Articles: sepsis.
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Nihon Geka Gakkai zasshi · Jun 1993
[Tissue oxygen metabolism and cellular injury in patients with septic multiple organ failure (SMOF)].
The present study was undertaken to study the pathophysiology of SMOF from the aspect of tissue hypoxia. Seventeen postoperative SMOF patients (9 survivors, 8 non-survivors) and 14 control ICU patients were evaluated their oxygen delivery (DO2I) and oxygen consumption (VO2I) in relation to cellular injury score (CIS) derived from 3 different intracellular metabolic indices, arterial ketone body ratio (AKBR), osmolality gap (OG) and blood lactate. ⋯ Further deterioration of CIS was accompanied with decreased VO2I. These data suggest that impaired tissue oxygen metabolism correlates with cellular injury and might be one of mechanisms of organ failure in SMOF patients.
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Advances in our understanding of the immune system and the body's normal response to injury have allowed for the development of innovative new therapies for critically ill patients. In the area of sepsis, significant information is being generated to support the concept that adjunctive immunotherapy can improve both morbidity and mortality. Investigational agents directed at immunotherapy targets that are currently being studied include colony stimulating factors, immunoglobulins, anticytokines, and opioid antagonists. This article reviews the basis for the use of such adjunctive immunotherapy in the critically ill patient.
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The present study was designed to investigate the effects of fluid administration on survival in endotoxemic or septicemic male Sprague-Dawley rats. Endotoxemia was induced by intravenous injection of Escherichia coli lipopolysaccharide (LPS), and septicemia produced by cecal ligation and puncture (CLP). In endotoxemic animals deprived of fluid resuscitation, 7-day survival following injection of LPS at doses of 1, 3, or 10 mg/kg LPS were 70% (n = 10), 30% (n = 10), and 0% (n = 10), respectively. ⋯ The improvement in survival with fluid infusion in the LPS and CLP models cannot be attributed to catheter implantation, or to improved hemodynamic parameters in the LPS model. The improvement in survival in the LPS model with fluid infusion was associated with attenuated increases in TNF alpha levels. Furthermore, these studies illustrate that fluid-resuscitated and nonfluid-resuscitated experimental animal models should not be considered equivalent.
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The systemic inflammatory response syndrome (SIRS) is an acute illness characterized by generalized activation of the endothelium. The most severe form of the syndrome is found in patients with shock due to gram-negative sepsis. We examined both animal and limited human data for the contribution of cytokines to this syndrome. ⋯ Preliminary clinical studies suggest that blockade may be useful in treating human SIRS. The various strategies for blocking IL-1 and TNF are presented; in addition, their mechanism(s) of action and safety in humans are discussed. We conclude that based on animal studies and preliminary clinical trials, strategies to block IL-1 or TNF may benefit patients with the syndrome, although thorough clinical trials have not been completed.