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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The concept of brain death is widely accepted in most countries. However, there are differences in the criteria for the diagnosis of brain death. In Taiwan, the diagnostic criteria of brain death has just been established. These criteria require strict preconditions to be fulfilled, necessary exclusions to be made, and adequate time of observation to ensure the irremediability of the disease. Tests of brainstem reflexes and apnea are then performed and should be repeated at an interval of at least 4 hours to establish the diagnosis. This prospective study was undertaken in order to examine the reliability of the present criteria. A total of 79 comatose patients (57 males and 22 females) on the ventilator were collected. Their ages ranged from 2.3 to 89 years, with a mean of 46.3 +/- 20.3 years. The preconditions or exclusions were not fulfilled in 5 patients (3 with drug intoxication, 1 with septicemia, and 1 due to an unknown cause). Among them, 1 with alcohol intoxication recovered well. Of 16 patients with hypoxic/ischemic brain damage, brain death was diagnosed in only 2; in the remaining 14 patients, 6 became vegetative and 8 died from cardiac arrest. Fifty-eight patients sustained structural brain damage, and brain death was diagnosed in 50 of these patients. The most frequent cause of brain death was head injury (31 cases), followed by intracerebral hemorrhage (11 cases). Of the 52 patients fulfilling the criteria of brain death, all sustained cardiac asystole in a limited interval of time (96% in 7 days).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prognosis of comatose patients on ventilator: a prospective study of brain death]. 275 21

Central pontine myelinolysis, also known as osmotic demyelination syndrome, is an uncommon disorder associated with rapid correction of severe hyponatremia. We present the case of a healthy young pregnant woman with hyperemesis gravidarum who developed severe hyponatremia (serum sodium 103 mEq/L). After rapid correction of her serum sodium within 12-15 hours with a 0.9% saline solution, the patient became comatose and died of sepsis and respiratory failure. Examination of the brain showed extensive demyelination in both pontine and extrapontine areas.
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PMID:Central pontine myelinolysis and pregnancy. 291 74

Critically ill patients with sepsis and/or organ failure are difficult to assess. They are often comatose or on steroids and many nonspecific findings such as fever, positive blood cultures, or septic shock which may suggest intra-abdominal sepsis are far from diagnostic. To determine whether decision making regarding the use of laparotomy in these patients could be improved upon, we reviewed our experience with consecutive intensive care unit patients who had laparotomy and we related laparotomy outcome to clinical signs and symptoms. Seventy-three per cent of the 100 laparotomies reviewed were positive for intra-abdominal sepsis. A discriminant function analysis revealed that eight factors in combination predicted laparotomy outcome. However, the overall accuracy of the discriminant function prediction (76.8%) offered little improvement over the policy in place for performing laparotomies in this group of patients at the participating hospitals during the time period of our investigation.
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PMID:Predicting the outcome of exploratory laparotomy in ICU patients with sepsis or organ failure. 291 55

During 72 h following severe head injury, 103 patients in acute posttraumatic coma were assessed by clinical examinations (documented by Glasgow Coma Score) and brain stem auditory evoked potentials (BAEP) as well as short-latency somatosensory evoked potentials (SEP) following median-nerve stimulation. Patient outcomes were classified at 6 months or more according to the following categories: good recovery, severely disabled or vegetative, and brain dead. Patients who had died of systemic complications (pneumonia, septicemia, renal failure, etc.) were excluded from the study. The Glasgow Coma Score was reliable in forecasting a favorable outcome; all patients with a Score over 9 points had a good recovery. The Glasgow Coma Score was not reliable in predicting an unfavorable outcome, however; some patients with the lowest possible Glasgow Coma Score (3 points) at the early clinical examination survived with good recovery. The BAEPs were reliable predictors of an unfavorable outcome; the outcome was unfavorable when a missing wave V or more missing waves pointed toward a secondary brainstem lesion. Normal BAEPs were not reliable, however, in predicting a favorable outcome. SEP data served as a prognostic indicator of unfavorable as well as favorable outcomes. In summary, evoked potentials add valuable information to the clinical examination in assessing a patient's outcome after severe head injury.
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PMID:[Early prognosis in severe cranio-cerebral trauma using the Glasgow Coma Score and evoked potentials]. 292 65

Abdominal crises are common in critically ill patients who are admitted to the intensive care unit for problems unrelated to the abdomen. General surgeons may be asked to assess these patients for such reasons as pain, distension, possible sepsis, radiologic or laboratory abnormalities. Since many of the diagnostic signs and symptoms of acute abdomen are blunted or absent in critically ill patients who may be comatose or have been given analgesics or steroids, frequent thorough physical examination and close cooperation with the service admitting the patient are necessary to ensure early diagnosis and aggressive treatment of the abdominal crisis.
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PMID:Mead Johnson Critical Care Symposium for the Practising Surgeon. 4. Abdominal crisis in the intensive care unit. 304 30

The postresuscitation disease is a specific pathophysiologic state of vital organ systems early after ischemic anoxia. This report summarizes reviews of past research and makes suggestions for future research concerning revival of the cerebral cortex after clinical death, CNS stimulation vs. sedation, postischemic coma and pain, near-death experiences, and extracerebral derangements. The stages of resuscitation when the CNS should be stimulated and those when it is preferable to depress the activity of not fully recovered higher centers remain to be clarified. Future research in reanimatology should include the chemical nature of endotoxins in terminal states. Adult respiratory distress syndrome (ARDS, shock lung), a component of the postresuscitation disease, occurs frequently after cardiac arrest or in sepsis and cannot be fully prevented by artificial ventilation. Prevention of ARDS should also be studied.
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PMID:Postresuscitation disease. 304 95

Convenience to the hospital staff is certainly not an acceptable reason for the use of a potentially dangerous drainage tube. An indwelling urinary drainage catheter should be used only in patients who need multiple straight urinary catheterizations, develop urinary obstruction or incontinence, or are comatose and require frequent urinary output measurements. An indwelling catheter may also be needed for drainage or stenting during or following genitourinary surgery. Once it has been determined that urinary catheterization is necessary, a closed urinary drainage system catheter must be carefully and aseptically inserted by experienced hospital personnel after careful preparation. The closed drainage system must be meticulously maintained throughout the patient's hospitalization and catheterization. After the catheter is removed, a urinary culture should be performed to identify any postcatheter infection. If there is infection, the patient must be treated with antibiotics. If symptoms of a urinary tract infection, bacteremia, or sepsis ensue, treatment must be rapidly begun with antibiotics as appropriate on the basis of drug sensitivity testing. These techniques will not eliminate bacteriuria associated with urinary drainage catheters. However, they will reduce the incidence, morbidity, and mortality associated with urinary catheterization.
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PMID:Nosocomial urinary tract infections. 305 56

An infant with the acute neonatal form of pyruvate carboxylase deficiency (cross-reacting material negative) presented with severe intractable lactic acidosis within 4 h after birth. He also had hyperammonemia, hypercitrullinemia, and hyperlysinemia. Plasma glutamine was not elevated. He had a rapidly deteriorating clinical course with severe liver dysfunction, repeated septicemia and seizures; he was comatose and was on a ventilator throughout; death occurred at 8 wk of age. Skin fibroblast study confirmed the enzyme deficiency. Detailed biochemical parameters and histopathology of the brain and liver are presented. The evidence from this infant suggests that disturbances of intracellular oxaloacetate levels as a result of the primary enzyme defect might also contribute to deficiency in ATP generation which may explain the various other biochemical changes and liver pathology.
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PMID:Biochemical and histologic pathology in an infant with cross-reacting material (negative) pyruvate carboxylase deficiency. 308 60

All hospitalized patients except infants (a total of 1,647 patients) who received central venous TPN solutions at UCDMC from 1981 through 1985 were studied to determine the incidence of complications from the use of TPN. A complication was considered to have occurred if the patient experienced obvious morbidity, mortality, or both; an event known to be deleterious, despite a lack of demonstrable morbidity; or premature loss of the central venous catheter. Complications related to catheter placement occurred in 5.7 percent of patients, sepsis in 6.5 percent, mechanical complications in 9 percent, and metabolic complications in 7.7 percent. The incidence of induction of sepsis increased during 1984 to 1985 due to the introduction of multilumen central venous catheters. The most frequent catheter placement complications were hemorrhage and pneumothorax. Major venous thrombosis and nursing mishaps were the most common mechanical complications. Metabolic complications were infrequent and were generally not severe after adjustment of the protocol in late 1981. Four patients (0.2 percent) died from TPN-associated complications: a child on home TPN who underwent a catheter change and in whom hyperosmolar hyperglycemic coma developed, a patient with end-stage chronic obstructive pulmonary disease in whom tension pneumothorax occurred, a patient who died from complications of subclavian artery laceration, and a patient who died from Candida septicemia. Complications of TPN are frequent and may be severe. Quality assurance mechanisms for identification of these complications are necessary and should form the basis for the establishment of appropriate protocols.
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PMID:Complications of parenteral nutrition. 308 44

608 patients admitted to a general Intensive Care Unit (ICU) over a 30 month period were analyzed according to the Apache II Severity of Disease Classification System on day one of admission. Hospital outcome details were available on 583 patients in the series. The mean Apache II scores for survivors (396) and non-survivors (187) were 13 (SD 7) and 24 (SD 9), and their Risk of Death were 16 (SD 16) and 47 (SD 27) respectively (p less than 0.001 for both). The majority of deaths (75%: 141/187) in our series came from those with chronic ill health (55%: 103/187), of whom 37% (38/103) were in endstage disease, and those with "old" trauma (18%: 34/187) often with incipient sepsis transferred from other hospitals after a mean delay of 9 days. Our higher than predicted mortality (mortality ratio 1.2) in comparison with centres in the United States of America (US) may be partly explained by the high proportion of our population from these unfavourable groups, by our use of the best Glasgow Coma Scale in the first 24 h following admission, and the major differences between our patient population and that of the US upon which the Apache II was based. The presence of these large unfavourable groups indicates a change in our admission policy is warranted.
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PMID:Audit of intensive care: a 30 month experience using the Apache II severity of disease classification system. 322 Oct 10


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