Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Sepsis-associated acute kidney injury (SA-AKI) is associated with significant morbidity and mortality. Immune dysregulation is a hallmark of sepsis, with important contributions to organ dysfunction including injury and repair mechanisms in AKI. Macrolide antibiotics, such as azithromycin, have previously demonstrated in preclinical models a myriad of immunomodulatory effects that may benefit critically ill patients with SA-AKI. The aim of this study was to determine if early receipt of azithromycin in SA-AKI is associated with a reduction in major adverse kidney events (MAKE) at hospital discharge. ⋯ Early exposure to azithromycin in SA-AKI is independently associated with lower odds of MAKE at hospital discharge.
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Multicenter Study
Heparin Binding Protein for The Early Diagnosis and Prognosis Of Sepsis In The Emergency Department: The Prompt Multicenter Study.
The validation of new biomarkers for the diagnosis and risk stratification of patients with sepsis at an early point is essential for successful treatment. Recent publications prompted us to investigate of heparin binding protein (HBP) for the emergency department (ED) admissions. ⋯ Admission HBP can be used as a tool for the early diagnosis of sepsis and for the risk of early death in the ED.
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The benefits of platelet thresholds for transfusion remain unclear. This study assessed the effect of two transfusion thresholds on the survival outcomes of patients with sepsis and thrombocytopenia. ⋯ In patients with sepsis and thrombocytopenia, platelet transfusion at a higher threshold was associated with a greater reduction in the 28- and 90-day mortalities than that at a lower threshold.
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Randomized Controlled Trial
Autoresuscitation of Poloxamer 188 in Pigs with Traumatic Severe Hemorrhage.
Poloxamer 188 (P188) is a copolymer surfactant with plasma membrane stabilizing action. This study investigated the effects of P188 on blood volume and coagulation in pigs after traumatic hemorrhage and hypotensive resuscitation. ⋯ Following traumatic hemorrhage and hypotensive resuscitation, P188 improved circulation volume and base deficit, but induced slower clotting initiation in pigs. Thus, P188 may have limited benefit as an initial small volume resuscitation adjunct following hemorrhage.
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Renal resistive index (RRI) has been used to evaluate renal blood flow. Our aim was to investigate the relation between RRI and global tissue hypoperfusion indices and their association with clinical outcome, in intensive care unit (ICU) patients. ⋯ Renal blood flow assessed by RRI, on ICU admission, correlates with global tissue hypoperfusion indices. In addition, RRI in combination with tissue perfusion estimation better predicts clinical outcome than RRI alone.