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

The impact of early prophylactic use of intravenous indomethacin on the incidence and severity of periventricular-intraventricular hemorrhage and patent ductus arteriosus in 199 oxygen-requiring premature infants (less than or equal to 1300 g birth weight) was prospectively investigated. The trial was controlled, the infants were randomized, and the investigators were unaware of the group assignments. Patients with minimal (grade I) or no periventricular-intraventricular hemorrhage determined by prestudy echoencephalography were randomized within two birth weight subgroups (500 to 899 and 900 to 1300 g) to receive either prophylactic indomethacin (n = 99) or an equal volume of saline-vehicle placebo (n = 100). The first dose (0.2 mg/kg) was given within 12 hours of delivery and two subsequent doses (0.1 mg/kg) were administered at 12 hourly intervals. Prophylactic indomethacin significantly reduced the incidence of grades II to IV periventricular-intraventricular hemorrhage. Intraventricular hemorrhage was half as common in infants given prophylactic indomethacin as in control infants (23% v 46%, P less than .002). The reduction was manifested in both birth weight subgroups. Results of this study also confirmed a lower incidence of clinically significant patent ductus arteriosus in infants who received prophylactic indomethacin in contrast to those who received placebo (11% v 42%, P less than .001). No significant differences were found between treatment and control groups in the duration of oxygen therapy, mechanical ventilation, or hospitalization or in the incidence of pneumothorax, chronic lung disease, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Early prophylactic indomethacin initiated within 12 hours of delivery is effective in reducing the incidence of intraventricular hemorrhage as well as clinically significant patent ductus arteriosus in very low birth weight premature infants.
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PMID:Prophylactic indomethacin for prevention of intraventricular hemorrhage in premature infants. 317 14

Extracorporeal membrane oxygenation (ECMO) has been successful (greater than 80% survival) in 35 centers in greater than 900 newborns with severe respiratory failure having an estimated mortality of greater than 80% on conventional management. During the last 3 years we have treated 79 newborns with 74 survivors (94%). Their diagnoses included meconium aspiration, persistent fetal circulation, respiratory distress syndrome, congenital diaphragmatic hernia, and sepsis. Seven patients (9%) had life-threatening intrathoracic complications requiring emergent intervention while on ECMO: tension hemothorax (3), tension pneumothorax (2), and pericardial tamponade (2). Pericardial tamponade and tension hemothorax and pneumothorax show a similar pathophysiology of increasing intrapericardial pressure and decreasing venous return. Perfusion is initially maintained by the nonpulsatile flow of the ECMO circuit before further decrease in venous return results in decreasing ECMO flow and progressive hemodynamic deterioration. Each of the seven patients demonstrated a clinical triad that includes increasing PaO2 and decreasing peripheral perfusion (as evidenced by decreasing pulse pressure and decreasing SvO2) followed by decreasing ECMO flow with progressive deterioration. The diagnoses were confirmed by transillumination, chest x-ray, or cardiac echocardiogram. Initial emergent placement of a percutaneous drainage catheter was temporizing in all seven cases. However, four patients required emergent thoracotomy for definitive treatment while still on ECMO. All seven patients were weaned from ECMO and are short-term survivors (6 months to 3.5 years). As use of ECMO for newborn severe respiratory failure increases, responsible physicians must be familiar with life-threatening intrathoracic complications and appropriate treatment strategies.
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PMID:Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation. 320 57

We assessed the complications associated with emergency department placement of subclavian vein catheters in trauma and burn patients, reviewing the charts of all of the 441 patients admitted to the burn-trauma unit through the emergency department during 1983. Fifty-two patients (12%) had infraclavicular placement of subclavian catheters while in the emergency department. Sex, age, insertion site, blood pressure at time of insertion, indications for placement, catheters left in place, and complications were recorded. Patients with severe chest trauma or known pneumothorax or hemothorax on the ipsilateral side of line placement were excluded. The eight complications (15%) directly attributable to the procedure itself were one pneumothorax, two hematomas at the site of insertion, one knotted catheter, two misplaced catheters, and two episodes of sepsis, confirming the higher complication rates for emergency subclavian catheter insertion. Two upper extremity, 14 gauge percutaneously placed intravenous catheters are usually sufficient for resuscitation; femoral and cutdown routes offer additional sites for massive resuscitation. Subclavian catheterization is seldom needed in the emergency room. Any intravenous lines inserted in the emergency room should be changed within 24 hours to minimize infection.
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PMID:Emergency department infraclavicular subclavian vein catheterization in patients with multiple injuries and burns. 335 64

As more patients are requiring permanent central venous catheters (PCC) for long term venous access, several associated complications have become evident, including: 1, sepsis; 2, thrombophlebitis; 3, insertion complications, such as unsuccessful placement, bleeding and pneumothorax, and 4, PCC transection with tip embolization. At our institution, 162 PCC were placed by way of cutdown or percutaneously. Sepsis occurred in 20 per cent (0.13 septic episodes per 100 catheter days), nearly always involving immunocompromised patients. Twenty-five per cent resolved with use of antibiotics and without removal of PCC. Two patients presented with clinical thrombophlebitis; both were treated with removal of PCC and anticoagulant medication. Failure of insertion was highest with the cephalic cutdown approach, and pneumothorax was highest with the subclavian approach. Transection of PCC is associated with the percutaneous subclavian approach and is heralded by intermittent catheter function and a "pinch-off" sign on roentgenogram. Methods of preventing these complications are emphasized herein.
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PMID:Prevention of complications in permanent central venous catheters. 338 Nov 87

Pharmacokinetic and clinical studies were carried out regarding the use of cefotiam (CTM) in the treatment of infections in newborn infants. Absorption and excretion: CTM was administered by bolus intravenous injection at a dose of 20 mg/kg to 9 newborns ranging in age from 1 to 28 days (gestational age, 34-40 weeks; birth weight, 2,000-3,380 g) and 6 infants aged 30 to 87 days (gestational age, 33 approximately 40 weeks; birth weight, 2,100-3,600 g) and its serum concentration and urinary excretion were determined. In the newborns, mean serum concentrations were 43.3 micrograms/ml at 1/4 hour, 36.7 microgram/ml at 1/2 hour, 27.8 micrograms/ml at 1 hour, 17.7 micrograms/ml at 2 hours, 8.8 micrograms/ml at 4 hours and 4.8 micrograms/ml at 6 hours, and in the infants, they were 44.5 micrograms/ml, 31.2 micrograms/ml, 19.1 micrograms/ml, 7.6 micrograms/ml, 2.2 micrograms/ml and 0.7 micrograms/ml at the above sampling times, respectively. Mean half-lives were 1.92 hours for the newborns and 0.96 hour for the infants, and mean urinary recoveries within 6 hours were 41.2% and 50.1% for the newborns and the infants, respectively. Taking individual differences into account, serum peak levels (at 1/4 hour) in newborns were very similar to each other irrespective of age (days after birth), and did not appear to be greatly different from those in infants. Half-lives, however, became shorter with aging, and the half-life of the serum CTM level in infants of about 1 month old should be close to those in young children or school-age children. From these observations, it is suggested to establish a standard regimen in which CTM is administered at a dose of 20 mg/kg once or twice a day to newborns within 3 days after birth, twice or 3 times a day to those aged 4 to 7 days, and 3 or 4 times a day to those aged 8 days or older. Clinical study: The CTM was administered to 11 patients with acute pneumonia, 2 patients each with suspected septicemia and with bullous impetigo, 1 patient with purulent lymphadenitis, 3 patients with idiopathic respiratory distress syndrome and 1 patient with pneumothorax, and its clinical effect was investigated. Excellent responses were observed in 12 of the 15 evaluated cases,good responses in 2, and a poor response in 1, thus an overall clinical effectiveness was 93.3%.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Study on the use of cefotiam in neonates]. 346 85

Between January 1982 and May 1986 a large subcapsular hemorrhage of the liver (SHL) was diagnosed in six infants who weighed 1000 g or less at birth at Royal Alexandria Hospitals, Edmonton. The diagnosis of a ruptured SHL was made between 4 and 18 days of life by means of clinical and sonographic findings in four of the infants; an intact SHL was diagnosed at autopsy in the other two. None of the cases was associated with parenchymal rupture of the liver. Thrombocytopenia was present in five of the six infants and in all four infants with hemoperitoneum. Other possibly relevant antecedent events included mechanical ventilation (in all six), administration of indomethacin (in all six), hypoxia (in five), bilateral pneumothorax necessitating repeated pleural drainage (in three), external cardiac massage (in three) and septicemia (in two). Two of the three infants who underwent surgery survived the operation but later died of unrelated events. One infant who was managed conservatively also survived. A large SHL should be considered in all infants of very low birth weight with unexplained hypovolemia or anemia.
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PMID:Subcapsular hematoma of the liver in infants of very low birth weight. 358 Sep 86

In order to identify potential problems and thereby minimise the risk of invasive vascular catheterisation, we conducted an analysis of these procedures in our medical intensive care unit with the aid of a computer database. During the 9-month study period 114 patients underwent 247 invasive vascular catheterisations, including pulmonary arterial (PA), central venous (CV) and arterial catheter insertions. Complications unique to PA catheterisation included burst catheter balloons (6%) and one serious episode of arrhythmia. The incidence of pneumothorax (2.8%) and inadvertent arterial puncture (2.2%) with PA and CV lines and our sepsis rate of 3.6% for all types of catheters are consistent with other studies. Arterial catheterisation proved to be relatively free of complications. Our study confirmed the safety of invasive vascular catheterisation. However, we review the precautions needed to limit potential complications.
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PMID:Invasive vascular catheterisation in the critically ill. 361 7

Percutaneous Transhepatic Biliary Drainage (PTHBD) was performed in 56 consecutive patients with severe acute cholangitis, during a period of one year. An immediate decompression effect with a "good" response was achieved in 46 (82.2%), who usually became afebrile within 18 to 24 hours, and "poor" response in 10 (17.8%). Five died (8.93%) in a subsequent operation. No mortality was associated with the use of PTHBD. Complications related to the procedure occurred in 12 of the 56 patients (21.4%). Hemobilia was the major complication. The other complications were intraabdominal hemorrhage, bleeding from the puncture site, transient hypotension, catheter occlusion and/or dislodgement, bile leak, pneumothorax and hemothorax. Two with hemobilia, one with intraabdominal hemorrhage and the other with bile leak required an emergency operation. PTHBD procedures can be lifesaving in biliary sepsis. Once infection and hyperbilirubinemia are controlled, rational subsequent therapy can be formulated for the underlying disease.
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PMID:Percutaneous transhepatic biliary drainage for acute cholangitis. 367 29

"Half-way", Secalon-Seldy, soft venous catheters, 40 cm long, were inserted by basilic (n = 90) and cephalic (n = 31) veins at the fossa cubiti in 121 patients (71 men and 50 women) aged between 19 and 88 years whose heights varied from 152-197 cm. The inserted catheter lengths approximated 1/5 of the patient's height. Sixty-five per cent of 106 radiologically investigated catheter tips were located proximally in the axillary veins, and 34% distally in the subclavian veins. The duration of catheterization varied from 1 to 44 (mean 9 +/- 7) days (means +/- 1 s.d.). Perfect function was recorded in 93 of 121 catheters. No serious, but some minor complications were registered such as temporary interruption of infusion flow with movements of the arm (n = 12), partial or total catheter occlusion (n = 16), leakage of the infusate at the insertion site (n = 1), and pain along the vein during infusion (n = 2). Five patients (4%) developed thrombophlebitis 2-.10 days after insertion. Pull out phlebographies at catheter withdrawal (4-35 days after insertion) were performed in 36 patients. Radiological thrombi were small and similar to those recorded in another 53 phlebographies of "long-way" brachial catheters of similar stiffness. Neither local infection nor episodes of sepsis were registered over a period of 1,081 catheter days. "Half-way" catheters proved able to take over all the functions of both peripheral and central venous catheters, lacking the frequent complications (phlebitis and infection) of the former, and the serious mechanical complications (pneumothorax, vein perforations, and injuries of the ductus thoracicus, nerves, arteries, and heart) of the latter.
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PMID:"Half-way" venous catheters. IV. Clinical experience and thrombogenicity. 386 73

Peri-operative high-calorie nutrition was administered, through a total of 500 catheters introduced into the superior vena cava via the subclavian vein, to 404 patients admitted to hospital for gastro-intestinal cancer resection or other major abdominal operations, some of them taking a complicated course. Most of the catheters remained in situ for 6-20 days; the longest period was 44 days. Catheter insertion was successful in 97.8%. Faulty position of the catheter occurred in 4.4%; in 2.8% it was rectified under fluoroscopic control. In 92.2% there were no complications ascribable to the catheter. A pneumothorax resulted in 1.4% of patients, central thrombosis in 0.4%. Catheter-related sepsis was noted in 6.2%.
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PMID:[Perioperative high-caloric alimentation with the central venous catheter. Prospective study in 404 patients]. 392 30


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