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

The purpose of this study was to evaluate the effect of direct hemoperfusion using a Polymyxin B (PMX) immobilized fiber column in septic patients with chronic renal failure after emergency surgery. Twenty-four renal failure patients, including 19 dialysis patients, with sepsis or septic shock were treated with direct hemoperfusion after emergency surgery. The 24 consecutive patients included nine with necrotic enterocolitis, six with colonic perforation due to diverticulitis, three with ruptured suture after colectomy, one with duodenal perforation, four with blood access infection, and one with an infected abdominal aortic aneurysm. The acute physiology and chronic health evaluation II score ranged from 13 to 26 (19 +/- 3). After completion of the first and the second hemoperfusion, mean blood pressure was significantly elevated from 69 +/- 12 mm Hg to 89 +/- 15 mm Hg and from 78 +/- 14 mm Hg to 95 +/- 13 mm Hg, respectively (P < 0.01). In addition, the catecholamine dosage needed to maintain the circulation could be decreased markedly after the treatment. The blood concentration of endotoxin in patients with Gram-negative sepsis, before and after the treatment, significantly decreased from 36 +/- 19 pg/mL to 19 +/- 19 pg/mL (P < 0.05). PMX was effective in patients with Gram-positive sepsis as well as Gram-negative sepsis. The 28-day mortality rate in patients who had emergency abdominal surgery was 10% (2/20), whereas that in patients with dialysis access infection was 50% (2/4). There was a significant difference in the Sequential Organ Failure Assessment (SOFA) score of all patients before and after treatment using PMX (9.2 +/- 3.3 vs. 7.5 +/- 3.5, P < 0.05). Furthermore, the SOFA score of survivors decreased significantly after PMX treatment (8.4 +/- 3.5 vs. 6.7 +/- 2.6, P < 0.01). Our results suggest that the early application of PMX may prevent multiple organ failure and improve survival in patients with chronic renal failure and sepsis/septic shock after emergency abdominal surgery, regardless of the type of pathogenic bacteria involved.
Ther Apher Dial 2004 Aug
PMID:Polymyxin B-immobilized fiber hemoperfusion after emergency surgery in patients with chronic renal failure. 1527 79

In the present study, we evaluated the clinical course and outcome of chronic peritoneal dialysis (PD) in a group of elderly patients. We enrolled 60 elderly patients (37 men, 23 women) starting PD over a 4-year study period and assessed outcomes. The mean age of our patients was 61 +/- 7 years; mean PD duration was 16 months (range: 3 - 40 months). Primary diseases were mainly diabetic nephropathy (54%) and glomerulonephritis (20%). In most patients, the PD modality was chosen because of cardiac instability. Complications during PD included peritonitis (1 episode per 9 patient-months) and exit-site infection (1 episode per 26 patient-months). Technique survival was 89% at 1 year. Patient survival was 83% and 32% at 1 and 4 years respectively. The most frequent causes of death were cerebrovascular accident, cardiac complications, and sepsis. We also compared predialysis parameters to final parameters for 20 deceased patients. Mean age in this group was 62 +/- 8 years, and mean PD duration was 13 +/- 8 months. Body mass index (BMI) was 23 +/- 3 kg/m2 predialysis versus 22 +/- 3 kg/m2 at the end of dialysis (p < 0.01); residual renal creatinine clearance was 4.4 +/- 2 mL/min versus 2.3 +/- 2 mL/min (p < 0.003), and weekly total Kt/V was 2.1 +/- 0.3 versus 1.8 +/- 0.3 (p < 0.002). Albumin showed positive correlations with BMI (r = 0.40, p < 0.02) and with creatinine (r = 0.40, p < 0.01). We conclude that survival of elderly patients on continuous ambulatory peritoneal dialysis is reasonable in the first year, and that further improvement may be achieved by initiating dialysis early, by increasing the dialysis dose, and by improving the patients' nutrition status.
Adv Perit Dial 2004
PMID:Outcome of continuous ambulatory peritoneal dialysis in a group of elderly patients from Bangladesh. 1538 6

Despite the use of potent antibiotics and intensive supportive care, the mortality among patients with sepsis and Gram-negative bacteremia remains high. In recent years, endotoxin adsorption therapy (PMX-DHP, polymyxin-direct hemoperfusion) has been widely used in Japan to remove endotoxin, a causative agent of sepsis. In septic patients whose clinical condition may change at any moment, the decision of when to perform blood purification in addition to conventional intensive care is a critical factor in the therapeutic strategy and prognosis. In the present study, we investigated the effect over time of PMX-DHP in sepsis. The subjects were 16 patients with systemic inflammatory response syndrome (SIRS) who required surgical treatment including a surgical operation and drainage. The following six parameters were compared between the first and second PMX-DHP: mean blood pressure and time-restricted urine at four time points - at baseline and at 6, 24 and 72 h after PMX-DHP; and white blood cell count, platelet count, base excess and Septic Severity Score (SSS) at 24 and 72 h after PMX-DHP. Mean blood pressure improved over time up to 24 h after both the first and second PMX-DHP. Time-restricted urine volume improved only at 6 h after the first PMX-DHP. White blood cell count improved over time up to 24 h after both the first and second PMX-DHP. The SSS improved at all time points studied except for 3 days after the second PMX-DHP. We conclude that PMX-DHP is expected to have important implications in terms of (i) correction of clinical conditions (by severity assessment); (ii) improvement of hemodynamics; (iii) possible anti-inflammatory effect; and (iv) possible improvement of oxygen metabolism in tissues.
Ther Apher Dial 2005 Apr
PMID:Effect over time of endotoxin adsorption therapy in sepsis. 1582 24

As a busy dialysis and apheresis unit and a referral center for vascular access, we had 850 hemodialysis catheter insertions in 2004, and >16 000 since 1976. According to data from literature and our experience, insertion should be guided by real-time ultrasonography whenever possible. Trisodium citrate in various concentrations (4-30%) seems to be a preferable locking solution (local anticoagulant and antimicrobial activity, no systemic anticoagulation, low price). Mupirocin at the exit site decreases the incidence of local infection and sepsis. The possible additive beneficial effects of the locking solution (citrate) and exit-site care with antibiotic (mupirocin, gentamycin) should be explored. According to our experience, temporary non-tunneled single-lumen catheters (one or two), with citrate locking and mupirocin at exit site, can be successfully used as a long-term vascular access in selected patients. The complications rate (malfunction and infection) of these catheters is comparable to tunneled, permanent catheters, but with the important advantage of easier insertion, exchange and removal.
Ther Apher Dial 2005 Jun
PMID:Hemodialysis catheters. 1596 93

A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant Staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, blood culture positivity persisted. The cerebrospinal fluid showed sterile meningitis. Subsequent imaging studies demonstrated aortic valve endocarditis and multiple mycotic aneurysms that appeared to include the intra- and extracranial vessels. The patient eventually died from sepsis. This case illustrates the aggressive and invasive nature of systemic infection with S. aureus and underscores the high morbidity and mortality associated with infections related to HD catheters.
Semin Dial
PMID:Mycotic aneurysms and death in a hemodialysis patient. 1607 60

Involvement of the activation of neutrophils and vascular endothelial cells in the pathology of sepsis has recently been reported. We therefore investigated whether direct hemoperfusion (DHP) with a polymyxin B immobilized fiber column (PMX) could reduce the level of plasminogen activator inhibitor-1 (PAI-1), an index of vascular endothelial cell activation. Twelve sepsis patients satisfying the following criteria were enrolled in the study: (i) stable global oxygen metabolism (oxygen delivery index>500 mL/min/m2 and oxygen consumption index>120 mL/min/m2); (ii) abnormal tissue oxygen metabolism (PCO2 gap: gastric mucosal PCO2 minus arterial PCO2 difference>8 mm Hg); and (iii) mean blood pressure>or=60 mm Hg. Direct hemoperfusion with PMX was performed twice (for 3 h each time) within 24 h. Plasminogen activator inhibitor-1 was measured a total of 5 times: before PMX-DHP, immediately after the first DHP with PMX session (3 h after the start), and 24, 48, and 72 h afterward. The PAI-1 value was 150+/-30.0 ng/mL before DHP with PMX, 178+/-60.0 ng/mL immediately after DHP with PMX, 90+/-22.1 ng/mL at 24 h after, 65+/-21.0 ng/mL at 48 h after, and 64+/-18.3 ng/mL 72 h after. The values were significantly lower from 48 h onward compared with baseline. These data suggest that DHP with PMX inhibits vascular endothelial cell activation.
Ther Apher Dial 2005 Aug
PMID:Hemoperfusion with an immobilized polymyxin B fiber column inhibits activation of vascular endothelial cells. 1607 71

Despite the commonly accepted indications for hemodialysis and extracorporeal depuritive techniques, some clinicians have come to rely on blood purification for clinical states where the targeted substance for removal differs from uremic waste products. Over the last decade, a number of studies have emerged to help define the application of extracorporeal blood purification (ECBP) to these "nonuremic" indications. This review describes the application of extracorporeal blood purification in clinical states including sepsis, rhabdomyolysis, congestive heart failure, hepatic failure, tumor lysis syndrome, adult respiratory distress syndrome, intravenous contrast exposure, and lactic acidosis. Additional comments are provided to review existing literature on thermoregulation and osmoregulation, including acute brain injury.
Semin Dial
PMID:The current state of nonuremic applications for extracorporeal blood purification. 1619 Nov 78

Many clinicians believe that de novo access is required when converting temporary hemodialysis (HD) catheters to long-term or permanent catheters. However, since vascular access sites are at a premium in the dialysis patient, it is important to preserve existing central venous catheters and conserve future access sites. In this retrospective study, data from 94 patients referred to interventional radiology for placement of long-term, tunneled HD catheters between July 2001 and September 2002 were reviewed. The study group consisted of 42 patients in whom the temporary catheter was exchanged for a peel-away sheath and a tunneled catheter inserted using the existing venous access site. The control group included 52 patients who received traditional de novo placement of permanent catheters. Based on available follow-up data, we report a 100% technical success rate, with 72% patency at 30 days in the study group (n = 32; mean age 58 years). By comparison, de novo catheter placement (n = 35; mean age 59 years) yielded a 100% technical success rate, with 83% patency at 30 days. The overall infection rate was 0.30 per 100 catheter-days (total 3036 catheter-days) and 0.36 per 100 catheter-days (total 3295 catheter-days), respectively (chi2 = 0.64, p > or = 0.05). There was no incidence of exit site infection, tunnel infection, or florid sepsis in either group. Likewise, no stenosis or bleeding complication was noted. Thus conversion of a temporary HD catheter to a tunneled catheter using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites.
Semin Dial
PMID:Conversion of temporary hemodialysis catheters to permanent hemodialysis catheters: a retrospective study of catheter exchange versus classic de novo placement. 1619 Nov 84

To cover intermediate sensitive Candida glabrata in ICU patients, fluconazole plasma peak levels at least in the range of 16-32 microg/ml appear necessary for treatment. Previous studies did not reach these fluconazole levels under continuous veno-venous haemofiltration (CVVHF) with dosages of 200-600 mg fluconzole daily. In the present study, nine patients simultaneously requiring CVVHF for treatment of acute oligoanuric renal failure and antimycotic therapy of Candida septicemia received fluconazole 800 mg/day. Fluconazole plasma levels were determined to evaluate whether this dosage is adequate to reach the advised fluconazole levels. Patients were dialysed on two consecutive days with an ultrafiltration rate (UF) of 1000 ml/h or 2000 ml/h, respectively, in a randomized order. The predilution was 800 ml/h and 1800 ml/h, respectively. The treatment was tolerated without adverse effects. All patients reached plasma fluconazole concentrations between 16 and 32 microg/ml, remaining in this range for a minimum of 1 up to 24 h with a mean of 9.6 h and a UF rate of 2000 ml/h, and 15.7 h with a UF rate of 1000 ml/h. So far, there are no in vivo data on the fluconazole plasma concentrations required for effective treatment. However, our data demonstrate, that at least the fluconazole concentrations desirable on the basis of in vitro susceptibility testing can be reached in critically ill patients on CVVHF in an ICU setting. However, in these patients, 800 mg fluconazole/day are necessary to achieve fungicidal drug concentrations.
Nephrol Dial Transplant 2006 Apr
PMID:Fluconazole dosing in continuous veno-venous haemofiltration (CVVHF): need for a high daily dose of 800 mg. 1631 Dec 63

Mortality rates in septic shock remain unacceptably high despite advances in our understanding of the syndrome and its treatment. Humoral factors are increasingly recognized to participate in the pathogenesis of septic shock, giving a biological rationale to therapies that might remove varied and potentially dangerous humoral mediators. While plasma water exchange in the form of hemofiltration can remove circulating cytokines in septic patients, the procedure, as routinely performed, does not have a substantial impact on their plasma levels. More intensive plasma water exchange, as high-volume hemofiltration (HVHF)can reduce levels of these mediators and potentially improve clinical outcomes. However, there are concerns about the feasibility and costs of HVHF as a continuous modality--very high volumes are difficult to maintain over 24 hours and solute kinetics are not optimized by this regimen. We propose pulse HVHF (PHVHF)-HVHF of 85 ml/kg/hr for 6-8 hours followed by continuous venovenous hemofiltration (CVVH) of 35 ml/kg/hr for 16-18 hours-as a new method to combine the advantages of HVHFimprove solute kinetics, and minimize logistic problems. We treated 15 critically ill patients with severe sepsis and septic shock using daily PHVHF in order to evaluate the feasibility of the technique, its effects on hemodynamics, and the impact of the treatment on pathologic apoptosis in sepsis. Hemodynamic improvements were obtained after 6 hours of PHVHF and were maintained subsequently by standard CVVHas demonstrated by the reduction in norepinephrine dose. PHVHFbut not CVVHsignificantly reduces apoptotic plasma activity within 1 hour and the pattern was maintained in the following hours. PHVHF appears to be a feasible modality that may provide the same or greater benefits as HVHFwhile reducing the workload and cost.
Semin Dial
PMID:Pulse high-volume hemofiltration in critically ill patients: a new approach for patients with septic shock. 1642 84


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