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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 20-month experience of mechanical ventilation (MV) in the newborn infants (birth weight greater than or equal to 1500 g) from a developing country is described. A total of 41 neonates (4.1% of total admissions to the Neonatal Intensive Care Unit) were treated with MV. The mode of MV was intermittent positive pressure ventilation and continuous positive airway pressure via nasotracheal intubation. The mean birth weight and gestational age were 2544 g and 36.2 weeks, respectively. The mean age at the start of MV was 141 h and the mean duration was 54 h. The indications for MV were respiratory distress syndrome (18), aspiration pneumonia (8), non-aspiration pneumonia (6), apnoea (8) and tetanus neonatorum (1). The complications encountered during MV were sepsis (26.8%), pulmonary haemorrhage (21.9%), congestive heart failure (17.1%), pneumothorax (14.6%) and intraventricular haemorrhage (7.3%). Post-extubation atelectasis was observed in 29.6% of cases. The overall survival rate was 43.9%. The risk factors for a poor outcome were birth weight less than 2000 g, prematurity and late referrals to the Neonatal Intensive Care Unit.
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PMID:Mechanical ventilation in newborn infants. 284 22

Hickman catheter insertion is usually accomplished surgically by means of either cutdown on the cephalic or jugular veins or percutaneous placement in the operating room. Sixty Hickman catheters were placed percutaneously in an interventional radiology suite in 51 consecutive patients. Complications included one case of pneumothorax and pulmonary artery air embolism (1.7%); one case of brachiocephalic vein thrombosis (1.7%); one case of arterial puncture in a patient with a coagulopathy causing mediastinal hemorrhage, sepsis, and eventual death (1.7%); four cases of catheter sepsis (6.7%); and three cases of suspected local infection or inflammation (5.0%). These rates are comparable to those in surgical series. Radiologic methods increased the convenience, decreased the time and cost of insertion, and enabled superior fluoroscopic control. Modern angiographic materials provide improved safety during access to the subclavian vein. The authors conclude that radiologic Hickman catheter placement offers significant advantages over traditional surgical placement.
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PMID:Radiologic placement of Hickman catheters. 291 52

All hospitalized patients except infants (a total of 1,647 patients) who received central venous TPN solutions at UCDMC from 1981 through 1985 were studied to determine the incidence of complications from the use of TPN. A complication was considered to have occurred if the patient experienced obvious morbidity, mortality, or both; an event known to be deleterious, despite a lack of demonstrable morbidity; or premature loss of the central venous catheter. Complications related to catheter placement occurred in 5.7 percent of patients, sepsis in 6.5 percent, mechanical complications in 9 percent, and metabolic complications in 7.7 percent. The incidence of induction of sepsis increased during 1984 to 1985 due to the introduction of multilumen central venous catheters. The most frequent catheter placement complications were hemorrhage and pneumothorax. Major venous thrombosis and nursing mishaps were the most common mechanical complications. Metabolic complications were infrequent and were generally not severe after adjustment of the protocol in late 1981. Four patients (0.2 percent) died from TPN-associated complications: a child on home TPN who underwent a catheter change and in whom hyperosmolar hyperglycemic coma developed, a patient with end-stage chronic obstructive pulmonary disease in whom tension pneumothorax occurred, a patient who died from complications of subclavian artery laceration, and a patient who died from Candida septicemia. Complications of TPN are frequent and may be severe. Quality assurance mechanisms for identification of these complications are necessary and should form the basis for the establishment of appropriate protocols.
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PMID:Complications of parenteral nutrition. 308 44

The impact of early prophylactic use of intravenous indomethacin on the incidence and severity of periventricular-intraventricular hemorrhage and patent ductus arteriosus in 199 oxygen-requiring premature infants (less than or equal to 1300 g birth weight) was prospectively investigated. The trial was controlled, the infants were randomized, and the investigators were unaware of the group assignments. Patients with minimal (grade I) or no periventricular-intraventricular hemorrhage determined by prestudy echoencephalography were randomized within two birth weight subgroups (500 to 899 and 900 to 1300 g) to receive either prophylactic indomethacin (n = 99) or an equal volume of saline-vehicle placebo (n = 100). The first dose (0.2 mg/kg) was given within 12 hours of delivery and two subsequent doses (0.1 mg/kg) were administered at 12 hourly intervals. Prophylactic indomethacin significantly reduced the incidence of grades II to IV periventricular-intraventricular hemorrhage. Intraventricular hemorrhage was half as common in infants given prophylactic indomethacin as in control infants (23% v 46%, P less than .002). The reduction was manifested in both birth weight subgroups. Results of this study also confirmed a lower incidence of clinically significant patent ductus arteriosus in infants who received prophylactic indomethacin in contrast to those who received placebo (11% v 42%, P less than .001). No significant differences were found between treatment and control groups in the duration of oxygen therapy, mechanical ventilation, or hospitalization or in the incidence of pneumothorax, chronic lung disease, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Early prophylactic indomethacin initiated within 12 hours of delivery is effective in reducing the incidence of intraventricular hemorrhage as well as clinically significant patent ductus arteriosus in very low birth weight premature infants.
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PMID:Prophylactic indomethacin for prevention of intraventricular hemorrhage in premature infants. 317 14

Extracorporeal membrane oxygenation (ECMO) has been successful (greater than 80% survival) in 35 centers in greater than 900 newborns with severe respiratory failure having an estimated mortality of greater than 80% on conventional management. During the last 3 years we have treated 79 newborns with 74 survivors (94%). Their diagnoses included meconium aspiration, persistent fetal circulation, respiratory distress syndrome, congenital diaphragmatic hernia, and sepsis. Seven patients (9%) had life-threatening intrathoracic complications requiring emergent intervention while on ECMO: tension hemothorax (3), tension pneumothorax (2), and pericardial tamponade (2). Pericardial tamponade and tension hemothorax and pneumothorax show a similar pathophysiology of increasing intrapericardial pressure and decreasing venous return. Perfusion is initially maintained by the nonpulsatile flow of the ECMO circuit before further decrease in venous return results in decreasing ECMO flow and progressive hemodynamic deterioration. Each of the seven patients demonstrated a clinical triad that includes increasing PaO2 and decreasing peripheral perfusion (as evidenced by decreasing pulse pressure and decreasing SvO2) followed by decreasing ECMO flow with progressive deterioration. The diagnoses were confirmed by transillumination, chest x-ray, or cardiac echocardiogram. Initial emergent placement of a percutaneous drainage catheter was temporizing in all seven cases. However, four patients required emergent thoracotomy for definitive treatment while still on ECMO. All seven patients were weaned from ECMO and are short-term survivors (6 months to 3.5 years). As use of ECMO for newborn severe respiratory failure increases, responsible physicians must be familiar with life-threatening intrathoracic complications and appropriate treatment strategies.
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PMID:Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation. 320 57

We assessed the complications associated with emergency department placement of subclavian vein catheters in trauma and burn patients, reviewing the charts of all of the 441 patients admitted to the burn-trauma unit through the emergency department during 1983. Fifty-two patients (12%) had infraclavicular placement of subclavian catheters while in the emergency department. Sex, age, insertion site, blood pressure at time of insertion, indications for placement, catheters left in place, and complications were recorded. Patients with severe chest trauma or known pneumothorax or hemothorax on the ipsilateral side of line placement were excluded. The eight complications (15%) directly attributable to the procedure itself were one pneumothorax, two hematomas at the site of insertion, one knotted catheter, two misplaced catheters, and two episodes of sepsis, confirming the higher complication rates for emergency subclavian catheter insertion. Two upper extremity, 14 gauge percutaneously placed intravenous catheters are usually sufficient for resuscitation; femoral and cutdown routes offer additional sites for massive resuscitation. Subclavian catheterization is seldom needed in the emergency room. Any intravenous lines inserted in the emergency room should be changed within 24 hours to minimize infection.
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PMID:Emergency department infraclavicular subclavian vein catheterization in patients with multiple injuries and burns. 335 64

As more patients are requiring permanent central venous catheters (PCC) for long term venous access, several associated complications have become evident, including: 1, sepsis; 2, thrombophlebitis; 3, insertion complications, such as unsuccessful placement, bleeding and pneumothorax, and 4, PCC transection with tip embolization. At our institution, 162 PCC were placed by way of cutdown or percutaneously. Sepsis occurred in 20 per cent (0.13 septic episodes per 100 catheter days), nearly always involving immunocompromised patients. Twenty-five per cent resolved with use of antibiotics and without removal of PCC. Two patients presented with clinical thrombophlebitis; both were treated with removal of PCC and anticoagulant medication. Failure of insertion was highest with the cephalic cutdown approach, and pneumothorax was highest with the subclavian approach. Transection of PCC is associated with the percutaneous subclavian approach and is heralded by intermittent catheter function and a "pinch-off" sign on roentgenogram. Methods of preventing these complications are emphasized herein.
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PMID:Prevention of complications in permanent central venous catheters. 338 Nov 87

In order to identify potential problems and thereby minimise the risk of invasive vascular catheterisation, we conducted an analysis of these procedures in our medical intensive care unit with the aid of a computer database. During the 9-month study period 114 patients underwent 247 invasive vascular catheterisations, including pulmonary arterial (PA), central venous (CV) and arterial catheter insertions. Complications unique to PA catheterisation included burst catheter balloons (6%) and one serious episode of arrhythmia. The incidence of pneumothorax (2.8%) and inadvertent arterial puncture (2.2%) with PA and CV lines and our sepsis rate of 3.6% for all types of catheters are consistent with other studies. Arterial catheterisation proved to be relatively free of complications. Our study confirmed the safety of invasive vascular catheterisation. However, we review the precautions needed to limit potential complications.
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PMID:Invasive vascular catheterisation in the critically ill. 361 7

Percutaneous Transhepatic Biliary Drainage (PTHBD) was performed in 56 consecutive patients with severe acute cholangitis, during a period of one year. An immediate decompression effect with a "good" response was achieved in 46 (82.2%), who usually became afebrile within 18 to 24 hours, and "poor" response in 10 (17.8%). Five died (8.93%) in a subsequent operation. No mortality was associated with the use of PTHBD. Complications related to the procedure occurred in 12 of the 56 patients (21.4%). Hemobilia was the major complication. The other complications were intraabdominal hemorrhage, bleeding from the puncture site, transient hypotension, catheter occlusion and/or dislodgement, bile leak, pneumothorax and hemothorax. Two with hemobilia, one with intraabdominal hemorrhage and the other with bile leak required an emergency operation. PTHBD procedures can be lifesaving in biliary sepsis. Once infection and hyperbilirubinemia are controlled, rational subsequent therapy can be formulated for the underlying disease.
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PMID:Percutaneous transhepatic biliary drainage for acute cholangitis. 367 29

"Half-way", Secalon-Seldy, soft venous catheters, 40 cm long, were inserted by basilic (n = 90) and cephalic (n = 31) veins at the fossa cubiti in 121 patients (71 men and 50 women) aged between 19 and 88 years whose heights varied from 152-197 cm. The inserted catheter lengths approximated 1/5 of the patient's height. Sixty-five per cent of 106 radiologically investigated catheter tips were located proximally in the axillary veins, and 34% distally in the subclavian veins. The duration of catheterization varied from 1 to 44 (mean 9 +/- 7) days (means +/- 1 s.d.). Perfect function was recorded in 93 of 121 catheters. No serious, but some minor complications were registered such as temporary interruption of infusion flow with movements of the arm (n = 12), partial or total catheter occlusion (n = 16), leakage of the infusate at the insertion site (n = 1), and pain along the vein during infusion (n = 2). Five patients (4%) developed thrombophlebitis 2-.10 days after insertion. Pull out phlebographies at catheter withdrawal (4-35 days after insertion) were performed in 36 patients. Radiological thrombi were small and similar to those recorded in another 53 phlebographies of "long-way" brachial catheters of similar stiffness. Neither local infection nor episodes of sepsis were registered over a period of 1,081 catheter days. "Half-way" catheters proved able to take over all the functions of both peripheral and central venous catheters, lacking the frequent complications (phlebitis and infection) of the former, and the serious mechanical complications (pneumothorax, vein perforations, and injuries of the ductus thoracicus, nerves, arteries, and heart) of the latter.
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PMID:"Half-way" venous catheters. IV. Clinical experience and thrombogenicity. 386 73


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