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

12 patients of an intensive care unit on respirator with peritonitis respectively septic complications were treated with 300 mg/die Ranitidine or 2000 mg Cimetidine/die administered via perfusor infusion under the conditions of a randomized double blind study. Both groups under investigation were comparable in respect to age, sex and grade of risk of stress induced bleedings. With ranitidine under the dosage mentioned above, a prophylactic sufficient control, yet not a complete control of intragastric pH-value was accomplished. With Cimetidine as monotherapy, however, even under the high dosage of 2000 mg/die, no successful control of the intragastric pH could be achieved. With 3 patients even the combinations of 2000 mg Cimetidine/die and 2 X 10 mg Pirenzepine/die did not prove sufficient. Especially for intensive care patients with a difficult to regulate intragastric pH (patients with peritonitis, sepsis) Ranitidine according to our findings is to prefer to Cimetidine for the prophylaxis of bleeding of gastroduodenal lesions.
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PMID:[Control of the intragastric pH value in infection and peritonitis by ranitidine versus cimetidine. A double-blind study]. 609 49

The effects of ranitidine, an H(2)-receptor antagonist, on gastric pH, incidence of upper gastrointestinal hemorrhage and postoperative metabolic alkalosis were evaluated in 23 pediatric liver transplant recipients. Intragastric pH probes were inserted postoperatively and pH was monitored for 48 h. Ranitidine was infused for 48 h at 0.2 mg kg(minus sign1) h(minus sign1) (0.15 with renal impairment) and increased once by 0.05 mg kg(minus sign1) if the pH was less than 4.0 for 4 h. The pretreatment gastric pH was 2.1 plus minus 0.7; ranitidine infusion raised the pH to 6.8 plus minus 0.6 (p greater-than-or-equal 0.05). An intragastric pH > 4 was achieved in 64 plus minus 36 min, with a median ED(50) (50% of maximum response) of 0.24 mg kg(minus sign1). The pH was < 4 for 5.3 plus minus 4.8% of the time after the initial response. Loss of pH control occurred in three patients, two of whom had bacterial sepsis. The incidence of upper gastrointestinal bleeding and metabolic alkalosis was evaluated by comparing the study patients to age- and weight-matched historic controls from our center. Bleeding occurred in 1 of 23 (4%) study patients compared to 7 of 23 (30%) controls (p greater-than-or-equal 0.05). Metabolic alkalosis did not develop in the study patients at 24 or 48 h postoperatively (p greater-than-or-equal 0.05 versus controls). Whole blood cyclosporine levels and hepatocellular enzymes were similar in the two groups. We conclude that continuous intravenous infusion of ranitidine in the postoperative pediatric liver transplant recipient raises intragastric pH, decreases the incidence of upper gastrointestinal hemorrhage and prevents the development of metabolic alkalosis.
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PMID:Continuous Infusion Ranitidine in Postoperative Pediatric Liver Transplant Patients: Effects on Intragastric pH, Gastrointestinal Bleeding and Metabolic Alkalosis. 1183 1

Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes. The aim of this paper was to identify how the Critical Care Outreach Team at one local hospital implemented the severe sepsis resuscitation care bundle for patients in the emergency department (ED) and on the general wards. It will include a presentation on the various ways the team raised the profile of severe sepsis and the care bundle at hospital and at national level. It also includes audit data that have been collected. The results showed that if the resuscitation care bundle was implemented within the first 24 h of hospital admission, mortality was 29%, whereas if the care bundle was instigated after this time mortality was more than at 49%. Audit data showed that the commonest sign of severe sepsis seen in patients in the ED and on wards was tachypnoea. This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle.
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PMID:Implementing the severe sepsis care bundles outside the ICU by outreach. 1788 15

Necrotizing enterocolitis (NEC) is a devastating disease of premature infants, with a mortality rate of 10-50%. It is uncommon in term infants and in premature infants who have not yet been fed. Most commonly NEC develops suddenly in a preterm infant who was otherwise well, with initial symptoms of abdominal distention, bilious or bloody emesis or gastric aspirates, hematochezia, and pneumatosis intestinalis, and sometimes progresses quickly to include bowel perforation, acidosis, shock, and death. Trigger factors (i.e. perinatal hypoxia, mild infection or formula feeding) cause focal mild intestinal mucosal injury. In the presence of proliferation of commensal bacteria, local breakdown of mucosal barrier may cause entry of bacterial products (e.g. lipopolysaccharides, platelet-activating factor). Endothelial platelet-activating factor and/or tumor necrotizing factor and/or direct stimulating effects of polymorphonuclear leukocytes cause proinflammatory cascade and focal necrosis, which increase the entry of large amounts of bacterial toxins, and then severe NEC, sepsis, and shock develop. Therapies for the prevention of NEC that appear to have some benefit are breastfeeding and antenatal steroids, and probably probiotics. Enteral immunoglobulin, polyunsaturated fatty acids, and arginine or glutamine supplementation are therapies for the prevention of NEC that do not appear to be of benefit. Enteral erythropoietin and enteral granulocyte colony-stimulating factor are promising novel therapies. Treatment options are limited to gut rest, parenteral nutrition, broad-spectrum antibiotics, and surgical interventions for enteral perforation. Two commonly used methods for NEC with intestinal perforation are laparotomy or primary peritoneal drainage ("patch, drain and wait"); however, the preferred method is controversial.
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PMID:What next in necrotizing enterocolitis? 1836 84

Background and Objectives. Antacids are often prescribed to preterm infants due to misdiagnosis of gastro-oesophageal reflux. This suppresses gastric acidity, a major defence mechanism against infection. This study aims to determine if ranitidine and omeprazole use in very low birth weight (VLBW) neonates, <1500 grams, is associated with increased risk of late onset sepsis, necrotising enterocolitis (NEC), and mortality. Methods. Retrospective analysis was conducted on neonates, <1500 grams, born and admitted into the Neonatal Intensive Care Unit at The Canberra Hospital during the period from January 2008 to December 2012. Information regarding late onset sepsis, NEC, mortality, ranitidine/omeprazole use, and other neonatal/hospital factors was collected for each neonate. Results. 360 neonates were evaluated, 64 received ranitidine and/or omeprazole, and 296 had not. There were no statistically significant differences in incidence of late onset sepsis (OR = 0.52, CI = 0.24-1.1, and p = 0.117), NEC Stage 2 and above (OR = 0.4, CI = 0.05-3.2, and p = 0.7), or mortality (OR = 0.35, CI = 0.08-1.5, and p = 0.19) between the two groups. After adjusting significant differences in neonatal and hospital factors, risk of late onset sepsis was significantly lower in those that received ranitidine/omeprazole (OR = 0.28, CI = 0.13-0.65, and p = 0.003). Conclusions. Ranitidine and omeprazole use in VLBW preterm infants may not be associated with an increased risk of infection, NEC, and mortality.
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PMID:Morbidity and Mortality in Preterm Infants following Antacid Use: A Retrospective Audit. 2799 Jan 66