiologies, pathophysiology, and management.
    Kidney Int 2017 Mar 16. Epub 2017 Mar 16.
    Columbia University Medical Center, New York, New York, USA. Electronic address:
    In various human diseases, an increase in capillary permeability to proteins leads to the loss of protein-rich fluid from the intravascular to the interstitial space. Although sepsis is the disease most commonly associated with this phenomenon, many other diseases can lead to a "sepsis-like" syndrome with manifestations of diffuse pitting edema, exudative serous cavity effusions, noncardiogenic pulmonary edema, hypotension, and, in some cases, hypovolemic shock with multiple-organ failure. The term capillary leak syndrome has been used to describe this constellation of disease manifestations associated with an increased capillary permeability to proteins. Read More

    The intensive care medicine clinical research agenda in paediatrics.
    Intensive Care Med 2017 Mar 17. Epub 2017 Mar 17.
    Division of Pediatric Intensive Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Sainte-Justine Hospital, Room 3431, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
    Background: Intensive Care Medicine set us the task of outlining a global clinical research agenda for paediatric intensive care (PIC). In line with the clinical focus of this journal, we have limited this to research that may directly influence patient care.

    Methods: Clinician researchers from PIC research networks of varying degrees of formality from around the world were invited to answer two main questions: (1) What have been the major recent advances in paediatric critical care research? (2) What are the top 10 studies for the next 10 years?

    Results: (1) Inclusive databases are well established in many countries. Read More

    Persistent Inflammation, Immunosuppression and Catabolism Syndrome.
    Crit Care Clin 2017 Apr;33(2):245-258
    Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, 1600 Southwest Archer Road, Room 6116, PO Box 100286, Gainesville, FL 32610-0286, USA. Electronic address:
    Following advances in critical care, in-hospital multiple organ failure-related mortality is declining. Consequently, incidence of chronic critical illness is increasing. These patients linger in the intensive care unit, have high resource utilization, and poor long-term outcomes. Read More

    [Fungemia and septic arthritis caused by Saprochaete capitata in a patient with fanconi aplastic anemia: a case report].
    Mikrobiyol Bul 2017 Jan;51(1):87-93
    Erciyes University Faculty of Medicine, Department of Medical Microbiology, Kayseri, Turkey.
    Saprochaete capitata (formerly known as Blastoschizomyces capitatus, Trichosporon capitatum, Geotrichum capitatum) is a rare but emerging yeast-like fungus. It is commonly found in environmental sources and can be isolated from skin, gastrointestinal system and respiratory tract of healthy individuals as well. It mainly infects patients with hematological malignancies such as acute myeloid leukemia (AML), especially in the presence of neutropenia; and mortality rates are high in those patients. Read More

    Risk Factors for Mortality in Asian Children Admitted to the Paediatric Intensive Care Unit after Haematopoietic Stem Cell Transplantation.
    Ann Acad Med Singapore 2017 Feb;46(2):44-49
    Department of Paediatrics, National University Health System, Singapore.
    Introduction: This study aimed to investigate the risk factors associated with mortality in haematopoietic stem cell transplant (HSCT) patients admitted to our paediatric intensive care unit (PICU) over an 8-year period.

    Materials And Methods: A retrospective chart review was conducted of all HSCT patients requiring PICU admission at our centre (a tertiary care university hospital in Singapore) from January 2002 to December 2010. Chief outcome measures were survival at the time of PICU discharge and survival at 6 months after initial PICU admission. Read More

    Serum oxygen radical activity and total antioxidation capacity are related with severities of surgical patient with sepsis: Prospective pilot study.
    J Crit Care 2017 Jun 12;39:131-136. Epub 2017 Feb 12.
    Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address:
    Purpose: The purpose of this pilot study was to evaluate the correlation between clinical severity and serum oxygen radical activity (ORA) and total antioxidation capacity (TAC) in critically ill surgical patients with sepsis.

    Materials And Methods: The prospective observational study was performed in surgical intensive care unit (SICU) patients with intra-abdominal sepsis. Serum ORA and TAC levels were measured using a spectrophotometry-based antioxidant assay machine. Read More

    Severe Tuberculosis Requiring Intensive Care: A Descriptive Analysis.
    Crit Care Res Pract 2017 30;2017:9535463. Epub 2017 Jan 30.
    Infectious Diseases Department, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, Porto, Portugal; Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal.
    Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors. Methods. Read More

    Specific Etiologies Associated With the Multiple Organ Dysfunction Syndrome in Children: Part 2.
    Pediatr Crit Care Med 2017 Mar;18(3_suppl Suppl 1):S58-S66
    1Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA. 2Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 3Department of Surgery, University of North Carolina, North Carolina Jaycee Burn Center, Chapel Hill, NC. 4Department of Pediatric Surgery, UT-Health, Children's Memorial Hermann Hospital, Houston, TX. 5Departments of Pediatrics and Biochemistry, Washington University in Saint Louis, Saint Louis, MO. 6Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD.
    Objective: To describe a number of conditions and therapies associated with multiple organ dysfunction syndrome presented as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Multiple Organ Dysfunction Workshop (March 26-27, 2015). In addition, the relationship between burn injuries and multiple organ dysfunction syndrome is also included although it was not discussed at the workshop.

    Data Sources: Literature review, research data, and expert opinion. Read More

    Recent advances in the pathophysiology and molecular basis of sepsis-associated organ dysfunction: Novel therapeutic implications and challenges.
    Pharmacol Ther 2017 Feb 21. Epub 2017 Feb 21.
    Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya 466-8550, Japan.
    Sepsis is one of the most common reasons for critically ill patients to be admitted to an intensive care unit and, despite advances in overall medical care, it represents a major clinical problem and remains the leading cause of death in the critically ill patient population. Although sepsis has been defined as a systemic inflammatory syndrome, in which there is an identifiable focus of infection, clinical trials aimed at anti-inflammatory therapeutic approaches have largely failed to identify an effective therapeutic target to improve clinical outcomes in sepsis. Very recently, the third international consensus definitions have been advocated for sepsis and septic shock. Read More

    SOFA and mortality endpoints in randomized controlled trials: a systematic review and meta-regression analysis.
    Crit Care 2017 Feb 24;21(1):38. Epub 2017 Feb 24.
    Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
    Background: The sequential organ failure assessment score (SOFA) is increasingly used as an endpoint in intensive care randomized controlled trials (RCTs). Although serially measured SOFA is independently associated with mortality in observational cohorts, the association between treatment effects on SOFA vs. effects on mortality has not yet been quantified in RCTs. Read More

    Mitochondrial and endoplasmic reticulum dysfunction and related defense mechanisms in critical illness-induced multiple organ failure.
    Biochim Biophys Acta 2017 Feb 17. Epub 2017 Feb 17.
    Clinical Division and Laboratory of Intensive Care Medicine, Department Cellular and Molecular Medicine, KU Leuven, Belgium. Electronic address:
    Patients with critical illness-induced multiple organ failure suffer from a very high morbidity and mortality, despite major progress in intensive care. The pathogenesis of this condition is complex and incompletely understood. Inadequate tissue perfusion and an overwhelming inflammatory response with pronounced cellular damage have been suggested to play an important role, but interventions targeting these disturbances largely failed to improve patient outcome. Read More

    Multiple Organ Dysfunction in Children Mechanically Ventilated for Acute Respiratory Failure.
    Pediatr Crit Care Med 2017 Apr;18(4):319-329
    1Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Cardiology, Boston Children's Hospital, Boston, MA. 3Division of Pediatric Critical Care, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 4Division of Critical Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO. 5Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA. 6Department of Pediatrics, Harvard Medical School, Boston, MA. 7School of Nursing, University of Pennsylvania, Philadelphia, PA. 8Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, MA.
    Objectives: The impact of extrapulmonary organ dysfunction, independent from sepsis and lung injury severity, on outcomes in pediatric acute respiratory failure is unclear. We sought to determine the frequency, timing, and risk factors for extrapulmonary organ dysfunction and the independent association of multiple organ dysfunction syndrome with outcomes in pediatric acute respiratory failure.

    Design: Secondary observational analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure cluster-randomized prospective clinical trial conducted between 2009 and 2013. Read More

    A fatal suppurative pneumonia in piglets caused by a pathogenic coagulase-positive strain of Staphylococcus hyicus.
    Vet Res Commun 2017 Jun 16;41(2):139-146. Epub 2017 Feb 16.
    Key Laboratory for Zoonosis Research, Ministry of Education, Institute of Zoonosis, Jilin University, Changchun, China.
    Staphylococcus hyicus is one of the opportunistic pathogens that cause infections to animals. Early studies have demonstrated that S. hyicus is the causative agents of exudative epidermitis in pigs, arthritis in horses and chicken, mastitis in cow, and bacteremia, sepsis and multiple organ failure in humans. Read More

    Thiamine as a Renal Protective Agent in Septic Shock. A Secondary Analysis of a Randomized, Double-Blind, Placebo-controlled Trial.
    Ann Am Thorac Soc 2017 May;14(5):737-741
    1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine.
    Rationale: Acute kidney injury (AKI) is common in patients with sepsis and has been associated with high mortality rates. The provision of thiamine to patients with sepsis may reduce the incidence and severity of sepsis-related AKI and thereby prevent renal failure requiring renal replacement therapy (RRT).

    Objectives: To test the hypothesis that thiamine supplementation mitigates kidney injury in septic shock. Read More

    Zoonotic necrotizing myositis caused by Streptococcus equi subsp. zooepidemicus in a farmer.
    BMC Infect Dis 2017 Feb 15;17(1):147. Epub 2017 Feb 15.
    The Gade Research Group for Infection and Immunity, Department of Clinical Science, University of Bergen, Bergen, Norway.
    Background: Streptococcus equi subsp. zooepidemicus is a beta-hemolytic group C streptococcus mainly causing infections in domesticated animals. Here we describe the first case of zoonotic necrotizing myositis caused by this bacterium. Read More

    Increased Dicarbonyl Stress as a Novel Mechanism of Multi-Organ Failure in Critical Illness.
    Int J Mol Sci 2017 Feb 7;18(2). Epub 2017 Feb 7.
    Department of Intensive Care, Maastricht University Medical Centre +, Maastricht 6229 HX, The Netherlands.
    Molecular pathological pathways leading to multi-organ failure in critical illness are progressively being unravelled. However, attempts to modulate these pathways have not yet improved the clinical outcome. Therefore, new targetable mechanisms should be investigated. Read More

    Fatal Rhabdomyolysis Caused by Morganella morganii in a Patient with Multiple Myeloma.
    Intern Med 2017 1;56(3):369-371. Epub 2017 Feb 1.
    Division of Hematology and Stem Cell Transplantation, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Japan.
    A 64-year-old Japanese man with multiple myeloma was admitted to our institute due to fever and hypotension. He had received multiple courses of chemotherapy just before his febrile episode. Blood culturing detected Morganella morganii. Read More

    Vancomycin during the Last Hour of the Hemodialysis Session: A Pharmacokinetic Analysis.
    Nephron 2017 3;135(4):261-267. Epub 2017 Feb 3.
    Department of Nephrology and Clinical Immunology, CHRU Tours, Tours, France.
    Background: Vancomycin is usually administered after the dialysis sessions to patients undergoing hemodialysis. Administration of vancomycin during (as opposed to after) sessions would save time, and would be more acceptable to patients and staff, but may lead to vancomycin underexposure. The aim of this study was to propose a new dosing regimen of vancomycin taking into account the dialysis-related losses of vancomycin when administered during dialysis. Read More

    Contamination of burn wounds by Achromobacter Xylosoxidans followed by severe infection: 10-year analysis of a burn unit population.
    Ann Burns Fire Disasters 2016 Sep;29(3):215-222
    Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
    Gram-negative infections predominate in burn surgery. Until recently, Achromobacter species were described as sepsis-causing bacteria in immunocompromised patients only. Severe infections associated with Achromobacter species in burn patients have been rarely reported. Read More

    Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case.
    Case Rep Crit Care 2017 3;2017:6987167. Epub 2017 Jan 3.
    "Carol Davila" University of Medicine & Pharmacy Bucharest, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania.
    Cytokine adsorber (CytoSorb) has been used successfully as adjunctive treatment for adult patients with elevated cytokine levels in the setting with severe sepsis and septic shock and to reduce blood myoglobin, unconjugated bilirubin, and conjugated bilirubin. In this article we present the case of a nine-month-old male infant who was admitted to the NICU due to sepsis after cardiac surgery, Fallot tetralogy, and multisystem organ failure (MSOF) including liver failure and renal failure which was successfully treated by a combination of continuous hemodiafiltration (HDF) and hemadsorption with CytoSorb. HDF was safe and effective from the first day for urea removal, but the patient's bilirubin levels kept increasing gradually, culminating on the 9th day with a maximum value of 54 mg/dL of total bilirubin and 31. Read More

    Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient.
    J Intensive Care 2017 21;5:12. Epub 2017 Jan 21.
    Department of Medicine, Division of Nephrology & Hypertension, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
    Background: Sepsis and septic shock are major healthcare problems, affecting millions of individuals around the world each year. Pathophysiologically, septic multiple organ dysfunction (MOD) is a life-threatening condition caused by an overwhelming systemic inflammatory response of the host's organism to an infection. We experimentally tested if high circulating cytokine levels might increase vascular permeability-a critical hallmark of the disease-and if this phenomenon can be reversed by therapeutic cytokine removal (CytoSorb®) in an exemplary patient. Read More

    Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit.
    JAMA 2017 01;317(3):290-300
    Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Prahran, Melbourne, Australia3Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Prahran, Melbourne, Australia8Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Australia.
    Importance: The Sepsis-3 Criteria emphasized the value of a change of 2 or more points in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score, introduced quick SOFA (qSOFA), and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition.

    Objective: Externally validate and assess the discriminatory capacities of an increase in SOFA score by 2 or more points, 2 or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes among patients who are critically ill with suspected infection.

    Design, Setting, And Participants: Retrospective cohort analysis of 184 875 patients with an infection-related primary admission diagnosis in 182 Australian and New Zealand intensive care units (ICUs) from 2000 through 2015. Read More

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