Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.456
Filtrar
1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1844-1847, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018359

RESUMO

Sepsis is life threatening organ dysfunction caused by microcirculatory dysfunction. With progression of sepsis, the patients are likely to develop septic shock which is associated with multi organ dysfunction. To treat sepsis and septic shock, Thrombomodulin alfa (TM alfa) was developed. Direct observation of the microcirculation may provide new and rich information in terms of the effect of TM alfa on sepsis. Thus we conducted rodent experiments in which we observed the microcirculation with a non-contact optical imaging setup and measured lactate value from collected blood. From the acquired motion pictures, we estimated the blood velocity. As a result, from experiments, the sham rats showed no significant change in both lactate value and the blood velocity during the observation. On the other hand, lactate value of the septic model rats increased and the blood velocity of them decreased. Lactate value of the septic model rats treated with TM alfa decreased after showing an increase while the blood velocity of them increased after showing a decrease. These findings suggest that microcirculatory alteration may be a sign of sepsis as well as septic shock progression and that the TM alfa may be effective for the treatment of sepsis and septic shock.


Assuntos
Sepse , Choque Séptico , Animais , Anticoagulantes , Humanos , Microcirculação , Ratos , Sepse/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Trombomodulina
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2756-2759, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018577

RESUMO

Persisting tachycardia is often observed in resuscitated septic shock patients, and it is an independent risk factor for increased mortality. Recently, several drugs, such as esmolol and ivabradine, have been proved to be beneficial in HR control, but their overall impact on cardiac functions needs further investigation. The aim of this study is to study the effects of the two drugs on heart function in a protocol of polymicrobial septic shock and resuscitation. Twelve pigs were divided into three experimental groups: the esmolol-treated group (n=4), the ivabradine-treated group (n=5) and the control group (n=3). Cardiac autonomic activity was estimated by heart rate variability (HRV) indices and baroreflex sensitivity (BRS). The Buckberg index was adopted to evaluate myocardial oxygenation efficiency. Septic shock induced a severe autonomic dysfunction and a lower cardiac efficiency, not resolved by fluids resuscitation. The administration of the drugs improved both the HRV and the BRS, but this favourable condition was preserved after noradrenaline administration only in the esmolol group. The interaction of esmolol with the autonomic system is beneficial in septic shock to restore an improved condition of HRV and control, while ivabradine is not as effective when administered in adjunction to noradrenaline.


Assuntos
Propanolaminas , Choque Séptico , Animais , Humanos , Ivabradina/uso terapêutico , Propanolaminas/uso terapêutico , Choque Séptico/tratamento farmacológico , Suínos , Taquicardia/tratamento farmacológico
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 382-385, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018008

RESUMO

An elevated heart rate (HR) often persists in resuscitated septic shock patients, increasing the risk of mortality. Several drugs for HR control, such as esmolol and ivabradine, have been tested in the recent years, but their benefit on the overall cardiovascular system is still under investigation. The aim of this study is to investigate the hemodynamic effects of the two drugs in a protocol of polymicrobial septic shock and resuscitation, mainly focusing on the vascular function. Twelve pigs were divided into three experimental groups: the esmolol-treated group (n=4), the ivabradine-treated group (n=5) and the control group (n=3). The characteristic arterial time constant τ was computed on aortic arterial pressure (AoP), together with estimates of total arterial compliance and peripheral resistance. Power spectral analysis of aortic and radial diastolic BP oscillations was performed to estimate the sympathetic autonomic control of vascular tone. Septic shock induced a severe cardiac and vascular disarray, only partially resolved by resuscitation. The administration of esmolol, but not ivabradine, was beneficial both for cardiac and vascular function, thereby its adjunction to standard therapies could help to improve patient's condition and optimize the resuscitation strategies.Clinical Relevance-This study shows a potential beneficial effect of esmolol on the arterial tree.


Assuntos
Propanolaminas , Choque Séptico , Animais , Humanos , Ivabradina , Propanolaminas/farmacologia , Choque Séptico/tratamento farmacológico , Suínos , Taquicardia/tratamento farmacológico
4.
Crit Care Resusc ; 22(3): 191-199, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32900325

RESUMO

OBJECTIVE: To determine whether hydrocortisone is a cost-effective treatment for patients with septic shock. DESIGN: Data linkage-based cost-effectiveness analysis. SETTING: New South Wales and Queensland intensive care units. PARTICIPANTS AND INTERVENTION: Patients with septic shock randomly assigned to treatment with hydrocortisone or placebo in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial. MAIN OUTCOME MEASURES: Health-related quality of life at 6 months using the EuroQoL 5-dimension 5-level questionnaire. Data on hospital resource use and costs were obtained by linking the ADRENAL dataset to government administrative health databases. Clinical outcomes included mortality, health-related quality of life, and quality-adjusted life-years gained; economic outcomes included hospital resource use, costs and cost-effectiveness from the health care payer perspective. We also assessed cost-effectiveness by sex. To increase the precision of cost-effectiveness estimates, we conducted unrestricted bootstrapping. RESULTS: Of 3800 patients in the ADRENAL trial, 1772 (46.6%) were eligible and 1513 (85.4% of those eligible) were included. There was no difference between hydrocortisone or placebo groups in regards to mortality (218/742 [29.4%] v 227/759 [29.9%]; HR, 0.93; 95% CI, 0.78-1.12; P = 0.47), mean number of QALYs gained (0.10 ± 0.09 v 0.10 ± 0.09; P = 0.52), or total hospital costs (A$73 515 ± 61 376 v A$69 748 ± 61 793; mean difference, A$3767; 95% CI, -A$2891 to A$10 425; P = 0.27). The incremental cost of hydrocortisone was A$1 254 078 per quality-adjusted life-year gained. In females, hydrocortisone was cost-effective in 46.2% of bootstrapped replications and in males it was cost-effective in 2.7% of bootstrapped replications. CONCLUSIONS: Adjunctive hydrocortisone did not significantly affect longer term mortality, health-related quality of life, health care resource use or costs, and is unlikely to be cost-effective.


Assuntos
Anti-Inflamatórios/economia , Anti-Inflamatórios/uso terapêutico , Hidrocortisona/economia , Hidrocortisona/uso terapêutico , Choque Séptico/tratamento farmacológico , Análise Custo-Benefício , Feminino , Humanos , Masculino , New South Wales , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Choque Séptico/mortalidade
6.
Internist (Berl) ; 61(10): 1002-1009, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32865593

RESUMO

Sepsis and septic shock are still associated with a high mortality and morbidity. A decisive factor for improvement of the outcome is the prompt initiation of an effective antibiotic treatment. The early recognition of sepsis within the first hour is here one of the biggest challenges. Effective empirical treatment comprises purposefully selected broad-spectrum antibiotics and also combination treatment or antimycotics in special situations. De-escalation strategies to narrow down or shorten the treatment are safe and can limit the side effects.


Assuntos
Anti-Infecciosos/uso terapêutico , Sepse/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Humanos , Resultado do Tratamento
7.
JAMA ; 324(7): 642-650, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32809003

RESUMO

Importance: The combination of ascorbic acid, corticosteroids, and thiamine has been identified as a potential therapy for septic shock. Objective: To determine whether the combination of ascorbic acid, corticosteroids, and thiamine attenuates organ injury in patients with septic shock. Design, Setting, and Participants: Randomized, blinded, multicenter clinical trial of ascorbic acid, corticosteroids, and thiamine vs placebo for adult patients with septic shock. Two hundred five patients were enrolled between February 9, 2018, and October 27, 2019, at 14 centers in the United States. Follow-up continued until November 26, 2019. Interventions: Patients were randomly assigned to receive parenteral ascorbic acid (1500 mg), hydrocortisone (50 mg), and thiamine (100 mg) every 6 hours for 4 days (n = 103) or placebo in matching volumes at the same time points (n = 102). Main Outcomes and Measures: The primary outcome was change in the Sequential Organ Failure Assessment (SOFA) score (range, 0-24; 0 = best) between enrollment and 72 hours. Key secondary outcomes included kidney failure and 30-day mortality. Patients who received at least 1 dose of study drug were included in analyses. Results: Among 205 randomized patients (mean age, 68 [SD, 15] years; 90 [44%] women), 200 (98%) received at least 1 dose of study drug, completed the trial, and were included in the analyses (101 with intervention and 99 with placebo group). Overall, there was no statistically significant interaction between time and treatment group with regard to SOFA score over the 72 hours after enrollment (mean SOFA score change from 9.1 to 4.4 [-4.7] points with intervention vs 9.2 to 5.1 [-4.1] points with placebo; adjusted mean difference, -0.8; 95% CI, -1.7 to 0.2; P = .12 for interaction). There was no statistically significant difference in the incidence of kidney failure (31.7% with intervention vs 27.3% with placebo; adjusted risk difference, 0.03; 95% CI, -0.1 to 0.2; P = .58) or in 30-day mortality (34.7% vs 29.3%, respectively; hazard ratio, 1.3; 95% CI, 0.8-2.2; P = .26). The most common serious adverse events were hyperglycemia (12 patients with intervention and 7 patients with placebo), hypernatremia (11 and 7 patients, respectively), and new hospital-acquired infection (13 and 12 patients, respectively). Conclusions and Relevance: In patients with septic shock, the combination of ascorbic acid, corticosteroids, and thiamine, compared with placebo, did not result in a statistically significant reduction in SOFA score during the first 72 hours after enrollment. These data do not support routine use of this combination therapy for patients with septic shock. Trial Registration: ClinicalTrials.gov Identifier: NCT03389555.


Assuntos
Corticosteroides/uso terapêutico , Ácido Ascórbico/uso terapêutico , Insuficiência de Múltiplos Órgãos/prevenção & controle , Choque Séptico/tratamento farmacológico , Tiamina/uso terapêutico , Corticosteroides/efeitos adversos , Adulto , Idoso , Ácido Ascórbico/efeitos adversos , Infecção Hospitalar , Quimioterapia Combinada , Feminino , Humanos , Hiperglicemia/induzido quimicamente , Hipernatremia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Escores de Disfunção Orgânica , Modelos de Riscos Proporcionais , Choque Séptico/complicações , Tiamina/efeitos adversos , Falha de Tratamento
8.
Medicine (Baltimore) ; 99(30): e20762, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791667

RESUMO

OBJECTIVES: Septic shock is the major cause of childhood mortality. However, the application of corticosteroids remains controversial. This work aimed to analyze the source of controversy based on existing data and recent randomized controlled trials by meta-analysis and to assess whether it can avoid these factors to guide clinical treatment. METHODS: We searched the public databases up to 8 June 2019 and included only randomized controlled trials. The primary outcome was mortality. Sensitivity analysis, subgroup analysis, and dose-response meta-analysis were performed in this work. RESULTS: We included twelve studies consisting of 701 children in the meta-analysis. For primary outcome, the fixed-effect model showed steroids could significantly reduce the mortality compared to the control (Odds Ratio: 0.67; 95% confidence interval: 0.46-0.98; P = .041). However, the random-effect model showed a negative result (Odds Ratio: 0.69; 95% confidence interval: 0.32-1.51; P = .252). None of the subgroup results rejected the null hypothesis that the overall effect equaled zero. Dose-response effect analysis showed that increased dosage at a low dosage might reduce the mortality, while at a high dosage, increasing the dose might increase the mortality. Moreover, the grading of recommendations assessment, development, and evaluation level of evidence is low for mortality. CONCLUSIONS: Corticosteroid application is not recommended for septic shock children under current medical conditions.


Assuntos
Corticosteroides/uso terapêutico , Choque Séptico/tratamento farmacológico , Criança , Contraindicações de Medicamentos , Humanos
9.
Crit Care ; 24(1): 488, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762765

RESUMO

BACKGROUND: The effect of the timing of norepinephrine initiation on clinical outcomes in patients with septic shock is uncertain. A systematic review and meta-analysis was performed to evaluate the impact of early and late start of norepinephrine support on clinical outcomes in patients with septic shock. METHODS: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) and cohort studies from inception to the 1st of March 2020. We included studies involving adult patients (> 18 years) with septic shock. All authors reported our primary outcome of short-term mortality and clearly comparing early versus late norepinephrine initiation with clinically relevant secondary outcomes (ICU length of stay, time to achieved target mean arterial pressure (≥ 65 mmHg), and volume of intravenous fluids within 6 h). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). RESULTS: Five studies including 929 patients were included. The primary outcome of this meta-analysis showed that the short-term mortality of the early group was lower than that of the late group (odds ratio [OR] = 0.45; 95% CI, 0.34 to 0.61; P < 0.00001; χ2 = 3.74; I2 = 0%). Secondary outcomes demonstrated that the time to achieved target MAP of the early group was shorter than that of the late group (mean difference = - 1.39; 95% CI, - 1.81 to - 0.96; P < 0.00001; χ2 = 1.03; I2 = 0%). The volume of intravenous fluids within 6 h of the early group was less than that of the late group (mean difference = - 0.50; 95% CI, - 0.68 to - 0.32; P < 0.00001; χ2 = 33.76; I2 = 94%). There was no statistically significant difference in the ICU length of stay between the two groups (mean difference = - 0.11; 95% CI, - 1.27 to 1.05; P = 0.86; χ2 = 0.85; I2 = 0%). CONCLUSIONS: Early initiation of norepinephrine in patients with septic shock was associated with decreased short-term mortality, shorter time to achieved target MAP, and less volume of intravenous fluids within 6 h. There was no significant difference in ICU length of stay between early and late groups. Further large-scale RCTs are still required to confirm these results.


Assuntos
Agonistas alfa-Adrenérgicos/uso terapêutico , Norepinefrina/uso terapêutico , Choque Séptico/tratamento farmacológico , Estudos de Coortes , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
10.
Isr Med Assoc J ; 7(22): 338-342, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32692493

RESUMO

BACKGROUND: Methylene blue (MB), an inhibitor of nitric oxide synthesis and its effects is a potentially effective treatment against distributive shock states such as septic shock and vasoplegic syndrome. MB has been shown to alleviate vasoplegia and promote an increase in blood pressure. It may reduce mortality. However, in the pediatric population, there are few case reports and only one controlled study on administration of MB use for vasoplegia, sepsis, or shock in general. OBJECTIVES: To summarize the experience of administering MB for vasoplegic shock in a tertiary care pediatric intensive care unit. METHODS: A retrospective chart review of seven pediatric cases treated with MB for vasoplegic shock was conducted. MB was administered as a bolus followed by continuous infusion. The authors measured blood pressure, vasopressor, and inotropic support. Patient outcome was monitored. RESULTS: The authors observed a favorable hemodynamic response with an increase in blood pressure and a reduction in vasopressor and inotropic support needed following MB administration in six patients. No side effects were observed. Three patients eventually died one to two days later, secondary to their underlying disease. CONCLUSIONS: This case series adds to the small body of evidence in the pediatric population supporting the use of MB for distributive shock states and emphasizes the need for larger, randomized trials evaluating its role in vasoplegic shock treatment.


Assuntos
Hemodinâmica/efeitos dos fármacos , Azul de Metileno/administração & dosagem , Choque Séptico/tratamento farmacológico , Vasoplegia/tratamento farmacológico , Pré-Escolar , Estado Terminal , Inibidores Enzimáticos/administração & dosagem , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Masculino , Estudos Retrospectivos , Resultado do Tratamento
11.
Zhonghua Nei Ke Za Zhi ; 59(6): 451-459, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32486586

RESUMO

Objective: To evaluate the effect of corticosteroids on the prognosis of patients with septic shock. Method: In order to compare administration of corticosteroids with placebo or standard supportive care in adults with septic shock, clinical randomized controlled trials (RCT) were searched and selected, according to inclusion and exclusion criteria. A systemic assessment and meta-analysis was performed using RevMan 5.3. Result: A total of 16 RCTs enrolling 6 896 patients were finally included in present analysis. The corticosteroids group included 3 448 patients, and the control group included 3 448 patients. The 28-day mortality in corticosteroids group and control group were 28.6% and 31.2%, respectively (P=0.16). The 90-day mortality, the mortality in intensive care unit (ICU) and the mortality in the hospital between corticosteroids group and control group were 31.7% vs. 34.0% (P=0.16), 37.5% vs. 37.5% (P=0.87), and 41.0% vs. 43.9% (P=0.35) respectively, which indicated that corticosteroids could not improve the mortality of patients with septic shock. Subgroup analyses showed that hydrocortisone combined with hydrocortisone could reduce the 28-day mortality, and the 28-day mortality in corticosteroids group and control group were 37.7% and 43.3%, respectively (P=0.02). However, other types of corticosteroids had no influence on 28-day mortality. The incidence of gastrointestinal hemorrhage and super-infections showed no statistical difference in corticosteroids group and control group. However, incidence of hyperglycemia was significantly increased in corticosteroids group, 27.1% vs. 25% (P<0.000 1). Conclusion: Corticosteroids could not improve the mortality of patients with septic shock, and simultaneously, significantly increase incidence of hyperglycemia. Corticosteroids have no influence on the incidence of gastrointestinal hemorrhage and super-infections. Subgroup analyses showed that hydrocortisone combined with hydrocortisone could reduce the 28-day mortality.


Assuntos
Corticosteroides/uso terapêutico , Hidrocortisona/uso terapêutico , Choque Séptico/tratamento farmacológico , Corticosteroides/administração & dosagem , Adulto , China/epidemiologia , Hemorragia Gastrointestinal , Humanos , Hidrocortisona/administração & dosagem , Hiperglicemia/epidemiologia , Incidência , Unidades de Terapia Intensiva , Prognóstico , Choque Séptico/mortalidade
12.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(4): 458-462, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-32527353

RESUMO

OBJECTIVE: To study the effect of Xuebijing on inflammatory response and prognosis in patients with septic shock. METHODS: A prospective randomized controlled study was conducted. Eighty septic shock patients admitted to department of critical care medicine of the First Affiliated Hospital of Zhengzhou University from January to December in 2019 were enrolled. The enrolled patients were divided into Xuebijing group and control group by randomized number table method, with 40 cases in each group. Both groups were strictly followed the guidelines for the diagnosis and treatment of septic shock to take comprehensive treatment measures against sepsis. On this basis, Xuebijing group received intravenous 100 mL Xuebijing injection twice a day for 7 days. Baseline data of enrolled patients were recorded. The levels of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and heparin binding protein (HBP) were measured before treatment and 3, 7 and 10 days after treatment. Mechanical ventilation time, the length of intensive care unit (ICU) stay, total hospitalization time and 28-day mortality were recorded. The differences of every indicator between the two groups were compared. Independent risk factors affecting patient prognosis were analyzed by binary Logistic regression. RESULTS: (1) There was no significant difference in baseline data such as gender, age, infection site, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure score (SOFA) between the two groups. (2) The levels of serum inflammatory factors in both groups showed a decreasing trend after treatment. Compared with the control group, IL-6 and HBP in the Xuebijing group significantly decreased on day 7 [IL-6 (ng/L): 66.20 (16.34, 163.71) vs. 79.81 (23.95, 178.64), HBP (ng/L): 95.59 (45.23, 157.37) vs. 132.98 (73.90, 162.05), both P < 0.05]; on day 10, PCT, CRP, IL-6 and HBP significantly decreased [PCT (µg/L): 1.14 (0.20, 3.39) vs. 1.31 (0.68, 4.21), CRP (mg/L): 66.32 (19.46, 115.81) vs. 89.16 (20.52, 143.76), IL-6 (ng/L): 31.90 (13.23, 138.74) vs. 166.30 (42.75, 288.10), HBP (ng/L): 62.45 (29.17, 96.51) vs. 112.33 (58.70, 143.96), all P < 0.05]. (3) Compared with the control group, mechanical ventilation time and the length of ICU stay were significantly shortened and the total hospitalization expenses were significantly reduced in Xuebijing group [mechanical ventilation time (hours): 57.0 (0, 163.5) vs. 168.0 (24.0, 282.0), the length of ICU stay (days): 8.80±4.15 vs. 17.13±7.05, the total hospitalization expenses (ten thousand yuan): 14.55±7.31 vs. 20.01±9.86, all P < 0.05]. There was no significant difference in 28-day mortality and the total hospitalization time [28-day mortality: 37.5% vs. 35.0%, the total hospitalization time (days): 13.05±8.44 vs. 18.30±9.59, both P > 0.05]. (4) Patients were divided into death and survival groups according to the prognosis, and univariate analysis showed that white blood cell (WBC), neutrophil percentage (NEU%), CRP, lactic acid (Lac), APACHE II score, IL-6, HBP were the factors influencing the prognosis of patients. The above indicators were further analyzed by Logistic regression, which showed that CRP, IL-6, and APACHE II score were independent risk factors for prognosis [odds ratio (OR) was 1.007, 1.828, 1.229, all P < 0.05]. CONCLUSIONS: Combined with Xuebijing to treat septic shock can reduce the body's inflammatory response to a certain extent, thereby reducing the time of mechanical ventilation, shortening the stay of ICU and reducing the total cost of hospitalization. But it cannot reduce the 28-day mortality of patients with septic shock.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Choque Séptico , APACHE , Humanos , Unidades de Terapia Intensiva , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Choque Séptico/tratamento farmacológico
13.
Orv Hetil ; 161(23): 977-979, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32453696

RESUMO

Primary peritonitis is very rare in healthy children without predisposing factors. In the absence of unique factors and signs, the clinical picture does not differ from secondary peritonitis. Therefore, the diagnosis is almost always an intraoperative diagnosis. Case report: We admitted a previously healthy 15-year-old boy with symptoms of acute enteritis. Within 24 hours, he developed acute abdomen and signs of septic shock. Computer tomography of the abdomen revealed air bubbles in the middle of the abdomen and near the terminal ileum. Suspecting perforation, we performed an emergency laparotomy. However, there was no perforation to be found in the background of the purulent peritonitis. We initiated empirical broad-spectrum antimicrobial therapy which we later adjusted. Septic shock and complications were treated successfully. We could not find the source of the primary peritonitis. Since hospital discharge, the child has been asymptomatic. In primary peritonitis, due to the nonspecific, rapidly progressing symptoms, an emergency surgery can not be avoided. With proper antibiotics and supportive therapy, the prognosis is favourable. Orv Hetil. 2020; 161(23): 977-979.


Assuntos
Peritonite/cirurgia , Abdome Agudo/etiologia , Adolescente , Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência , Humanos , Laparotomia , Masculino , Peritonite/diagnóstico , Choque Séptico/tratamento farmacológico
15.
Chest ; 158(2): e55-e58, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32335068

RESUMO

We report the case of an 88-year-old man with coronavirus disease 2019 (COVID-19) who presented with ARDS and septic shock. The patient had exquisite BP sensitivity to low-dose angiotensin II (Ang-2), allowing for rapid liberation from high-dose vasopressors. We hypothesize that sensitivity to Ang-2 might be related to biological effect of severe acute respiratory syndrome coronavirus 2 infection. The case is suggestive of a potential role for synthetic Ang-2 for patients with COVID-19 and septic shock. Further studies are needed to confirm our observed clinical efficacy.


Assuntos
Angiotensina II/metabolismo , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Idoso de 80 Anos ou mais , Angiotensina II/efeitos dos fármacos , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Síndrome do Desconforto Respiratório do Adulto/etiologia , Choque Séptico/complicações , Choque Séptico/metabolismo
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(2): 134-139, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-32274994

RESUMO

OBJECTIVE: To investigate the effect of terlipressin on prognosis of adult septic shock patients. METHODS: All randomized controlled clinical trials (RCT) of terlipressin in the treatment of adult septic shock patients from January 1980 to December 2019 were retrieved from CNKI, Wanfang, SinoMed, PubMed, Embase, Springer Link, Cochrane Library, Google Scholar, and etc. Patients in the treatment group received terlipressin while patients in the control group received norepinephrine or other vasopressors. Main outcome indicator was mortality. Secondary outcome indicators included the incidence of severe adverse events, limb peripheral ischemic events and renal complications. Literature screening, data extraction and quality evaluation were conducted by two researchers respectively. Meta-analysis was performed with RevMan 5.3 software. Funnel plot was used to analyze the publication bias. RESULTS: A total of 507 related literatures were retrieved. According to the inclusion and exclusion criteria, 8 RCT studies were finally included, with a total of 811 patients. One study was considered to have a lower risk of bias, 6 studies had uncertain risk of bias, and 1 study had a higher risk of bias. The Meta-analysis showed that terlipressin did not significantly improve the mortality of septic shock patients compared with the control group [odds ratio (OR) = 0.89, 95% confidence interval (95%CI) was 0.67-1.19, P = 0.45]; increased the incidence of severe adverse events (OR = 2.98, 95%CI was 1.99-4.45, P < 0.000 01); there was a tendency to increase the incidence of limb peripheral ischemic events, but without statistical difference (OR = 10.81, 95%CI was 0.88-133.19, P = 0.06); and reduced the incidence of renal complications (OR = 0.30, 95%CI was 0.09-0.96, P = 0.04). Funnel plot analysis indicated that there might be publication bias in a study on case fatality and incidence of serious adverse events in the included literature. No significant publication bias was found in studies on the incidence of limb peripheral ischemic events and the incidence of kidney-related complications. CONCLUSIONS: The available evidence suggests that terlipressin could not significantly improve mortality in adult's septic shock patients, but it may reduce the incidence of renal complications. A tendency to increase the incidence of limb peripheral ischemic events in the terlipressin-treated group needs to be emphasized.


Assuntos
Choque Séptico/diagnóstico , Choque Séptico/tratamento farmacológico , Terlipressina/uso terapêutico , Vasoconstritores/uso terapêutico , Adulto , Humanos , Norepinefrina , Prognóstico
17.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(2): 210-214, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-32275008

RESUMO

OBJECTIVE: To investigate the effects and mechanisms of low-dose hydrocortisone on myocardial injury in early septic shock rats. METHODS: Seventy-two healthy male Sprague-Dawley (SD) rats were divided into Sham group, lipopolysaccharide (LPS) model group (LPS group) and low dose hydrocortisone intervention group (LD group) according to the random number table method, with 24 rats in each group. The rat model of septic shock was produced by intravenous injection of LPS at 20 mg/kg. Sham group was injected with an equal amount of physiological saline. The LD group was injected 5 mg/kg of hydrocortisone via right femoral vein after model establishment. Sham group and LPS group were injected with an equal amount of physiological saline. Blood pressure and heart rate (HR) of rats in each group were continuously monitored. In each group, 8 rats were sacrificed for arterial blood gas analysis at 0, 3 and 6 hours after model establishment, and the level of plasma N-terminal B-type brain natriuretic peptide precursor (NT-proBNP) was detected by enzyme linked immunosorbent assay (ELISA). The expressions of cleaved-caspase-3 and nuclear factor-κB p65 (NF-κB p65) were detected by Western Blot. Myocardial tissue was harvested 6 hours after model establishment, the histopathological changes were observed by hematoxylin eosin (HE) staining, and the apoptosis rate of myocardial cells was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL). RESULTS: After LPS injection, mean arterial pressure (MAP) decreased significantly at 1 hour, then gradually increased, and was significantly higher than Sham group at 6 hours. There was no significant change in HR, and the difference was not statistically significant compared with Sham group. Blood lactic acid (Lac), base excess (BE), plasma NT-proBNP level, myocardial tissue caspase-3 and NF-κB p65 expression increased with the extension of time, all reach the peak in 6 hours, and significantly higher than Sham group. After early treatment with low-dose hydrocortisone in septic shock, MAP showed an increasing trend and Lac, BE decreased slowly. At 6 hours, MAP, Lac and BE were significantly lower than those in the LPS group [MAP (mmHg, 1 mmHg = 0.133 kPa): 98.6±7.5 vs. 106.1±8.5, Lac (mmol/L): 1.29±0.08 vs. 2.42±0.37, BE (mmol/L): 4.45±0.57 vs. 8.18±1.03, all P < 0.05]. The level of plasma NT-proBNP, and the expressions of caspase-3 and NF-κB p65 in myocardial tissue were significantly lower than those in LPS group at 3 hours and 6 hours after low-dose hydrocortisol treatment [NT-proBNP (ng/L): 2 740.56±97.31 vs. 4 425.60±743.32 at 3 hours, 2 638.81±205.12 vs. 4 993.01±373.78 at 6 hours; caspase-3/GAPDH: 0.567±0.045 vs. 0.841±0.162 at 3 hours, 0.496±0.071 vs. 1.116±0.172 at 6 hours; NF-κB p65/GAPDH: 0.852±0.734 vs. 1.232±0.115 at 3 hours, 0.783±0.047 vs. 1.383±0.215 at 6 hours, all P < 0.05]. HE staining results showed that myocardial cells in the LPS group were broken and inflammatory cells infiltrated. The myocardial histopathological changes in LD group were significantly less than those in LPS group. TUNEL staining showed that the apoptosis of myocardial cells in LPS group increased, and the apoptosis rate was significantly higher than that in Sham group [(82.41±1.57)% vs. (5.77±0.69)%, P < 0.05]. The apoptosis rate in LD group was significantly lower than that in LPS group [(27.82±1.77)% vs. (82.41±1.57)%, P < 0.05]. CONCLUSIONS: Low-dose hydrocortisone plays a protective role in the myocardial injury of early septic shock, and its mechanism may be related to the inhibition of caspase-3 and NF-κB p65 expression, the reduction of apoptosis rate and myocardial inhibition.


Assuntos
Anti-Inflamatórios/uso terapêutico , Hidrocortisona/uso terapêutico , Miocárdio , Choque Séptico/tratamento farmacológico , Animais , Anti-Inflamatórios/administração & dosagem , Hidrocortisona/administração & dosagem , Masculino , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa
18.
BMC Infect Dis ; 20(1): 270, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264829

RESUMO

BACKGROUND: Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar. CASE PRESENTATION: A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. However, the situation of the illness deteriorated into refractory septic shock and multiple organ dysfunction rapidly,although the treatment of anti-sepsis was used in 3rd-5th day. Orientia tsutsugamushi was determined to be the causative pathogen by Next-generation sequencing of his plasma sample in 6th day. Then, the patient was treated with doxycycline and azithromycin and recovered quickly. CONCLUSIONS: Next-generation sequencing was a new diagnostic technology and could identify scrub typhus in accurately and fast without the pathognomonic eschar.


Assuntos
Bacteriemia/diagnóstico , Doenças Transmissíveis/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Orientia tsutsugamushi/genética , Tifo por Ácaros/diagnóstico , Choque Séptico/diagnóstico , Idoso , Animais , Azitromicina/uso terapêutico , Bacteriemia/tratamento farmacológico , Mordeduras e Picadas , Doenças Transmissíveis/tratamento farmacológico , Confiabilidade dos Dados , Doxiciclina/uso terapêutico , Humanos , Masculino , Tifo por Ácaros/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Resultado do Tratamento , Trombiculidae/microbiologia
19.
Crit Care ; 24(1): 117, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32216822

RESUMO

BACKGROUND: Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. METHODS: A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). RESULTS: Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03-6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04-4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12-0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08-4.24, p = 0.02). CONCLUSIONS: Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.


Assuntos
Candidemia/complicações , Candidemia/mortalidade , Hospitalização/estatística & dados numéricos , Choque Séptico/microbiologia , Choque Séptico/mortalidade , Abdome , Fatores Etários , Idoso , Candidemia/tratamento farmacológico , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Choque Séptico/tratamento farmacológico , Espanha/epidemiologia , Taxa de Sobrevida , Resultado do Tratamento
20.
BMC Infect Dis ; 20(1): 223, 2020 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171281

RESUMO

BACKGROUND: Streptococcus suis is a zoonotic pathogen that causes serious systemic infections in pigs and occupation-related infections in humans who contact with pigs or pork products. In China, it has caused two outbreaks of human infection and surveillance for S.suis has been ongoing since last time. CASE PRESENTATION: Two cases of meningitis and sepsis caused by S. suis were reported in this study. Both patients work in relation to the pork trade, a risk factor for S. suis infection. The outcome was favorable after a prolonged ceftriaxone therapy but one patient was left with mild hearing loss. Two isolates were identified as sequencing type (ST) 7, S. suis serotype 2 (SS2), which is one the most prevalent and cause two outbreaks in China. Whole-genome sequencing (WGS) revealed that a high degree identity was noted in the genome organizations and sequences between two sporadic ST7 SS2 isolates in this study and representative epidemic virulent isolates. Major differences among them are two sporadic ST7 SS2 isolates lacked a virulence factor called agglutinin receptor and an 89 K pathogenicity island (PAI), which plays important role in the pathogenesis of streptococcal toxic shock syndrome (STSS). A summary about STs of human infection with S. suis in China was completed. The result showed ST1 and ST7 were still the major STs and several novel STs were successfully discovered in different provinces. CONCLUSIONS: Our results enhanced the understanding of the ability to cause life-threatening infections in humans and the distribution and evolution of the S. suis in China.


Assuntos
Epidemias , Doenças Profissionais/microbiologia , Sorogrupo , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/genética , Streptococcus suis/genética , Doenças dos Suínos/epidemiologia , Idoso , Animais , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , China/epidemiologia , Genoma Bacteriano/genética , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus suis/isolamento & purificação , Suínos/microbiologia , Doenças dos Suínos/transmissão , Resultado do Tratamento , Fatores de Virulência
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA