PTU-128 A Web-based Survey To Investigate Physicians’ And Intensivists’ Attitudes To Critical Care Admission For Cirrhosis And Multiple Organ Dysfunction

ABSTRACTObjective: The novel H1N1 influenza pandemic renewed the concern that during a severe pandemic illness, critical care and mechanical ventilation resources will be inadequate to meet the needs of patients. Several published protocols address the need to triage patients for access to ventilator resources. However, to our knowledge, none of these has addressed the pediatric populations.Methods: We used a systematic review of the pediatric critical care literature to evaluate pediatric critical care prognosis and multisystem organ failure scoring systems. We used multiple search engines, including MEDLINE and EMBASE, using a search for terms and key words including including multiple organ failure, multiple organ dysfunction, PELOD, PRISM III, pediatric risk of mortality score, pediatric logistic organ dysfunction, pediatric index of mortality pediatric multiple organ dysfunction score, “child+multiple organ failure + scoring system. ” Searches were conducted in the period January 2010-February 2010.Results: Of the 69 papers reviewed, 22 were used. Five independently derived scoring systems were evaluated for use in a respiratory pandemic ventilator triage protocol. The Pediatric Logistic Organ Dysfunction (PELOD) scoring system was the most appropriate for use in such a triage protocol.Conclusions: We present a pediatric-specific ventilator triage protocol using the PELOD scoring system to complement the NY State adult triage protocol. Further evaluation of pediatric scoring systems is imperative to ensure appropriate triage of pediatric patients.(Disaster Med Public Health Preparedness. 2012;6:131–137)

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Surgical Critical Care for the Patient with Sepsis and Multiple Organ Dysfunction

Anesthesiology Clinics ◽

10.1016/j.anclin.2016.06.005 ◽

2016 ◽

Vol 34 (4) ◽

pp. 681-696 ◽

Cited By ~ 2

Author(s):

Gary J. Kaml ◽

Kimberly A. Davis

Keyword(s):

Critical Care ◽

Organ Dysfunction ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Surgical Critical Care

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Year in review 2010: Critical Care - multiple organ dysfunction and sepsis

Critical Care ◽

10.1186/cc10359 ◽

2011 ◽

Vol 15 (6) ◽

pp. 236 ◽

Cited By ~ 22

Author(s):

Etienne de Montmollin ◽

Djillali Annane

Keyword(s):

Critical Care ◽

Organ Dysfunction ◽

Multiple Organ ◽

Multiple Organ Dysfunction

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Advances in the Understanding of Clinical Manifestations and Therapy of Severe Sepsis: An Update for Critical Care Nurses

American Journal of Critical Care ◽

10.4037/ajcc2003.12.2.120 ◽

2003 ◽

Vol 12 (2) ◽

pp. 120-133 ◽

Cited By ~ 12

Author(s):

E. Wesley Ely ◽

Ruth M. Kleinpell ◽

Richert E. Goyette

Keyword(s):

Critical Care ◽

Severe Sepsis ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Protein C ◽

Multiple Organ ◽

Critical Care Nurses ◽

Health Concern ◽

Multiple Organ Dysfunction ◽

Drotrecogin Alfa Activated

Severe sepsis is a major public health concern and a burden on the healthcare system. Despite improvements in efforts to control the source of infection and increased recognition by healthcare providers of patients with the disease, the mortality rate remains unacceptably high, from 30% to 50%. The systemic inflammatory response syndrome criteria are used as diagnostic indicators of sepsis when they occur in patients with known or suspected infection. The outcome of a patient with severe sepsis is often related to the occurrence of sepsis-induced multiple organ dysfunction syndrome. Multiple organ dysfunction syndrome appears to result from a cascade of organism-related factors, inflammatory mediators, endothelial injury, disturbed hemostasis, and microcirculatory abnormalities. In patients with severe sepsis, derangements of inflammation and coagulation are tightly linked. Although numerous clinical trials focused on interventions in one or the other of the inflammatory and coagulation systems failed to show reduced mortality due to sepsis, a member of a new class of drugs called “cogins” was effective. In its active form, protein C has anti-inflammatory, antithrombotic, and profibrinolytic properties that can reduce organ injury associated with severe sepsis. A recombinant form of activated protein C, drotrecogin alfa (activated), significantly reduces 28-day mortality due to all causes in patients with severe sepsis and has an acceptable safety profile. This review provides an overview of severe sepsis, highlighting recent advances in treatment of the disease and the role of critical care nurses.

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Disseminated intravascular coagulation in meningococcal sepsis

Hämostaseologie ◽

10.1055/s-0037-1619581 ◽

2003 ◽

Vol 23 (03) ◽

pp. 125-130 ◽

Cited By ~ 2

Author(s):

S. Zeerleder ◽

R. Zürcher Zenklusen ◽

C. E. Hack ◽

W. A. Wuillemin

Keyword(s):

Organ Dysfunction ◽

Disseminated Intravascular Coagulation ◽

Skin Necrosis ◽

Multiple Organ ◽

Meningococcal Sepsis ◽

Multiple Organ Dysfunction ◽

Intravascular Coagulation ◽

Therapeutic Concepts ◽

New Therapeutic Concepts ◽

Coagulation And Fibrinolysis

SummaryWe report on a man (age: 49 years), who died from severe meningococcal sepsis with disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome and extended skin necrosis. We discuss in detail the pathophysiology of the activation of coagulation and fibrinolysis during sepsis. The article discusses new therapeutic concepts in the treatment of disseminated intravascular coagulation in meningococcal sepsis, too.

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Multiple Organ Dysfunction Syndrome of Alcoholic Origin in an 18-Year-Old Patient

The International Annals of Medicine ◽

10.24087/iam.2018.2.12.712 ◽

2018 ◽

Vol 2 (12) ◽

Author(s):

Francesco Gazia ◽

Giacomo De Luca ◽

Imbalzano Gabriele ◽

Vincenzo Pellicanò

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Multiple Organ ◽

Multiple Organ Dysfunction

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IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2018.8.jns18676 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1931-1937 ◽

Cited By ~ 2

Author(s):

Sungho Lee ◽

Hyunsoo Hwang ◽

Jose-Miguel Yamal ◽

J. Clay Goodman ◽

Imoigele P. Aisiku ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Sofa Score ◽

Plasma Concentrations ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Poor Outcome ◽

Initial Plasma

OBJECTIVETraumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODSThe authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTSTwo hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94–42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)–6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20–1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01–1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24–2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18–19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06–1.40, p = 0.006).CONCLUSIONSAdmission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.

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