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

During 45 wk from August 1980 to June 1981, the catheter sepsis rate increased from a prior 2 to 34% (23 of 68 patients on intravenous hyperalimentation). The causative organism was Staphylococcus epidermidis, grown on blood cultures in 21 of the 23 patients and on the catheter-tips of all 23. Routine cultures of the catheter-tips of the 45 patients who received intravenous hyperalimentation during this period with no evidence of catheter sepsis grew S. epidermidis on three catheter-tips (6.7%), possibly contamination during catheter removal. Sepsis resolved within 24 hr after catheter removal, with no antibiotics given for the sepsis. The organism had identical antibiograms on the blood and catheter-tip cultures in each patient, but antibiograms varied between patients. In these complex patients undergoing multiple medical events, the intravenous hyperalimentation nurse recorded that iv tubing in septic patients had leaked solution at the attachment to the catheter hub, and a review of nursing notes on charts of patients who had been on intravenous hyperalimentation revealed that a leak had been noted in the patients who subsequently had catheter sepsis. The leak was due to a manufacturing defect resulting in a decrease in diameter of the plastic connection of the iv tubing, which produced a loose attachment to the hub. The problem was remedied by switching to a Luer-lok attachment. However, in July 1982, two patients had separation of the Luer due to a manufacturing defect in the threads, followed by a catheter sepsis. Sepsis from the local contamination was not manifest until 5.4 +/- 2.7 days later. Quality control by manufacturers is emphasized.
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PMID:An outbreak of Staphylococcus epidermidis septicemia. 641 16

A nutritional support team was used in the assessment and management of patients on a general urological service. Indications for nutritional evaluation included history of weight loss, anorexia, significant infection, chronic neoplastic disease, trauma or major surgery. The fat and protein status of the patient was assessed by anthropomorphic and laboratory determinations. The patient then was categorized as having mild, moderate or severe degrees of nutritional depletion. Deficiencies in vitamins, trace elements or essential fatty acids were not noted. Caloric and protein needs were calculated by multiplication of the basal energy expenditure by a metabolic activity factor, which was derived from the degree of illness or stress. Nutritional support was provided by enteral feedings via oral, nasogastric or jejunal feeding tubes and/or intravenous hyperalimentation via peripheral or central venous nutrient lines. During a 6-month interval nutritional consultation was requested for 50 patients, who represented 7 per cent of the urological admissions. Nutritional support was provided for patients who had obstructive uropathy with or without neoplasms, radiation cystitis, sepsis, urinary fistulas, mental depression, end stage renal disease or neurological dysfunction. In patients in whom urological treatment controlled the disease nutritional support maintained the weight, and stabilized serum albumin and lymphocyte counts. We concluded that a nutritional support program has a significant and, often, unappreciated role in the management of urological patients.
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PMID:Nutritional support in a general urological service. 642 56

The history of burns treatment in Sweden shows that not until an organized Burns Unit was established in 1954 was there any real progress in this field. From that date and onward the treatment of burns has continuously been improved based on results from experimental and clinical research. It is interesting to note that most of the burn research during this period has slowly changed from description of different organ failures towards studies of functional disturbances on cell level. The resuscitation following thermal injury is nowadays usually under control. The greatest problems arise later, caused by hypermetabolism, malnutrition and burn wound sepsis. The combined treatment with aggressive surgery, hyperalimentation, environmental control, avoidance of multiple organ failure etc., mainly based on results from the last 20 years of burn research, has significantly increased the survival rate of severe thermal injuries.
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PMID:The history of burns treatment in Sweden. 642 48

The present study investigated the feasibility of basal continuous subcutaneous insulin infusion (CSII) in four patients with postoperative sepsis or extensive burns during continuous enteral hyperalimentation with 2,500 to 3,000 calories/day, containing approximately 390 g of simple carbohydrates. The mean duration of CSII treatment was 16.8 days (range, seven to 32 days). The mean capillary blood glucose level fell from 322 +/- 52 mg/dL during pre-CSII therapy to 195 +/- 33 mg/dL during CSII therapy. Only 1.3% of 1,254 capillary blood glucose values were less than 60 mg/dL. Most values (61.6%) were between 61 and 200 mg/dL. The mean insulin infusion rate was 2.5 +/- 1.5 units/hr. These preliminary observations suggest that basal infusion CSII is a safe and effective means of improving blood glucose control in patients receiving enteral hyperalimentation despite the high glucose intake and presence of insulin resistance. Thus, CSII therapy can enhance the metabolic response to hyperalimentation without requiring an intravenous access route.
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PMID:Insulin pump therapy improves blood glucose control during hyperalimentation. 643 58

Twenty-one consecutive patients with pancreatic abscess were managed by an open packing technique. Despite an anticipated mortality of less than 65 per cent predicted by Ranson's prognostic signs, the mortality in this group of patients was only 14 per cent. The marked improvement in results was attributed to several factors: earlier diagnosis and surgical intervention based upon serial abdominal tomography; prevention of persistent or recurrent sepsis by frequent scheduled dressing changes, and prevention of frequently related complications. Seven patients were found to have significant anaerobic involvement. All wounds were permitted to heal by secondary intention, and each patient received intravenous hyperalimentation. The average duration of hospitalization was 76 days, a period not differing significantly from that required by conventional closed methods of drainage. Open packing of pancreatic abscesses appears to represent a significant advance in the management of these difficult patients.
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PMID:Open treatment of pancreatic abscess. 643 21

The coexistence of malignancy and dysphagia makes nutritional deprivation especially serious in patients with carcinoma of the esophagus. Intravenous hyperalimentation (IVH) is often given and should be of particular value in these patients. Sixty-four patients with carcinoma of the esophagus seen between January, 1975, and February, 1982, were studied retrospectively during their first hospitalization for the disease. Thirty-seven patients received IVH, and 27 did not. There were no significant differences at the time of admission to the hospital between the two groups with respect to age, sex, pathological status, and location of the carcinoma. Also, there was no difference in the incidence of hypoalbuminemia (less than 3 gm/dl) or lymphocytopenia (less than 1,500/mm3). More patients in the IVH group underwent surgical resection of the esophagus. Surgical intervention did not significantly influence hospital mortality. The IVH therapy reduced weight loss (p less than 0.05), but was associated with an increased incidence of pulmonary sepsis (p less than 0.05) and longer hospital stay. The incidence of hypoalbuminemia and lymphocytopenia increased between admission and the end of hospitalization, but it did not significantly differ between the groups. Thus, one cannot assume the effectiveness of IVH in this clinical setting, as its value was not demonstrated in this retrospective series. A prospective randomized study is warranted in view of the high cost and the doubtful clinical impact of an IVH regimen in patients with carcinoma of the esophagus.
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PMID:Clinical impact of intravenous hyperalimentation on esophageal carcinoma: is it worthwhile? 643 36

The treatment for pulmonary edema with the adult respiratory distress syndrome is aimed at the early supportive management of hypovolemic shock. The addition of massive corticosteroid dosage, Methylprednisolone Succinate, of 30 mg/kg body wt/dose ever six hours for a 24-48 hour period has been shown in our investigation to be efficacious, particularly in the traumatic and septic shock groups of patients but not in patients with multiple system diseases. Ventilator care utilizing constant positive pressure breathing or constant positive airway pressure in the patient who has spontaneous respirations is of prime importance. The recent utilization of hyperalimentation has also been very effective as an adjunctive therapy and should be used in the management of this problem in the future in conjunction with the steroids. Hemodynamic monitoring employing the specific parameters as delineated in our discussion are all major steps that should be pursued on a routine basis in the vast majority of these patients. The most important factor in the prognosis of this condition is the severity and number of injuries that have occurred at the time of the initial trauma. Other factors affecting the outcome are age, prolonged shock, associated degenerative cardiovascular disease, metabolic imbalance, severe multiple system involvement, and sepsis. We now feel that the utilization of massive corticosteroid therapy is indicated with the first earliest clinical signs of this condition in order to attempt to prevent complications and probably improve survival rate.
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PMID:Acute pulmonary edema with respiratory failure--newer concepts in therapy. 675 Nov 64

Over an 8-year period, 106 patients with cancer who were major operative risks received intravenous hyperalimentation (IVH). All were malnourished, had gastrointestinal obstruction or had postoperative complications such as fistulas, evisceration or intra-abdominal sepsis, which left IVH as the only means of achieving anabolism. When IVH was started preoperatively and continued postoperatively (34 patients), no deaths or major complications occurred. When IVH was first started after serious complications had occurred (62 patients), the incidence of recovery was high; the mortality was 17.7%. When IVH was given to cachectic patients whose cancer was inoperable to enable them to tolerate radiotherapy or chemotherapy (10 patients), the mortality was 40.0%. Although this last group is small, IVH is worthwhile in selected patients in whom good palliation life can be obtained. With careful IVH and improvement in the quality of technique, the risk of sepsis was no greater than in patients without cancer.
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PMID:Hyperalimentation and cancer. 676 42

Management of protein-calorie malnutrition found in 32 patients with severe liver diseases such as fulminant hepatitis and cirrhosis of the liver was carried out using 2 types of synthetic amino acid solution (Hep-OU and Fischer solution) for intravenous and enteral alimentations with rapid monitoring of serum aminogram. Intravenous hyperalimentation of these cases resulted in maintenance of nutritional status with improvement of nitrogen balance and normalization of impaired serum aminogram. During this study, however, nutritional support was initiated only when intractable ascites, upper gastrointestinal bleeding and hepatic encephalopathy were observed. In 2 cases of fulminant hepatitis with sepsis and 3 hepatoma patients with ascites, elemental diet containing maltose and amino acids was used to supply sufficient amounts of nutrients in a minimum volume of water. These techniques with simultaneous monitoring of urinary excretion of 3-methylhistidine and creatinine height index as nutritional parameters make nutritional management easy for patients with liver disease.
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PMID:Nutritional management of patients with severe liver disease by using intravenous hyperalimentation and elemental diet. 676 41

This case exemplifies the severe gastrointestinal manifestations of scleroderma. Esophageal, gastric, small intestinal, and colonic motility disorders were present. The patient was unable to survive on oral feedings or tube feedings. He was clinically resistant to the pharmacologic stimulation of gastrointestinal motility. After considerable discussion the patient was begun on intravenous hyperalimentation to be performed at home. Approximately 1 hr later, he has done remarkably well. He has maintained his weight and has had only one brief hospitalized for a sepsis most likely related to the intravenous feedings. He is still unable to take oral feedings. Other organs have remained clinically uninvolved, and the skin and joint disease have remained stable. It is our feeling that intravenous home alimentation has provided a useful adjunct to management in this patient with severe gastrointestinal involvement of scleroderma. It is hoped that the newer therapeutic modalities described by Dr. Jimenez may be effective in patients with this disease who can now be nourished parenterally.
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PMID:The gastrointestinal manifestations of scleroderma: pathogenesis and management. 676 49


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