Articles: sepsis.
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The relationship between the partial pressure of oxygen in arterial blood (PaO2) and the prognosis of sepsis patients, and its potential variation over time, remains unclear. The optimal PaO2 range for sepsis patients has always been a contentious issue, with no consensus. We aimed to explore the association between different levels of PaO2 exposure over time and the 28-day mortality of sepsis patients, and to identify the optimal PaO2 range for sepsis patients within a specific time frame. ⋯ PaO2 in sepsis patients should be closely monitored. During the first 1-7 days of ICU admission, PaO2 should be maintained within the range of ≥130 mmHg and ≤ 160 mmHg. A dose-dependent relationship exists between high-risk PaO2 outside the range and patient outcome.
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Sepsis-associated encephalopathy (SAE) represents a severe complication of sepsis, substantially elevating both mortality and healthcare costs for patients. Gastrodin (GAS), a principal bioactive constituent of Gastrodia elata Blume, is neuroprotective in various neurological disorders, including ischemic stroke, epilepsy, Alzheimer's disease, and neuropathic pain. In this study, we sought to investigate whether GAS could serve as a protective agent against SAE. ⋯ Our study elucidated that GAS offers protection against SAE by suppressing ferroptosis through the activation of the COX-2/PGE2/GPX4 axis. This research validates the therapeutic potential of GAS and provides novel insights into potential therapeutic strategies for the management of SAE.
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Multicenter Study Observational Study
Steroid therapy for patients with septic shock: A multicenter observational study conducted in Japan.
Objective The Clinical Practice Guidelines for the Management of Sepsis and Septic Shock weakly recommend steroids for septic shock resistant to fluid resuscitation and vasopressors. This study aimed to describe the clinical practices for septic shock in the real world and to compare the association between the intermittent or continuous infusion of steroids and the prognosis. Methods This was a retrospective cohort study based on the AMOR-VENUS, in which Japanese intensive care unit (ICU) inpatients were enrolled between January and March 2018. ⋯ In the steroid group, hydrocortisone was used in 85.7%, the median daily dose was 192 mg, and the steroids were administered within 6 h of initiating vasopressor in 71.4%. The adjusted odds ratios of shock reversal on the 7th day and the ICU mortality for continuous versus intermittent infusion were 1.90 (95% confidence interval, 0.43-8.40) and 0.61 (0.10-3.85), respectively. Conclusion There was considerable variation in the criteria for the selection of patients and in the decision to use continuous or intermittent steroid infusion.
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Journal of critical care · Dec 2024
Early high-dose vasopressors in refractory septic shock: A cohort study.
Septic shock refractory to high-dose vasopressors confers unacceptably high mortality, however, the impact of timing of peak vasopressor dose exposure on outcomes is unknown. ⋯ In vasopressor-refractory septic shock, achieving the peak vasopressor dose within the first six hours of shock onset was associated with reduced mortality and more days alive and free from organ-support therapies.