261 research outputs found
A worldwide perspective of sepsis epidemiology and survival according to age: Observational data from the ICON audit
No full textPurpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world.
Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult (>16 years) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - ≤50, 51-60, 61-70, 71-80, >80 years. Sepsis was defined as infection plus at least one organ failure.
Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (≤50 = 25.2%; 51-60 = 30.3%; 61-70 = 32.8%; 71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients ≤50 years (49.3% vs 25.2%, p 70 years was independently associated with increased risk of dying.
Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years.Fil: Kotfis, Katarzyna. Pomeranian Medical University; Polonia.Fil: Wittebole, Xavier. Cliniques Universitaires St Luc; Bélgica.Fil: Jaschinski, Ulrich. Klinik für Anästhesiologie und Operative Intensivmedizin; Alemania.Fil: Solé-Violán, Jordi. Hospital Universitario de Gran Canaria Dr. Negrín; España.Fil: Kashyap, Rahul. Mayo Clinic; Estados Unidos.Fil: Leone, Marc. Aix Marseille Université; Francia.Fil: Nanchal, Rahul. Medical College of Wisconsin; Estados Unidos.Fil: Fontes, Luis E. Petrópolis Medical School; Brasil.Fil: Sakr, Yasser. Uniklinikum Jena; Alemania.Fil: Vincent, Jean-Louis. Université Libre de Bruxelles; Bélgica.Fil: Wainsztein, Néstor Adrián. Fleni. Departamento de Medicina Interna; Argentina
Use of the molecular adsorbent recirculating system (MARS™) for the management of acute poisoning with or without liver failure
No full textINTRODUCTION: There is an increasing interest in recent developments in bioartificial and non-bioartificial devices, so called extracorporeal liver assist devices, which are now used widely not only to increase drug elimination, but also to enhance the removal of endogenous substances in acute liver failure. Most of the non-bioartificial techniques are based on the principle of albumin dialysis. The objective is to remove albumin-bound substances that could play a role in the pathophysiology of acute liver failure by dialysing blood against an albumin-containing solution across a high flux permeable membrane. The most widely used device is the Molecular Adsorbent Recirculating System (MARS™).
METHODS: The relevant English and French literature was identified through Medline using the terms, 'molecular adsorbent recirculating system', 'MARS', 'acute liver failure', 'acute poisoning', 'intoxication'. This search identified 139 papers of which 48 reported on a toxic cause for the use of MARS™. Of these 48 papers, 39 specified the substance (eighteen different substances were identified); two papers reported on the same group of patients. BIOARTIFICIAL AND NON-BIOARTIFICIAL SYSTEMS: Bioartificial systems based on porcine hepatocytes incorporated in the extracorporeal circuit are no longer in use due to the possibility of porcine retroviral transmission to humans. Historically, experience with such devices was limited to a few cases of paracetamol poisoning. In contrast, an abundant literature exists for the non-bioartificial systems based on albumin dialysis. The MARS™ has been used more widely than other techniques, such as the one using fractionated plasma separation and adsorption (Prometheus™). All the extracorporeal liver assist devices are able to some extent to remove biological substances (ammonia, urea, creatinine, bilirubin, bile acids, amino acids, cytokines, vasoactive agents) but the real impact on the patient's clinical course has still to be determined. Improvement in cardiovascular or neurological dysfunction has been shown both in acute liver failure and acute-on-chronic liver failure but no impact on mortality has been reported. ACUTE POISONING WITH LIVER FAILURE: Randomized controlled trials are very limited in number and patients poisoned by paracetamol or Amanita phalloides are usually included for outcome analysis in larger groups of acute liver failure patients. Initial results look promising but should be confirmed. Beyond its effect in liver failure, MARS™ could also enhance the elimination of the drug or toxin responsible for the failure, as is described with paracetamol. ACUTE POISONING WITHOUT LIVER FAILURE: Extracorporeal liver assist devices have also been used to promote elimination of drugs that are highly protein bound. Data in various case reports confirm a high elimination of phenytoin, theophylline and diltiazem. However, definite conclusions on the toxicokinetic or clinical efficacy cannot be drawn.
CONCLUSIONS: Despite the lack of large multicentre randomized trials on the use of MARS™ in patients with acute liver failure, the literature shows clinical and biological benefit from this technique. In drug or toxin-induced acute liver failure, such as paracetamol or mushroom poisoning, MARS™ has been used extensively, confirming in a non-randomized fashion, the positive effect observed in the larger population of acute liver failure patients. Furthermore, as MARS™ has been shown in experimental studies to remove protein-bound substances, it is potentially a promising treatment for patients with acute poisoning from drugs that have high protein-binding capacity and are metabolized by the liver, especially, if they develop liver failure concomitantly
Influence des relations toxicocinétiques-toxicodynamiques sur la prise en charge des patients intoxiqués
No full textPharmacokinetic-pharmacodynamic (PK-PD) relationships are defined by the existing link between the evolution in time of the plasma concentration of a substance and its clinical effect. In clinical toxicology, they are better defined as toxicokinetic-toxicodynamic (TK-TD) relationships. Their usefullness remains debated for poisoned patients disposition. Many factors could interfer with these relationships and will be discussed in this paper. For most of the substances involved in intoxication, clinical signs will be the clue to determine the best therapeutic approach. Nevertheless, in some cases, the knowledge of the TK-TD relationships will be helpful to define which strategy has to be implemented. © 2002 Éditions scientifiques et médicales Elsevier SAS
Phagetherapy: Clinical Applications – Critical Appraisal of Randomized Controlled Trials
No full textPhagotherapy, defined as the use of bacteriophage to treat bacterial infections, was initially proposed by Felix d’Herelle, a French-Canadian who did a lot of research on this topic in Paris, but also travelled the world to treat patients in different settings and conditions. While the literature on this topic is quite extensive, the number of randomized controlled trials is rather limited. Large studies were performed and published in the former USSR republics more than 50 years ago. Since then, there were few trials performed, enrolling a limited number of patients and assessing potential phage efficacy in different settings such as chronic otitis or infected burn wounds. In this chapter, we review and discuss these different randomized trials. While the results might look disappointing at first sight, they all confirm safety of phage used for treatment of difficult clinical situations. Those trials should help define further studies in order to obtain the best possible results and hopefully confirm that phages could be used as an alternative to treat difficult to treat multi-drug-resistant bacterial infections
High-dose insulin therapy in a case of subarachnoid hemorrhage-related severe cardiodepression with ischemic-like electrocardiographic changes
No full text
Les effets et l’adaptation de la pression expiratoire positive chez un patient ayant un syndrome de détresse respiratoire aiguë : revue de la littérature
No full textObjectifs : L’objectif de ce mémoire est de parcourir la littérature scientifique récente et de récolter le plus d’informations possible afin de savoir comment adapter de manière optimale la pression expiratoire positive chez le patient ayant un syndrome de détresse respiratoire aiguë. Méthodes : Une équation de recherche a été créée et introduite dans 4 moteurs de recherches. La sélection des articles a été structurée par les critères PICO(S) déterminés au préalable, ainsi que par le diagramme PRISMA. Les articles sélectionnés sont de qualités scientifiques variées, allant de l’essai randomisé contrôlé à l’étude de cas. Résultats: Un réglage de la pression expiratoire positive haut permet de diminuer le nombre de défaillance d’organes ainsi que le nombre de jours sous assistance ventilatoire. La manière de régler la PEP reste encore controversée mais la méthode qui a la plus d’évidence scientifique est le réglage de la PEP en fonction de la compliance pulmonaire maximale. Deux autres méthodes, le réglage en fonction du stress index et en fonction de la pression plateau maximale semblent également prometteur. Conclusion : Une pression expiratoire positive est donc bénéfique au patient. Il faut toutefois être pragmatique et rester vigilant à l’hémodynamique. Il est également indispensable de respecter une ventilation protectrice. Pour ce qui est de la façon de régler de la PEP, la compliance maximale semble être la plus appropriée mais plus de recherches scientifiques sont nécessaires.Master [60] en kinésithérapie et réadaptation, Université catholique de Louvain, 201
Biomarkers of Infection and Sepsis.
No full textThe role of biomarkers for detection of sepsis has come a long way. Molecular biomarkers are taking front stage at present, but machine learning and other computational measures using bigdata sets are promising. Clinical research in sepsis is hampered by lack of specificity of the diagnosis; sepsis is a syndrome with no uniformly agreed definition. This lack of diagnostic precision means there is no gold standard for this diagnosis. The final conclusion is expert opinion, which is not bad but not perfect. Perhaps machine learning will displace expert opinion as the final and most accurate definition for sepsis
Prise en charge des hépatites fulminantes d'origine toxique en réanimation
No full textToxin-related liver diseases are a common cause of acute and fulminant liver failure. Numerous substances may be involved. The diagnosis is important because in some cases specific treatment with an antidote is required. Other therapeutic interventions such as supportive measures, liver assist devices and transplantation are discussed. © 2001 Éditions scientifiques et médicales Elsevier SAS
Clinical review: Drotrecogin alfa (activated) as adjunctive therapy for severe sepsis--practical aspects at the bedside and patient identification.
No full textAdministration of drotrecogin alfa (activated) has been demonstrated to reduce mortality in patients with severe sepsis who are at high risk for death or who have multiple organ dysfunction. This benefit was associated with an increased incidence of bleeding events, but the latter were mainly procedure related. Drug infusion interruptions should be instituted, in accordance with recent recommendations. Monitoring coagulation parameters may help in identifying patients at higher risk for bleeding but it is not indicated to adjust drug dosage. Acute renal failure and hemodialysis are not contraindications to this therapy, and no drug dosage adjustment is indicated. Finally, the type and source of infection, and its anticipated natural history, may determine whether drotrecogin alfa (activated) is indicated as well as the timing of its administration
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