Database : MEDLINE Search on : Sepsis [Words] References found : 81377 [refine] Displaying: 1 .. 10   in format [Detailed]

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[PMID]: 23503667 [Au] Autor: Kierdorf HP [Ad] Address: Klinik für Nieren- und Hochdruckkrankheiten, Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland, h.kierdorf@klinikum-braunschweig.de. [Ti] Title: Der Dialysepatient auf der Intensivstation. [Dialysis patients in intensive care units]. [So] Source: Med Klin Intensivmed Notfmed;108(4):290-4, 2013 May. [Is] ISSN: 2193-6226 [Cp] Country of publication: Germany [La] Language: ger [Ab] Abstract: The number of dialysis patients needing intensive medical care is steadily increasing, mostly due to cardiovascular diseases. Of the patients 50 % are admitted due to myocardial infarction, malignant arrhythmia or acute cardiac failure and many also due to hyperkalemia and acute volume overload against the background of anuria or oligouria associated with arterial hypertension and hypervolemic hypertensive pulmonary edema. The treatment of an acute cardiac syndrome is comparable to the treatment of patients with healthy kidneys and despite the significantly higher cardiovascular mortality of these patients the acute prognosis is not significantly different to non-dialysis patients. In association with hypervolemic hypertensive pulmonary edema and all forms of hyperkalemia, dialysis treatment is always necessary. In the case of complications due to infections, in particular septicemia, dialysis patients seem to profit from the general therapy guidelines for septic patients, such as early goal-directed therapy. Underdosing of antibiotics for dialysis patients with sepsis represents a substantial problem in the clinical practice and can additionally endanger these patients. [Pt] Publication type: ENGLISH ABSTRACT; JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review [do] DOI: 10.1007/s00063-012-0194-y

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[PMID]: 23443518 [Au] Autor: Staudinger T; Schellongowski P [Ad] Address: Universitätsklinik für Innere Medizin I, Intensivstation 13.i2, Medizinische Universität Wien, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich, thomas.staudinger@meduniwien.ac.at. [Ti] Title: Der chronisch kritisch kranke Patient aus der Perspektive des Hämatoonkologen. [Chronic critically ill patients from the perspective of hematologists/oncologists]. [So] Source: Med Klin Intensivmed Notfmed;108(4):295-302, 2013 May. [Is] ISSN: 2193-6226 [Cp] Country of publication: Germany [La] Language: ger [Ab] Abstract: Many factors contribute to making critically ill patients with underlying hematological or oncological diseases into a special collective on intensive care units, such as an often incurable or at least doubtfully curable underlying disease, therapy associated complications and a commonly present immunosuppression. The prognosis of these patients has clearly improved in recent years so that a general reluctance in deciding to treat these patients in intensive care units can no longer be justified. Comprehensive infection diagnostics and a guideline oriented causal and supportive treatment can improve the prognosis of sepsis even in hematology/oncology patients. In the therapy of respiratory failure non-invasive ventilation is of great importance for a reduction in mortality if used early and contraindications, such as termination criteria are considered. Considerations on long-term prognosis, quality of life and palliative care are increasingly becoming topics in intensive care medicine. [Pt] Publication type: ENGLISH ABSTRACT; JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review [do] DOI: 10.1007/s00063-012-0196-9

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[PMID]: 22961004 [Au] Autor: Weimann A; Kern BR; Löffler M; Sablotzki A; Thiele F; Brunkhorst FM [Ad] Address: Klinik für Allgemein- und Visceralchirurgie, Klinikum St. Georg gGmbH, Delitzscher Str. 141, 04129, Leipzig, Deutschland, arved.weimann@sanktgeorg.de. [Ti] Title: Der Einschluss von Intensivpatienten in klinische Studien : Ethische, rechtliche und organisatorische Probleme aus interdisziplinärer Sicht. [Enrolment of intensive care patients in clinical studies : Ethical, legal and organizational problems from an interdisciplinary point of view]. [So] Source: Med Klin Intensivmed Notfmed;108(4):303-10, 2013 May. [Is] ISSN: 2193-6226 [Cp] Country of publication: Germany [La] Language: ger [Ab] Abstract: Nowadays, most patients in hospital die in the intensive care unit from sepsis and multiple organ failure. Clinical research in this critically ill and vulnerable patient population bears a lot of ethical and legal problems; however, it remains a must in order to develop evidence-based diagnostic and therapeutic strategies for life-threatening diseases with special respect to limited health care resources. With regard to the Declaration of Helsinki, good clinical practice guidelines (GCP) from the European Medicines Agency (EMA) and the German medical drug law (AMG) this article discusses ethical and legal aspects of patient inclusion for clinical trials as well as incentives for appropriate patient recruitment from an interdisciplinary point of view. [Pt] Publication type: ENGLISH ABSTRACT; JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review [do] DOI: 10.1007/s00063-012-0153-7

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[PMID]: 23558714 [Au] Autor: Lindenmann J; Matzi V; Neuboeck N; Anegg U; Maier A; Smolle J; Smolle-Juettner FM [Ad] Address: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria, jo.lindenmann@medunigraz.at. [Ti] Title: Management of esophageal perforation in 120 consecutive patients: clinical impact of a structured treatment algorithm. [So] Source: J Gastrointest Surg;17(6):1036-43, 2013 Jun. [Is] ISSN: 1873-4626 [Cp] Country of publication: United States [La] Language: eng [Ab] Abstract: INTRODUCTION: The therapy of esophageal perforation is still challenging. The aim of this study was to assess the etiology, specific treatment, and outcome of esophageal disruption in order to generate an optimal therapeutic approach to improve patient's outcome. METHODS: We reviewed the cases of 120 consecutive patients with esophageal perforation treated within 10 years. RESULTS: Iatrogenic perforation was the most frequent cause of esophageal perforation (58.3 %); Boerhaave's syndrome was detected in 15 cases (6.8 %). Surgery was performed in 66 patients (55 %), 17 (14 %) patients received conservative treatment and 37 (31 %) patients underwent endoscopic stenting after tumorous perforation. Statistically significant impact on mean survival had Boerhaave's syndrome (p = 0.005), initial sepsis (p = 0.002), pleural effusion/empyema (p = 0.001), mediastinitis (p = 0.003), peritonitis (p = 0.001), and redo-surgery (p = 0.000). Overall mortality rate was 11.7 %, in the esophagectomy group 17 % and in the patients with Boerhaave's syndrome 33.3 %. CONCLUSIONS: An approach considering etiology and extent of perforation, diagnostic delay, and septic status is required to improve patient's outcome. Primary repair is feasible in patients without intrinsic esophageal disease and evidence of sepsis. The greater the diagnostic delay, the more the destruction of the esophageal wall especially in the case of septic esophageal disease, thus the stronger the argument for esophagectomy if anatomically and/or oncologically possible. [Pt] Publication type: JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review [do] DOI: 10.1007/s11605-012-2070-8

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[PMID]: 23591028 [Au] Autor: Song J; Kang IS; Huh J; Lee OJ; Kim G; Jun TG; Yang JH [Ad] Address: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea. kis4298@gmail.com. [Ti] Title: Interstage mortality for functional single ventricle with heterotaxy syndrome: a retrospective study of the clinical experience of a single tertiary center. [So] Source: J Cardiothorac Surg;8:93, 2013. [Is] ISSN: 1749-8090 [Cp] Country of publication: England [La] Language: eng [Ab] Abstract: BACKGROUND: In spite of improved survival after palliation for single ventricle, interstage mortality for a single ventricle with heterotaxy syndrome is unknown. The purpose of this study was to quantify interstage mortality and influence mortality risk factors. METHODS: From November 1994 until February 2012, all patients that had a functional single ventricle and heterotaxy syndrome who underwent palliative operations at our center were included. Patients with hypoplastic left heart syndrome and operative mortality cases were excluded. The factors that influenced interstage mortality were determined by multivariate Cox analysis. RESULTS: There were 16 patients with interstage mortality (41.0%), much higher than the non-heterotaxy group (vs. 11.3%, P = 0.001, OR = 5.478). The major presumptive causes of death were infection or sepsis (37.5%) and unknown sudden death (31.3%). When we compared the survival group and the mortality group with heterotaxy syndrome, Blalock-Taussig shunt as a 1st palliation is most common for both groups but there were more for the mortality group (81.2% vs. 52.2%), and there were more with bidirectional cavo-pulmonary shunt as a 1st palliation in the survival group (10 patients vs. 2 patients). The existence of pulmonary vein stenosis at initial diagnosis was more common for the mortality group. In multivariate Cox analysis, however, the duration of hospitalization at palliation, the duration of intensive care unit stay after palliation and the existence of pulmonary vein stenosis at diagnosis were significant risk factors. CONCLUSION: Interstage mortality for a functional single ventricle with heterotaxy syndrome is significantly higher than for non-heterotaxy syndrome. Therefore more attention should be given to the prevention of interstage mortality in these patients with risk factors. [Pt] Publication type: JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review [do] DOI: 10.1186/1749-8090-8-93

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[PMID]: 23559078 [Au] Autor: Myburgh J; McIntyre L [Ad] Address: Critical Care Medicine, The George Institute for Global Health, St George Clinical School, University of New South Wales, Sydney, Australia, j.myburgh@unsw.edu.au. [Ti] Title: New insights into fluid resuscitation. [So] Source: Intensive Care Med;39(6):998-1001, 2013 Jun. [Is] ISSN: 1432-1238 [Cp] Country of publication: United States [La] Language: eng [Ab] Abstract: Recent high-quality randomised-controlled trials comparing the effects of hydroxyethyl starch (HES) preparations and crystalloids for fluid resuscitation in critically ill patients have demonstrated an increased risk of death and use of renal replacement therapy (RRT). Consequently, a number of systematic reviews incorporating these new results have been published that have consistently demonstrated an increased risk of death and use of RRT associated with HES solutions, regardless of type of HES and dose administered, both in general intensive care patients and in those with severe sepsis. These effects become apparent in the post-resuscitation period and may relate to increased tissue accumulation associated with HES. These results question the clinical role of semi-synthetic colloids for fluid resuscitation and mandate a reappraisal about how these fluids are administered to critically ill patients, specifically considering the potential for toxicity. [Pt] Publication type: JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review [do] DOI: 10.1007/s00134-013-2890-3

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[PMID]: 23559077 [Au] Autor: van Beest PA; Lont MC; Holman ND; Loef B; Kuiper MA; Boerma EC [Ad] Address: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 30001, 9700 RB, Groningen, The Netherlands, p.van.beest@umcg.nl. [Ti] Title: Central venous-arterial pCO2 difference as a tool in resuscitation of septic patients. [So] Source: Intensive Care Med;39(6):1034-9, 2013 Jun. [Is] ISSN: 1432-1238 [Cp] Country of publication: United States [La] Language: eng [Ab] Abstract: PURPOSE: To investigate the interchangeability of mixed and central venous-arterial carbon dioxide differences and the relation between the central difference (pCO2 gap) and cardiac index (CI). We also investigated the value of the pCO2 gap in outcome prediction. METHODS: We performed a post hoc analysis of a well-defined population of 53 patients with severe sepsis or septic shock. Mixed and central venous pCO2 were determined earlier at a 6 h interval (T = 0 to T = 4) during the first 24 h after intensive care unit (ICU) admittance. The population was divided into two groups based on pCO2 gap (cut off value 0.8 kPa). RESULTS: The mixed pCO2 difference underestimated the central pCO2 difference by a mean bias of 0.03± 0.32 kPa (95 % limits of agreement: -0.62-0.58 kPa). We observed a weak relation between pCO2 gap and CI. The in hospital mortality rate was 21 % (6/29) for the low gap group and 29 % (7/24) for the high gap group; the odds ratio was 1.6 (95 % CI 0.5-5.5), p = 0.53. At T = 4 the odds ratio was 5.3 (95 % CI 0.9-30.7); p = 0.08. CONCLUSIONS: From a practical perspective, the clinical utility of central venous pCO2 values is of potential interest in determining the venous-arterial pCO2 difference. The likelihood of a bad outcome seems to be enhanced when a high pCO2 gap persists after 24 h of therapy. [Pt] Publication type: JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review [do] DOI: 10.1007/s00134-013-2888-x

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[PMID]: 23622880 [Au] Autor: Al-Banna NA; Pavlovic D; Bac VH; Utpatel K; Janke E; Rippke JN; Borowiak M; Cerny V; Spassov A; Johnston B; Issekutz TB; Lehmann CH [Ad] Address: Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada. [Ti] Title: Acute administration of antibiotics modulates intestinal capillary perfusion and leukocyte adherence during experimental sepsis. [So] Source: Int J Antimicrob Agents;41(6):536-43, 2013 Jun. [Is] ISSN: 1872-7913 [Cp] Country of publication: Netherlands [La] Language: eng [Ab] Abstract: Antibiotic treatment represents a mainstay of therapy for clinical sepsis. Distinct from their antimicrobial effects, antibiotics may impact the inflammatory process in sepsis, e.g. within the intestinal microcirculation. The impact of seven antibiotics relevant to clinical sepsis on intestinal leukocyte recruitment and capillary perfusion was studied in rats with colon ascendens stent peritonitis (CASP)-induced sepsis or after endotoxin [lipopolysaccharide (LPS)] challenge. The following antibiotics were included: daptomycin; erythromycin; imipenem; linezolid; tigecycline; tobramycin; and vancomycin. The number of rolling and adherent leukocytes in intestinal submucosal venules and the functional capillary density (FCD) in three layers of the intestinal wall were assessed using intravital microscopy. CASP-induced sepsis reduces the intestinal FCD by 30-50%. Single administration of daptomycin, tigecycline or linezolid increased the intestinal FCD. CASP sepsis increased the number of rolling leukocytes by 4.5-fold, which was reduced by erythromycin but increased by vancomycin. The number of adherent leukocytes increased 3-fold in rats with CASP sepsis. It was reduced following administration of daptomycin, tigecycline (in V1 and V3 venules), erythromycin and linezolid (in V1 venules). However, following tobramycin and vancomycin, leukocyte adhesion was further enhanced. Administration of tigecycline and linezolid reduced the LPS-induced increase in the number of adherent leukocytes by 50%. However, imipenem did not affect leukocyte adherence. In conclusion, this work highlights the beneficial impact of the antibiotics daptomycin, tigecycline, erythromycin and linezolid in that they improve intestinal capillary perfusion and/or reduce leukocyte recruitment, whilst the antibiotics imipenem, tobramycin and vancomycin do not exert these properties. [Pt] Publication type: JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review

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[PMID]: 23577835 [Au] Autor: Usmani GN; Woda BA; Newburger PE [Ad] Address: Division of Pediatric Hematology and Oncology, University of Massachusetts Medical Center, Worcester, MA, USA. [Ti] Title: Advances in understanding the pathogenesis of HLH. [So] Source: Br J Haematol;161(5):609-22, 2013 Jun. [Is] ISSN: 1365-2141 [Cp] Country of publication: England [La] Language: eng [Ab] Abstract: Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory disorder resulting from immune dysfunction reflecting either primary immune deficiency or acquired failure of normal immune homeostasis. Familial HLH includes autosomal recessive and X-linked disorders characterized by uncontrolled activation of T cells and macrophages and overproduction of inflammatory cytokines, secondary to defects in genes encoding proteins involved in granule-dependent cytolytic pathways. In older children and adults, HLH is associated more often with infections, malignancies, autoimmune diseases, and acquired immune deficiencies. HLH, macrophage activation syndrome, sepsis, and systemic inflammatory response syndrome are different clinical entities that probably represent a common immunopathological state, termed cytokine storm. These conditions may be clinically indistinguishable; all include massive inflammatory response, elevated serum cytokine levels, multi-organ involvement, haemophagocytic macrophages, and often death. Tissues of haematopoietic and lymphoid function are directly involved; other organs are secondarily damaged by circulating cytokines and chemokines. Haemophagocytic disorders are now increasingly diagnosed in the context of severe inflammatory reactions to viruses, malignancies and systemic connective tissue diseases. Many of these cases may reflect underlying genetic predispositions to HLH. The detection of gene defects has contributed considerably to our understanding of HLH, but the mechanisms leading to acquired HLH have yet to be fully determined. [Pt] Publication type: JOURNAL ARTICLE [Em] Entry month: 1305 [Js] Journal subset: IM [St] Status: In-Data-Review [do] DOI: 10.1111/bjh.12293

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[PMID]: 23671439 [Au] Autor: Hermann J; Szmeja J; Koscinski T; Meissner W; Drews M [Ad] Address: Department of General, Gastrointestinal and Endocrinological Surgery, Poznan University of Medical Sciences, Poland. [Ti] Title: Primary ileo-anal pouch anastomosis in patients with acute ulcerative colitis. [So] Source: Arch Med Sci;9(2):283-7, 2013 Apr 20. [Is] ISSN: 1734-1922 [Cp] Country of publication: Poland [La] Language: eng [Ab] Abstract: INTRODUCTION: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) was performed in ulcerative colitis (UC) for emergent or urgent indications in three stages. Since the three-step procedure imposes enormous demands on a patient, there was an attempt to introduce primary IPAA for urgent indications. The aim of this study was to compare early complications after Hartmann's colectomy (HC) and IPAA in a selected group of patients. MATERIAL AND METHODS: Medical records of 274 patients who underwent surgery for UC between 1996 and 2010 were retrospectively evaluated. Finally, a group of 77 patients with acute form of UC entered this study. RESULTS: All patients were divided into two groups. Group 1 consisted of 32 (42%) patients who underwent HC, whereas group 2 comprised 45 (58%) patients after IPAA. There was no postoperative mortality. Respiratory failure occurred in 8 (24%) patients after HC and in 6 (14%) patients who underwent IPAA. Intra-abdominal sepsis developed in 4 (12%) patients after HC and in 8 (17%) undergoing IPAA. Fascia dehiscence was present in 3 (8%) patients after HC and in 4 (9%) with IPAA. Bowel obstruction occurred in 1 (4%) patient after the former operation and in 3 (6%) patients after the latter one. Wound infection was diagnosed in 6 (20%) patients after HC and in 9 (20%) after IPAA. The differences between the investigated groups of patients were not statistically significant. CONCLUSIONS: The IPAA could be performed for urgent indications only in the patients with no critical dilatation of the colon or with active UC but without signs of severe malnutrition. [Pt] Publication type: JOURNAL ARTICLE [Em] Entry month: 1305 [St] Status: In-Data-Review [do] DOI: 10.5114/aoms.2013.33175

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