Articles: sepsis.
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Am. J. Respir. Crit. Care Med. · Sep 1999
Randomized Controlled Trial Multicenter Study Clinical TrialImpact of immunomodulating therapy on morbidity in patients with severe sepsis.
We assessed the impact, over a 28-d period, of therapy with the tumor necrosis factor (TNF) neutralizing receptor fusion protein (p55-IgG) on the incidence of end-organ failures in patients with severe sepsis or early septic shock in a subgroup of 165 patients recruited into a randomized, multicenter clinical trial to receive placebo (n = 78) or a single infusion of p55-IgG, 0.083 mg/kg (n = 87). At study entry, distribution of organ dysfunctions and other baseline characteristics were similar for the two study groups. Treatment with p55-IgG was associated with a trend toward reduced 28-d mortality (p = 0.07), a decreased incidence of new organ dysfunctions (relative risk [RR], 0.57; 95% confidence interval [95% CI] 0.29 to 1.10, p = 0.10), and a decreased overall incidence-density of organ failures (RR 0.65; 95% CI 0.60 to 0.71, p = 0.0001). ⋯ For those patients who survived, this difference was 4.1 d (95% CI 1.6 to 6.6). Duration of ventilatory support was 3.2 d shorter (95% CI 0.1 to 6.3) among 28-d survivors who received p55-IgG, compared with placebo. In conclusion, in the population of septic patients studied, treatment with p55-IgG was associated with a trend toward shorter need for mechanical ventilatory support, a decreased length of stay (LOS), and a decreased incidence and duration of organ failure.
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Journal of critical care · Jun 1999
Randomized Controlled Trial Multicenter Study Clinical TrialIL-1ra administration does not improve cardiac function in patients with severe sepsis.
The purpose of this study was to investigate the effects of interleukin-1 receptor antagonist (IL-1ra) on myocardial function in septic patients. ⋯ IL-1ra administration has no effect on cardiac function in septic patients.
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Critical care medicine · Jun 1999
Randomized Controlled Trial Comparative Study Clinical TrialThe ex vivo antimicrobial activity and colonization rate of two antimicrobial-bonded central venous catheters.
Catheter-related sepsis is an important complication associated with the use of central venous catheters. Recent studies have suggested that antimicrobial-bonded catheters may reduce catheter colonization and catheter-related sepsis. The aim of this study was to determine the relationship between the antimicrobial activity and the colonization rate of two commercially available antimicrobial-bonded central venous catheters. ⋯ The Bio-Guard central venous catheter had greater ex vivo antimicrobial activity against MRSA, S. epidermidis, and E. faecalis compared with the ARROWgard catheter, and this was associated with a significantly lower rate of catheter colonization.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Use of tunneled femoral catheters to prevent catheter-related infection. A randomized, controlled trial.
The risk for catheter-related infection seems higher with femoral catheters than with catheters inserted at other sites. ⋯ The incidence of femoral catheter-related infections in critically ill patients can be reduced by using subcutaneous tunneling.
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Critical care medicine · Apr 1999
Randomized Controlled Trial Multicenter Study Clinical TrialEffects of ibuprofen on the physiology and survival of hypothermic sepsis. Ibuprofen in Sepsis Study Group.
The objective was to compare the clinical and physiologic characteristics of febrile septic patients with hypothermic septic patients; and to examine plasma levels of cytokines tumor necrosis factor alpha (TNF-alpha and interleukin 6 (IL-6) and the lipid mediators thromboxane B2 (TxB2) and prostacyclin in hypothermic septic patients in comparison with febrile patients. Most importantly, we wanted to report the effect of ibuprofen treatment on vital signs, organ failure, and mortality in hypothermic sepsis. ⋯ Hypothermic sepsis has an incidence of approximately 10% and an untreated mortality twice that of severe sepsis presenting with fever. When compared with febrile patients, the hypothermic group has an amplified response with respect to cytokines TNF-alpha and IL-6 and lipid mediators TxB2 and prostacyclin. Treatment with ibuprofen may decrease mortality in this select group of septic patients.