Articles: sepsis.
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Critical care medicine · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialMetabolic effects of a D-beta-hydroxybutyrate infusion in septic patients: inhibition of lipolysis and glucose production but not leucine oxidation.
To study the effect of a D-beta-hydroxybutyrate infusion on protein metabolism, lipolysis, and endogenous glucose production in septic patients. ⋯ Exogenous ketone-bodies infusion decreased lipolysis and glucose production in septic patients but had no beneficial effect on protein metabolism, as evaluated with L[1-13C]leucine.
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To review the difficulties associated with defining sepsis and its complications and to characterize the role of the proinflammatory cytokines in the development of human septic shock, adult respiratory distress syndrome, and the systemic inflammatory response syndrome. ⋯ Sepsis and its complications constitute a complex biological cascade that may be defined by specific clinical characteristics. The clinical variability in these events suggests that definitions based on clinical end points be used in combination with assessments of severity of illness to best define patient status, predict clinical course, and guide treatment decision-making.
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Comparative Study Clinical Trial Controlled Clinical Trial
Neonatal tumor necrosis factor, interleukin-1 alpha, interleukin-1 beta, and interleukin-6 response to infection.
Various studies have shown that in vitro production of cytokines by leukocytes from the newborn are normal, decreased, or increased. We investigated the blood levels of tumor necrosis factor-alpha (TNF-alpha) interleukin-1 alpha, interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) simultaneously to assess the cytokine response to systemic infection during the neonatal period. One or more cytokine levels were elevated in all of the newborns with sepsis. ⋯ Gram-negative bacteria were the main causative agents in these patients, although one of them was infected with gram-positive bacteria, besides one premature infant (29 weeks) with Candida sepsis also had significantly elevated TNF, IL-1 beta, and IL-6 levels. Our data show that both mature and premature neonates were able to produce and significantly increase the blood levels of the cytokines in response to sepsis. Because the biologic relevance of cytokine levels is not known, further prospective and sequential studies on cytokine levels simultaneously and correlation with clinical parameters are needed to clarify the biological role of this important component of the host defense system.
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Crit Care Nurs Clin North Am · Jun 1994
ReviewMediator-specific therapies for the systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock: present and future approaches.
Despite recent advances in critical care and cardiopulmonary support, mortality from septic shock and its complications remains high. Effective therapies are needed to halt the progression of SIRS and the septic cascade prior to development of shock and organ ischemia/dysfunction. Such therapies are directed at prevention of infection/endotoxemia and modulation of mediators. These therapies are the focus of this article.
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Comparative Study
The role of septic complications in aortic aneurysm surgery.
Out of 229 patients operated due to abdominal aortic aneurysms, 51 (22.3%) had prolonged (> 120 hours) postoperative intensive care stay. The mortality rate in this group was 27% representing 46% of the total mortality. ⋯ Reoperations, time for ventilatory support, incidence of renal failure and dialysis, gastrointestinal complications and mortality were all frequent in patients with septic postoperative complications as compared to those with non-septic complications, the latter mainly of cardiovascular origin. Signs of organ dysfunction should raise a suspicion of a septic complication and prompt insertion of diagnostic procedures and therapeutic interventions are necessary in order to minimize morbidity and mortality.