Articles: sepsis.
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To review the difficulties associated with defining sepsis and its complications and to characterize the role of the proinflammatory cytokines in the development of human septic shock, adult respiratory distress syndrome, and the systemic inflammatory response syndrome. ⋯ Sepsis and its complications constitute a complex biological cascade that may be defined by specific clinical characteristics. The clinical variability in these events suggests that definitions based on clinical end points be used in combination with assessments of severity of illness to best define patient status, predict clinical course, and guide treatment decision-making.
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To review the role of antimediator therapy in the inflammatory cascade associated with sepsis, and to review the status of animal and clinical studies being conducted on novel therapies for septic shock. ⋯ Clinical trials of antiendotoxin antibodies have not shown them to have therapeutic benefit. New agents that neutralize or antagonize the cellular effects of endotoxin may provide an alternative means to inhibit endotoxin effects during severe Gram-negative infections. Anti-interleukin-1 and antitumor necrosis factor-alpha therapies have demonstrated efficacy in animal models, but the results have been inconsistent in human trials. Preliminary results from clinical trials of cytokine antagonists suggest that these therapies may be effective in the most severely ill patients. Further clinical trials will be required to determine the therapeutic role of these agents in septic shock.
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Acute renal failure in the critically ill patient may have a wide range of clinical presentations and necessitate numerous nursing interventions. This article reviews the etiologies, pathophysiology, and diagnoses related to acute kidney dysfunction with a particular emphasis on sequelae related to sepsis. Additionally, the nursing care for managing patients with acute renal failure with the available renal replacement modalities is discussed.
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Sepsis and organ failure are significant causes of morbidity and mortality in the geriatric patient. A number of factors contribute to increased risk of septic complications in the elderly. ⋯ Atypical presentation is also common with infection in the elderly. The key to blunting the effects of severe infection in the elderly is rapid diagnosis and aggressive resuscitation.
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Crit Care Nurs Clin North Am · Jun 1994
ReviewThe systemic inflammatory response, sepsis, and multiple organ dysfunction: new definitions for an old problem.
Sepsis is one of the leading causes of morbidity and mortality in the United States. Until recently, there was much variation in the definition and descriptions of sepsis. This article outlines the report of the consensus conference between the Society of Critical Care Medicine and the American College of Chest Physicians, which established recommendations for the terminology to be used when describing sepsis. An overview of the epidemiology of sepsis and the current state-of-the-art therapy are also provided.