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

Pulmonary surfactant, which is crucial for alveolar stability, may also be involved in endogenous defense mechanisms of the lungs. Thus, alterations in pulmonary surfactant may promote infections, including pneumonia and septicemia. Because patients who have acute respiratory failure often develop pneumonia, thus septicemia, we investigated when surfactant is altered in these patients and whether there is a specific pattern of changes in surfactant phospholipid composition associated with septicemia in these patients. To answer these questions, we determined the phospholipid content and composition in lung washings obtained from alveolar sites (by bronchoalveolar lavage) and from tracheal sites (by aspiration). Both techniques were performed serially over a period of 18 days in 30 patients who had acute respiratory failure resulting from polytrauma, 18 of whom developed septicemia caused by pneumonia. We found that in lung washings obtained from the alveolar sites from all patients, the phosphatidylglycerol content was decreased and the phosphatidylinositol content was increased as early as 6 hr after trauma and normalized during recovery of the patients. In addition, alveolar phosphatidylcholine content was decreased 24 hr after trauma. In patients who developed septicemia during the observation time, but not in patients who had uncomplicated courses of acute respiratory failure, the concentrations of alveolar phosphatidylethanolamine (normally 4.8% of total phospholipids) and alveolar phosphatidylcholine (normally 62.8%) both approached the proportions found in the trachea (phosphatidylethanolamine 33.4%, phosphatidylcholine 35.6%), suggesting that surfactant phospholipid pool size had progressively decreased. Our results indicate that in patients who have acute respiratory failure, pulmonary surfactant is altered very early, and that when septicemia complicates the course of acute respiratory failure, the surfactant phospholipid pool size decreases progressively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Altered pulmonary surfactant in uncomplicated and septicemia-complicated courses of acute respiratory failure. 229 63

The course of 225 multiple traumatized patients in our ICU with a mean age of 35 +/- 16.8 years, a mean ISS of 30 +/- 8.3 and an overall mortality of 18.2% was evaluated retrospectively. For comparable ISS the mortality was higher in patients over 65 years, and increased further with age. The most common causes of death were MOF (41.5%), severe head injury (34.1%), and acute respiratory failure (ARF) (19.5%). The mortality increased when two or more organ failures were present. 105 patients had fractures of the long bones; in 28 of these all fractures were stabilized primarily (during the first 24 hours). Organ failure was seen less frequently in these patients compared to those with secondary stabilization: ARF 10.7% vs. 51.9% (p less than 0.0004), acute renal failure 3.6% vs. 11.7%, liver failure 3.6% vs. 11.7%, sepsis 14.3% vs. 29.9%. Mortality was significantly lower in the patient with primarily stabilized fractures (7.1% vs. 24.7%, p less than 0.05). The study demonstrates that early stabilization of long bone fractures results in a more favourable course, and that this should be carried out whenever feasible.
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PMID:[Organ failure in patients with multiple trauma. The effect of early osteosynthesis of fractures on complications]. 230 92

Escherichia coli hemolysin has been implicated as a pathogenicity factor in extraintestinal E. coli infections including sepsis. In the present study the effects of intravascular administration of hemolysin were investigated in isolated blood-free perfused rabbit lungs. Low concentrations of the toxin in the perfusate (0.05-5 hemolytic units/ml, corresponding to approximately 5-500 ng/ml), caused a dose- and time-dependent release of potassium, thromboxane A2, and prostaglandin I2, but not of lactate dehydrogenase, into the recirculating medium, as well as a dose-dependent liberation of the prostanoids into the bronchoalveolar space. These events were paralleled by a dose-dependent pulmonary hypertension, and studies with different inhibitors collectively indicated that the vasoconstrictor response was mediated predominantly by pulmonary thromboxane generation. In addition, E. coli hemolysin elicited a protracted, dose-dependent increase in the lung capillary filtration coefficient, which was independent of the prostanoid-mediated pressor response and resulted in severe pulmonary edema formation. We conclude that E. coli hemolysin can elicit thromboxane-mediated pulmonary hypertension combined with severe vascular leakage in isolated lungs in the absence of circulating inflammatory cells and humoral mediator systems, mimicking the key events in the development of acute respiratory failure in states of septicemia.
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PMID:Thromboxane-mediated hypertension and vascular leakage evoked by low doses of Escherichia coli hemolysin in rabbit lungs. 250 Apr 55

Since June 1977 eight patients with acute leukemia and three with chronic myelogenous leukemia (CML) have undergone cytoreductive therapy prior to a second allogeneic or syngeneic bone marrow transplantation (BMT). The median age was 24 years (range 7-49 years) and the median time to second BMT was 495 days (range 122-1887 days). Prompt hematopoietic recovery was documented in 11/11 patients and verified by cytogenetic analysis in 7/11. Early death (less than 100 days) was the result of sepsis in one, veno-occlusive disease in one and interstitial pneumonitis in two. Of seven patients who survived beyond 1 year, two patients subsequently died, one as a result of acute respiratory failure and one of leukemia relapse. Five are currently disease-free at 8+, 20+, 42+, 49+ and 72+ months after the second BMT. In this patient population which is at high risk for resistant disease and treatment-related toxicity, a second preparative therapy and BMT may offer a durable disease remission with tolerable toxicity.
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PMID:Second bone marrow transplantation after leukemia relapse in 11 patients. 264 76

Patients who acquire sepsis, ARDS, ARF, or MSOF subsequent to multiple trauma have a high mortality rate. The pathophysiology of these complications is complex and is thought to involve ischemia, the generation of mediators, alterations in regional perfusion, and cellular oxygen use. Because of the critical nature of the patient with these complications, nursing care requires indepth knowledge as well as competent nursing management, necessitating use of both the art and science of nursing.
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PMID:Complications of multiple trauma. 267 90

Pulmonary intravascular macrophages reside in the pulmonary capillaries and phagocytize bacteria and particulates. These cells are prominent in several animals species, but they have not been described in humans. Samples of lung tissue from patients undergoing thoracotomies for excision of noninfectious diseases were examined with transmission electron microscopy to determine if pulmonary intravascular macrophages are present in humans. The macrophages, with cytoplasm closely adjacent to the capillary and with an irregular contour, were seen in specimens from all patients. The morphologic features of human pulmonary intravascular macrophages resemble the appearance of these cells in animals. The potential significance of pulmonary intravascular macrophages is discussed with regard to sepsis-induced acute respiratory failure.
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PMID:Intravascular macrophages in pulmonary capillaries of humans. 293 62

Severe falciparum malaria complicated by acute renal failure resulted in very high mortality. Ten patients with acute renal failure from falciparum malaria (infected rbc up to 80%) were continuously dialysed using Tenckhoff peritoneal catheter. Five were oliguric and BUN was maintained between 60 to 80 mg/dl (21.4 to 28.6 mmol/l) by hourly 1 to 1.5 liter dialysate exchange during the acute phase. The peritoneal urea clearance (mean +/- SD) was 12.1 +/- 1.2 ml/min with urea nitrogen removal of 13.4 +/- 2.3 g/day. In nonoliguric cases dialysis was also needed for additional removal of waste products since the remaining renal function could not cope with the hypercatabolic state. Peritoneal glucose absorption (135 to 565 g/day) gave considerable caloric supply without volume load and also contributed to the prevention of hypoglycemia. Varying degree of acute respiratory failure developed in all patients with 5 cases (2 oliguric and 3 nonoliguric) progressing to pulmonary edema. Swan-Ganz catheterization and hemodynamic study suggested the role of increased capillary permeability and volume overload from endogenous water formation in the development of pulmonary complication. Continuous removal of fluid and waste products minimized these problems and may prevent the progression of respiratory failure. One patient died of severe sepsis and the other nine survived. This study showed the beneficial contribution of continuous peritoneal dialysis in the management of acute renal failure from severe falciparum malaria.
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PMID:Continuous peritoneal dialysis in acute renal failure from severe falciparum malaria. 312 24

Acute respiratory failure has a high mortality in patients with acquired immunodeficiency syndrome (AIDS). This study was undertaken to determine the etiology of acute respiratory failure and the outcome of children with AIDS and AIDS-related complex. Records of 31 children with AIDS or AIDS-related complex admitted to the pediatric intensive care unit for acute respiratory failure throughout a 46-month period were reviewed. Acute respiratory failure was due to Pneumocystis carinii pneumonia in 13, cytomegalovirus pneumonia in six, bacterial pneumonia in five, severe bacterial sepsis in four, Candida pneumonia in two, and a giant cell pneumonia in one patient. In addition, 11/19 patients with acute respiratory failure due to P carinii pneumonia or cytomegalovirus had superinfections with bacteria or Candida. Of the total of 19 primary and secondary bacterial infections, Pseudomonas aeruginosa was responsible in ten and Klebsiella pneumoniae in three children. Five children (16%) survived until pediatric intensive care unit discharge; three died within 6 months. The causes of acute respiratory failure were not significantly different in survivor and nonsurvivor groups. It is concluded that, in addition to P carinii pneumonia and cytomegalovirus pneumonia, bacterial infections (especially due to Pseudomonas and other Gram-negative organisms) are important causes of respiratory failure. The high mortality and grim ultimate prognosis seen may have implications for pediatricians attempting to identify the proper limits of medical intervention for this group of patients.
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PMID:Respiratory failure in children with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex. 326 Oct 5

Ten patients with acute respiratory failure (ARF), (4 pneumonia, 4 sepsis, 2 polytrauma), underwent computerized tomography (CT) of the lungs, (apex, hilum, base), at 5, 10, 15 cm H2O positive end expiratory pressure (PEEP). The ARF lungs, on CT scan, appeared as a patchwork of normal and dense areas with generally well defined boundaries. Most of the densities were found in the dependent regions. The areas of density were correlated with PaO2 (r = 0.51). The PEEP increase resulted in a significant expansion of total cross-sectional lung surface area. The dense areas decreased significantly at the hilum and base when increasing PEEP while the changes at the apex were not significant. The changes of density with PEEP were highly correlated with the changes in oxygenation (r = 0.91). In the individual patient, however, the modifications of gas exchange can not be entirely predicted from morphological changes, possibly due to a diversion of pulmonary blood flow.
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PMID:Morphological response to positive end expiratory pressure in acute respiratory failure. Computerized tomography study. 352 33

Eight cases of pulmonary involvement were observed in 17 severe cases of ictero-haemorrhagic leptospirosis. Haemoptysis (7 cases) occurred on the 4th day of the infectious syndrome and was associated with other haemorrhagic manifestations in 4 cases. Cough, pain and polypnoea were not constant. Chest X-ray showed diffuse, non-specific changes, such as nodular opacities or infiltrates. Septicaemia was confirmed in all cases with acute renal failure in 7 cases and meningitis in 6 cases. Severe thrombocytopenia was demonstrated in 2 cases. Six patients recovered quickly with regression of the lung changes within 12 days. Two patients died, one of a fulminant haemoptysis related to a disseminated intravascular coagulation syndrome, and the other of acute respiratory failure. All cases were confirmed serologically. Although lung changes in leptospirosis are usually benign and mild, haemoptysis and polypnoea with diffuse radiological changes are poor prognostic factors. The pathological changes were similar to those of haemorrhagic alveolitis. These changes may be either due to the liberation of toxins or to an immunological phenomenon.
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PMID:[Pulmonary manifestations in severe ictero-hemorrhagic leptospirosis]. 363 26


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