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Pesquisa : C01.539.757.800 [Categoria DeCS]
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  1 / 19995 MEDLINE  
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[PMID]:29447181
[Au] Autor:Chen KYH; Messina N; Germano S; Bonnici R; Freyne B; Cheung M; Goldsmith G; Kollmann TR; Levin M; Burgner D; Curtis N
[Ad] Endereço:Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Vic, Australia.
[Ti] Título:Innate immune responses following Kawasaki disease and toxic shock syndrome.
[So] Source:PLoS One;13(2):e0191830, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo: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. We measured the in vitro production of interferon (IFN)-γ, tumour necrosis factor (TNF)-α, interleukin (IL)-1ß, IL-6, IL-1 receptor antagonist (IL-1ra), and IL-10 following whole blood stimulation with toll-like receptor and inflammasome ligands in 52 KD, 20 TSS, and 53 control participants in a case-control study. Analyses were adjusted for age, sex, and unstimulated cytokine concentrations. Compared to controls, KD participants have reduced IL-1ra production in response to stimulation with double stranded RNA (geometric mean ratio (GMR) 0.37, 95% CI 0.15, 0.89, p = 0.03) and increased IL-6 production in response to incubation with Lyovec™ (GMR 5.48, 95% CI 1.77, 16.98, p = 0.004). Compared to controls, TSS participants have increased IFN-γ production in response to peptidoglycan (GMR 4.07, 95% CI 1.82, 9.11, p = 0.001), increased IL-1ß production to lipopolysaccharide (GMR 1.64, 95% CI 1.13, 2.38, p = 0.01) and peptidoglycan (GMR 1.61, 95% CI 1.11, 2.33, p = 0.01), and increased IL-6 production to peptidoglycan (GMR 1.45, 95% CI 1.10, 1.92, p = 0.01). Years following the acute illness, individuals with previous KD or TSS exhibit a pro-inflammatory innate immune phenotype suggesting a possible underlying immunological susceptibility or innate immune memory.
[Mh] Termos MeSH primário: Imunidade Inata
Síndrome de Linfonodos Mucocutâneos/imunologia
Choque Séptico/imunologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Casos e Controles
Criança
Feminino
Seres Humanos
Inflamassomos/metabolismo
Masculino
Receptores Toll-Like/metabolismo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Inflammasomes); 0 (Toll-Like Receptors)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191830


  2 / 19995 MEDLINE  
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[PMID]:29397598
[Au] Autor:Yu C; Liu DW; Wang XT; He HW; Pan P; Xing ZQ
[Ad] Endereço:Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
[Ti] Título:[The clinical significance of microcirculation and oxygen metabolism evaluation in acute kidney injury assessment in patients with septic shock after resuscitation].
[So] Source:Zhonghua Nei Ke Za Zhi;57(2):123-128, 2018 Feb 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To evaluate the value of microcirculation and oxygen metabolism evaluation (MicrOME) in acute kidney injury(AKI) evaluation in patients with septic shock after resuscitation. Consecutive patients with septic shock after resuscitation and mechanical ventilation were enrolled from October 2016 to February 2017 in ICU at Peking Union Medical College Hospital.Patients were divided into 3 groups based on 10 min transcutaneous oxygen challenge test transcutaneous partial pressure of oxygen(PtcO(2))and venoarterial pressure of carbon dioxide difference (Pv-aCO(2)) /arteriovenous O(2) content difference (Ca-vO(2)) by blood gas analysis, i.e. group A [ΔPtcO(2)>66 mmHg(1 mmHg=0.133 kPa) and Pv-aCO(2)/Ca-vO(2)≤1.23], group B (ΔPtcO(2)≤66 mmHg), group C (ΔPtcO(2)>66 mmHg and Pv-aCO(2)/Ca-vO(2)>1.23). Heart rate,mean arterial pressure,central venous pressure,noradrenaline dose,lactate,Pv-aCO(2),Ca-vO(2), lactate clearance, central venous oxygen saturation(ScvO(2)) and liquid equilibrium were assessed after resuscitation.AKI staging based on Kidney Disease Global Improving Outcomes (KDIGO) clinical practice guideline was analyzed. The predictive value of lactate, ScvO(2), Pv-aCO(2)/Ca-vO(2) to progression of AKI after resuscitation was determined using receiver operating characteristic(ROC)curve analysis. A total of 49 septic shock patients were enrolled including 30 males and 19 females with mean age of (61.10±17.10)years old.There were 19 patients in group A,21 patients in group B, and 9 patients in group C. Acute physiology and chronic health evaluation â…¡ score was 20.92±7.19 and sequential organ failure assessment score 12.02±3.28. There were 4 patients with AKI and 1 progressed in group A, 11 patients with AKI and 2 progressed in group B, 6 patients with AKI and 4 progressed in group C. The cutoff value of Pv-aCO(2)/Ca-vO(2) was equal or more than 2.20 for predicting progression of AKI, resulting in a sensitivity of 85.7% and a specificity of 73.8%. MicrOME is a significant parameter to predict the progression of AKI in patients with septic shock after resuscitation. Pv-aCO(2)/Ca-vO(2) is also a good predictive factor.
[Mh] Termos MeSH primário: Lesão Renal Aguda/complicações
Pressão Venosa Central
Microcirculação
Oxigênio/metabolismo
Choque Séptico/complicações
[Mh] Termos MeSH secundário: Lesão Renal Aguda/sangue
Adulto
Idoso
Dióxido de Carbono
Feminino
Frequência Cardíaca
Seres Humanos
Ácido Láctico
Masculino
Meia-Idade
Norepinefrina
Troca Gasosa Pulmonar
Curva ROC
Respiração Artificial
Ressuscitação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
142M471B3J (Carbon Dioxide); 33X04XA5AT (Lactic Acid); S88TT14065 (Oxygen); X4W3ENH1CV (Norepinephrine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180206
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2018.02.008


  3 / 19995 MEDLINE  
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[PMID]:28460438
[Au] Autor:Chen X; Zhu W; Tan J; Nie H; Liu L; Yan D; Zhou X; Sun X
[Ad] Endereço:Chinese Cochrane Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuang, China.
[Ti] Título:Early outcome of early-goal directed therapy for patients with sepsis or septic shock: a systematic review and meta-analysis of randomized controlled trials.
[So] Source:Oncotarget;8(16):27510-27519, 2017 Apr 18.
[Is] ISSN:1949-2553
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Various trials and meta-analyses have reported conflicting results concerning the application of early goal-directed therapy (EGDT) for sepsis and septic shock. The aim of this study was to update the evidence by performing a systematic review and meta-analysis. Multiple databases were searched from initial through August, 2016 for randomized controlled trials (RCTs) which investigated the associations between the use of EGDT and mortality in patients with sepsis or septic shock. Meta-analysis was performed using random-effects model and heterogeneity was examined through subgroup analyses. The primary outcome of interest was patient all-cause mortality including hospital or ICU mortality. Seventeen RCTs including 6207 participants with 3234 in the EGDT group and 2973 in the control group were eligible for this study. Meta-analysis showed that EGDT did not significantly reduce hospital or intensive care unit (ICU) mortality (relative risk [RR] 0.89, 95% CI 0.78 to 1.02) compared with control group for patients with sepsis or septic shock. The findings of subgroup analyses stratified by study region, number of research center, year of enrollment, clinical setting, sample size, timing of EGDT almost remained constant with that of the primary analysis. Our findings provide evidence that EGDT offers neutral survival effects for patients with sepsis or septic shock. Further meta-analyses based on larger well-designed RCTs or individual patient data meta-analysis are required to explore the survival benefits of EDGT in patients with sepsis or septic shock.
[Mh] Termos MeSH primário: Sepse/terapia
Choque Séptico/terapia
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Terapia Combinada
Gerenciamento Clínico
Mortalidade Hospitalar
Seres Humanos
Unidades de Terapia Intensiva
Razão de Chances
Viés de Publicação
Ensaios Clínicos Controlados Aleatórios como Assunto
Sepse/diagnóstico
Sepse/mortalidade
Choque Séptico/diagnóstico
Choque Séptico/mortalidade
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.18632/oncotarget.15550


  4 / 19995 MEDLINE  
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[PMID]:29390356
[Au] Autor:Medam S; Zieleskiewicz L; Duclos G; Baumstarck K; Loundou A; Alingrin J; Hammad E; Vigne C; Antonini F; Leone M
[Ad] Endereço:Aix Marseille Université, Service d'anesthésie et de réanimation, Hôpital Nord, AP-HM.
[Ti] Título:Risk factors for death in septic shock: A retrospective cohort study comparing trauma and non-trauma patients.
[So] Source:Medicine (Baltimore);96(50):e9241, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to compare septic shock directly associated-mortality between severe trauma patients and nontrauma patients to assess the role of comorbidities and age. We conducted a retrospective study in an intensive care unit (ICU) (15 beds) of a university hospital (928 beds). From January 2009 to May 2015, we reviewed 2 anonymized databases including severe trauma patients and nontrauma patients. We selected the patients with a septic shock episode. Among 385 patients (318 nontrauma patients and 67 severe trauma patients), the ICU death rate was 43%. Septic shock was directly responsible for death among 35% of our cohort, representing 123 (39%) nontrauma patients and 10 (15%) trauma patients (P < 0.0). A sequential organ failure assessment score above 12 (odds ratio [OR]: 6.8; 95% confident interval (CI) [1.3-37], P = 0.025) was independently associated with septic shock associated-mortality, whereas severe trauma was a protective factor (OR: 0.26; 95% CI [0.08-0.78], P = 0.01). From these independent risk factors, we determined the probability of septic shock associated-mortality. The receiver-operating characteristics curve has an area under the curve at 0.76 with sensitivity of 55% and specificity of 86%. Trauma appears as a protective factor, whereas the severity of organ failure has a major role in the mortality of septic shock. However, because of the study's design, unmeasured confounding factors should be taken into account in our findings.
[Mh] Termos MeSH primário: Choque Séptico/etiologia
Choque Séptico/mortalidade
Ferimentos e Lesões/complicações
[Mh] Termos MeSH secundário: Adulto
Feminino
França
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Ferimentos e Lesões/mortalidade
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009241


  5 / 19995 MEDLINE  
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[PMID]:28749818
[Au] Autor:Lehingue S; Rambaud R; Guervilly C; Adda M; Forel JM; Cassir N; Zandotti C; Hraiech S; Papazian L
[Ad] Endereço:Réanimation des Détresses Respiratoires et Infections Sévères, Aix-Marseille University, APHM, Hôpital Nord, Marseille, France.
[Ti] Título:Fatal Septic Shock Triggered by Donor Transmitted Varicella Zoster Virus Reinfection 3 Days After Lung Transplantation.
[So] Source:Transplantation;101(12):e351-e352, 2017 12.
[Is] ISSN:1534-6080
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Herpesvirus Humano 3/patogenicidade
Transplante de Pulmão/efeitos adversos
Pulmão/virologia
Insuficiência de Múltiplos Órgãos/virologia
Choque Séptico/virologia
Doadores de Tecidos
Infecção pelo Vírus da Varicela-Zoster/transmissão
Infecção pelo Vírus da Varicela-Zoster/virologia
[Mh] Termos MeSH secundário: Adulto
Evolução Fatal
Feminino
Seres Humanos
Masculino
Meia-Idade
Insuficiência de Múltiplos Órgãos/diagnóstico
Choque Séptico/diagnóstico
Infecção pelo Vírus da Varicela-Zoster/diagnóstico
[Pt] Tipo de publicação:CASE REPORTS; LETTER
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1097/TP.0000000000001899


  6 / 19995 MEDLINE  
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[PMID]:29450521
[Au] Autor:Semler MW; Andrews B; Bernard GR
[Ad] Endereço:Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
[Ti] Título:Early Resuscitation for Adults With Sepsis in a Low-income Country-Reply.
[So] Source:JAMA;319(6):614-615, 2018 02 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Ressuscitação
Sepse
[Mh] Termos MeSH secundário: Adulto
Hidratação
Seres Humanos
Pobreza
Choque Séptico
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180217
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.20410


  7 / 19995 MEDLINE  
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[PMID]:29450518
[Au] Autor:Nedel WL; Deutschendorf C
[Ad] Endereço:Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
[Ti] Título:Early Resuscitation for Adults With Sepsis in a Low-Income Country.
[So] Source:JAMA;319(6):614, 2018 02 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Ressuscitação
Sepse
[Mh] Termos MeSH secundário: Adulto
Hidratação
Seres Humanos
Pobreza
Choque Séptico
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180217
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.20406


  8 / 19995 MEDLINE  
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[PMID]:29254296
[Au] Autor:Liu SY; Zhang L; Zhang Y; Zhen Y; Wu YF
[Ad] Endereço:Department of Neurosurgery, Second Hospital, Jilin University, Changchun, China.
[Ti] Título:Bioinformatic analysis of pivotal genes associated with septic shock.
[So] Source:J Biol Regul Homeost Agents;31(4):935-941, 2017 Oct-Dec.
[Is] ISSN:0393-974X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:We aimed to identify important genes associated with septic shock and then explore the possibly significant mechanisms of this disease. We downloaded GSE26440 expression data of samples from 98 children with septic shock and 32 normal controls from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) in samples from patients with septic shock were analyzed in comparison with those in samples from normal controls using a limma package. Functional enrichment analysis for DEGs was performed using DAVID, and a protein–protein interaction (PPI) network was constructed. Upstream transcription factors for DEGs were predicted using the CHIPBase database, and a transcriptional regulation network was constructed. A total of 383 significantly DEGs, including 141 downregulated and 242 upregulated genes, were obtained in the sepsis shock group compared with the normal group. The top five nodes in the PPI network were lysine (K)-specific demethylase 6B (KDM6B), histone deacetylase 2 (HDAC2), V-Myc avian myelocytomatosis viral oncogene homolog (MYC), heat-shock protein 90 kDa alpha (cytosolic), class B member 1 (HSP90AB1), and poly (A)-binding protein, cytoplasmic 1 (PABPC1). Nuclear factor kappa-light-chain-enhancer of activated B cells (NFkB) was the transcription factor targeted by most genes, and it regulated the expression of KDM6B, HDAC2, MYC, HSP90AB1, and PABPC1. In conclusion, KDM6B, HDAC2, MYC, HSP90AB1, and PABPC1 may play important roles in the development of septic shock. Furthermore, NFκB may be involved in septic shock by regulating the expression of KDM6B, HDAC2, MYC, HSP90AB1, and PABPC1.
[Mh] Termos MeSH primário: Biologia Computacional/métodos
Redes Reguladoras de Genes
NF-kappa B/genética
Choque Séptico/genética
Transcriptoma
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Criança
Pré-Escolar
Feminino
Perfilação da Expressão Gênica
Regulação da Expressão Gênica
Proteínas de Choque Térmico HSP90/genética
Proteínas de Choque Térmico HSP90/metabolismo
Histona Desacetilase 2/genética
Histona Desacetilase 2/metabolismo
Seres Humanos
Histona Desmetilases com o Domínio Jumonji/genética
Histona Desmetilases com o Domínio Jumonji/metabolismo
Masculino
NF-kappa B/metabolismo
Proteína I de Ligação a Poli(A)/genética
Proteína I de Ligação a Poli(A)/metabolismo
Mapeamento de Interação de Proteínas
Proteínas Proto-Oncogênicas c-myc/genética
Proteínas Proto-Oncogênicas c-myc/metabolismo
Choque Séptico/metabolismo
Choque Séptico/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (HSP90 Heat-Shock Proteins); 0 (HSP90AB1 protein, human); 0 (MYC protein, human); 0 (NF-kappa B); 0 (Poly(A)-Binding Protein I); 0 (Proto-Oncogene Proteins c-myc); EC 1.14.11.- (Jumonji Domain-Containing Histone Demethylases); EC 1.14.11.- (KDM6B protein, human); EC 3.5.1.98 (HDAC2 protein, human); EC 3.5.1.98 (Histone Deacetylase 2)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


  9 / 19995 MEDLINE  
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[PMID]:29384877
[Au] Autor:Huang ZH; Chiu YC; Ho LL; Fan HL; Lu CC
[Ad] Endereço:Division of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital.
[Ti] Título:Acute appendicitis complicated with necrotizing fasciitis in a patient with adult-onset Still's disease: A case report.
[So] Source:Medicine (Baltimore);97(5):e9794, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Adult-onset Still disease (AOSD) is a rare systemic inflammatory disease of unknown etiology characterized by evanescent salmon-pink rash, spiking fever, arthralgia/ arthritis, and lymphadenopathy. AOSD sometimes was fatal when it is complicated by macrophage activation syndrome (MAS) or hemophagocytic lymphohistiocytosis (HLH). Nonetheless, the literature provides no recommendations for treatment of AOSD patients with severe sepsis. PATIENT CONCERNS: A previously healthy 65-year-old man with history of AOSD was referred to our hospital for persistent right lower quadrant abdominal pain for 2 days. One week later, an abdominal wall abscess and hematoma developed by extravasation from the inferior epigastric vessels, complicated by necrotizing fasciitis of the right thigh and groin region. To our best knowledge, this case was the first reported case of a perforated appendix complicated with necrotizing fasciitis in a patient with AOSD. DIAGNOSES: The patient was diagnosed as acute appendicitis complicated with necrotizing fasciitis and abdominal wall abscess. INTERVENTIONS: This case received intravenous tigecycline injection and daily 10 mg prednisolone initially, and shifted to daily intravenous hydrocortisone 200 mg for suspected MAS or HLH. This patient underwent surgical intervention and debridement for necrotizing fasciitis. OUTCOMES: The patient's symptoms progressed worse rapidly. He died from cytomegalovirus viremia and bacterial necrotizing fasciitis complicated by septic shock. LESSONS: (1) The steroid dose was difficult to titrate when AOSD complicated by sepsis. The differential diagnosis from MAS/HLH with bacterial/viral infection related severe sepsis was difficult but critical for decision making from clinicians and rheumatologists. (2) The conservative treatment with antibiotics for perforated appendix is safe but has a higher failure rate in immunocomprised patients such as systemic lupus erythematosus and AOSD. Early surgical intervention might contribute to better outcome. (3) The abdominal wall abscess can be spread from intra-abdominal lesion through the inferior epigastric vessels which were as weak points of abdominal wall. Imaging examinations contribute to acute diagnosis and help surgeons perform surgical interventions to prevent morbidity and mortality.
[Mh] Termos MeSH primário: Apendicite/etiologia
Fasciite Necrosante/etiologia
Choque Séptico/etiologia
Doença de Still de Início Tardio/complicações
[Mh] Termos MeSH secundário: Idoso
Evolução Fatal
Seres Humanos
Masculino
Doença de Still de Início Tardio/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009794


  10 / 19995 MEDLINE  
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[PMID]:29419665
[Au] Autor:Lago AF; de Oliveira AS; de Souza HCD; da Silva JS; Basile-Filho A; Gastaldi AC
[Ad] Endereço:Department of Physiotherapy, Rehabilitation and Functional Performance Post Graduation Program.
[Ti] Título:The effects of physical therapy with neuromuscular electrical stimulation in patients with septic shock: Study protocol for a randomized cross-over design.
[So] Source:Medicine (Baltimore);97(6):e9736, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Septic shock is a potentially fatal organ dysfunction caused by an imbalance of the host response to infection. The changes in microcirculation during sepsis can be explained by the alterations in the endothelial barrier function. Endothelial progenitor cells (EPCs) are a potential recovery index of endothelial function and it an increase in response to neuromuscular electrical stimulation (NMES) was demonstrated. Therefore, the objective of this study is to investigate the effects of NMES in patients with septic shock. METHODS AND ANALYSIS: It is a study protocol for a randomized cross-over design in an intensive care unit of a tertiary University hospital. Thirty-one patients aged 18 to 65 years. The study will be divided in 2 phases: the phase one will be held in the first 72 hours of septic shock and the phase two after 3 days of first assessment. Patients will be randomly selected to the intervention protocol (decubitus position with the limbs raised and NMES) and control protocol (decubitus position with the limbs raised without NMES). After this procedure, the patients will be allocated in group 1 (intervention and control protocol) or group 2 (control and intervention protocol) with a wash-out period of 4 to 6 hours between them. The main outcome is mobilization of EPCs. The secondary outcome is metabolic and hemodynamic data. A linear mixed model will be used for analysis of dependent variables and estimated values of the mean of the differences of each effect.
[Mh] Termos MeSH primário: Células Progenitoras Endoteliais/fisiologia
Insuficiência de Múltiplos Órgãos/prevenção & controle
Choque Séptico/terapia
Estimulação Elétrica Nervosa Transcutânea/métodos
[Mh] Termos MeSH secundário: Adulto
Cuidados Críticos/métodos
Estudos Cross-Over
Feminino
Seres Humanos
Masculino
Microcirculação/fisiologia
Meia-Idade
Insuficiência de Múltiplos Órgãos/etiologia
Avaliação de Resultados (Cuidados de Saúde)
Projetos de Pesquisa
Choque Séptico/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009736



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