scholarly journals Enigmatic role of coagulopathy among sepsis survivors: a review of coagulation abnormalities and their possible link to chronic critical illness

2020 ◽  
Vol 5 (1) ◽  
pp. e000462
Author(s):  
Leah K Winer ◽  
Christen Salyer ◽  
Nadine Beckmann ◽  
Charles C Caldwell ◽  
Vanessa Nomellini
Keyword(s):  
Intensive Care Unit ◽  
Critical Illness ◽  
Long Term Outcomes ◽  
Causative Mechanism ◽  
Coagulation Abnormalities ◽  
Chronic Critical Illness ◽  
Sepsis Survivors

There are sparse clinical data addressing the persistence of disordered coagulation in sepsis and its role in chronic critical illness. Coagulopathy in the absence of anticoagulant therapy and/or liver disease can be highly variable in sepsis, but it tends to be prolonged in patients in the intensive care unit with a length of stay greater than 14 days. These coagulation abnormalities tend to precede multisystem organ failure and persistence of these coagulation derangements can predict 28-day mortality. The studies evaluated in this review consistently link sepsis-associated coagulopathy to poor long-term outcomes and indicate that disordered coagulation is associated with unfavorable outcomes in chronic critical illness. However, the causative mechanism and the definitive link remain unclear. Longer follow-up and more granular data will be required to fully understand coagulopathy in the context of chronic critical illness.

scholarly journals Dysregulated Immunity and Immunotherapy after Sepsis

2021 ◽  
Vol 10 (8) ◽  
pp. 1742
Author(s):  
Dijoia B. Darden ◽  
Lauren S. Kelly ◽  
Brittany P. Fenner ◽  
Lyle L. Moldawer ◽  
Alicia M. Mohr ◽  
...  
Keyword(s):  
Immune System ◽  
Critical Illness ◽  
The Elderly ◽  
Long Term Outcomes ◽  
Diagnosis And Management ◽  
Persistent Inflammation ◽  
Chronic Critical Illness ◽  
Initial Hospitalization ◽  
Sepsis Survivors

Implementation of protocolized surveillance, diagnosis, and management of septic patients, and of surgical sepsis patients in particular, is shown to result in significantly increased numbers of patients surviving their initial hospitalization. Currently, most surgical sepsis patients will rapidly recover from sepsis; however, many patients will not rapidly recover, but instead will go on to develop chronic critical illness (CCI) and experience dismal long-term outcomes. The elderly and comorbid patient is highly susceptible to death or CCI after sepsis. Here, we review aspects of the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) endotype to explain the underlying pathobiology of a dysregulated immune system in sepsis survivors who develop CCI; then, we explore targets for immunomodulatory therapy.

scholarly journals Chronic Critical Illness and PICS Nutritional Strategies

2021 ◽  
Vol 10 (11) ◽  
pp. 2294
Author(s):  
Martin D. Rosenthal ◽  
Erin L. Vanzant ◽  
Frederick A. Moore
Keyword(s):  
Critical Illness ◽  
Low Grade ◽  
Long Term Outcomes ◽  
Persistent Inflammation ◽  
Chronic Critical Illness ◽  
Similar Phenotype ◽  
Sepsis Survivors ◽  
Low Grade Inflammation ◽  
Nutritional Strategies

The nutritional hallmark of chronic critical illness (CCI) after sepsis is persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which results in global resistance to the anabolic effect of nutritional supplements. This ultimately leaves these patients in a downward phenotypic spiral characterized by cachexia with profound weakness, decreased capacity for rehabilitation, and immunosuppression with the propensity for sepsis recidivism. The persistent catabolism is driven by a pathologic low-grade inflammation with the inability to return to homeostasis and by ongoing increased energy expenditure. Better critical care support systems and advances in technology have led to increased intensive care unit (ICU) survival, but CCI due to PICS with poor long-term outcomes has emerged as a frequent phenotype among ICU sepsis survivors. Unfortunately, therapies to mitigate or reverse PICS-CCI are limited, and recent evidence supports that these patients fail to respond to early ICU evidence-based nutrition protocols. A lack of randomized controlled trials has limited strong recommendations for nutrition adjuncts in these patients. However, based on experience in other conditions characterized by a similar phenotype, immunonutrients aimed at counteracting inflammation, immunosuppression, and catabolism may be important for improving outcomes in PICS-CCI patients. This manuscript intends to review several immunonutrients as adjunctive therapies in treating PICS-CCI.

A New Role of Staged Tympanoplasty for Cholesteatoma

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P52-P52
Author(s):  
Yasuyuki Hinohira ◽  
Naoaki Yanagihara ◽  
Naohito Hato
Keyword(s):  
Mastoid Cavity ◽  
Pathological Findings ◽  
Long Term Outcomes ◽  
Retraction Pocket ◽  
Endoscopic Observation ◽  
Middle Ear Cholesteatoma ◽  
Long Term Follow Up

Objective 1) Investigate a correlation between pathological findings at the 2nd stage operation and long-term outcomes in a staged canal wall-up tympanoplasty (SCUT) for middle ear cholesteatoma. 2) Advocate a new role of the staged manner based on the study. Methods SCUT was performed on 90 ears with cholesteatoma involving both the ossicles and the mastoid cavity. The 1st stage operation included scutum plasty and mastoid cortex plasty with bone pate following removal of cholesteatoma and ossicles involved. The 2nd stage operation records were reviewed regarding the pathological findings associated with retraction pocket (RP) and residual cholesteatoma (RC) formation. The scutum defect was revised with auricular cartilage, and the mastoid cortex plasty was again performed after removal of RC. Postoperative follow-up with endoscopic observation and CT was performed for all patients. Results At the 2nd stage, RP was seen in 15 ears (16.7%) which all showed partial or total absorption of the scutum reconstructed. Aeration grade of the mastoid cavity reconstructed did not correlate with RP or RC formation. RC was found in 28 ears (31.1%) regardless of RP formation. The long-term follow up study revealed that the statistically higher incidence of RP re-formation (26.7%) and RC (3.2%) was seen in ears which had been identified at the 2nd stage, respectively. Conclusions The present study showed that the long-term outcomes after SCUT were correlated with RP and RC formation at the 2nd stage. This indicates the 2nd stage operation has a role of the long-term prognosis in addition to exploration of RC.

Predictors of ICU admission and long-term outcomes in overdose presentations to Emergency Department

2020 ◽  
Vol 28 (1) ◽  
pp. 75-79
Author(s):  
Mark Savage ◽  
Ross Kung ◽  
Cameron Green ◽  
Brandon Thia ◽  
Dinushka Perera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Psychiatric Illness ◽  
Atypical Antipsychotics ◽  
Long Term Outcomes ◽  
Icu Admission ◽  
History Of

Objective: To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. Methods: Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. Results: During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients ( n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% ( n = 22). Conclusion: A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.

scholarly journals Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

2018 ◽  
Author(s):  
Oliver J Schofield-Robinson ◽  
Sharon R Lewis ◽  
Andrew F Smith ◽  
Joanne McPeake ◽  
Phil Alderson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Long Term Outcomes

scholarly journals Bariatric surgery: a potential cure for asthma?

2019 ◽  
Vol 28 (152) ◽  
pp. 190003 ◽  
Author(s):  
Toufic A. Chaaban
Keyword(s):  
Bariatric Surgery ◽  
Long Term Outcomes ◽  
Asthmatic Patients ◽  
Asthma Incidence ◽  
Related Hospitalisation ◽  
Asthma Outcomes ◽  
Weight Loss Interventions

Asthma incidence and severity are increased in obese populations. Systematic reviews have shown benefit from weight-loss interventions on asthma outcomes, but the role of bariatric surgery is still unclear. In this review, cohorts of obese asthmatic patients undergoing bariatric surgery were examined regarding different asthma outcomes. The available data on patients who were followed up showed improvements in asthma control, exacerbation risk, asthma-related hospitalisation, medication use and airway hyperresponsiveness, with some patients not requiring further treatment for asthma. Follow-up duration was variable, being mostly of 1 year, with some studies reporting long-term outcomes after 5 years. The studies reviewed had many limitations, including small numbers of patients, lack of control arm in some studies and lack of standardisation of asthma diagnosis, classification and outcome measures, in addition to possible reporting bias. Data on small numbers of patients also show the possibility of benefit exclusively in nonallergic asthma. Larger, more stringent clinical trials are needed before recommending bariatric surgery for treatment of asthma.

scholarly journals Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

2017 ◽  
Author(s):  
Oliver J Schofield-Robinson ◽  
Sharon R Lewis ◽  
Andrew F Smith ◽  
Joanne McPeake ◽  
Phil Alderson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Long Term Outcomes
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