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

Multiple organ system failure is a major cause of mortality in the adult respiratory distress syndrome (ARDS). We serially evaluated parameters of multiple organ function in 24 patients during the first week after the diagnosis of ARDS and related them to outcome. The adult respiratory distress syndrome was associated with sepsis (n = 16), postoperation (n = 7), and trauma (n = 1). Fourteen of the 24 patients (58 percent) died. Although there were no significant differences in the indices of pulmonary or renal dysfunction between survivors and nonsurvivors, evidence of hepatic dysfunction was different in the two groups. On the day we identified ARDS, serum bilirubin was 1.2 mg/dl +/- 0.9 mg/dl in patients who survived, and was 2.3 mg/dl +/- 2.8 mg/dl (chi +/- SD) in those who died. Initial serum glutamic oxalacetic transaminase (SGOT) and alkaline phosphatase levels were lower in survivors than in those who died (71 +/- 44 IU/L vs 399 +/- 807 IU/L, and 121 +/- 53 IU/L vs 269 +/- 243 IU/L, respectively). These abnormalities persisted during the first week of respiratory failure, with significant differences in serum bilirubin and alkaline phosphatase between survivors and nonsurvivors (p less than 0.01). The degree of pulmonary and renal dysfunction was similar in both groups. These data suggest that liver function may be a major determinant of survival in patients with the adult respiratory distress syndrome.
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PMID:Hepatic dysfunction in the adult respiratory distress syndrome. 292 17

The use of tracheostomies in burned patients with inhalation injuries is now reserved for specific indications rather than as prophylactic airway management. A 5-year burn center experience with tracheostomies used in this fashion is presented. Ninety-nine tracheostomies were performed in 3246 patients who had indications of prolonged respiratory failure or acute loss of airway. Although colonization of the sputum was universal, neither rates of pulmonary sepsis nor mortality were significantly increased in patients who underwent tracheostomies. Twenty-eight patients developed late upper airway sequelae, including tracheal stenosis (TS), tracheoesophageal fistula (TEF), and tracheoarterial fistula (TAF). Duration of intubation correlated only with development of TAF, whereas patients in whom TEF developed were significantly older and more likely to have evidence of tracheal necrosis at the time of tracheostomy. The pathogenesis of upper airway sequelae in these patients as divergent responses to the combined insults of inhalation injury, infection, and intubation is considered.
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PMID:Tracheostomies in burn patients. 293 Feb 91

The effect of two ranitidine intravenous infusion regimens on intragastric pH was studied in 134 critically ill patients admitted to 15 intensive care units. Intragastric pH was determined hourly for 30 hours. Those patients whose intragastric acidity fell below pH 4.0 for 3 or more of the first 6 hours were considered 'at risk' of developing stress-related gastric lesions and randomized to receive a 50 mg bolus of ranitidine together with a continuous intravenous infusion of either 0.125 or 0.25 mg kg-1 h-1 ranitidine for 24 hours. The maximal elevation in intragastric pH was achieved within 12 hours. The median intragastric pH for the last 20 hours of the infusion period was 5.9 for the higher dose group and 5.6 for the lower dose group. The increase in intragastric pH achieved by the two dosage regimens did not differ significantly throughout the 24 hour period. Patients having two or more of five major risk factors (head injury, major trauma, sepsis, respiratory failure/insufficiency and major surgery) had better overall control of intragastric pH on the higher dose of ranitidine than those receiving the lower dose. The majority of intensive care patients are likely to receive satisfactory treatment with the lower dosage regimen that was tested (0.125 mg kg-1 h-1). Those with multiple risk factors may, however, require treatment with higher doses of ranitidine (0.25 mg kg-1 h-1).
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PMID:A comparison of two ranitidine intravenous infusion regimens in critically ill patients. 297 34

Six patients accepted into a cardiac transplantation program have been supported with a Biomedicus LVAD. Five of the six patients deteriorated while awaiting a donor organ; the sixth was being supported with a device following mitral valve surgery and showed no recovery of ventricular function. In all cases the device was used only after all other therapeutic modalities had failed. The periods of support ranged from 2.5 to 31 days, mean of 10 days. Three patients underwent cardiac transplantation and all three have been discharged and are well. The three survivors were supported for 2.5, 3, and 31 days. Three deaths occurred in the patients supported for 5, 9, and 15 days, the causes being sepsis, massive cerebral embolism, and respiratory failure. Patients were for the most part maintained with some degree of heparinization, and hemolysis was a significant problem in only one patient and associated with a very small arterial return cannula. Flows were routinely maintained above 2.4 L/min/m2, and all showed recovery of other organ functions while being supported. The patient supported for 31 days was capable of limited mobilization by use of the removable drive system. The Biomedicus LVAD represents a relatively inexpensive support modality for patients awaiting cardiac transplantation.
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PMID:Nonpulsatile ventricular assist bridging to transplantation. 305 81

Malnutrition has a tremendous impact on respiratory functions. It affects respiratory muscle performance, lung structure, defense mechanisms, and control of ventilation and predisposes to respiratory failure and prolonged mechanical ventilation. Calling clinicians' attention to this common clinical problem is the first step toward developing a systematic approach to patient care in which correction of malnutrition is an integral part of the therapy. The increased morbidity and mortality in malnourished patients can be better understood when they are superimposed on other disease conditions, such as chronic lung disease, sepsis, trauma, and cardiovascular dysfunction. Most important is the fact that many of the consequences of malnutrition can be partially reversible with appropriate refeeding.
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PMID:Malnutrition and respiratory function. 308 50

The effect of preoperative total parenteral nutrition (TPN) on morbidity and mortality was studied in medical records of discharged surgical patients. Patients were classified into two groups on the basis of their ability to meet established criteria for malnutrition and the use of preoperative or postoperative TPN. The control group consisted of 44 patients who received TPN only after surgery or for less than 5 days preoperatively. The experimental group consisted of 26 patients who received treatment for at least 5 days before surgery and/or after surgery. Nutrition parameters measured included serum albumin, total lymphocyte count, hemoglobin, weight, and percent weight loss. Major septic complications (MSC) considered were intra-abdominal sepsis, wound dehiscence, septicemia, and pneumonia. Other complications included respiratory failure, congestive heart failure, fistulas, urinary tract infection, shock, and death. The experimental group showed improvements after surgery in the nutritional parameters listed and had a lower incidence of morbidity and mortality. Deficits in serum albumin, total lymphocyte count, and weight losses greater than or equal to 10% have been significantly (p less than .01) linked to the incidence of MSC. MSC also has been more frequently noted among patients who did not have TPN prior to surgery and who died following surgery. Therefore, preoperative TPN does appear to make a difference in the outcome of surgery.
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PMID:The effect of preoperative total parenteral nutrition on surgery outcomes. 311 53

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

In the last ten years, 17 patients with respiratory failure refractory to standard ventilator therapy have been treated with extracorporeal membrane oxygenation (ECMO) at the Toronto General Hospital. One patient was treated with ECMO twice. Four perfusions were veno-arterial, the remainder veno-venous. Perfusions ranged from 1 1/2 to 19 days, with a mean of six days. Ten patients died during treatment or soon after it was discontinued. Eight patients improved enough to allow resumption of standard ventilation, and four patients recovered sufficiently to have normal arterial blood gas levels on room air. Three are long-term survivors. Multiple surgical procedures have been performed successfully during use of ECMO including lung lavage, open lung biopsy and three lung transplants. Major complications include hemorrhagic diatheses and sepsis. The technique involves a substantial commitment of time and personnel but remains a tenable option for presumed reversible life-threatening respiratory failure.
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PMID:Ten-year experience with extracorporeal membrane oxygenation for severe respiratory failure. 316 65

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

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


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