5,507 research outputs found
Hydrocortisone therapy for patients with septic shock
No full textBackground Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Methods In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period. At 28 days, the primary outcome was death among patients who did not have a response to a corticotropin test. Results Of the 499 patients in the study, 233 (46.7%) did not have a response to corticotropin (125 in the hydrocortisone group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the two study groups who did not have a response to corticotropin (39.2% in the hydrocortisone group and 36.1% in the placebo group, P=0.69) or between those who had a response to corticotropin (28.8% in the hydrocortisone group and 28.7% in the placebo group, P=1.00). At 28 days, 86 of 251 patients in the hydrocortisone group (34.3%) and 78 of 248 patients in the placebo group (31.5%) had died (P=0.51). In the hydrocortisone group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock. Conclusions Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004 [ClinicalTrials.gov] .)Peer reviewedPublisher PD
Towards a novel carbon device for the treatment of sepsis
No full textSepsis is a systemic inflammatory response to infection in which the balance of pro- andanti-inflammatory mediators, which normally isolate and eliminate infection, is disrupted. Gram negative sepsis is initiated by bacterial endotoxin release which activates macrophages and circulating monocytes to release TNF and IL-1β followed by IL-6 and other inflammatory cytokines. As the disease progresses, an unregulated inflammatory response results in, tissue injury, haematological dysfunction and organ dysfunction. Severe sepsis, involving organ hypoperfusion may be further complicated by hypotension that is unresponsive to adequate fluid replacement, resulting in septic shock and finally death.Despite improvements in anti-microbial and supportive therapies, sepsis remains a significant cause of morbidity and mortality in ICUs worldwide. The complexity of processes mediating the progression of sepsis suggests that an extracorporeal device combining blood filtration with adsorption of a wide range of toxins, and inflammatory mediators offers the most comprehensive treatment strategy. However, no such device exists at present. A novel, uncoated, polymer pyrolysed synthetic carbon device is proposed which combines the superior adsorption properties of uncoated activated carbons with the capacity to manipulate porous structure for controlled adsorption of target plasma proteins and polypeptides. Preliminary haemocompatibility and adsorptive capacity was assessed using a carbon matrix prototype
Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study
No full textINTRODUCTION: Albumin administration in the critically ill has been the subject of some controversy. We investigated the use of albumin solutions in European intensive care units (ICUs) and its relationship to outcome. METHODS: In a cohort, multicenter, observational study, all patients admitted to one of the participating ICUs between 1 May and 15 May 2002 were followed up until death, hospital discharge, or for 60 days. Patients were classified according to whether or not they received albumin at any time during their ICU stay. RESULTS: Of 3,147 admitted patients, 354 (11.2%) received albumin and 2,793 (88.8%) did not. Patients who received albumin were more likely to have cancer or liver cirrhosis, to be surgical admissions, and to have sepsis. They had a longer length of ICU stay and a higher mortality rate, but were also more severely ill, as manifested by higher simplified acute physiology score (SAPS) II and sequential organ failure assessment (SOFA) scores than the other patients. A Cox proportional hazard model indicated that albumin administration was significantly associated with decreased 30-day survival. Moreover, in 339 pairs matched according to a propensity score, ICU and hospital mortality rates were higher in the patients who had received albumin than in those who had not (34.8 versus 20.9% and 41.3 versus 27.7%, respectively, both p < 0.001). CONCLUSION: Albumin administration was associated with decreased survival in this population of acutely ill patients. Further prospective randomized controlled trials are needed to examine the effects of albumin administration in sub-groups of acutely ill patients
Crisis management during anaesthesia: sepsis
No full text© 2005 BMJ Publishing Group Ltd.BackgroundAnaesthesia with concurrent sepsis is risky, and involves consideration of possible organ dysfunctions-respiratory, cardiovascular, renal, and haematological--as well as ensuring that appropriate antibiotics are given after taking the necessary microbiological specimens. Because prompt attention needs to be paid to so many body systems, the place for a structured approach during anaesthesia for a septic patient was assessed.ObjectivesTo examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for sepsis, in the management of sepsis occurring in association with anaesthesia.MethodsThe potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.ResultsSepsis was identified as the primary problem in 13 of the first 4000 reports (ConclusionSepsis involves a serious physiological stress upon multiple organ systems. The use of a structured approach involving a core algorithm and additional sub-algorithms as required provides a series of checklists that can successfully deal with the complex multiple and interrelating problems that these patients present.J A Myburgh, M J Chapman, S M Szekely, G A Osborn
Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study
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High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury
No full textSCOPUS: ar.jinfo:eu-repo/semantics/publishe
Open access self-archiving: An author study
No full textThis, our second author international, cross-disciplinary study on open access had 1296 respondents. Its focus was on self-archiving. Almost half (49%) of the respondent population have self-archived at least one article during the last three years. Use of institutional repositories for this purpose has doubled and usage has increased by almost 60% for subject-based repositories. Self-archiving activity is greatest amongst those who publish the largest number of papers. There is still a substantial proportion of authors unaware of the possibility of providing open access to their work by self-archiving. Of the authors who have not yet self-archived any articles, 71% remain unaware of the option. With 49% of the author population having self-archived in some way, this means that 36% of the total author population (71% of the remaining 51%), has not yet been appraised of this way of providing open access. Authors have frequently expressed reluctance to self-archive because of the perceived time required and possible technical difficulties in carrying out this activity, yet findings here show that only 20% of authors found some degree of difficulty with the first act of depositing an article in a repository, and that this dropped to 9% for subsequent deposits. Another author worry is about infringing agreed copyright agreements with publishers, yet only 10% of authors currently know of the SHERPA/RoMEO list of publisher permissions policies with respect to self-archiving, where clear guidance as to what a publisher permits is provided. Where it is not known if permission is required, however, authors are not seeking it and are self-archiving without it. Communicating their results to peers remains the primary reason for scholars publishing their work; in other words,
researchers publish to have an impact on their field. The vast majority of authors (81%) would willingly comply with a mandate from their employer or research funder to deposit copies of their articles in an institutional or subject-based repository. A further 13% would comply reluctantly; 5% would not comply with such a mandate
Progress of international hydrogen production network for the thermochemical Cu–Cl cycle
No full textThis paper presents recent advances by an international team which is developing the thermochemical copper–chlorine (Cu–Cl) cycle for hydrogen production. Development of the Cu–Cl cycle has been pursued by several countries within the framework of the Generation IV International Forum (GIF) for hydrogen production with the next generation of nuclear reactors. Due to its lower temperature requirements in comparison with other thermochemical cycles, the Cu–Cl cycle is particularly well matched with Canada's Generation IV reactor, SCWR (Super-Critical Water Reactor), as well as other heat sources such as solar energy or industrial waste heat. In this paper, recent developments of the Cu–Cl cycle are presented, specifically involving unit operation experiments, corrosion resistant materials and system integration.Atomic Energy of Canada LimitedOntario Research Excellence FundNatural Sciences and Engineering Research Council of CanadaUniversity Network of Excellence in Nuclear Engineering (UNENE)Canada Research Chairs progra
ŻYCIE UKRYTE W SŁOWIE. "BEKSIŃSCY. PORTRET PODWÓJNY" MAGDALENY GRZEBIAŁKOWSKIEJ W ŚWIETLE POSTSTRUKTURALIZMU
No full textLife Hidden in Words. Magdalena Grzebiałkowska\u27s "Beksińscy. Portret podwójny" and Poststructuralism
The article analyzes Magdalena Grzebiałkowska\u27s biographical "Beksińscy. Portret podwójny" which focuses on the lives of Zdzisław Beksiński and Tomasz Beksiński. The author looks at the construction of the biography and its relationship to poststructuralism, which allows for an appreciation of the literary features of the book. He points to how the specificity of the content, language, a mode of narration in Grzebiałkowska\u27s book make it a full-fledged literary work itself. As such the book departs from a typical biographical scheme. Juxtaposing the book with poststructural ideas leads to the reconsideration of the role of the author in the process of shaping of a biographical narrative
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