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

During January 1989-September 1991, in India, neonatologists prescribed assisted ventilation (intermittent positive pressure ventilation [IPPV] and continuous positive airway pressure [CPAP]) for 90 neonates born and treated at a tertiary hospital in Delhi. All neonates requiring more than 168 hours of ventilation received IPPV. The smallest surviving neonate weighed 830 g at birth and was born at 26 weeks' gestation. This neonate received 510 hours of ventilation. One neonate received 48 days of ventilation (gestational age at birth, 28 weeks; birth weight, 800 g). This neonate eventually died due to necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and sepsis. This infant was the only infant to develop NEC. A total of two newborns developed BPD. One infant developed retinopathy of prematurity (ROP). Indications for ventilation were hyaline membrane disease (HMD) (45/90), apnea (13/90), and transient tachypnea of the newborn (TTNB) (11/90). Almost all HMD cases who weighed more than 1.5 kg at birth on CPAP survived. CPAP successfully treated all TTNB cases. Nine neonates developed pneumothorax. Three of them survived. 34 neonates developed sepsis, the most common complication. 20 sepsis cases also had underlying pneumonia. Sepsis was responsible for 35% of deaths (14/40). Five infants on IPPV developed persistent pulmonary hypertension (persistent fetal circulation). 35 infants developed infection during ventilation, 34 of whom had a nosocomial infection. The nosocomial infection rate was 37.7%. Nosocomial infection was responsible for 35% of deaths. 12 babies (13%) developed pulmonary air leaks, 50% of whom died. 25 of the 33 infants on CPAP survived. Few CPAP cases developed pulmonary air leak, BPD, and ROP. Six of 22 very low birth weight (VLBW) infants (1 kg) survived. These findings led the researchers to recommend that medical centers with basic facilities for level II care should provide neonatal ventilation. They proposed that ventilation may not be cost effective for VLBW newborns, however.
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PMID:Three-year experience with neonatal ventilation from a tertiary care hospital in Delhi. 788 27

From July 1987 to October 1991, we experienced 10 full-term newborn infants with severe adult respiratory distress syndrome (ARDS). The triggering events were intrauterine/perinatal asphyxia in 6 and sepsis in 4. All had severe respiratory distress/failure and were mechanically ventilated with high concentration of inspired oxygen and positive end-expiratory pressure. Radiography of the chest all showed bilateral dense consolidation (white out lungs) and reduced lung volume. Persistent pulmonary hypertension (PPHN) was documented in 9 cases (90%). The concomittent occurrence of ARDS and PPHN rendered respiratory management extremely difficult. High-rate ventilation and tolazoline infusion were used in all these 9 PPHN cases. Acute complication of respiratory therapy (pneumothorax) was encountered in 5 patients. Only 3 cases survived, all belonging to the asphyxia group. Of these 3 survivors, 1 developed bronchopulmonary dysplasia, 1 had cerebral palsy on follow up and the other one was lost on follow up. The outcome of neonatal ARDS was generally poor.
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PMID:Adult respiratory distress syndrome in full term neonates. 817 41

Among 182 episodes with ARF (PaCO2 > 50 torr) in 400 episodes of COPD patients who were admitted to Chulalongkorn Hospital during the period 1982 to 1986, despite conservative treatment, 66 developed severe acute respiratory failure requiring assisted ventilation. Patients with a history of chronic cough, pneumonia as a precipitating factor and more severe ARF on admission, as indicated by palpitation, headache, cyanosis, alteration of consciousness, cor-pulmonale and decompensated acidosis (pH < 7.30), were likely to require mechanical ventilation. Indications for mechanical ventilation were carbon dioxide narcosis (43 episodes), severe hypoxemia despite on a high FIO2 (one episode), various combination parameters of respiratory muscle fatigue, cardiovascular instability (22 episodes). The major complications of mechanical ventilation were pneumonia, sepsis, pneumothorax, UGI bleeding of 16, 8, 5 and 9 episodes, respectively. The average duration of assisted ventilation and hospitalization were 15.8 and 19.02 days, respectively. The mortality rate was 50 per cent in the mechanical ventilation group compared with 9.8 per cent in the non-mechanical ventilation group. Increased mortality rate was found in those with pneumonia as the precipitating factor (68.4 vs 14.3%, respectively, in comparing the two groups). Complications of mechanical ventilation, which included pneumonia, sepsis, fluid overload, hyponatremia and persistent acidosis, were high-risk factors for the non-surviving group.
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PMID:Mechanical and non-mechanical ventilation of respiratory failure in chronic obstructive pulmonary disease. 822 88

One hundred and seventy-seven infants of birth weight less than 1500 grams admitted to the neonatal intensive care unit of Mackay Memorial Hospital in 1987 were studied. The sex distribution, male to female ratio was 100:77, inborn 78 cases, outborn 99 cases. At one year follow-up, the mortality rate of these weighed between 500 gm and 799 gm was 100%, between 800 gm and 999 gm 54%, between 1000 gm and 1249 gm 17%, between 1250 gm and 1499 gm 19% respectively. The mortality rate of outborns was higher than that of inborns (X2 = 6.03, P < .05). The most common cause of mortality of these infants was intracranial hemorrhage, it accounts for 55% of the mortality. Seventy-three percent of the deceased cases expired during the first three hospitalization days. Of these 177 cases, 94 were put on respirator with IPPB initially, another 47 cases were on nasal CPAP. Only 36 cases didn't require respiratory therapy. Complications of the extreme prematurity and management including intraventricular hemorrhage, pulmonary hemorrhage, sepsis, pneumothorax, persistent pulmonary hypertension, disseminated intravascular coagulopathy, electrolyte imbalance, bronchopulmonary dysplasia and retinopathy of prematurity were discussed. In order to improve survival and reduce complications of these extreme prematurity, advanced monitoring system, early detection and prevention of intracranial hemorrhage, establishment of the transport system are essential.
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PMID:[Clinical study of infants with birth weight less than 1500 grams]. 823 56

Total parenteral nutrition (TPN) for the nonoperative treatment of acute pancreatic pseudocyst has been of hypothetical benefit. We reviewed pseudocyst hospital admissions in 40 patients treated with TPN who had serial imaging studies. The mean cyst size was 7.4 cm on presentation, decreasing to 5.6 cm after nonoperative treatment with TPN (mean 32.5 days). After a nonoperative period, 68 per cent of cysts regressed, completely in 14 per cent, partially in 54 per cent. Except for a patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complication, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), in the course of hospitalization. The majority of TPN-treated patients had a clinical and radiographic regression of their pseudocyst. However, the increased risk of catheter-related complications in this group suggests that this therapy should be limited to patients who are unable to sustain enteral nutrition.
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PMID:The limited role of total parenteral nutrition in the management of pancreatic pseudocyst. 823 96

The authors report on a retrospective series of 37 liver abscesses treated via the percutaneous route in 34 patients, in order to assess the efficacy of this method. One or more aspiration punctures were undertaken in 24 patients (70.6%), while percutaneous drainage was performed in 10 patients (29.4%). In 27 cases (79.5%), this percutaneous treatment resulted in a cure. Further surgical drainage, carried out in 7 patients (20.5%) was only required in 3 cases, twice due to the inefficacy of percutaneous drainage and once in the presence of three liver abscesses containing particularly thick pus. Ultrasonographic monitoring demonstrated a return to normal in 66.6% of cases, the persistence of a slight residual collection in 26.6% patients and one relapse, two months after percutaneous drainage. Two complications inherent to the percutaneous treatment were noted: a pneumothorax and a case of septicemia, both of which had a favourable outcome.
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PMID:[Percutaneous treatment of liver abscess. Apropos of 34 cases]. 836 Aug 63

The patient, a 70-year-old man, diagnosed as having left pneumothorax and hydrothorax, was admitted and had a thoracic drain inserted. The evacuation of stool was noted from 3 days after insertion. With the abscess in the left thoracic cavity shown on emergency CT, a diagnosis of perforation of the digestive tract in the left thoracic cavity was made and emergency operation was performed. On the basis of the intraoperative findings, the case was diagnosed as adult Bochdalek hernia with intrathoracic colon perforation, and repair of hernia and colostomy were done by laparotomy and thoracotomy. However, the patient died of DIC and sepsis 5 days after operation. Two cases of adult Bochdalek hernia complicated with spontaneous pneumothorax have hitherto been report. However, there has been no reported case which had adult Bochdalek hernia complicated with pneumothorax considered due to intrathoracic colon perforation as in this case. So this case was considered very rare and worthy of reporting.
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PMID:[A case of intrathoracic colon perforation due to adult Bochdalek hernia]. 836 Nov 13

Indwelling venous catheters are invaluable for long-term chemotherapy, antibiotics, and hyperalimentation. However, their placement and chronic use can cause serious complications. This study was done to develop guidelines for minimizing complications of long-term vascular access. Complications associated with 355 lines placed in 297 patients were recorded prospectively at the George Washington University Hospital. Single or double lumen catheters were placed via the infraclavicular subclavian approach (126), external jugular cutdown (133), internal jugular cutdown (22), and cephalic vein cutdown (42). While catheters were malpositioned in 15 cases (5.2%), route of placement did not influence this adverse outcome. Pneumothorax occurred only in the subclavian approach (5.6%). Axillary vein thrombosis was significantly more prevalent in catheters placed via the subclavian vein (10.3%) compared with the external jugular (2.3%) P < 0.05 or cephalic (2.3%) vein. Line sepsis occurred in 28 instances; this was statistically associated with an abnormal white blood count and with the use of double-lumen catheters (double-lumen catheter sepsis = 18.4%, single lumen = 4.4%, P < 0.01). The morbidity of long-term venous catheters is affected significantly by the route of placement, the number of catheter lumens, and the pre-placement white blood count. As a result of our analysis, we recommend single-lumen catheter placement using the external jugular cutdown route whenever possible.
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PMID:Avoiding complications of long-term venous access. 836 59

Despite an association with meconium and blood aspiration, pneumonia, sepsis, pneumothorax, prematurity, and congenital diaphragmatic hernia, no cause for persistent pulmonary hypertension of the newborn can be found in many cases. This article discusses the advances in current therapies including the promising new therapy of inhaled nitric oxide.
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PMID:Advances in the treatment of persistent pulmonary hypertension of the newborn. 841 18

Clostridial necrotising pneumonia is a rare complication of aspiration, bronchial tumour or foreign body, pulmonary infarction, trauma and debilitating medical conditions. Although spontaneous clostridial pneumonia has been reported previously, close scrutiny of those case reports suggests that most of the patients had a recognised predisposing cause. We report a case of true spontaneous Clostridium perfringens pneumonia complicated by septic shock, pneumothorax and pulmonary necrosis. The patient responded poorly to conventional treatment with benzylpenicillin, and although the addition of metronidazole produced dramatic resolution of the sepsis, lobectomy was required to effect cure.
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PMID:Spontaneous Clostridium perfringens lung abscess unresponsive to penicillin. 844 82


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