scholarly journals Effects of High Volume Haemodiafiltration on Inflammatory Response Profile and Microcirculation in Patients with Septic Shock

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Kadri Tamme ◽  
Liivi Maddison ◽  
Rein Kruusat ◽  
Hans-Erik Ehrlich ◽  
Mirjam Viirelaid ◽  
...  
Keyword(s):  
Septic Shock ◽  
Kidney Injury ◽  
High Volume ◽  
Target Range ◽  
Sublingual Microcirculation ◽  
Cytokine Levels ◽  
Before And After ◽  
Single Centre Study ◽  
The Mean ◽  
Improve Patient

Background. High volumes of haemofiltration are used in septic patients to control systemic inflammation and improve patient outcomes. We aimed to clarify if extended intermittent high volume online haemodiafiltration (HVHDF) influences patient haemodynamics and cytokines profile and/or has effect upon sublingual microcirculation in critically ill septic shock patients.Methods. Main haemodynamic and clinical variables and concentrations of cytokines were evaluated before and after HVHDF in 19 patients with septic shock requiring renal replacement therapy due to acute kidney injury. Sublingual microcirculation was assessed in 9 patients.Results. The mean (SD) time of HVHDF was 9.4 (1.8) hours. The median convective volume was 123 mL/kg/h. The mean (SD) dose of norepinephrine required to maintain mean arterial pressure at the target range of 70–80 mmHg decreased from 0.40 (0.43) μg/kg/min to 0.28 (0.33) μg/kg/min (p= 0.009). No significant changes in the measured cytokines or microcirculatory parameters were observed before and after HVHDF.Conclusions. The single-centre study suggests that extended HVHDF results in decrease of norepinephrine requirement in patients with septic shock. Haemodynamic improvement was not associated with decrease in circulating cytokine levels, and sublingual microcirculation was well preserved.

scholarly journals Use of high-volume haemodiafiltration in patients with refractory septic shock and acute kidney injury

2012 ◽  
Vol 6 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Vincent Bourquin ◽  
Belén Ponte ◽  
Jérôme Pugin ◽  
Pierre-Yves Martin ◽  
Patrick Saudan
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
High Volume ◽  
Refractory Septic Shock

scholarly journals Prolonged Infusion of ß-lactams Decreases Mortality in Patients with Septic Shock: A Retrospective Before-and-after Study

2021 ◽  
Author(s):  
Daniel Christoph Richter ◽  
Maximilian Dietrich ◽  
Lazar Detelinov Lalev ◽  
Felix C.F. Schmitt ◽  
Mascha Onida Fiedler ◽  
...  
Keyword(s):  
Septic Shock ◽  
Invasive Ventilation ◽  
Beta Lactam ◽  
Unbound Fraction ◽  
Improve Patient Survival ◽  
Beneficial Effects ◽  
Beta Lactam Antibiotics ◽  
Pharmacokinetic Properties ◽  
Before And After ◽  
Improve Patient

Septic shock substantially alters the pharmacokinetic properties of ß-lactams with a subsequently high risk of insufficiently low serum concentrations and treatment failure. Considering their pharmacokinetic (PK)/pharmacodynamic (PD) index, prolonged infusions (PI) of ß-lactams extend the time that the unbound fraction of the drug remains above the minimal inhibitory concentration MIC (ft >MIC) and may improve patient survival. The present study is a monocentric, retrospective before-and-after analysis of septic shock patients treated with ß-lactams. Patients of the years 2015-2017 received intermittent bolus application whereas patients of 2017-2020 received PI of ß-lactams. The primary outcome was mortality at day 30 and 90 after diagnosis of septic shock. Mortality rates in the PI group were significantly lower on day 30 (PI: 41%, n=119/290 vs. IB: 54.8%, n=68/114; p=0.0097) and day 90 (PI: 47.9%, n=139/290 vs. IB: 62.9%, n=78/124; p=0.005). After propensity-score matching, 30- and 90-day mortality remained lower for the PI group (-10%). PI further reduced duration of invasive ventilation. PI of β-lactam antibiotics led to a stronger decrease in SOFA scores within a 14d-observation period. PI of ß-lactams significantly reduces mortality in patients with septic shock and may have beneficial effects on invasive ventilation and recovery from sepsis-related organ failure.

A Single Surgeons Experience with Enhanced Recovery after Surgery: An Army of One

2016 ◽  
Vol 82 (7) ◽  
pp. 594-601 ◽  
Author(s):  
Catalina Mosquera ◽  
Nicholas J. Koutlas ◽  
Timothy L. Fitzgerald
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Univariate Analysis ◽  
Intestinal Resection ◽  
High Volume ◽  
Before And After ◽  
Individual Surgeon ◽  
The Mean ◽  
Eras Protocol ◽  
Surgical Oncologist

The benefits of enhanced recovery after surgery (ERAS) have been demonstrated for multiple surgical procedures in high-volume programs. However, resources required for its implementation may be daunting to individual surgeons. Patients undergoing elective abdominal procedures from June 2013 to April 2015 by a surgical oncologist before and after the implementation of an ERAS protocol were reviewed. A total of 179 patients were included. The mean age of the patients was 63 years, and a majority of them were females (53.6%), white (61.5%), had a Charlson score of 0 to 2 (45.8%), and a Clavien complication grade of 0 to I (60.1%). The univariate analysis revealed that the ERAS protocol was associated with shorter length of stay (LOS) (6.2 vs 9.6 days), lower cost ($21,674 vs $30,380), and lower mortality (0 vs 3.3%); P < 0.05. Differences were noted in LOS and costs for all procedures, the differences were the greatest for hepatic resection (3.8 vs 8.4 days and $16,770 vs $28,589), intestinal resection/stoma closure (4.8 vs 7.6 days and $18,391 vs $22,239), and other abdominal procedures (5.0 vs 10.8 and $17,713 vs $30,900); P < 0.05. The differences were less for patients undergoing procedures for which postoperative pathways were already in place such as pancreatic (9 vs 10.8 days and $30,524 vs $34,291) and colorectal (5.3 vs 6.5 days and $20,733 vs $25,150) surgeries. P > 0.05. An ERAS program can be instituted by an individual surgeon with the benefits of decreased LOS, cost, and mortality.

606 AUDIT: IV Fluid Prescribing in Surgical Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Shakir ◽  
E Mills ◽  
A Koomson ◽  
M Iqbal
Keyword(s):  
Kidney Injury ◽  
Improve Patient Care ◽  
District General Hospital ◽  
Recent Change ◽  
Surgical Patients ◽  
Maintenance Fluid ◽  
Maintenance Fluid Therapy ◽  
The Mean ◽  
Maintenance Fluids ◽  
Improve Patient

Abstract Aim A recent change to electronic fluid prescribing has enabled us to evaluate our adherence to recommendations. NICE clinical guideline 174 states that patients should receive 25-30ml/kg/day water and 1mmol/kg/day of sodium, potassium, and chloride with regards to maintenance fluid therapy. We retrospectively audited our practice in surgical patients. Method Patients were selected from two surgical inpatient wards in a district general hospital utilising random sampling over a one-month period. Prescribed intravenous fluid (IV) therapy over a 24-hour period was collected; in addition to weight, presence of an acute kidney injury (AKI) and indication for IV replacement (maintenance versus resuscitation). Results 50 patients were identified during the period. All of them were emergency presentations. Maintenance fluids were prescribed for 76% of patients. No patients had an AKI at time of data collection. The mean weight was 75kg. Overall, patients received a mean fluid volume of 2.3L/day. The mean concentration of electrolytes administered over a 24-hour period were: Sodium 297mmol, Potassium 13mmol, Chloride 237mmol. When adjusting for patient weight, this resulted in a net administration of: Sodium +221mmol, Potassium -62mmol, Chloride +162mmol. Conclusions Three quarters of surgical patients were administered maintenance fluids. The electrolyte contents of these fluids were inadequate. Patients received 295% excess Sodium, 216% excess Chloride, and 82% less than the recommended daily requirement of Potassium. We aim to introduce a protocol for maintenance fluid prescribing, in addition to teaching sessions, that would allow for adherence to guidelines and improve patient care.

scholarly journals Protein carbonyl concentration as a biomarker for development and mortality in sepsis-induced acute kidney injury

2018 ◽  
Vol 38 (1) ◽  
Author(s):  
Nara Aline Costa ◽  
Ana Lúcia Gut ◽  
Paula Schmidt Azevedo ◽  
Suzana Erico Tanni ◽  
Natália Baraldi Cunha ◽  
...  
Keyword(s):  
Septic Shock ◽  
Prospective Observational Study ◽  
Kidney Injury ◽  
Protein Carbonyl ◽  
Apache Ii Score ◽  
Roc Curve Analysis ◽  
Logistic Regression Models ◽  
Icu Admission ◽  
Icu Stay ◽  
The Mean

The objective of the present study was to evaluate protein carbonyl concentration as a predictor of AKI development in patients with septic shock and of renal replacement therapy (RRT) and mortality in patients with SAKI. This was a prospective observational study of 175 consecutive patients over the age of 18 years with septic shock upon Intensive Care Unit (ICU) admission. After exclusion of 46 patients (27 due to AKI at ICU admission), a total of 129 patients were enrolled in the study. Demographic information and blood samples were taken within the first 24 h of the patient’s admission to determine serum protein carbonyl concentrations. Among the patients who developed SAKI, the development of AKI was evaluated, along with mortality and need for RRT. The mean age of the patients was 63.3 ± 15.7 years, 47% were male and 51.2% developed SAKI during ICU stay. In addition, protein carbonyl concentration was shown to be associated with SAKI. Among 66 patients with SAKI, 77% died during the ICU stay. Protein carbonyl concentration was not associated with RRT in patients with SAKI. However, the ROC curve analysis revealed that higher levels of protein carbonyl were associated with mortality in these patients. In logistic regression models, protein carbonyl level was associated with SAKI development (OR: 1.416; 95% CI: 1.247–1.609; P<0.001) and mortality when adjusted by age, gender, and APACHE II score (OR: 1.357; 95% CI: 1.147–1.605; P<0.001). In conclusion, protein carbonyl concentration is predictive of AKI development and mortality in patients with SAKI, with excellent reliability.

scholarly journals Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective Before-and-After Study

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 687
Author(s):  
Daniel Christoph Richter ◽  
Maximilian Dietrich ◽  
Lazar Detelinov Lalev ◽  
Felix C.F. Schmitt ◽  
Mascha Onida Fiedler ◽  
...  
Keyword(s):  
Septic Shock ◽  
Invasive Ventilation ◽  
Unbound Fraction ◽  
Improve Patient Survival ◽  
Beneficial Effects ◽  
Pharmacokinetic Properties ◽  
Before And After ◽  
Reduction Of Mortality ◽  
Improve Patient ◽  
Observation Period

Septic shock substantially alters the pharmacokinetic properties of β-lactams with a subsequently high risk of insufficiently low serum concentrations and treatment failure. Considering their pharmacokinetic (PK)/pharmacodynamic (PD) index, prolonged infusions (PI) of β-lactams extend the time that the unbound fraction of the drug remains above the minimal inhibitory concentration MIC (ft >MIC) and may improve patient survival. The present study is a monocentric, retrospective before-and-after analysis of septic shock patients treated with β-lactams. Patients of the years 2015-2017 received intermittent bolus application whereas patients of 2017–2020 received PI of β-lactams. The primary outcome was mortality at day 30 and 90 after diagnosis of septic shock. Mortality rates in the PI group were significantly lower on day 30 (PI: 41%, n = 119/290 vs. IB: 54.8%, n = 68/114; p = 0.0097) and day 90 (PI: 47.9%, n = 139/290 vs. IB: 62.9%, n = 78/124; p = 0.005). After propensity-score matching, 30- and 90-day mortality remained lower for the PI group (−10%, p = 0.14). PI was further associated with a reduction in the duration of invasive ventilation and a stronger decrease in SOFA scores within a 14d-observation period. PI of β-lactams was associated with a significant reduction of mortality in patients with septic shock and may have beneficial effects on invasive ventilation and recovery from sepsis-related organ failure.

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