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    POSTOPERATIVE SERUM LEVELS OF ENDOCAN ARE ASSOCIATED WITH THE DURATION OF NOREPINEPHRINE SUPPORT AFTER CORONARY ARTERY BYPASS SURGERY.
    Anaesth Crit Care Pain Med 2018 Feb 21. Epub 2018 Feb 21.
    Sorbonne Universités, UPMC Univ Paris 06, Department of Anaesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, Hôpital Pitié-Salpêtrière, Paris, France.
    Background: Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response and an endothelial dysfunction, whose qualitative assessment appears to be a major issue. Endocan (ESM-1, endothelial cell specific molecule - 1) is a protein preferentially expressed by the endothelium and previously associated with prognosis of septic shock or acute respiratory distress syndrome. In this pilot study, we investigated the kinetic of Endocan in planned coronary artery bypass grafting (CABG) surgery with CPB. Read More

    Prognosis of patients excluded by the definition of septic shock based on their lactate levels after initial fluid resuscitation: a prospective multi-center observational study.
    Crit Care 2018 Feb 24;22(1):47. Epub 2018 Feb 24.
    Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
    Background: Septic shock can be defined both by the presence of hyperlactatemia and need of vasopressors. Lactate levels should be measured after volume resuscitation (as per the Sepsis-3 definition). However, currently, no studies have evaluated patients who have been excluded by the new criteria for septic shock. Read More

    Treatment and outcome of congenital nephrotic syndrome.
    Nephrol Dial Transplant 2018 Feb 20. Epub 2018 Feb 20.
    Hôpital Necker-Enfants malades, Néphrologie pédiatrique, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris-Cité, Paris, France.
    Background: Recommendations for management of Finnish-type congenital nephrotic syndrome (CNS) followed by many teams include daily albumin infusions, early bilateral nephrectomy, dialysis and transplantation. We aimed to assess the treatment and outcome of patients with CNS in France.

    Methods: We conducted a nationwide retrospective study on 55 consecutive children born between 2000 and 2014 treated for non-infectious CNS. Read More

    Using lean methodology to optimize time to antibiotic administration in patients with sepsis.
    Am J Health Syst Pharm 2018 Mar;75(5 Supplement 1):S13-S23
    Henry Ford Hospital, Detroit, MI.
    Purpose: Results of a study to apply lean methodology to an inpatient pharmacy workflow to optimize timely administration of Centers for Medicare and Medicaid Services (CMS)-approved antibiotics for patients with severe sepsis or septic shock are presented.

    Methods: This quasi-experimental study was conducted at an 802-bed institution using lean methodology to assess the inpatient pharmacy workflow for dispensing antibiotics to adult patients. The preintervention and postintervention phases occurred from February to September, 2015, and from October 2015 to May 2016, respectively. Read More

    Early Immune Function and Duration of Organ Dysfunction in Critically Ill Septic Children.
    Am J Respir Crit Care Med 2018 Feb 22. Epub 2018 Feb 22.
    Nationwide Children's Hospital, Columbus, Ohio, United States.
    Rationale: Late immune suppression is associated with nosocomial infection and mortality in septic adults and children. Relationships between early immune suppression and outcomes in septic children remain unclear.

    Objective: Prospective observational study to test the hypothesis that early innate and adaptive immune suppression are associated with longer duration of organ dysfunction in children with severe sepsis/septic shock. Read More

    Epidemiology and risk factors of extensively drug-resistant Pseudomonas aeruginosa infections.
    PLoS One 2018 22;13(2):e0193431. Epub 2018 Feb 22.
    Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Background: The incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality.

    Methods: We retrospectively studied a cohort of adult, hospitalized patients with P. Read More

    Oral Supplementation with Bovine Colostrum Prevents Septic Shock and Brain Barrier Disruption During Bloodstream Infection in Preterm Newborn Pigs.
    Shock 2018 Feb 21. Epub 2018 Feb 21.
    Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Preterm infants have increased risk of neonatal sepsis, potentially inducing brain injury, and they may benefit from early initiation of enteral milk feeding. Using preterm pigs as models, we hypothesized that early provision of bovine colostrum to parentally nourished newborns protects against sepsis and neuroinflammation during bloodstream infection. Preterm newborn pigs were administered 10 CFU/kg of intra-arterial Staphylococcus epidermidis (SE, an opportunistic pathogen often causing sepsis in preterm infants), followed by administration of total parenteral nutrition (TPN, SE + TPN, n = 15) or oral provision of bovine colostrum with supplementary parenteral nutrition (SE + COL, n = 14), and compared with uninfected, TPN-nourished controls (CON + TPN, n = 11). Read More

    Delayed presentation of toxic epidermal necrolysis-like cutaneous acute graft-versus-host disease in the setting of recent immunosuppressant discontinuation.
    Dermatol Online J 2017 Oct 15;23(10). Epub 2017 Oct 15.
    Department of Dermatology, Northwestern University, Chicago, Illinois.
    Acute graft-versus-host disease (GvHD) is a process that classically has been defined as occurring less than 100 days after stem cell transplant. When Stage IV cutaneous acute GvHD occurs outside this window, it can be difficult to distinguish clinically from toxic epidermal necrolysis (TEN). A 50-year-old man with diffuse large B-cell lymphoma who had undergone an allogeneic stem cell transplant 20 months previously was admitted for neutropenic septic shock. Read More

    Effect of blood thiamine concentrations on mortality: Influence of nutritional status.
    Nutrition 2017 Dec 7;48:105-110. Epub 2017 Dec 7.
    Applied Statistics, Federal University of São Paulo, São Paulo, Brazil.
    Objective: To test the hypothesis that low blood thiamine concentrations in malnourished critically ill children are associated with higher risk of 30-d mortality.

    Methods: Prospective cohort study in 202 consecutively admitted children who had whole blood thiamine concentrations assessed on admission and on days 5 and 10 of intensive care unit (ICU) stay. The primary outcome variable was 30-d mortality. Read More

    The cholinergic anti-inflammatory pathway revisited.
    Neurogastroenterol Motil 2018 Mar;30(3)
    Department of Anatomy, Physiology, and Cell Biology, UC Davis School of Veterinary Medicine, UC Davis, Davis, CA, USA.
    Inflammatory bowel disease negatively affects the quality of life of millions of patients around the world. Although the precise etiology of the disease remains elusive, aberrant immune system activation is an underlying cause. As such, therapies that selectively inhibit immune cell activation without broad immunosuppression are desired. Read More

    Cholecystokinin octapeptide inhibits the inflammatory response and improves neurological outcome in a porcine model of cardiopulmonary resuscitation.
    Exp Ther Med 2018 Mar 27;15(3):2583-2588. Epub 2017 Dec 27.
    Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.
    Previous studies have demonstrated that cholecystokinin octapeptide (CCK8) induces hypothermia and inhibits the systemic inflammatory response in septic shock in rat and murine models. The present study aimed to ascertain whether CCK8 induced hypothermia and improved the neurological outcomes in a porcine model of cardiopulmonary resuscitation (CPR). Ventricular fibrillation was induced and left untreated for 10 min in 12 male Bama miniature pigs. Read More

    Protracted immune disorders at one year after ICU discharge in patients with septic shock.
    Crit Care 2018 Feb 21;22(1):42. Epub 2018 Feb 21.
    Department of Anesthesiology and Intensive Care Medicine, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.
    Background: Sepsis is a leading cause of mortality and critical illness worldwide and is associated with an increased mortality rate in the months following hospital discharge. The occurrence of persistent or new organ dysfunction(s) after septic shock raises questions about the mechanisms involved in the post-sepsis status. The present study aimed to explore the immune profiles of patients one year after being discharged from the intensive care unit (ICU) following treatment for abdominal septic shock. Read More

    ADJunctive Ulinastatin in Sepsis Treatment in China (ADJUST study): study protocol for a randomized controlled trial.
    Trials 2018 Feb 21;19(1):133. Epub 2018 Feb 21.
    Medical Intensive Care Unit, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China.
    Background: Sepsis is a major challenge in critical care and is associated with high mortality. Current management of sepsis and septic shock remains mainly supportive. Both basic and clinical research has shown that ulinastatin can improve the prognosis of sepsis. Read More

    Caspase-1-dependent pyroptosis of peripheral blood mononuclear cells predicts the development of sepsis in severe trauma patients: A prospective observational study.
    Medicine (Baltimore) 2018 Feb;97(8):e9859
    Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, P.R. China.
    Pyroptosis plays a pivotal role in sepsis and septic shock in animal studies. However, its clinical significance in pathological conditions has not been well elucidated. This study aimed to evaluate the correlation between the percentage of pyroptotic peripheral blood mononuclear cells (PBMCs) and the clinical index and to investigate the relationship between PBMCs pyroptosis and the development of sepsis in trauma patients. Read More

    Maternal sepsis.
    Semin Perinatol 2018 Feb;42(1):9-12
    John Hopkins School of Medicine, 600 N. Wolfe St, Phipps 228, Baltimore, MD 21287. Electronic address:
    Sepsis is a leading cause of maternal morbidity and mortality in developed and developing nations. Obstetric practitioners should be familiar with guidelines that promote the safe and expeditious recovery of those affected. This article will provide the reader with rational steps to aid in the recovery of such a patient. Read More

    The practice of intensive care in Latin America: a survey of academic intensivists.
    Crit Care 2018 Feb 21;22(1):39. Epub 2018 Feb 21.
    Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Diagonal Paraguay #362, Santiago Centro, RM, 8330077, Chile.
    Background: Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. Read More

    Associated Mortality of Liberal Fluid Administration in Sepsis.
    J Pharm Pract 2018 Jan 1:897190018759857. Epub 2018 Jan 1.
    1 Department of Pharmacy, Virginia Commonwealth University Health System, Richmond, VA, USA.
    Fluid resuscitation, to restore intravascular volume and improve oxygen delivery, is a crucial step in early resuscitation efforts of patients with sepsis or septic shock. The 2016 Surviving Sepsis Campaign guidelines suggest the use of dynamic versus static measures of fluid responsiveness and fluid resuscitation with at least 30 mL/kg of intravenous crystalloid within the first 3 hours followed by fluid administration if hemodynamic factors continue to improve. Despite these recommendations, risks to this practice may exist as multiple studies have demonstrated an association between a positive fluid balance and/or administration of large fluid volume and increase in mortality. Read More


    Non-occlusive Mesenteric Ischemia in Patients with Methamphetamine Use.
    J Trauma Acute Care Surg 2018 Feb 17. Epub 2018 Feb 17.
    University of California Davis Health Department of Surgery.
    Background: Data suggest that methamphetamine may increase the risk of non-occlusive mesenteric ischemia (NOMI). We describe patterns of presentation and outcomes of patients with methamphetamine use who present with NOMI to a single institution.

    Methods: This is an observational study of patients from January 2015 to September 2017 with methamphetamine use who presented with NOMI at an academic medical center in Northern California. Read More

    Toll Like Receptor 4 Signaling Licenses the Cytosolic Transport of Lipopolysaccharide from Bacterial Outer Membrane Vesicles.
    Shock 2018 Feb 16. Epub 2018 Feb 16.
    Department of Hematology and Key Laboratory of non-resolving inflammation and cancer of Human Province, The 3rd Xiangya Hospital, Central South University, Changsha, Hunan Province, 410000 P.R. China.
    Outer membrane vesicles (OMVs), released by variety of bacteria, are membrane-enclosed entities enriched in microbial components, toxins and virulent factors. OMVs could deliver lipopolysaccharide (LPS) into the cytosol of host cells and subsequently activate caspase-11, which critically orchestrates immune responses and mediates septic shock. Though it is known that caspase-11 is activated by intracellular LPS, how OMVs deliver LPS into the cytosol remains largely unknown. Read More

    Septic Shock Alters Mitochondrial Respiration of Lymphoid Cell-Lines and Human Peripheral Blood Mononuclear Cells: The Role of Plasma.
    Shock 2018 Feb 14. Epub 2018 Feb 14.
    Service d'Accueil des Urgences, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France.
    Introduction: In septic shock patients, post-septic immunosuppression state following the systemic inflammatory response syndrome is responsible for nosocomial infections, with subsequent increased mortality. The aim of the present study was to assess the underlying cellular mechanisms of the post-septic immunosuppression state, by investigating mitochondrial functions of peripheral blood mononuclear cells (PBMCs) from septic shock patients over 7 days.

    Materials And Methods: Eighteen patients admitted to a French intensive care unit for septic shock were included. Read More

    Evidence Underpinning the U.S. Government-Mandated Hemodynamic Interventions for Sepsis: A Systematic Review.
    Ann Intern Med 2018 Feb 20. Epub 2018 Feb 20.
    National Institutes of Health, Bethesda, Maryland (D.J.P., D.J., J.S., J.W., C.N., P.Q.E.).
    Background: The Severe Sepsis and Septic Shock Early Management Bundle (SEP-1), the sepsis performance measure introduced by the Centers for Medicare & Medicaid Services (CMS), requires up to 5 hemodynamic interventions, as many as 141 tasks, and 3 hours to document for a single patient.

    Purpose: To evaluate whether moderate- or high-level evidence shows that use of SEP-1 or its hemodynamic interventions improves survival in adults with sepsis.

    Data Sources: PubMed, Embase, Scopus, Web of Science, and ClinicalTrials. Read More

    Septic Shock Shapes B Cell Response toward an Exhausted-like/Immunoregulatory Profile in Patients.
    J Immunol 2018 Feb 19. Epub 2018 Feb 19.
    Hospices Civils de Lyon, Immunology Laboratory, Edouard Herriot Hospital, 69437 Lyon, France;
    Septic shock is accompanied by the development of immune dysfunctions whose intensity and duration are associated with increased risk of secondary infections and mortality. Although B lymphocytes play a pivotal role in the immune response to infections, no comprehensive exploration of circulating B cell status has been performed during the immunosuppressive phase of septic shock. Thus, our aim was to extensively characterize the phenotype and function of B cells in septic shock, including IL-10 production. Read More

    Infective Endocarditis Associated with Streptococcal Toxic Shock Syndrome due tosubsp.Infection in a Hemodialysis Patient.
    Case Rep Nephrol Dial 2017 Sep-Dec;7(3):154-160. Epub 2017 Nov 29.
    Division of Cardiology, Osaka Saiseikai Izuo Hospital, Osaka, Japan.
    The risk of infective endocarditis in chronic hemodialysis patients is markedly higher than that in the general population. We report the first case of a hemodialysis patient with infective endocarditis caused bysubsp.(SDSE) who presented with streptococcal toxic shock syndrome. Read More

    Evaluation of the Benefits of De-Escalation for Patients with Sepsis in the Emergency Intensive Care Unit.
    J Pharm Pharm Sci 2018 ;21(1):54-59
    Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
    Purpose: Although the 2016 Japanese guidelines for the management of sepsis recommend de-escalation of treatment after identification of the causative pathogen, adherence to this practice remain unknown. The objective of this study was to evaluate the benefits of de-escalating treatment for sepsis patients at an advanced critical care and emergency medical centre.

    Methods: Based on electronic patient information, 85 patients who were transported to the centre by ambulance, and diagnosed with sepsis between January 2008 and September 2013 were enrolled and evaluated. Read More

    Septicemia from Lactobacillus rhamnosus GG, from a Probiotic Enriched Yogurt, in a Patient with Autologous Stem Cell Transplantation.
    Probiotics Antimicrob Proteins 2018 Feb 17. Epub 2018 Feb 17.
    Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan.
    Probiotic-rich foods are consumed without much restriction. We report here, a case of septic shock caused by yogurt derived Lactobacillus species in a 54-year-old male patient with acute promyelocytic leukemia, in second complete remission, and who was an autologous stem cell transplantation recipient. He received high dose chemotherapy and autologous peripheral blood stem cell transplantation. Read More

    Respiratory quotient estimations as additional prognostic tools in early septic shock.
    J Clin Monit Comput 2018 Feb 17. Epub 2018 Feb 17.
    Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Tauli, 1, 08208, Sabadell, Spain.
    Central venous-to-arterial carbon dioxide difference (PCO), and its correction by the arterial-to-venous oxygen content difference (PCO/CO) have been proposed as additional tools to evaluate tissue hypoxia. Since the relationship between pressure and content of CO(CCO) might be affected by several factors, some authors advocate for the use of CCO/CO. The aim of the present study was to explore the factors that might intervene in the difference between PCO/COand CCO/CO, and to analyze their association with mortality. Read More

    Effects of Bilateral Nasal Packing on Oxygen Saturation and Blood Pressure.
    JNMA J Nepal Med Assoc 2017 Oct-Dec;56(208):442-446
    Department of ENT-HN Surgery, Kathmandu Medical College, Kathmandu, Nepal.
    Introduction: Nasal packing is one of the most common rhinological procedures in ENT practice exerting local in nose and systemic effects. Systemic effects may be due to poor sleep quality, respiratory difficulty, decreased oxygen saturation, circulatory problems and toxic shock syndrome which can threaten the life of a person.The study was done to investigate the effect on bilateral nasal packing on blood oxygen saturation and blood pressure changes. Read More

    Immune barriers of Ebola virus infection.
    Curr Opin Virol 2018 Feb 13;28:152-160. Epub 2018 Feb 13.
    Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, 20359 Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg, Germany. Electronic address:
    Since its initial emergence in 1976 in northern Democratic Republic of Congo (DRC), Ebola virus (EBOV) has been a global health concern due to its virulence in humans, the mystery surrounding the identity of its host reservoir and the unpredictable nature of Ebola virus disease (EVD) outbreaks. Early after the first clinical descriptions of a disease resembling a 'septic-shock-like syndrome', with coagulation abnormalities and multi-system organ failure, researchers began to evaluate the role of the host immune response in EVD pathophysiology. In this review, we summarize how data gathered during the last 40 years in the laboratory as well as in the field have provided insight into EBOV immunity. Read More

    Norepinephrine exerts an inotropic effect during the early phase of human septic shock.
    Br J Anaesth 2018 Mar 21;120(3):517-524. Epub 2017 Nov 21.
    Service de réanimation médicale, Hôpital Bicêtre, Hôpitaux universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
    Background: We conducted this study to investigate whether norepinephrine increases cardiac contractility when administered during the early phase of septic shock.

    Methods: We studied 38 patients with septic shock who had been resuscitated for <3 h and whose mean arterial pressure (MAP) remained <65 mm Hg. Echocardiographic variables were obtained before (T) and after either initiation or an increase in the dose of a norepinephrine infusion to increase MAP to ≥ 65 mm Hg (T). Read More

    Reducing patient mortality, length of stay and readmissions through machine learning-based sepsis prediction in the emergency department, intensive care unit and hospital floor units.
    BMJ Open Qual 2017 25;6(2):e000158. Epub 2017 Oct 25.
    Dascena, Hayward, California, USA.
    Introduction: Sepsis management is a challenge for hospitals nationwide, as severe sepsis carries high mortality rates and costs the US healthcare system billions of dollars each year. It has been shown that early intervention for patients with severe sepsis and septic shock is associated with higher rates of survival. The Cape Regional Medical Center (CRMC) aimed to improve sepsis-related patient outcomes through a revised sepsis management approach. Read More

    Inducible nitric oxide synthase during the late phase of sepsis is associated with hypothermia and immune cell migration.
    Lab Invest 2018 Feb 14. Epub 2018 Feb 14.
    Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Aichi, 466-8560, Japan.
    Hypothermia is a significant sign of sepsis, which is associated with poor prognosis, but few mechanisms underlying the regulation of hypothermia are known. Inducible nitric oxide synthase (iNOS) is a key inflammatory mediator of sepsis. However, the therapeutic benefit of iNOS inhibition in sepsis is still controversial, and requires elucidation in an accurate model system. Read More

    A Rare Colonization in the Peritonitis Following Blunt Abdominal Trauma.
    Balkan Med J 2018 Feb 15. Epub 2018 Feb 15.
    Background: Schewanella spp. is Gram-negative bacteria, saprophytes and rarely pathogenic. Initially isolated in 193, these belong to the marine environment; Schewanella (Pseudomonas) putrefaciens was found in water, soil and animal sources and produces hydrogen sulphide. Read More

    Innate immune responses following Kawasaki disease and toxic shock syndrome.
    PLoS One 2018 15;13(2):e0191830. Epub 2018 Feb 15.
    Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Vic, Australia.
    The pathogenesis of Kawasaki disease (KD) remains unknown and there is accumulating evidence for the importance of the innate immune system in initiating and mediating the host inflammatory response. We compared innate immune responses in KD and toxic shock syndrome (TSS) participants more than two years after their acute illness with control participants to investigate differences in their immune phenotype. Toxic shock syndrome shares many clinical features with KD; by including both disease groups we endeavoured to explore changes in innate immune responses following acute inflammatory illnesses more broadly. Read More

    Sepsis 2018: Definitions and Guideline Changes.
    Surg Infect (Larchmt) 2018 Feb/Mar;19(2):117-125
    Acute Care Surgery, Trauma and Surgical Critical Care, University of Michigan Health System , Ann Arbor, Michigan.
    Background: Sepsis is a global healthcare issue and continues to be the leading cause of death from infection. Early recognition and diagnosis of sepsis is required to prevent the transition into septic shock, which is associated with a mortality rate of 40% or more.

    Discussion: New definitions for sepsis and septic shock (Third International Consensus Definitions for Sepsis and Septic Shock [Sepsis-3]) have been developed. Read More

    Microbiology and clinical outcomes of puerperal sepsis: a prospective cohort study.
    J Obstet Gynaecol 2018 Feb 15:1-7. Epub 2018 Feb 15.
    a Department of Obstetrics and Gynaecology , University of Zimbabwe College of Health Sciences , Harare , Zimbabwe.
    The objectives of this study were to determine the identity and antibacterial susceptibility profiles of bacteria colonising the female genital tract and blood stream and their association with clinical outcomes in women with puerperal sepsis. A prospective descriptive cohort study was conducted at two tertiary hospitals in Zimbabwe. Endocervical swabs and blood were collected for culture and susceptibility testing from 151 consecutive women who met the World Health Organisation criteria for puerperal sepsis. Read More

    Sodium lactate improves renal microvascular thrombosis compared to sodium bicarbonate and 0.9% NaCl in a porcine model of endotoxic shock: an experimental randomized open label controlled study.
    Ann Intensive Care 2018 Feb 14;8(1):24. Epub 2018 Feb 14.
    Centre de Réanimation - Rue Emile Laine, CHU de Lille - Hôpital R Salengro, 59037, Lille Cedex, France.
    Background: Sodium lactate seemed to improve fluid balance and avoid fluid overload. The objective of this study was to determine if these beneficial effects can be at least partly explained by an improvement in disseminated intravascular coagulation (DIC)-associated renal microvascular thrombosis.

    Methods: Ancillary work of an interventional randomized open label controlled experimental study. Read More

    The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016).
    Acute Med Surg 2018 Jan 5;5(1):3-89. Epub 2018 Feb 5.
    Department of Emergency and Critical Care MedicineChiba University Graduate School of MedicineChibaJapan.
    Background And Purpose: The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English-language version of these guidelines was created based on the contents of the original Japanese-language version.

    Methods: Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. Read More

    Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae.
    Clin Microbiol Rev 2018 Apr 14;31(2). Epub 2018 Feb 14.
    Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena/Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
    Therapy of invasive infections due to multidrug-resistant(MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer β-lactam-β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. Read More

    Fluid resuscitation during early sepsis: a need for individualization.
    Minerva Anestesiol 2018 02 14. Epub 2018 Feb 14.
    Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, APHP, Service De Réanimation Médicale, Le Kremlin-Bicêtre, France -
    The prognosis of septic shock is tightly linked to the earliness of both appropriate antibiotic therapy and early hemodynamic resuscitation. This latter is essentially based on fluid and vasopressors administration. The step-by-step strategy, called "early goal-directed therapy" (EGDT) developed in 2001 and endorsed by the Surviving Sepsis Campaign (SSC) between 2004 and 2016 is no longer recommended. Read More

    Survey of Staphylococcus aureus in a general pediatric population and focus on isolates with three clinically relevant toxin-encoding genes.
    World J Pediatr 2018 Feb 13. Epub 2018 Feb 13.
    Montpellier University, UMR 5569 HydroSciences Montpellier, Pharmacy University of Montpellier, Montpellier, France.
    Background: In children, surveys on Staphylococcus aureus have focused on specific infections, situations or strains but no study has so far given an overview on S. aureus isolation without any selection. Here, we describe the overall bacteriological and clinical characteristics of S. Read More

    Elevated central venous pressure is associated with increased mortality in pediatric septic shock patients.
    BMC Pediatr 2018 02 13;18(1):58. Epub 2018 Feb 13.
    Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
    Background: Central venous pressure (CVP) is an important factor affecting capillary blood flow, and it is associated with poor outcomes in adult septic shock patients. However, whether a similar association exists in pediatric patients remains unclear.

    Methods: We retrospectively analyzed data from patients admitted to our pediatric intensive care unit (PICU) between February 2009 and July 2015. Read More

    Septic shock following surgical decompression of obstructing ureteral stones: a prospective analysis.
    J Endourol 2018 Feb 14. Epub 2018 Feb 14.
    Hospital das Clínicas, University of Sao Paulo Medical School, Division of Urology, São Paulo, São Paulo, Brazil ;
    Purpose: To investigate risk factors for septic shock and death in patients with obstructive pyelonephritis due to ureteral stone, who underwent urinary tract decompression.

    Patients And Methods: We prospectively enrolled patients who presented at the emergency department of our institution with clinical signs of pyelonephritis, systemic inflammatory reaction syndrome (SIRS) and obstructive ureteral stone confirmed by computed tomography scan. Forty patients that underwent urinary tract decompression were included. Read More

    Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings.
    Trans R Soc Trop Med Hyg 2017 Nov;111(11):483-489
    Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand.
    Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking.

    Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind.

    Results: We suggest using capillary refill time, skin mottling scores and skin temperature gradients; suggest a passive leg raise test to guide fluid resuscitation; recommend crystalloid solutions as the initial fluid of choice; recommend initial fluid resuscitation with 30 ml/kg in the first 3 h, but with extreme caution in settings where there is a lack of mechanical ventilation; recommend against an early start of vasopressors; suggest starting a vasopressor in patients with persistent hypotension after initial fluid resuscitation with at least 30 ml/kg, but earlier when there is lack of vasopressors and mechanical ventilation; recommend using norepinephrine (noradrenaline) as a first-line vasopressor; suggest starting an inotrope with persistence of plasma lactate >2 mmol/L or persistence of skin mottling or prolonged capillary refill time when plasma lactate cannot be measured, and only after initial fluid resuscitation; suggest the use of dobutamine as a first-line inotrope; recommend administering vasopressors through a central venous line and suggest administering vasopressors and inotropes via a central venous line using a syringe or infusion pump when available. Read More

    Presumed Systemic Inflammatory Response Syndrome in the Pediatric Emergency Department.
    Pediatr Emerg Care 2018 Feb 12. Epub 2018 Feb 12.
    Objective: The aim of this study was to examine the incidence and outcomes of patients presenting with systemic inflammatory response syndrome (SIRS) in the pediatric emergency department (PED).

    Methods: This was a descriptive, retrospective cohort study of all patients from birth to 18 years presenting to the PED of a single center on 16 days distributed over 1 year. The presence of presumed SIRS (pSIRS, defined as noncore temperature measurement and cell count when clinically indicated) and sepsis was determined for all study patients. Read More

    Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock.
    BMJ Case Rep 2018 Feb 7;2018. Epub 2018 Feb 7.
    Orthopedics, Division of Podiatry, Mount Sinai Queens Hospital, Astoria, New York, USA.
    We report a case of a 75-year-old Hispanic man treated for septic shock after undergoing surgery for impacted renal stones. He was given vasopressors and later developed symmetrical peripheral gangrene (SPG) on both his feet and left hand. SPG is a serious and rare condition presenting clinically as an acute onset of ischaemia with no vessel occlusion. Read More

    Sepsis - thoughtful management for the non-expert.
    Clin Med (Lond) 2018 Feb;18(1):62-68
    Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK.
    Sepsis is a common and often devastating medical emergency with a high mortality rate and, in many survivors, long-term morbidity. It is defined as the dysregulated host response to infection resulting in organ dysfunction, and its incidence is increasing as the population ages. However, it is a treatable and potentially reversible condition, especially if identified and treated promptly. Read More

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