Articles: sepsis.
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American heart journal · Jun 2013
Multicenter Study Comparative StudyAtrial fibrillation among Medicare beneficiaries hospitalized with sepsis: incidence and risk factors.
Newly diagnosed atrial fibrillation (AF) during severe sepsis is associated with increased risks of in-hospital stroke and mortality. However, the prevalence, incidence, and risk factors associated with AF during the sepsis syndromes are unclear. ⋯ Atrial fibrillation is common among critically ill patients with sepsis. Acute factors, rather than preexisting cardiovascular comorbid conditions, are associated with increased risk for newly diagnosed AF during sepsis, suggesting that mechanisms of newly diagnosed AF during sepsis may differ from the general population of patients with AF.
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Multicenter Study Comparative Study
Severe sepsis and septic shock in patients with pre-existing non-cardiac pulmonary hypertension: contemporary management and outcomes.
To review treatment and outcomes of septic shock in patients with pulmonary hypertension (PH) managed at a tertiary care institution. ⋯ The severity of PH, new-onset AF, and longer vasopressor support were associated with poor outcomes in patients with PH who developed severe sepsis and septic shock.
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Pharmacogenomics J. · Jun 2013
Multicenter StudyBeyond single-marker analyses: mining whole genome scans for insights into treatment responses in severe sepsis.
Management of severe sepsis, an acute illness with high morbidity and mortality, suffers from the lack of effective biomarkers and largely empirical predictions of disease progression and therapeutic responses. We conducted a genome-wide association study using a large randomized clinical trial cohort to discover genetic biomarkers of response to therapy and prognosis utilizing novel approaches, including combination markers, to overcome limitations of single-marker analyses. Sepsis prognostic models were dominated by clinical variables with genetic markers less informative. In contrast, evidence for gene-gene interactions were identified for sepsis treatment responses with genetic biomarkers dominating models for predicting therapeutic responses, yielding candidates for replication in other cohorts.
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High levels of endotoxin have been reported as a risk factor for mortality in critical patients. Toraymyxin® is a column designed to remove circulating blood endotoxin by direct hemoperfusion widely used in Japan. ⋯ Performing two sessions of DHP-PMX treatment in a cohort of patients with abdominal sepsis is a feasible adjuvant therapeutic approach, safe in terms of coagulation abnormalities, can be done with different anticoagulation protocols, improves hemodynamic status and may impact on survival.
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Intensive care medicine · Jun 2013
Multicenter StudyCentral venous-arterial pCO₂ difference as a tool in resuscitation of septic patients.
To investigate the interchangeability of mixed and central venous-arterial carbon dioxide differences and the relation between the central difference (pCO₂ gap) and cardiac index (CI). We also investigated the value of the pCO₂ gap in outcome prediction. ⋯ From a practical perspective, the clinical utility of central venous pCO₂ values is of potential interest in determining the venous-arterial pCO₂ difference. The likelihood of a bad outcome seems to be enhanced when a high pCO₂ gap persists after 24 h of therapy.