Articles: sepsis.
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Case Reports
Adult respiratory distress syndrome (ARDS), sepsis, and extracorporeal membrane oxygenation (ECMO).
This report presents data obtained in the care of 830 patients requiring assisted ventilation. When these patients were divided into groups by the severity of their respiratory failure as defined by the duration of ventilatory assistance (greater than 48 hours, less than 48 hours) and level of positive end expiratory pressure (PEEP) required (greater than 5 cm HoH, less than 5 cm HoH), it was found that evidence of concurrent bacterial infection was present in the majority of patients with severe respiratory failure. ⋯ In addition, this analysis demonstrated the important association of active pulmonary infection with the occurrence of barotrauma in these patients. Case analysis of patients subjected to extracorporeal membrane oxygenation has led to the suggestion that underlying sepsis in patients failing to respond to conventional ventilatory assistance similarly limits the usefulness of membrane oxygenator support.
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Septicemia developed in 34 patients per 10,000 admissions to a community hospital during 1970 through 1973. Two thirds of the 207 patients had community-acquired septicemia, and one third had nosocomial septicemia. Septicemia-related mortality was 20.3%. ⋯ Septicemia was associated with shock in 9.7% of the patients. Foley catheterization and prophylactic antibiotic therapy could not be implicated as major risk factors for the development of septicemia. This study shows an incidence of Gram-negative bacteremia, septic shock, and mortality substantially less than that described in published data from noncommunity hospitals.