scholarly journals The Independent Association of Mechanical Ventilation with Septic Shock Severity

2020 ◽  
Author(s):  
A.A. Merchant ◽  
A.M. Esper ◽  
G.S. Martin ◽  
A.L. Holder
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Independent Association

scholarly journals Healthcare trajectories before and after critical illness: population-based insight on diverse patients clusters

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Youenn Jouan ◽  
Leslie Grammatico-Guillon ◽  
Noémie Teixera ◽  
Claire Hassen-Khodja ◽  
Christophe Gaborit ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Length Of Stay ◽  
Population Based ◽  
Hospital Length Of Stay ◽  
Healthcare Use ◽  
Icu Admission ◽  
Icu Discharge

Abstract Background The post intensive care syndrome (PICS) gathers various disabilities, associated with a substantial healthcare use. However, patients’ comorbidities and active medical conditions prior to intensive care unit (ICU) admission may partly drive healthcare use after ICU discharge. To better understand retative contribution of critical illness and PICS—compared to pre-existing comorbidities—as potential determinant of post-critical illness healthcare use, we conducted a population-based evaluation of patients’ healthcare use trajectories. Results Using discharge databases in a 2.5-million-people region in France, we retrieved, over 3 years, all adult patients admitted in ICU for septic shock or acute respiratory distress syndrome (ARDS), intubated at least 5 days and discharged alive from hospital: 882 patients were included. Median duration of mechanical ventilation was 11 days (interquartile ranges [IQR] 8;20), mean SAPS2 was 49, and median hospital length of stay was 42 days (IQR 29;64). Healthcare use (days spent in healthcare facilities) was analyzed 2 years before and 2 years after ICU admission. Prior to ICU admission, we observed, at the scale of the whole study population, a progressive increase in healthcare use. Healthcare trajectories were then explored at individual level, and patients were assembled according to their individual pre-ICU healthcare use trajectory by clusterization with the K-Means method. Interestingly, this revealed diverse trajectories, identifying patients with elevated and increasing healthcare use (n = 126), and two main groups with low (n = 476) or no (n = 251) pre-ICU healthcare use. In ICU, however, SAPS2, duration of mechanical ventilation and length of stay were not different across the groups. Analysis of post-ICU healthcare trajectories for each group revealed that patients with low or no pre-ICU healthcare (which represented 83% of the population) switched to a persistent and elevated healthcare use during the 2 years post-ICU. Conclusion For 83% of ARDS/septic shock survivors, critical illness appears to have a pivotal role in healthcare trajectories, with a switch from a low and stable healthcare use prior to ICU to a sustained higher healthcare recourse 2 years after ICU discharge. This underpins the hypothesis of long-term critical illness and PICS-related quantifiable consequences in healthcare use, measurable at a population level.

scholarly journals Drotrecogin Alpha (Activated) in Two Patients with the Hantavirus Cardiopulmonary Syndrome

2006 ◽  
Vol 13 (5) ◽  
pp. 272-274 ◽  
Author(s):  
Robert C McDermid ◽  
RT Noel Gibney ◽  
Ronald J Brisebois ◽  
Neil M Skjodt
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Definitive Diagnosis ◽  
Endothelial Injury ◽  
Capillary Leak ◽  
Hypoxemic Respiratory Failure ◽  
Vasoactive Medications ◽  
Drotrecogin Alpha

Hantavirus cardiopulmonary syndrome (HCPS) is associated with rapid cardiopulmonary collapse from endothelial injury, resulting in massive capillary leak, shock and severe hypoxemic respiratory failure. To date, treatment remains supportive and includes mechanical ventilation, vasopressors and extracorporeal membrane oxygenation, with mortality approaching 50%. Two HCPS survivors initially given drotrecogin alpha (activated) (DAA) for presumed bacterial septic shock are described. Vasoactive medications were required for a maximum of 52 h, whereas creatinine levels and platelet counts normalized within seven to nine days. Given the similar presentations of HCPS and bacterial septic shock, empirical DAA therapy will likely be initiated before a definitive diagnosis of HCPS is made. Further observations of DAA in HCPS seem warranted.

Outcome and Prognostic Factors in Patients with Hematological Malignancy That Are Admitted to the Intensive Care Unit.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5285-5285
Author(s):  
Christelle Ferra ◽  
Maite Misis ◽  
Albert Oriol ◽  
Pilar Marcos ◽  
Natalia Lloveras ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Icu Admission ◽  
Life Threatening ◽  
Discharged Patients ◽  
Life Threatening Complication

Abstract When patients with hematological malignancies develop a life-threatening complication there may be reluctance to admit them in intensive care units (ICU) because of their supposed poor prognosis. The objective of this study was to evaluate the mortality during the ICU admission, the long-term survival, and the prognostic factors that contribute to the survival of patients with hematological malignancies who were transferred to ICU due to a life-threatening complication. From January 2000 to May 2004, the variables at admission and during stay at the ICU, and the follow-up were reviwed in 58 consecutive critically-ill patients with a hematological malignancy from a single institution. The median age (range) was 55 (15–75) years and the male/female ratio was: 38/20. The hematological underlying diseases were: NHL (18 patients), AML (10), ALL (9), MM (6), chronic lymphoproliferative disorder (5), chronic myeloproliferative disorder (4), myelodysplastic syndrome (3), aplastic anemia (2) and Hodgkin’s lymphoma (1). Seven patients had received a hematopoietic stem cell transplant prior to the ICU admission. The main life-threatening acute illness precipitating the ICU transfer were: septic shock (26 patients, 45%), respiratory failure (21, 36%), non-septic hemodynamic instability (5, 9%), respiratory arrest related to a neurological event (2, 3%), post-surgical status (2, 3%), cardiac infarction (1, 2%) and polytrauma (1, 2%). Twenty-one patients (36%) could be discharged alive from the ICU. The median overall survival (range) for ICU discharged patients was 23 (0–54) months, with a median follow-up of 8 months. The actuarial probability of discharged patients to be alive was 56% (CI 95%: 31–75) at 6 months, and a 48% (CI 95%: 13–70) at 12 months. The mean Acute Physiology and Chronic Health Evaluation II (APACHE) score at admission, neutropenia, need for mechanical ventilation, maximum FIO2 requirements at 24 hours from admission, presence of septic shock, renal impairment or liver damage, were associated with a poor outcome in the univariate analysis. A documented infection was not associated with a higher mortality rate except for fungal infection. The APACHE II score at 48 and 72 hours of ICU admission decreased both in surviving and non-surviving patients due to therapeutic manoeuvres and was not predictive of the outcome. The type of the hematological malignancy, its prognosis and the presence of active disease at ICU admission did not predict patients outcome in our series. The number of failing organs also predicted a poorer survival for patients with more than two failing organs (p=0.038). In a multivariate logistical regression model, only the cardiovascular failure requiring vasoactive and the need of mechanical ventilation predicted outcome in the ICU admitted patients diagnosed with a hematological malignancy. A high proportion of admitted patients with a life-threatening complication and a hematological malignancy could be discharged from ICU. Although the mortality rate immediately after ICU discharge was high, those patients that survived the first week outside ICU had an expected survival only conditioned by their hematological malignancy.

scholarly journals Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256368
Author(s):  
Roshan Acharya ◽  
Aakash Patel ◽  
Evan Schultz ◽  
Michael Bourgeois ◽  
Natalie Kandinata ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Mechanical Ventilation ◽  
Severe Sepsis ◽  
Case Control Study ◽  
Case Control ◽  
Retrospective Case ◽  
Fluid Bolus ◽  
Baseline Characteristics ◽  
Control Study

Background The use of ≥30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data. Methods The retrospective case-control study included 671 adult patients who presented to the emergency department of a tertiary care hospital from January 01, 2017 to December 31, 2019 with severe sepsis or septic shock. Patients were categorized into the CHF group and the non-CHF group. The primary outcome was to evaluate the compliance with ≥30 mL/Kg fluid bolus within 6 hours of presentation. The comparison of baseline characteristics and secondary outcomes were done between the groups who received ≥30 mL/Kg fluid bolus. For the subgroup analysis of the CHF group, it was divided based on if they received ≥30 mL/Kg fluid bolus or not, and comparison was done for baseline characteristics and secondary outcomes. Univariate and multivariable analyses were performed to explore the differences between the groups for in-hospital mortality and mechanical ventilation. Results The use of ≥30 mL/Kg fluid bolus was low in both the CHF and non-CHF groups [39% vs. 66% (p<0.05)]. Mortality was higher in the CHF group [33% vs 18% (p<0.05)]. Multivariable analysis revealed that the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 12% [OR 0.88, 95% CI 0.82–0.95 (p<0.05)]. The use of ≥30 mL/Kg fluid bolus did not increase the odds of mechanical ventilation [OR 0.99, 95% CI 0.93–1.05 (p = 0.78)]. In subgroup analysis, the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 5% [OR 0.95, 95% CI 0.90–0.99, (p<0.05)] and did not increase the odds of mechanical ventilation. The presence of the low ejection fraction did not influence the chance of getting fluid bolus. Conclusion The use of ≥30 mL/Kg fluid bolus seems to confer protection against in-hospital mortality and is not associated with increased chances of mechanical ventilation in heart failure patients presenting with severe sepsis or septic shock.

Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

2018 ◽  
Vol 35 (5) ◽  
pp. 485-493 ◽  
Author(s):  
Christopher J. Miller ◽  
Bruce A. Doepker ◽  
Andrew N. Springer ◽  
Matthew C. Exline ◽  
Gary Phillips ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Severe Sepsis ◽  
Clinical Outcomes ◽  
Serum Phosphate ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Sepsis And Septic Shock ◽  
The Impact ◽  
Ventilated Patients

Background: Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock. Methods: A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed. Patients were randomly selected from an internal intensive care unit (ICU) database at an academic medical center in the United States and screened for inclusion and exclusion criteria. Time-weighted phosphate was calculated using all phosphate measurements obtained during ICU admission. The associations between time-weighted phosphate and duration of mechanical ventilation, 28-day mortality, and ICU and hospital length of stay were evaluated using linear or logistic regression as appropriate. Results: One-hundred ninety-seven patients were evaluated: 33 were categorized as hypophosphatemia, 123 as normophosphatemia, and 41 as hyperphosphatemia. Patients with time-weighted hyperphosphatemia had a higher Simplified Acute Physiology Score III score and incidence of septic shock. Significantly higher rates of 28-day mortality were observed among those with time-weighted phosphate levels above 3.5 mg/dL. However, both time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. For every 0.5 mg/dL increase in time-weighted phosphate referent values from 4.0 to 6.0, the duration of mechanical ventilation decreased by 8% to 26%. For every 0.5 mg/dL decrease in time-weighted phosphate referent values from 3.0 to 1.0, significant decreases in duration of mechanical ventilation ranged from 14% to 41%. Conclusion: Time-weighted hyperphosphatemia may be associated with increased mortality in mechanically ventilated patients with severe sepsis or septic shock. However, time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. Future studies should further describe the impact of hypo- and hyperphosphatemia on clinical outcomes among critically ill patients with severe sepsis or septic shock.

Azithromycin and Septic Shock Outcomes

2021 ◽  
pp. 089719002110641
Author(s):  
Joseph M. Johnson ◽  
Raymond J. Yost ◽  
Mark H. Pangrazzi ◽  
Katri A. Golden ◽  
Ayman O. Soubani ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Antimicrobial Treatment ◽  
Teaching Hospitals ◽  
Shock Duration ◽  
Shock Onset ◽  
Clinical Effects ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration

Introduction: Although there is evidence describing the immunomodulatory effects of macrolide antibiotics, there is little literature exploring the clinical effects these properties may have and their impact on measurable outcomes. Objective: The purpose of this study was to determine if empiric antimicrobial regimens containing azithromycin shorten time to shock resolution. Methods: A retrospective study was performed in adults with septic shock admitted to intensive care units (ICUs) of 3 university-affiliated, urban teaching hospitals between June 2012 and June 2016. Eligible patients with septic shock required treatment with norepinephrine as the first-line vasopressor for a minimum of 4 hours and received at least 48 hours of antimicrobial treatment from the time of shock onset. Propensity scores were utilized to match patients who received azithromycin to those who did not. Results: A total of 3116 patients met initial inclusion criteria. After propensity score matching, 258 patients were included, with 124 and 134 patients in the azithromycin and control groups, respectively. Median shock duration was similar in patients treated with or without azithromycin (45.6 hr vs 59.7 hr, P = .44). In-hospital mortality was also similar (37.9% vs 38.1%, P = .979). There were no significant differences in mechanical ventilation duration, ICU length of stay (LOS), or hospital LOS. Conclusions: In patients admitted to the ICU with septic shock, empiric azithromycin did not have a significant effect on shock duration, mechanical ventilation duration, ICU LOS, hospital LOS, or in-hospital mortality.

Airway Management of COVID 19 and Low Cost Ventilators - A boon or bane

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1682-1688
Author(s):  
Shristi Verma
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Drug Therapy ◽  
Oxygen Therapy ◽  
Close Contact ◽  
Low Cost ◽  
Invasive Procedure ◽  
Non Invasive ◽  
Progression Of Disease ◽  
Corona Viruses

Corona viruses are a large group of infectants that caused illness in humans and animals. In human it spreads through contact between people which is observed with MERS and SARS. Close contact leads to the spread of this deadly virus through the droplets from cough, sneezes or talks. The incubation period ranges between 2-14 days which is still uncertain in many a lot of cases. Depending on the symptoms disease has been categorized for the management, thus mild symptoms with sore throat, fever, cough and malaise are treated with antipyretic and antitussives with nutritive care. For moderate symptoms oxygen therapy, Anticoagulation, corticosteroids is given with antiviral drugs, demand for the supply must be maintained. WRT the severe cases drug therapy should be continued and oxygenation maintained early in the disease, with the progression of disease to ARDS ventilation protocol is taken into action firstly with non-invasive procedure supplying oxygen by the mask or the nasal cannula and maintaining the SpO2 and FiO2. If the condition worsens the Lung no longer acts compliant endotracheal intubation is performed for implementation of mechanical ventilation in the setting with access to expertise. For the patients who undergoes septic shock, patient is started on antimicrobial therapy, fluid loadings maintained and vasopressors given. Glucocorticoids can be used for short duration for the worsening condition of the patient. Their raised a situation of scarcity of ventilators, suddenly with the pandemic in the country alarming the under preparation of the demand for the present and future. Thus, by going local the ideology of low-cost ventilators happened.

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