Articles: sepsis.
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Sepsis remains an uncommon, but potentially devastating problem in the previously healthy pregnant patient. Although septic sequelae, including organ failure and shock, are unusual, they are likely to lead to morbidity and mortality as high, or higher, than in the general population. At the present time, hemodynamic support, surgery, and antimicrobial therapy aimed at reducing polymicrobial aerobic and anaerobic infection remain the gold standard of therapy. New antimediator and anti-inflammatory therapies offer promise of improved survival in the general and obstetric population with severe sepsis.
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Gram-negative bacterial infections are difficult to control and often lead to septic shock or septic syndrome. Many physiologic changes in sepsis are due to bacterial triggering of host responses. ⋯ New therapeutic agents are currently being evaluated in animal and human studies. By combining these advances with adequate antibiotic therapy, it may be possible to improve overall survival in patients with gram-negative sepsis.
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Review
Gastric intramucosal pH: a noninvasive method for the indirect measurement of tissue oxygenation.
Monitoring the adequacy of tissue oxygenation is an important goal in the care of the critically ill patient. Global alterations in tissue oxygenation are inferred from changes in systemic oxygen transport (defined as the product of cardiac output and arterial oxygen content) and total oxygen consumption. These parameters, however, cannot measure the level of oxygenation of specific tissue beds, in particular those that are first affected by hypoxia, such as the gastrointestinal tract and the kidneys. ⋯ Gastrointestinal tonometry is a relatively noninvasive device that appears capable of measuring metabolic changes produced by hypoxia. Because of the sensitive nature of the gastrointestinal mucosa, these changes often occur well in advance of other, more common, indices of hypoxia. The use of the tonometer may become a routine procedure in the overall monitoring of critically ill patients.
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Critical care medicine · Jun 1992
Review Practice Guideline GuidelineAmerican College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.
To define the terms "sepsis" and "organ failure" in a precise manner. ⋯ The use of these terms and techniques should assist clinicians and researchers who deal with sepsis and its sequelae.