Articles: sepsis.
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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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Sepsis is noted for producing disruptions in hemostasis. The patient-related risk factors, clinical presentation, and management strategies are dependent upon the presiding disorder. ⋯ Nursing care focuses on prevention, early recognition, and supportive care for the thrombotic or bleeding patient. An overview of the disorders of hemostasis in sepsis and nursing care of these patients are described in 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.
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Pediatr. Infect. Dis. J. · Jun 1994
Neonatal sepsis and meningitis in a developing Latin American country.
In a retrospective study at Hospital del Niño in Panama City, Panama, 577 neonates with culture-proved sepsis and/or meningitis were identified during an 18-year period (1975 to 1992). Overall there was an incidence of 3.5 cases/1000 live births. Three hundred thirty-three patients (58%) were of low birth weight (< 2500 g) and 260 (45%) were premature. ⋯ The case-fatality rate was 32%. Mortality was greater in infants with early onset sepsis than in those with late infections (44% vs. 22%, P < 0.0001; odds ratio, 2.8; 95% confidence interval, 1.9 to 4.1) and lesser in neonates infected by coagulase-negative staphylococci than in those infected by any other pathogen (12 vs. 39%, P < 0.001; odds ratio, 0.2; 95% confidence interval, 0.1 to 0.4). These findings provide guidelines for the selection of empiric antimicrobial agents in our country and possibly in other Latin American countries and suggest that a continued thorough epidemiologic evaluation is needed to anticipate bacteriologic changes over time.