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    Metabolomic findings in sepsis as a damage of host-microbial metabolism integration.
    J Crit Care 2017 Sep 15;43:246-255. Epub 2017 Sep 15.
    Negovsky Research Institute of General Reanimatology, Moscow, Russia; Lomonosov Moscow State University, Moscow, Russia.
    Metabolomics globally evaluates the totality of the endogenous metabolites in patient's body, at the same time reflecting gene function, enzyme activity and degree of organ dysfunction in sepsis. The authors performed the analysis of the main chemical classes of low molecular weight compounds (amino acids, polyols, fatty acids, hydroxy acids, amines, nucleotides and their derivatives) that quantitatively distinguish patients with sepsis from healthy ones. The following keywords were used to find papers published in the Scopus and Web of Science databases from 2008 to 2015: (marker OR biomarker) AND (sepsis OR critical ill OR pneumonia OR hypoxia). Read More

    Association of HLA-G 3'UTR polymorphisms and haplotypes with severe sepsis in a Brazilian population.
    Hum Immunol 2017 Sep 20. Epub 2017 Sep 20.
    Department of Genetics, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil. Electronic address:
    Background: The human leukocyte antigen G (HLA-G) is a molecule involved in immune system modulation, acting in the maintenance of a state of immune tolerance. Some polymorphisms in the HLA-G gene 3' untranslated region (3'UTR) were associated to distinct levels of HLA-G expression and to sepsis development. In the present study, haplotypes and polymorphisms of the HLA-G 3'UTR were analyzed in Brazilian septic patients. Read More

    Adjunctive Steroid Therapy for Treatment of Pediatric Septic Shock.
    Pediatr Clin North Am 2017 Oct 18;64(5):1133-1146. Epub 2017 Aug 18.
    Pediatric Critical Care Medicine, Seattle Children's Hospital, Harborview Medical Center, University of Washington School of Medicine, 4800 Sand Point Way Northeast, Room FA.2.300-B, Seattle, WA 98105, USA. Electronic address:
    Septic shock remains the major cause of childhood morbidity and mortality worldwide. Although early sepsis recognition, fluid resuscitation, timely administration of antimicrobials, and vasoactive-inotropic drug infusions are all key to achieving good sepsis outcomes, therapy using various steroid drug classes remains an attractive adjunctive intervention to minimize the duration of septic shock and transition to multiple organ dysfunction syndrome. All steroid drug classes possess biological plausibility to affect a beneficial clinical effect among children with septic shock, but none has undergone rigorous, prospective assessment in a large, high-quality pediatric interventional trial. Read More

    Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017.
    Intensive Care Med 2017 Sep 21. Epub 2017 Sep 21.
    Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University and Hospitals, Louvain, 3000, Belgium.
    Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients.

    Participants: A multispecialty task force of 16 international experts in Critical Care Medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine.

    Design/methods: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Read More

    Clinical Presentation, Management, and Prognostic Factors of Idiopathic Systemic Capillary Leak Syndrome: A Systematic Review.
    J Allergy Clin Immunol Pract 2017 Sep 19. Epub 2017 Sep 19.
    Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea; Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, Korea; Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea. Electronic address:
    Background: The idiopathic systemic capillary leak syndrome is a rare disease characterized by unexplained recurrent shock caused by capillary hyperpermeability. Because of the rarity of the disease, this disease has easily been misdiagnosed and evidence of efficacious agents used empirically is lacking.

    Objective: To analyze the clinical and laboratory data, treatment modalities, and mortality rate of patients and to find contributing factors leading to mortality. Read More

    Clozapine-induced acute gastrointestinal necrosis: a case report.
    J Med Case Rep 2017 Sep 23;11(1):270. Epub 2017 Sep 23.
    Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
    Background: Clozapine is known to cause fecal impaction and ileus with resultant colonic necrosis due to compression of colonic mucosa. There are rare reports of clozapine causing necrosis of other portions of the gastrointestinal tract unrelated to constipation. We describe a case of acute necrosis of the upper gastrointestinal tract and small bowel to due to clozapine and quetiapine. Read More

    Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017.
    Crit Care Med 2017 Sep 21. Epub 2017 Sep 21.
    1General ICU Department, Raymond Poincaré Hospital (APHP), Health Science. 2Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada. 4Institute of Metabolism and Systems Research (IMSR), University of Birmingham and Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK. 5Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA. 6Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, The Netherlands. 7Anesthesiology and Critical Care Medicine, Klinik für Anästhesiologie, Klinikum der Universität, Munich, Germany. 8Department of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 9Department of Endocrinology, Diabetology and Metabolism, Clinical Research, University Hospital Basel, Basel, Switzerland. 10Department of Endocrinology, Concord Hospital, University of Sidney, Sidney, NSW, Australia. 11Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA. 12Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Memphis Veterans Affairs Medical Center, Memphis, TN, USA. 13College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 14Clinical Adjunct Faculty, University of New Mexico and Sandoval Regional Medical Center, Albuquerque, NM, USA. 15Division of Critical Care Medicine, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. 16Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University and Hospitals, Louvain, Belgium. Dr. Djillali Annane and Dr. Stephen M. Pastores were co-chairs of the task force and contributed equally to this work.
    Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients.

    Participants: A multispecialty task force of 16 international experts in critical care medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine.

    Design/methods: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Read More

    Time Course of Septic Shock in Immunocompromised and Nonimmunocompromised Patients.
    Crit Care Med 2017 Sep 20. Epub 2017 Sep 20.
    1Service de réanimation médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France. 2Université Paris Descartes, Paris, France. 3Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.
    Objectives: To address the impact of underlying immune conditions on the course of septic shock with respect to both mortality and the development of acute infectious and noninfectious complications.

    Design: An 8-year (2008-2015) monocenter retrospective study.

    Setting: A medical ICU in a tertiary care center. Read More

    Vitamin C: The next step in sepsis management?
    J Crit Care 2017 Sep 18;43:230-234. Epub 2017 Sep 18.
    Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, United States; Georgetown University School of Medicine, Washington, DC, United States.
    Sepsis is a life-threatening medical condition, affecting approximately 26 million people worldwide every year. The disease is a continuum, marked by dysregulated inflammation and hemodynamic instability leading to shock, multi-system organ dysfunction, and death. Over the past decades, there has been a focus on the early identification and treatment of sepsis primarily with bundled and goal directed therapy. Read More

    [Development of views on pathophysiology of sepsis].
    Vnitr Lek 2017 ;63(7-8):481-487
    Sepsis was understood as a disease caused by an invasive bacterial infection associated with deluging of organism with bacterial toxins (blood poisoning). Schottmüllers definition emphasized the existence of a focus as the source of invading bacteria. Further research led to the discovery of the cytokine cascade and to the recognition that sepsis is induced by our own endogenous mediators. Read More

    Extracorporeal membrane oxygenation support for refractory septic shock in liver transplantation recipients.
    Ann Surg Treat Res 2017 Sep 30;93(3):152-158. Epub 2017 Aug 30.
    Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    Purpose: This study was designed to assess the outcome of the extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) recipients with refractory septic shock and predict the prognosis of those cases.

    Methods: From February 2005 to October 2012, ECMO was used in 8 cases of refractory septic shock. Laboratory values including lactate and total bilirubin level just before starting ECMO were obtained and sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACH) II score and simplified acute physiology score (SAPS) 3 were calculated. Read More

    Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature.
    J Med Case Rep 2017 Sep 21;11(1):268. Epub 2017 Sep 21.
    Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
    Background: Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. Read More

    Changes in Radial Artery Pulse Pressure During a Fluid Challenge Cannot Assess Fluid Responsiveness in Patients With Septic Shock.
    J Intensive Care Med 2017 Jan 1:885066617732291. Epub 2017 Jan 1.
    1 Department of Critical Care Medicine, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Mexico City, Mexico.
    Background: Arterial blood pressure is the most common variable used to assess the response to a fluid challenge in routine clinical practice. The aim of this study was to evaluate the accuracy of the change in the radial artery pulse pressure (rPP) to detect the change in cardiac output after a fluid challenge in patients with septic shock.

    Methods: Prospective observational study including 35 patients with septic shock in which rPP and cardiac output were measured before and after a fluid challenge with 400 mL of crystalloid solution. Read More

    Predictive Value of Matrix Metalloproteinases and Their Inhibitors for Mortality in Septic Patients: A Cohort Study.
    J Intensive Care Med 2017 Jan 1:885066617732284. Epub 2017 Jan 1.
    2 Medicine Program, Faculty of Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia.
    Purpose: Over 170 biomarkers are being investigated regarding their prognostic and diagnostic accuracy in sepsis in order to find new tools to reduce morbidity and mortality. Matrix metalloproteinases (MMPs) and their inhibitors have been recently studied as promising new prognostic biomarkers in patients with sepsis. This study is aimed at determining the utility of several cutoff points of these biomarkers to predict mortality in patients with sepsis. Read More

    Peripheral Muscle Near-Infrared Spectroscopy (NIRS) Variables are Altered Early in Septic Shock.
    Shock 2017 Sep 19. Epub 2017 Sep 19.
    Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
    Background: Non-invasive evaluation of muscle perfusion using near infrared spectroscopy (NIRS) coupled with a vascular occlusion test (VOT) may provide an early and simple marker of altered perfusion and microcirculatory function in sepsis.

    Objective: To compare the time-course of NIRS-derived variables with systemic measures of perfusion in an experimental model of peritonitis.

    Methods: Peritonitis was induced in eight anesthetized, mechanically ventilated, adult sheep (24-34 Kg), by injecting autologous feces into the peritoneal cavity. Read More

    Procalcitonin: A Powerful Rescuer on Surgical Floors.
    Cureus 2017 Jul 8;9(7):e1446. Epub 2017 Jul 8.
    Fmh College of Medicine, FMH College of Medicine.
    Necrotizing fasciitis (NF) is a rare but life-threatening medical and surgical emergency. It is characterized by necrosis of the soft tissue leaving the overlying tissue unaffected, which delays the diagnosis and treatment. Delay in recognition of the severity of necrotizing fasciitis might lead to serious morbidity and mortality. Read More

    Treatment of femoral shaft fractures with monoaxial external fixation in polytrauma patients.
    F1000Res 2017 7;6:1333. Epub 2017 Aug 7.
    Department of Orthopaedics Surgery, Division of Muscular-Skeletal Traumatology, AOU Città della Salute, CTO Hospital, Turin, Italy.
    Background: Femoral shaft fractures, typical in younger people, are often associated with polytrauma followed by traumatic shock. In these situations, despite intramedullary nailing being the treatment of choice, external fixation could be used as the definitive treatment. The aim of this study is to report evidence regarding definitive treatment of femoral shaft fractures with monoaxial external fixation. Read More

    Impact of weekend admission on mortality and other outcomes among patients with burn injury: A nationwide analysis.
    Burns 2017 Sep 16. Epub 2017 Sep 16.
    Department of Plastic and Reconstructive Surgery, Johns Hopkins University Medical Center, Burn Unit, Bayview Campus, 4940 Eastern Ave, Baltimore, MD 21224, United States. Electronic address:
    Objective: To study the relationship between day of admission and important outcomes among patients with burn injuries.

    Methods: The 2014 National Inpatient Sample database was used. Inclusion criterion was a principal diagnosis of burn injury. Read More

    Endotoxin adsorption: Direct hemoperfusion with the polymyxin B-immobilized fiber column (PMX).
    Transfus Apher Sci 2017 Aug 31. Epub 2017 Aug 31.
    Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan.
    Toraymyxin(®) is a medical device developed to adsorb circulating endotoxins in the blood using direct hemoperfusion therapy for patients with septic shock. In 1994, the Japanese National Health Insurance system approved the use of Toraymyxin for the treatment of endotoxemia and septic shock. Since then, Toraymyxin has been safely used in more than 100,000 cases in emergency and intensive care units in Japan. Read More

    Risk factors for mortality in patients with low lactate level and septic shock.
    J Microbiol Immunol Infect 2017 Aug 26. Epub 2017 Aug 26.
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
    Background: According to the new definition of septic shock, vasopressor therapy and hyperlactatemia are essential for diagnosis. However, there is controversy regarding the cutoff value for lactate, and prognostic factors in patients with septic shock and hypolactatemia. This study evaluated the prognostic significance of the cutoff value for lactate level in septic shock patients. Read More

    Preliminary clinical evaluation of automated analysis of the sublingual microcirculation in the assessment of patients with septic shock: Comparison of automated versus semi-automated software.
    Clin Hemorheol Microcirc 2017 Sep 11. Epub 2017 Sep 11.
    Department of Anaesthesia, Pain Management and Perioperative Medicine's, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
    Introduction: The outcome of patients in septic shock has been shown to be related to changes within the microcirculation. Modern imaging technologies are available to generate high resolution video recordings of the microcirculation in humans. However, evaluation of the microcirculation is not yet implemented in the routine clinical monitoring of critically ill patients. Read More

    Clinical outcomes and nephrotoxicity of colistin loading dose for treatment of extensively drug-resistant Acinetobacter baumannii in cancer patients.
    Infect Drug Resist 2017 7;10:293-298. Epub 2017 Sep 7.
    Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
    Background: Colistin is a last-line defense therapy against extensively drug-resistant Acinetobacter baumannii (XDR-AB). Despite a loading dose of colistin being applied in many clinical practices, studies evaluating the effect of the loading dose of colistin in cancer patients remain limited.

    Patients And Methods: A retrospective cohort study of cancer patients who received either a loading or non-loading dose of colistin for treatment of XDR-AB was conducted. Read More

    Clinical manifestations, risk factors and prognosis of patients with Morganella morganii sepsis.
    J Microbiol Immunol Infect 2017 Sep 6. Epub 2017 Sep 6.
    Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew-University-Hadassah Medical School, Faculty of Medicine, Jerusalem, Israel. Electronic address:
    Background: There are few studies of Morganella bacteremia. We evaluated risk factors and outcome of patients with Morganella bacteremia.

    Methods: Medical records of patients with Morganella bacteremia were reviewed (1997-2014). Read More

    Mortality of severe septic patients between physician's high and low care volumes.
    Biomed J 2017 Aug 27;40(4):226-231. Epub 2017 Jul 27.
    Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address:
    Background: Patients with severe sepsis frequently require intensive care unit (ICU) admission and different ICU care models may influence their outcomes. The mortality of severe septic patients between physician's high and low care volume remains unclear.

    Methods: We analyzed the data from a three-year prospective observation study, which was performed in an adult medical ICU of Chung Gung Memorial Hospital, Keelung. Read More

    Group A Streptococcal bacteraemia. Experience at King Fahad Medical City in Riyadh, Saudi Arabia.
    Saudi Med J 2017 Oct;38(10):1034-1037
    Pediatric Infectious Diseases Section, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
    Objectives: To identify clinical presentation, predisposing factors, and the outcome in patients with Group A Streptococcal bacteremia. Methods: This is a retrospective study of 33 pediatric and adult patients with Streptococcus pyogenes bacteremia, admitted at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia from 2007 to 2015. Results: Thirty-three patient records, documenting bacteremia with group A beta-hemolytic streptococcus, were reviewed. Read More

    Myeloperoxidase can differentiate between sepsis and non-infectious SIRS and predicts mortality in intensive care patients with SIRS.
    Intensive Care Med Exp 2017 Sep 15;5(1):43. Epub 2017 Sep 15.
    Department of Intensive Care Medicine, University Medical Centre, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
    Background: Systemic inflammatory response syndrome (SIRS) is a clinical syndrome following inflammation. Clinically, it is difficult to distinguish SIRS following an infection, i.e. Read More

    Controversies in Corticosteroid use for Sepsis.
    J Emerg Med 2017 Sep 12. Epub 2017 Sep 12.
    Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
    Background: Severe sepsis and septic shock are potentially deadly conditions managed in the emergency department (ED). Management centers on source control, fluid resuscitation, broad-spectrum antimicrobials, and vasopressors as needed. The use of corticosteroids is controversial. Read More

    Does Early and Appropriate Antibiotic Administration Improve Mortality in Emergency Department Patients with Severe Sepsis or Septic Shock?
    J Emerg Med 2017 Sep 12. Epub 2017 Sep 12.
    Department of Emergency Medicine, University of California, San Diego, San Diego, California; Division of Pulmonary, Critical Care, and Sleep Medicine, University of California-San Diego, San Diego, California.
    Background: Severe sepsis and septic shock remain significant public health concerns. Appropriate emergency department management includes early recognition, hemodynamic resuscitation, source control, and prompt antibiotic administration. Current international guidelines strongly recommend administration of early and appropriate antibiotics for patients with severe sepsis and septic shock. Read More

    Synergistic antibiotic effect of looped antimicrobial peptide CLP-19 with bactericidal and bacteriostatic agents.
    Oncotarget 2017 Aug 23;8(34):55958-55966. Epub 2017 May 23.
    Department of Pharmacy, Southwest Hospital, Third Military Medical University, Chongqing, China.
    The treatment of drug-resistant infections is complicated and the alarming rise in infectious diseases poses a unique challenge for development of effective therapeutic strategies. Antibiotic-induced liberation of the bacterial endotoxin lipopolysaccharide (LPS) may have immediate adverse effects promoting septic shock in patients. In the present study, we first confirmed our previous finding that looped antimicrobial peptide CLP-19 exerts non-specific direct antibacterial activity with no toxic to mammalian cells and second revealed that CLP-19 has synergistic effect to enhance the antibacterial activities of other conventional bactericidal (ampicillin and ceftazidime) and bacteriostatic (erythromycin and levofloxacin) agents. Read More

    Effects of polymyxin B hemoperfusion on hemodynamics and prognosis in septic shock patients.
    J Crit Care 2017 Apr 25;43:202-206. Epub 2017 Apr 25.
    Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, Taiwan, ROC. Electronic address:
    Purpose: We designed this study to examine the clinical effects of polymyxin B hemoperfusion (PMX-HP) in septic shock patients.

    Material And Methods: We retrospectively examined the effects of PMX-HP in septic shock patients with intra-abdominal or gram-negative bacterial infection during October 2013-May 2016. A one-to-one matching between the PMX-HP and conventional groups was performed, and 28-day mortality, and change in inotropic score, Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score at 24h in the two groups were compared. Read More

    Mutilating Purpura Fulminans in an Adult with Meningococcal Sepsis.
    P R Health Sci J 2017 Sep;36(3):179-182
    Department of Radiology, Aspetar-Orthopaedic and Sports Medicine Hospital, Al Buwairda St. Doha, Qatar.
    We report a dramatic case of meningococcal sepsis manifesting as purpura fulminans in an elderly diabetic woman. Hemodynamic instability and severe bilateral cutaneous lesions involving her hands and feet developed rapidly. Specific antibiotic therapy and the administration of inotropic and vasopressor drugs were initiated. Read More

    Hyperoxia in Septic Shock: Crafty Therapeutic Weapon or Double-Edged Sword?
    Crit Care Med 2017 Oct;45(10):1796-1798
    Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, Angers, France Service de Réanimation Polyvalente Adulte, Centre Hospitalier Intercommunal, Créteil, France Institut für Klinische und Experimentelle Trauma-Immunologie, Universitätsklinikum, Ulm, Germany Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Ulm, Germany.

    CE: Assessing Patients During Septic Shock Resuscitation.
    Am J Nurs 2017 Sep 13. Epub 2017 Sep 13.
    Elizabeth Bridges is a clinical nurse researcher at the University of Washington Medical Center, Seattle, and a professor in the University of Washington School of Nursing. Contact author: The author and planners have disclosed no potential conflicts of interest, financial or otherwise.
    How to integrate capillary refill time and skin mottling score into the six-hour bundle.

    Abstract: In 2015, the Surviving Sepsis Campaign six-hour bundle was updated. The revised version now recommends documenting the reassessment of volume status and tissue perfusion after initial fluid resuscitation through a repeated focused examination. Read More

    National Trends (2007-2013) of Clostridium difficile Infection in Patients with Septic Shock: Impact on Outcome.
    J Hosp Med 2017 Sep;12(9):717-722
    Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
    Background: Clostridium difficile is the most common infectious cause of healthcare-associated diarrhea and is associated with worse outcomes and higher cost. Patients with septic shock (SS) are at increased risk of acquiring C. difficile infections (CDIs) during hospitalization, but little data are available on CDI complicating SS. Read More

    Class A CpG Oligonucleotide Priming Rescues Mice from Septic Shock via Activation of Platelet-Activating Factor Acetylhydrolase.
    Front Immunol 2017 30;8:1049. Epub 2017 Aug 30.
    Department of Interdisciplinary Genome Sciences and Cell Metabolism, Institute for Biomedical Sciences, Shinshu University, Nagano, Japan.
    Sepsis is a life-threatening, overwhelming immune response to infection with high morbidity and mortality. Inflammatory response and blood clotting are caused by sepsis, which induces serious organ damage and death from shock. As a mechanism of pathogenesis, platelet-activating factor (PAF) induces excessive inflammatory responses and blood clotting. Read More

    A double blind randomized experimental study on the use of IgM-enriched polyclonal immunoglobulins in an animal model of pneumonia developing shock.
    Immunobiology 2017 Sep 8. Epub 2017 Sep 8.
    SC Anestesia e Rianimazione, Ospedale Sant'Andrea (ASL VC), Vercelli, Italy; Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy; CRRF Mons. L. Novarese, Moncrivello, VC, Italy.
    Background: Patients with severe pneumonia often develop septic shock. IgM-enriched immunoglobulins have been proposed as a potential adjuvant therapy for septic shock. While in vitro data are available on the possible mechanisms of action of IgM-enriched immunoglobulins, the results of the in vivo experimental studies are non-univocal and, overall, unconvincing. Read More

    TPF plus cetuximab induction chemotherapy followed by biochemoradiation with weekly cetuximab plus weekly cisplatin or carboplatin: a randomized phase II EORTC trial.
    Ann Oncol 2017 Sep;28(9):2219-2224
    Department of Oncology, Antwerp University Hospital, Edegem and Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
    Background: Our aim was to test the safety of cetuximab added to chemoradiation with either cisplatin or carboplatin after prior induction chemotherapy.

    Methods: Patients with stage III/IV unresectable, squamous cell carcinoma of the head and neck received up to four cycles of TPF-E (cisplatin and docetaxel 75 mg/m2 on day 1 followed by 5-FU 750 mg/m2/day as a continuous infusion on days 1-5 plus cetuximab at a loading dose of 400 mg/m2 followed by a weekly dose of 250 mg/m2), with prophylactic antibiotics but no growth factors. Patients not progressing after four cycles of TPF-E were randomly assigned to radiotherapy (70 Gy over 7 weeks in 2 Gy fractions) and weekly cetuximab with either weekly cisplatin 40 mg/m2 or carboplatin, AUC of 1. Read More

    Racial Disparities in Sepsis-Related In-Hospital Mortality: Using a Broad Case Capture Method and Multivariate Controls for Clinical and Hospital Variables, 2004-2013.
    Crit Care Med 2017 Sep 12. Epub 2017 Sep 12.
    1Truven Health Analytics, an IBM Company, Bethesda, MD. 2Agency for Healthcare Research and Quality, Rockville, MD. 3M.L. Barrett, Del Mar, CA. 4National Center for Health Statistics, Hyattsville, MD.
    Objectives: As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. Read More

    Effect of Transfusion on Mortality and Other Adverse Events Among Critically Ill Septic Patients: An Observational Study Using a Marginal Structural Cox Model.
    Crit Care Med 2017 Sep 12. Epub 2017 Sep 12.
    1UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care Inserm/ Univ Paris Diderot, Sorbonne Paris Cité, Paris, France. 2Medical and Infectious Intensive Care Unit, Bichat Claude Bernard University Hospital, AP-HP, Paris, France. 3Medical-Surgical Intensive Care Unit, Saint-Joseph Hospital, Paris, France. 4Medical-Surgical Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France. 5Medical-Surgical Intensive Care Unit, Gonesse Hospital, Gonesse, France. 6Medical Intensive Care Unit, Saint-Louis University Hospital, APHP, Paris, France. 7Intensive care Unit, Edouard Herriot University Hospital, Lyon, France. 8Medical Intensive Care Unit, Clermont-Ferrand University Hospital, Clemont-Ferrand, France. 9Medical Intensive Care Unit, Saint-Etienne University Hospital, Saint-Priest-en-Jarez, France. 10Medical-Surgical Intensive Care Unit, Avicenne University Hospital, APHP, Bobigny, France. 11Medical-Surgical Intensive Care Unit, Grenoble University Hospital, Grenoble Cedex, France. 12Medical-Surgical Intensive Care Unit, André Mignot Hospital, Le Chesnay, France.
    Objectives: RBC transfusion is often required in patients with sepsis. However, adverse events have been associated with RBC transfusion, raising safety concerns. A randomized controlled trial validated the 7 g/dL threshold, but previously transfused patients were excluded. Read More

    How Useful is Extravascular Lung Water Measurement in Managing Lung Injury in Intensive Care Unit?
    Indian J Crit Care Med 2017 Aug;21(8):494-499
    Department of Anaesthesiology and Critical Care, NEIGRIHMS, Shillong, Meghalaya, India.
    Context: The primary goal of septic shock management is optimization of organ perfusion, often at the risk of overloading the interstitium and causing pulmonary edema. The conventionally used end points of resuscitation do not generally include volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).

    Aims: This study aimed to assess the prognostic value of EVLWI and PVPI by calculating their correlation with the severity of lung injury. Read More

    Bacterial distributions and prognosis of bloodstream infections in patients with liver cirrhosis.
    Sci Rep 2017 Sep 13;7(1):11482. Epub 2017 Sep 13.
    Medical School of Chinese PLA, Beijing, China.
    Bloodstream infections (BSIs) are a frequently observed complication in liver cirrhosis patients. This study aimed to investigate the microbiological characteristics and outcomes of BSIs in patients with liver cirrhosis. We retrospectively studied 852 patients with liver cirrhosis who developed a BSI. Read More

    Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014.
    JAMA 2017 Sep 13. Epub 2017 Sep 13.
    Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
    Importance: Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time.

    Objective: To estimate the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. Read More

    Successful venoarterial extracorporeal membrane oxygenation for postoperative septic shock in a child with liver transplantation: A case report.
    Pediatr Transplant 2017 Sep 12. Epub 2017 Sep 12.
    Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
    Refractory septic shock after LT is a life-threatening complication. VA ECMO is used to treat refractory cardiorespiratory failure. We present herein the case of a 5-year-old girl with post-Kasai biliary atresia, who underwent a living donor LT and suffered refractory septic shock. Read More

    Diabetes insipidus after discontinuation of vasopressin infusion for septic shock.
    J Clin Pharm Ther 2017 Sep 11. Epub 2017 Sep 11.
    Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, USA.
    What Is Known And Objective: Despite widespread use of vasopressin for the treatment of septic shock, few cases of diabetes insipidus (DI) following its discontinuation have been reported.

    Case Summary: A 54-year-old man presented with pneumonia progressing to septic shock, requiring norepinephrine and vasopressin for refractory hypotension. After clinical improvement, the patient on 3 separate occasions developed polyuria and severe hypernatremia upon discontinuation of vasopressin, with prompt recovery upon its resumption. Read More

    Palivizumab Prophylaxis Against Respiratory Syncytial Virus Infection in Children with Immunocompromised Conditions or Down Syndrome: A Multicenter, Post-Marketing Surveillance in Japan.
    Paediatr Drugs 2017 Sep 11. Epub 2017 Sep 11.
    AbbVie GK, Mita 3-5-27, Minato-ku, Tokyo, 108-6302, Japan.
    Objective: The aim of this study was to assess the safety and effectiveness of palivizumab for the prevention of lower respiratory tract infection (LRI) caused by respiratory syncytial virus (RSV) in children with immunocompromised conditions or Down syndrome.

    Methods: In this multicenter, post-marketing surveillance study (December 2013 to December 2015), children aged ≤24 months with immunocompromised conditions or Down syndrome (without hemodynamically significant congenital heart disease) receiving palivizumab immunoprophylaxis during two RSV seasons were observed until 30 days after the final palivizumab injection. Safety [adverse events (AEs), serious AEs (SAEs), adverse drug reactions (ADRs), serious ADRs (SADRs)] and effectiveness (frequency, incidence, and duration of hospitalization due to RSV infections) were assessed. Read More

    Type I Interferon Induced by Streptococcus suis Serotype 2 is Strain-Dependent and May Be Beneficial for Host Survival.
    Front Immunol 2017 28;8:1039. Epub 2017 Aug 28.
    Research Group on Infectious Diseases in Production Animals (GREMIP), Swine and Poultry Infectious Diseases Research Center (CRIPA), Faculty of Veterinary Medicine, Department of Pathology and Microbiology, University of Montreal, Saint-Hyacinthe, QC, Canada.
    Streptococcus suis serotype 2 is an important porcine bacterial pathogen and emerging zoonotic agent mainly responsible for sudden death, septic shock, and meningitis, with exacerbated inflammation being a hallmark of the infection. However, serotype 2 strains are genotypically and phenotypically heterogeneous, being composed of a multitude of sequence types (STs) whose virulence greatly varies: the virulent ST1 (Eurasia), highly virulent ST7 (responsible for the human outbreaks in China), and intermediate virulent ST25 (North America) are the most important worldwide. Even though type I interferons (IFNs) are traditionally associated with important antiviral functions, recent studies have demonstrated that they may also play an important role during infections with extracellular bacteria. Read More

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