Articles: sepsis.
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Infusionsther Transfusionsmed · Apr 1993
[Early immunoglobulin therapy in high risk patients for infection after heart surgery].
The efficacy of early supplemental intravenous immunoglobulin G (ivIgG) treatment was investigated in 41 patients at risk for sepsis following cardiac surgery (APACHE II score > or = 19 on the 1st postoperative day). The ivIgG preparation (Psomaglobin N) was chosen because of its reported high antibody titers and effectiveness in animal models against gram-positive microorganisms, preponderant as infective agents after heart surgery. ⋯ In this group, ivIgG therapy led to higher (p < 0.05) response rates defined as a score decrease > or = 7 within 4 days (ivIgG-treated patients 54%, controls 19%), and a reduction in mortality (ivIgG-treated patients 46%, controls 76%; p = 0.08). Given the good comparability of the study groups, the results of this trial indicate, despite its nonrandomized design, that early supplemental ivIgG treatment seems to decrease disease severity and probably also improve the prognosis in APACHE II score identified high-risk patients after cardiac surgery.
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Anaesth Intensive Care · Apr 1993
Aminoglycoside volume of distribution and illness severity in critically ill septic patients.
The volume of distribution of amikacin and the APACHE II score were determined in 42 critically ill patients being treated for a gram-negative infection. The mean volume of distribution (Vdt) was 0.41 +/- 0.12 l/kg with a wide range (normal of 0.25 l/kg). ⋯ Critically ill patients should receive larger loading doses of aminoglycosides in order to achieve therapeutic blood levels. The aminoglycoside Vdt may be useful in determining the degree of capillary leak and tissue oedema that accompanies sepsis.
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Infusionsther Transfusionsmed · Apr 1993
[Continuous measurement of peripheral oxygen availability in skeletal muscle of patients with infection].
In patients with sepsis, a pathologic oxygen uptake supply dependence due to an oxygen extraction defect was suggested to result in tissue hypoxia--a hypothesis which is discussed controversially. In order to determine more directly whether the oxygen transport to tissue was reduced in patients with sepsis, the distribution of skeletal muscle pO2 was measured intermittently by polarographic needle electrodes in 28 patients with sepsis for 7 days. Comparison of intermittent with continuous measurements by pO2 catheters showed a close linear relation (r = 0.88; p < 0.001) and acceptable agreement. ⋯ From our data we infer that the hypothesis of tissue hypoxia in sepsis must be questioned at least for the skeletal muscle. The increase of skeletal muscle pO2 in sepsis, however, suggested that oxygen utilization within skeletal muscle decreased the more severe the stage of sepsis was. A decreased oxygen utilization within tissue, which may result from a 'downregulation' of oxygen-dependent metabolic pathways, might account for a decreased oxygen extraction of peripheral tissue in sepsis.