Nihon rinsho. Japanese journal of clinical medicine
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Systemic inflammatory response syndrome (SIRS) is defined by four simple clinical and laboratory indices and now widely accepted for diagnosing sepsis. However, since the SIRS criteria include patients with a wide range of severity, other parameters are necessary to evaluate the severity and outcome of the patients. In this review, we discussed several methods to estimate the severity of SIRS, such as number of positive SIRS indices among four, duration of SIRS, plasma IL-6 and procalcitonin, etc.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Activated protein C (the impact of PROWESS trial)].
The inflammatory response in severe sepsis is integrally linked to procoagulant activity and endothelial activation. The abnormalities in the microcirculation results in the development of septic organ dysfunction. The natural anticoagulant activated protein C is expected not only to improve the unbalanced coagulation/fibrinolysis system, but also to modulate the endothelial function, and to express the anti-inflammatory properties. ⋯ The results showed the statistically significant improved survival in patients with sepsis induced organ dysfunction (absolute risk reduction in 6.1%). As a result, activated protein C is recommended in patients at high risk of death such as Acute Physiology and Chronic Health Evaluation II > or = 25. However, since bleeding risk is reported as an adverse effect, activated protein C is contraindicated in patients with bleeding tendency.
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The normal heart rate is regulated by a number of interacting physiological control systems that operate on widely different time scales. Thus, instantaneous heart rate is not steady, but rather demonstrates continuous fluctuations. ⋯ We found that the reduction of HRV precedes the occurrence of septic shock. Therefore, we conclude that analysis of HRV is a novel and useful tool to predict the occurrence of septic shock among the patients with severe sepsis.
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Review
[Basic concept and definition of SIRS and sepsis--present consideration and future perspectives].
SIRS (systemic inflammatory response syndrome) is thought to be caused by hypercytokinemia. On the other hand, interleukin-6 (IL-6) is reported to be one of most easily measurable cytokines and we found that IL-6 blood levels on SIRS patients are above 1,500 pg/ml which is compatible to the previously reported values. ⋯ On the other hand, it is reported that cytokine-related genetic polymorphism may affect the cytokine production following insult, or may affect the development of SIRS following insult. Therefore, we must also consider genetic aspect of cytokine biology in future study.
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This article will review for bedside clinicians how to manage septic ALI. ARDS and shock to use the principles of EBM to evaluate the various therapeutic approaches for them. Low tidal volume ventilation (6 mg/dl/kg) is recommended for ALI. ⋯ Aggressive infusion of crystalloid and colloid is recommended for septic shock, but blood transfusion and bicarbonate administration are not recommended. Vasopressors are recommended for septic shock: preference for norepinephrine and cautious use of vasopressin. Stress-dose of steroid and activated protein C for severe sepsis are useful if shock don't recover by aggressive fluid infusion and vasopressors' administration.