Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Acute respiratory distress syndrome (ARDS) develops in patients with predisposing conditions that induce systemic inflammatory response such as sepsis, pneumonia, acute pancreatitis, major trauma, or multiple transfusions. Sepsis is the most common cause of ARDS. Sepsis-related ARDS patients have significantly lower PaO2 /FiO2 ratios than patients with non-sepsis-related ARDS. Furthermore, their recovery from lung injury is prolonged, weaning from mechanical ventilation less successful, and extubation rate slower. ⋯ The pool of data on treatment possibilities for patients with ARDS grows every year, with specifically designed mechanical ventilation strategies. Ventilator modes and adequate positive end-expiratory pressure (PEEP) settings play a major role in these strategies. However, how can we best apply these experimental and clinical data to everyday clinical practice? This article emphasizes protective ventilation as a measure that is proven to reduce mortality in this group of patients, when systematically and consistently applied.
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Septic cardiomyopathy is a reversible myocardial dysfunction in patients with sepsis. Depression in myocardial contractility is detected in more than 40% of patients with severe sepsis or septic shock. Sepsis-induced myocardial dysfunction (SIMD) is one of the main predictors of poor outcome in patients with sepsis. ⋯ There are several therapeutic interventions such as infection control, optimization of hemodynamic parameters, adequate volume resuscitation, inotropic drugs, transfusion of blood derivatives, and statins. However, for now, there is no efficient therapy for septic cardiomyopathy. The management of SIMD includes cardio-protective therapy, etiologic treatment of sepsis and septic shock, and supportive measures.
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Statins, inhibitors of hydroxymethylglutaryl coenzyme A reductase, are the mainstay of the treatment of hypercholesterolemia in patients with cardiovascular disease. Besides the effects on cholesterol synthesis, they also have other effects. Pleiotropic effects of statins have been noted as anti-inflammatory, immunomodulatory, antioxidant, anti-thrombotic and endothelium stabilizing. All the mentioned effects could have beneficial role in the systemic response to infection, i.e. sepsis, but also in other systemic inflammatory conditions. We give a review of pharmacological effects of statins and of trials investigating the effects of statins in acute inflammatory response and sepsis.
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The incidence of healthcare-associated infections and sepsis (HAIs) is 5-10 times higher in patients in intensive care units (ICUs) than in those at other hospital departments. Predisposition for these lies in many intrinsic (disease severity, loss of immunity) and extrinsic factors (frequent use of broad-spectrum antibiotics with consequent presence of antibiotic-resistant pathogens). The majority of HAIs in ICUs are associated with the use of invasive devices (DA-HAIs; device-associated healthcare-associated infections) (19%). ⋯ DA-HAIs endanger and slow down patient recovery, prolong hospital stay, and generally increase the mortality rate. DA-HAIs are of special interest of the Hospital Committee Center for Infective Disease in order to improve patient safety and reduce total cost allocated for prevention of DA-HAIs. DA-HAI rate is the most useful intra- and inter-hospital measure to compare surveillance and effectiveness of preventive procedures among different ICU types.