Articles: sepsis.
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J. Thorac. Cardiovasc. Surg. · Mar 1995
Comparative StudyResults of extracorporeal membrane oxygenation in neonates with sepsis. The Extracorporeal Life Support Organization experience.
Use of extracorporeal membrane oxygenation for treatment of respiratory failure caused by sepsis is controversial because of concerns over survival benefit and hemorrhage-related complications. To evaluate the impact of the primary diagnosis of sepsis on outcome, we reviewed data from 6853 neonates in the Extracorporeal Life Support Organization Registry and defined two groups: group 1 (n = 1060), all patients undergoing extracorporeal membrane oxygenation with a primary diagnosis of sepsis; group 2 (n = 5793), those with any other primary diagnosis. A multivariate logistic regression analysis that considered 15 variables present before extracorporeal membrane oxygenation (including age, sex, birth weight, prior cardiopulmonary arrest, arterial blood gas results, and ventilator settings) was used to compare outcomes between groups. ⋯ Neonates with sepsis are more likely to have neurologic, renal, and metabolic complications from extracorporeal membrane oxygenation but may still achieve a survival benefit equivalent to those without sepsis. From these data, extracorporeal membrane oxygenation should not be withheld from neonates solely on the basis of sepsis. Rather, management strategies should focus on limiting the incidence or severity of the common complications.
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Critical care medicine · Mar 1995
Renovascular interaction of epinephrine, dopamine, and intraperitoneal sepsis.
To determine the effect of intraperitoneal sepsis on the systemic and renal actions of the continous infusion of epinephrine or dopamine, and during the concurrent administration of both drugs. ⋯ These results do not support the routine use of low-dose dopamine, and demonstrate a change in renovascular responses to catecholamines during intraperitoneal sepsis. The infusion of epinephrine at 40 micrograms/min had few deleterious effects on the kidney, and augmented both MAP and systemic DO2. Its role as a catecholamine in the management of sepsis may need to be reconsidered.
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During the last two decades the reported risk of overwhelming postsplenectomy infection (OPSI) has resulted in a conservative approach to splenic trauma, with the aim of splenic salvage. The appropriateness of this strategy is now questioned. The risk of OPSI varies with age and indication for splenectomy from less than 1% in adults to more than 4% in children. ⋯ A prerequisite for splenic preservation procedures should be a haemodynamically stable patient without other intraabdominal injuries. The benefits derived from non-operative treatment of splenic salvage procedures may be overshadowed by the potential risk of transfusion-related bacterial and viral diseases. Polyvalent pneumococcal vaccines given early after splenectomy appear to reduce the incidence of OPSI substantially.
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To document the risk of catheter sepsis associated with central venous catheter changes every 7 days in paediatric burn patients, and analysis of data collected prospectively on 234 such catheters was performed. During an 18-month period there were 301 acutely burned children admitted to a regional paediatric burn facility of whom 53, with an average burn size of 42 per cent TBSA, required 234 central venous catheters. A central venous catheter management protocol was followed which included catheter changes every 7 days. ⋯ There was no difference in sepsis rates between catheters placed at a new site or replaced by guidewire. There were no deaths attributed to catheter-related sepsis. We conclude that a protocol allowing for catheter change to a new site, or replacement by guidewire, every 7 days was associated with a low risk of catheter sepsis in paediatric burn patients.