Articles: sepsis.
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The incidence of maternal mortality related to sepsis has decreased during the past 2 decades because of the availability of broad spectrum antibiotics and advances in critical care. However, sepsis continues to account for approximately 7.6% of maternal deaths in the United States. ⋯ Nursing and medical management strategies are included. A case study is presented to illustrate the typical clinical course from infection, to bacteremia, sepsis, and septic shock.
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Central venous catheters are used widely for a variety of therapeutic purposes and have an increased incidence of infections related to their use. The purpose of this article is to address the issue of central venous catheter-related infections, including pathogenesis, predictors and diagnosis, and prevention.
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Comparative Study
Reduced tumor necrosis factor production in endotoxin-spiked whole blood after trauma: experimental results and clinical correlation.
The overproduction of tumor necrosis factor-alpha (TNF) plays a key role in virtually every experimental model of septic shock, which has led to the development of several therapies that target TNF and other cytokines in clinical sepsis. However, our previous work showed that plasma TNF was reduced, rather than increased, when a septic challenge was administered 3 days after hemorrhagic shock. In this study we compared whole-blood TNF production ex vivo in human beings and animals after trauma. ⋯ There was no evidence of TNF overproduction in whole blood after trauma. If these results could be generalized to other tissues, it would be difficult to justify therapeutic targeting of TNF in exaggerated inflammatory response (or septic complications) after trauma.
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Critical care medicine · Jul 1995
Comparative StudyReduced intestinal absorption of arginine during sepsis.
To investigate the effect of sepsis on the intestinal absorption of arginine. ⋯ Experimental sepsis, induced by either cecal ligation and puncture or intraperitoneal injection of lipopolysaccharide, resulted in impaired intestinal amino acid uptake. Impaired intestinal arginine absorption may explain the lack of benefit of enteral, compared with parenteral, arginine therapy on survival from a septic insult.
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Immune competence declines following major injury, and predisposes the trauma patient to infection. Interleukin-10 (IL-10), although an immunosuppressive cytokine, is also important in the initiation of immune responses. This study investigated alterations in IL-10 and immune function associated with polymicrobial sepsis following trauma using murine femur fracture (FFx) and cecal ligation/puncture (CLP) models. ⋯ Lymphocyte proliferative responses were significantly suppressed in FFx and CLP animals. Splenocyte IL-10 production was significantly reduced in FFx and CLP animals, with concurrent increases in nitrite and tumor necrosis factor release. This study documents that trauma induces alterations in the inflammatory cytokine cascade that affect the immune response to subsequent septic challenges.