Articles: sepsis.
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Nihon Geka Gakkai zasshi · May 1995
Clinical Trial[Endotoxin eliminating therapy in patients with severe sepsis--direct hemoperfusion using polymyxin B immobilized fiber column].
PMX is a blood purifier containing chemically immobilized polymyxin B fiber (PMX-F). To evaluate its effectiveness on the severe septic human, direct hemoperfusion (DHP) using a PMX-F was performed for 2 hours. The changes in various circulatory parameters, symptoms of septic shock, and blood endotoxin concentration and the survival rate, were evaluated. ⋯ DHP was performed 61 times in 42 patients, of whom 38 had septic MOF, 25 with gram-negative bacterial infection. At the initiation of this treatment, 33 patients were receiving vasoactive agents, and 36 were under artificial ventilation via endotracheal intubation. The mean septic severity score (SSS) in all patients was about 46.6. Twenty-two of the 42 survived. The endotoxin concentration (mean +/- S.E.; pg/ml) was 85.0 +/- 27.2 immediately before treatment but significantly decreased to 57.5 +/- 28.4 after treatment (n = 50) and to 28.2 +/- 4.4 on the next day (n = 23) (p < 0.01). The endotoxin concentrations at the inlet and outlet of the PMX also significantly decreased 30 minutes after the initiation of DHP. Circulatory parameters, BP, CI, SVR and Vo2I demonstrated significant improvement. Body temperature also showed the same results. The removal of endotoxin in the blood using PMX was effective for severe sepsis or septic MOF. Various symptoms due to endotoxin was alleviated after this treatment.
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This article addresses controversial issues in the field of intra-abdominal sepsis with particular attention to major changes in management that have evolved during the past decade. In the area of diagnostics, scanning techniques have revolutionized the ability to detect loculated collections, although many of these techniques are of limited value in the early stages of inflammation. The greatest debate concerns the relative merits of scanning techniques; the author's choice is CT scans with contrast, although ultrasonography is preferred in patients who cannot be transported and is probably preferred for pelvic infections. ⋯ Nevertheless, surveys of practicing surgeons indicate that most actually combine this oral preparation with parenteral agents as well. The final controversy concerns percutaneous drainage, which has now become a standard technique for dealing with intra-abdominal abscesses in 50% to 90% of cases. This controversy has sometimes been seen as a territorial battle between surgeons and radiologists, and most cases are clearly the prerogative of one discipline or the other, but many are in a gray zone in which clearly defined indications are not readily available.
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The onset of sepsis in neonates while on extracorporeal membrane oxygenation (ECMO) may portend adverse results. Nevertheless, ECMO has been used as a therapy in the management of septic conditions. This study assessed morbidity and mortality in neonates in whom septic complications developed while they were on ECMO. ⋯ Oxygenator thrombi and hemofilter malfunction occurred more often in septic patients (p < 0.03). New strategies to prevent sepsis and associated thrombotic and metabolic complications may be indicated. A critical reappraisal of continued aggressive support may be warranted when septic complications develop in neonates during ECMO.
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Editorial Review
Interleukin-1 and interleukin-1 antagonism in sepsis, systemic inflammatory response syndrome, and septic shock.
Interleukin-1 (IL-1) is one of several proinflammatory cytokines produced during infection, sepsis, and the systemic inflammatory response syndrome (SIRS) that serves to initiate the host inflammatory response and to integrate nonspecific immunity. Many of IL-1's biologic effects are beneficial to the host in times of stress, but when produced for extended periods of time or in excessive quantities, IL-1 contributes to morbidity and mortality. ⋯ This article will review the role for IL-1 in sepsis and septic shock, and the function and status of the IL-1 receptors and IL-1 receptor antagonist in modulating IL-1 actions. The results of investigations of IL-1 inhibition in animal models and in human subjects with sepsis and septic shock will also be reviewed.
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A group of 125 patients with abdominal sepsis admitted to the intensive therapy unit between January 1990 and June 1993 were reviewed to determine outcome. Mean(s.d.) age was 66(12) years and admission Acute Physiology And Chronic Health Evaluation (APACHE) II score 23(9). The hospital mortality rate was 63 per cent. ⋯ No patient survived to become completely disabled. The factors associated with survival did not predict subsequent quality of life. Accurately defining the characteristics of this heterogeneous group of patients is a prerequisite for improved treatment, patient selection and research.