Articles: sepsis.
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The nutritional needs of critically ill septic patients or patients with multiple injuries are often difficult to estimate. Indirect calorimetry can simply and accurately determine individual caloric and nutritional needs, especially in cases of critically ill patients with complicated injuries. This prospective study compared the measured energy expenditures of 30 patients using indirect calorimetry with their predicted basal energy expenditure according to the Harris-Benedict equation, or their calculated energy expenditure derived from basal energy expenditure times, an activity factor, and a stress factor. ⋯ Their stress factors could be modified as "0.97 + 0.0125 x SSS" to get a more accurate Harris-Benedict calculation. For the 15 patients with multiple injuries in whom the measured energy expenditure per kilogram was 34.9 +/- 1.6 kcal/kg, the ISS offered the best correlation with measured energy expenditure per kilogram (r = 0.84, Y = -31.47 +/- 1.73 X). Their stress factors could be modified as "1.04 + 0.0077 x ISS" to get a more accurate Harris-Benedict calculation.
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The pro-inflammatory cytokines, tumor necrosis factor (TNF) and interleukin-1 (IL-1), are widely assumed to participate in the initial systemic manifestations of sepsis. While the toxicities of excessive cytokine activity have been well described in animal models, clinical evaluations often fail to detect circulating forms of these mediators in critically ill patients. It is now evident that a diverse array of host mechanisms serve to attenuate or block excessive cytokine influences. ⋯ Recombinantly derived forms of these natural cytokine antagonists have proven effective in preventing many of the adverse consequences of sepsis. Prospective clinical trials of these agents are currently underway. While results of such trials are not fully available at present, it is likely that one or more therapies directed against TNF and IL-1 may prove effective in the management of septic shock.
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Journal of anesthesia · Jan 1993
Modification of hepatic protein kinase C with phorbol myristate acetate and staurosporine alters hemodynamics in the perfused rat liver.
Activation of protein kinase C (PKC) has been implicated in the pathogenesis of endotoxicosis and severe sepsis. Since hepatic blood flow and metabolism have been known to be altered in endotoxicosis and sepsis, we studied the hemodynamic effect of PKC modulation with phorbol 12-myristate 13-acetate (PMA) and staurosporine (St) on the perfused rat liver. The liver was isolated from overnight-fasted male Sprague-Dawley rats and placed in a recirculating perfusion apparatus. ⋯ Pretreatment with St significantly attenuated the flow reduction by PMA. St significantly suppressed the flow reductions by 4 x 10(-6) M of prostaglandin E2 and D2. These results suggest that the PKC inside the liver may play an important role in the regulation of hepatic blood flow during endotoxicosis and sepsis.
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Sepsis and multiple organ failure are major problems in medical and surgical intensive care units. Critical illness polyneuropathy occurs in 70% of these patients. Difficulty in weaning from the ventilator is an early sign. ⋯ Other effects on muscle are cachectic myopathy and panfascicular muscle fibre necrosis. A variety of combinations of these conditions may affect the same patient. Only well-designed prospective studies will determine the true effect of these medications on the neuromuscular system in septic patients.