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

Of approximately 6000 admissions to the Henry Ford Hospital medical ICU between October 1969 and September 1984, 61 (1%) had active tuberculosis (TB). Forty-three (70%) of these 61 had acute respiratory failure (ARF). TB was considered to be the sole cause of ARF in 12 and contributory in 31. Eighteen patients with TB but without ARF were admitted for treatment of other critical illnesses. Alcoholism was present in 31 (51%) of the TB patients. Only one of 12 whose ARF was caused primarily by TB had a history of known TB at the time of admission. Important factors contributing to ARF in TB patients included Gram-negative pneumonia and/or sepsis, chronic obstructive pulmonary disease, prior TB with anti-TB medication noncompliance, and malignancy. Six patients were not suspected of having TB when admitted to the medical ICU; three patients who had not been treated for TB were found to have TB on autopsy. The inhospital mortality rate for all patients with TB requiring intensive care was 67%, but was 81% in those with ARF.
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PMID:Active tuberculosis in the medical intensive care unit: a 15-year retrospective analysis. 367 43

Patients requiring prolonged (greater than 24 hours) mechanical ventilation have various conditions that result in respiratory failure. All patients requiring prolonged mechanical ventilation were subdivided into the following six groups: uncomplicated acute lung injury; respiratory failure complicated by multisystem failure; previous lung disease; trauma; other medical causes; and routine postoperative ventilation. During a one-year period, 327 patients required prolonged mechanical ventilation; acute lung injury and chronic obstructive pulmonary disease were the predominant conditions. Sepsis was both the major predisposing factor for and complication of acute lung injury. Mortality for patients with acute lung injury was 40 percent in the uncomplicated group and 81 percent in patients with acute lung injury complicated by multisystem failure. Acute respiratory failure in association with acute renal failure had a mortality of 89 percent. Number of organ systems involved also correlated with mortality. In patients with chronic obstructive pulmonary disease and pneumonitis or retained secretions, mortality was lower (30 percent), but a significant percentage of these patients (43 percent) became ventilator-dependent. Ventilator dependence did not significantly increase mortality during the course of respiratory failure.
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PMID:Clinical outcome of respiratory failure in patients requiring prolonged (greater than 24 hours) mechanical ventilation. 374 48

The effects of almitrine administration on pulmonary gas exchange and pulmonary and systemic hemodynamics were assessed in eight patients with severe acute respiratory failure (ARF) secondary to sepsis or shock. A control group of five patients not receiving the drug were submitted to the same protocol. All the patients were sedated, paralyzed, and mechanically ventilated. Measurements were made before (BASELINE), during (ALM 15), at the end of (ALM 30), and at 30 minute intervals after (POSTALM 30, 60, 90, 120) the intravenous (IV) infusion of 0.5 mg/kg body weight of almitrine in 30 minutes. Almitrine produced an increase in PaO2 from 86 +/- 14 (BASELINE) to 129 +/- 69 (ALM 15) and 129 +/- 86 mm Hg (ALM 30). The PaO2 quickly declined after stopping the infusion. The P(A-a)O2 and QVA/QT decreased with almitrine administration. The Ppa and QT increased transiently at ALM 30. We conclude that IV almitrine improves gas exchange and may be useful in the management of ARF.
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PMID:Almitrine in acute respiratory failure. Effects on pulmonary gas exchange and circulation. 381 17

Adult respiratory distress syndrome remains one of the most lethal conditions treated in surgical and medical intensive care units. Mortality rates of 50 per cent are still reported in recent reviews. Many risk factors are linked with an increased incidence of ARDS, but sepsis and direct pulmonary injury from aspiration, pulmonary contusion, and other forms of trauma are the most commonly associated risk factors. Studies implicate various cellular and chemical mediators associated with acute lung injury. Many pharmacologic agents and various forms of high-frequency ventilation are being studied for their effectiveness in treating ARDS. We consider that the standard treatment continues to be PEEP and mechanical ventilation to reverse hypoxemia linked with the pathophysiologic changes of ARDS. There are no prospective randomized studies comparing the various end points of therapy used clinically at present. We believe, however, that early intervention, with institution of ventilatory support as soon as signs of acute respiratory failure develop, may eliminate some deaths due to progressive hypoxemia leading to the full adult respiratory distress syndrome. Therapy should be started at this time and maintained while the etiologic factors are identified and treated. Minimal ventilatory support should be continued until the primary diseases have resolved and the multisystem impact of the critical illness has lessened. Weaning from inspiratory (IMV) support, manipulation of expiratory pressures (PEEP), and airway control should then be more easily accomplished and more successful in practice.
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PMID:Ventilatory support in patients with ARDS. 390 48

Synergistic necrotizing cellulitis is a rapidly progressive infection of subcutaneous tissues and muscles. We report a rare case of synergistic necrotizing cellulitis of the chest wall occurring after a pneumonectomy in a patient without any predisposing factors. Despite rapid and aggressive treatment, the patient died in acute respiratory failure 28 h after the first signs of sepsis.
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PMID:Synergistic necrotizing cellulitis after pneumonectomy. 399 77

The hospital and ICU course of 98 patients who required mechanical ventilatory support longer than 72 h was reviewed to determine if mortality rates were influenced by admitting diagnosis. Patients with malignant diagnoses were compared to patients with nonmalignant diagnoses and to those admitted to the ICU after myocardial infarction or cardiorespiratory arrest. Although there was no significant intergroup difference in incidence of multiple organ system failure, age, and length of ICU and hospital stay, there was a much higher incidence of sepsis (p less than .05) and mortality (p less than .01) in the cancer group. Cancer patients and their families should be made aware of the extremely poor prognosis if prolonged acute respiratory failure develops.
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PMID:Acute respiratory failure: mortality associated with underlying disease. 406 9

From 1978 to 1983 a total of 328 patients was admitted to Royal Newcastle Hospital Intensive Care Unit with chest injuries; 255 had other injuries as well. Of the 328, 171 developed acute respiratory failure, 174 received mechanical ventilation (159 for acute respiratory failure) and 46 died. The commonest causes of death were head injury (19), sepsis (10) and uncontrollable haemorrhage (10). Associated head (131) and/or abdominal (89) injuries tripled mortality. Those without respiratory, cardiac, renal or hepatic failure (155) had a mortality rate of 5.8% while the remainder had mortality rates of 21.6%, 12.5%, 37.5% and 100%, for respiratory (171), cardiac (8), renal (8) and hepatic (5) failures, respectively. Shock was present on admission in 55, of whom 19 died. Sepsis developed in 59 and 14 with this complication died. Sepsis remains a potentially avoidable late cause of death and attention needs to be directed towards limiting invasive techniques of management to those which are necessary, and towards early diagnosis of abdominal injuries with early exploratory surgery. The best chance of survival in the initial phase of injury may lie in the establishment of an integrated regional trauma centre system together with improved pre-hospital and retrieval systems.
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PMID:Factors affecting outcome after chest injury. 407 48

Our experience in treating seven patients with severe crush injury of the lower limbs is described. They were brought to hospital 12 h after rescue and had no treatment until then. All seven developed acute renal failure due to myoglobinuria and dehydration. Five were anuric and three non-oliguric. All developed severe sepsis and two had also acute respiratory failure. No bleeding tendency was observed. They were treated along the following lines: early extensive fasciotomy and removal of dead tissues; early fluid challenge; early peritoneal dialysis and/or hemodialysis; high caloric, high protein nutrition; vigorous antibiotic therapy when infection was evident. There were no deaths in our patients. Our management and results are discussed and compared with those in the literature.
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PMID:Management of crush syndrome. 609 Dec 2

Seven episodes of rhabdomyolysis with acute renal failure (ARF) have been observed in 6 patients treated with various short-acting tranquilizers and antidepressants. Clinical features usually included severe hyperthermia, diffuse hypertonicity with or without coma, circulatory failure or unstable blood pressure, and often acute respiratory failure. Serum CPK were always elevated. The type of ARF was prerenal failure without oliguria in 5/7 episodes, and acute tubular necrosis in 2/7 episodes, requiring hemodialyses in one patient. Three patients died. In any case, the tranquilizers and antidepressants responsible for this syndrome were stopped, and electrolyte disorders and acidosis were corrected. Associated acute circulatory failure, septicemia and/or acute hepatic failure required prompt therapy, and artificial ventilation was required in 4 instances. The further use of phenothiazines, butyrophenones, sulpiride and their derivatives should be avoided in any patient having developed such an accident, whose pathophysiology is similar to that described in malignant hyperthermia of various origin.
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PMID:[Rhabdomyolysis with acute renal failure and malignant neuroleptic syndrome]. 613 93

The evolution of acute respiratory failure was studied in 27 patients with generalized peritonitis. The natural history of pulmonary failure indicates an incidence of 74% of atelectasis progressing to pneumonitis in the majority of patients. In 21 patients, similar aerobic microorganisms were recovered from the sputum and abdominal focus of infection. The emergence of gram negative pneumonia by the third day of onset of peritonitis appeared to add significantly to respiratory failure. In the management of respiratory failure, early use of positive and expiratory pressure with mechanical ventilation was associated with improvement or reversal of hypoxia. A high fatality (89%) was attributed to uncontrolled sepsis rather than to respiratory failure.
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PMID:Acute respiratory failure in patients with generalized peritonitis. 631 48


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