scholarly journals Evaluation of renal perfusion by Doppler ultrasonography and the effect of Ulinastatin to it in a porcine model of septic shock

2021 ◽  
Author(s):  
Chen-Chen Hang ◽  
Yu-Hong Guo ◽  
Chun-Sheng Li ◽  
Shuo Wang
Keyword(s):  
Septic Shock ◽  
Porcine Model ◽  
Resistive Index ◽  
Venous Catheter ◽  
Renal Perfusion ◽  
Shock Group ◽  
Time Intensity Curve ◽  
Post Injury ◽  
Significant Difference ◽  
Arcuate Artery

Abstract Objective To develop a reliable and noninvasive method to evaluate the renal perfusion in a porcine model of septic shock and investigate the effect of UTI on it. Methods Thirty-two healthy male domestic pigs were randomly assigned to one of four groups: a sham group (SH, n=5); a septic shock group (SS, n=9); a septic shock group treated with vancomycin (15mg/kg) (VAN, n=9) and a septic shock group treated with UTI (50,000U/kg) + vancomycin (UTI, n= 9). Contrast-enhanced ultrasound (CEUS) of kidney at the baseline and the end of protocol (24h) were performed. The spectrum of interlobar or arcuate artery was selected to calculate the corrected resistive index (cRI). Sulphur hexafluoride (SF6) microbubbles were bolus injected via venous catheter. The peak intensity (Pi) and area under curve (AUC) were calculated by a time-intensity curve (TIC). Results cRI increased significantly at the end of the protocol except the SH groups, significant difference was found between each experimental group and the SH group. Linear regression was found between the cardiac output (CO) and Pi (Pi = 7.082 × CO + 5.026, R2=0.752, F=84.878, P < 0.001). The AUC decreased significantly post-injury in the SS and VAN group. All above parameters were improved by the UTI treatment, significant differences were found between the UTI and SS or VAN group respectively (P<0.05). Conclusions Septic shock occasionally accompanies with a significant low perfusion in renal microcirculation and UTI can improve it significantly.

scholarly journals A Nationwide Comparison Between Sepsis-2 and Sepsis-3 Definition in Japan

2019 ◽  
Vol 35 (12) ◽  
pp. 1389-1395 ◽  
Author(s):  
Shuhei Takauji ◽  
Mineji Hayakawa ◽  
Satoshi Fujita
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Prognostic Factors ◽  
Multivariate Logistic Regression Analysis ◽  
Chronic Hemodialysis ◽  
Shock Group ◽  
Sepsis Group ◽  
Icu Mortality ◽  
Chronic Heart Disease ◽  
Significant Difference

Background: Currently, it remains controversial whether the Sepsis-3 definition provides the most appropriate criteria for clinical use. The purpose of this study was to compare between the Sepsis-2 and Sepsis-3 definitions using Japan’s nationwide registry. Methods: Data were obtained from a multicenter registry conducted at 42 intensive care units (ICUs) throughout Japan, in which patients received treatment for severe sepsis or septic shock between January 2011 and December 2013. Results: A total of 2797 patients diagnosed using the Sepsis-2 criteria were included in the present study. These patients were categorized into “Severe sepsis” (n = 1154) and “Sepsis-2 shock” (n = 1643) groups. Among the “Sepsis-2 shock” group, patients who did not meet the Sepsis-3 criteria for septic shock were categorized into the “Sepsis-2 shock-only” (n = 448, 27.3%) group, while patients who met the Sepsis-3 criteria for septic shock were categorized into “Sepsis-3 shock (n = 1195, 72.7%)” group. The ICU mortality in the “Sepsis-3 shock” group, “Sepsis-2 shock-only” group, and “Severe sepsis” group was 28.5%, 10.9%, and 14.1%, respectively. We observed no significant difference between the “Severe sepsis” and “Sepsis-2 shock-only” groups in terms of in-hospital survival ( P = .098), while the “Sepsis-3 shock” group had the highest in-hospital mortality rate ( P < .001). In a multivariate logistic regression analysis, liver insufficiency and immunocompromised status were independent prognostic factors in the “Sepsis-2 shock-only” group. In contrast, chronic heart disease and chronic hemodialysis were independent prognostic factors in the “Sepsis-3 shock” group. Conclusions: The ICU mortality of the “Sepsis-2 shock-only” group was significantly low. Besides septic shock diagnosed by the Sepsis-3 definition selects patients with more severe cases of sepsis among the “Sepsis-2 shock” group.

Vitamin C, Thiamine, and Hydrocortisone in the Treatment of Sepsis: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

2021 ◽  
pp. 088506662098780
Author(s):  
Yazan Zayed ◽  
Bashar N. Alzghoul ◽  
Momen Banifadel ◽  
Hima Venigandla ◽  
Ryan Hyde ◽  
...  
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Vitamin C ◽  
Sofa Score ◽  
Sequential Analysis ◽  
Trial Sequential Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Icu Length Of Stay ◽  
Significant Difference

Background: There is a conflicting body of evidence regarding the benefit of vitamin C, thiamine, and hydrocortisone in combination as an adjunctive therapy for sepsis with or without septic shock. We aimed to assess the efficacy of this treatment among predefined populations. Methods: A literature review of major electronic databases was performed to include randomized controlled trials (RCTs) evaluating vitamin C, thiamine, and hydrocortisone in the treatment of patients with sepsis with or without septic shock in comparison to the control group. Results: Seven studies met our inclusion criteria, and 6 studies were included in the final analysis totaling 839 patients (mean age 64.2 ± 18; SOFA score 8.7 ± 3.3; 46.6% female). There was no significant difference between both groups in long term mortality (Risk Ratio (RR) 1.05; 95% CI 0.85-1.30; P = 0.64), ICU mortality (RR 1.03; 95% CI 0.73-1.44; P = 0.87), or incidence of acute kidney injury (RR 1.05; 95% CI 0.80-1.37; P = 0.75). Furthermore, there was no significant difference in hospital length of stay, ICU length of stay, and ICU free days on day 28 between the intervention and control groups. There was, however, a significant difference in the reduction of SOFA score on day 3 from baseline (MD −0.92; 95% CI −1.43 to −.41; P < 0.05). In a trial sequential analysis for mortality outcomes, our results are inconclusive for excluding lack of benefit of this therapy. Conclusion: Among patients with sepsis with or without septic shock, treatment with vitamin C, thiamine, and hydrocortisone was not associated with a significant reduction in mortality, incidence of AKI, hospital and ICU length of stay, or ICU free days on day 28. There was a significant reduction of SOFA score on day 3 post-randomization. Further studies with a larger number of patients are needed to provide further evidence on the efficacy or lack of efficacy of this treatment.

A comparative study of the acute effects of knee brace vs. kinesiotape on selected isokinetic strength variables of the knee muscles

2021 ◽  
pp. 1-6
Author(s):  
Ali Kerim Yilmaz ◽  
Mehmet Vural ◽  
Mustafa Özdal ◽  
Menderes Kabadayi
Keyword(s):  
Knee Injuries ◽  
Knee Extension ◽  
Acute Effects ◽  
Post Injury ◽  
Kinesio Tape ◽  
Knee Strength ◽  
Significant Difference ◽  
S Peak ◽  
Male Subjects ◽  
Methods Of Treatment

BACKGROUND: Different methods of treatment for preventing knee injuries, enhancing knee strength and minimising post-injury risks have been explored. Among these methods, Kinesio tape (KT) and knee braces (KB) are commonly used. OBJECTIVE : To investigate the acute effects of KT and KB on isokinetic knee strength parameters. METHODS: A total of 15 healthy sedentary male subjects voluntarily participated in the study. Concentric isokinetic knee extension (EX) and flexion (FLX) strength were measured at three sessions: 1. Baseline 2. with KT (’KT’) 3. with KB (’KB’). Tests were performed at 60, 180 and 240∘/s. Peak moment (PM), Hamstring/Quadriceps ratio (HQR), and joint angle at peak moment (JAPM) were measured. RESULTS: ‘KT’ and ‘KB’ were associated with increase in PMEX, PMFLX, HQR at 60 and 240∘/s (p< 0.05) and increased JAPMEX. No significant difference was observed at 180∘/s (p> 0.05). CONCLUSION: In healthy individuals, ‘I’ shape KT and KB positively affect EX and FLX strengths and HQR, especially at low angular velocity.

scholarly journals Peroxynitrite decomposition catalyst reduces vasopressin requirement in ovine MRSA sepsis

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Osamu Fujiwara ◽  
Satoshi Fukuda ◽  
Ernesto Lopez ◽  
Yaping Zeng ◽  
Yosuke Niimi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Fluid Resuscitation ◽  
Conscious State ◽  
Smoke Inhalation ◽  
Post Injury ◽  
Adjunct Treatment ◽  
Aggressive Fluid Resuscitation ◽  
Severe Hypotension ◽  
Bolus Intravenous Injection

Abstract Background Sepsis is one of the most frequent causes of death in the intensive care unit. Host vascular hypo-responsiveness to vasopressors during septic shock is one of the challenging problems. This study tested the hypothesis that adjunct therapy with peroxynitrite decomposition catalyst (WW-85) would reduce arginine vasopressin (AVP) requirements during sepsis resuscitation, using ovine sepsis model. Methods Thirteen adult female Merino sheep, previously instrumented with multiple vascular catheters, were subjected to “two-hit” (cotton smoke inhalation and intrapulmonary instillation of live methicillin-resistant Staphylococcus aureus; 3.5 × 1011 colony-forming units) injury. Post injury, animals were awakened and randomly allocated to the following groups: (1) AVP: injured, fluid resuscitated, and titrated with AVP, n = 6 or (2) WW-85 + AVP: injured, fluid resuscitated, treated with WW-85, and titrated with AVP, n = 7. One-hour post injury, a bolus intravenous injection of WW-85 (0.1 mg/kg) was followed by a 23-h continuous infusion (0.02 mg/kg/h). Titration of AVP started at a dose of 0.01 unit/min, when mean arterial pressure (MAP) decreased by 10 mmHg from baseline, despite aggressive fluid resuscitation, and the rate was further adjusted to maintain MAP. After the injury, all animals were placed on a mechanical ventilator and monitored in the conscious state for 24 h. Results The injury induced severe hypotension refractory to aggressive fluid resuscitation. High doses of AVP were required to partially attenuate the sepsis-induced hypotension. However, the cumulative AVP requirement was significantly reduced by adjunct treatment with WW-85 at 17–24 h after the injury (p < 0.05). Total AVP dose and the highest AVP rate were significantly lower in the WW-85 + AVP group compared to the AVP group (p = 0.02 and 0.04, respectively). Treatment with WW-85 had no adverse effects. In addition, the in vitro effects of AVP on isolated artery diameter changes were abolished with peroxynitrite co-incubation. Conclusions The modulation of reactive nitrogen species, such as peroxynitrite, may be considered as a novel adjunct treatment option for septic shock associated with vascular hypo-responsiveness to vasopressors.

scholarly journals SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

2021 ◽  
Vol 11 (3) ◽  
pp. 164
Author(s):  
Mahmoud Al-Obeidallah ◽  
Dagmar Jarkovská ◽  
Lenka Valešová ◽  
Jan Horák ◽  
Jan Jedlička ◽  
...  
Keyword(s):  
Septic Shock ◽  
Body Temperature ◽  
Sofa Score ◽  
Porcine Model ◽  
Venous Blood ◽  
Mixed Venous Blood ◽  
Mechanically Ventilated ◽  
Multiple Parameters ◽  
Failure Assessment ◽  
Sepsis And Septic Shock

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

Mortality Benefit From the Passive Leg Raise Maneuver in Guiding Resuscitation of Septic Shock Patients: A Systematic Review and Meta-Analysis of Randomized Trials

2021 ◽  
pp. 088506662110197
Author(s):  
Moosa Azadian ◽  
Suyee Win ◽  
Amir Abdipour ◽  
Carolyn Krystal Kim ◽  
H. Bryant Nguyen
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Fluid Resuscitation ◽  
Standard Care ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Time Interval ◽  
Eligibility Criteria ◽  
Significant Difference ◽  
Passive Leg Raise

Background: Fluid therapy plays a major role in the management of critically ill patients. Yet assessment of intravascular volume in these patients is challenging. Different invasive and non-invasive methods have been used with variable results. The passive leg raise (PLR) maneuver has been recommended by international guidelines as a means to determine appropriate fluid resuscitation. We performed this systematic review and meta-analysis to determine if using this method of volume assessment has an impact on mortality outcome in patients with septic shock. Methods: This study is a systematic review and meta-analysis. We searched available data in the MEDLINE, CINAHL, EMBASE, and CENTRAL databases from inception until October 2020 for prospective, randomized, controlled trials that compared PLR-guided fluid resuscitation to standard care in adult patients with septic shock. Our primary outcome was mortality at the longest duration of follow-up. Results: We screened 1,425 article titles and abstracts. Of the 23 full-text articles reviewed, 5 studies with 462 patients met our eligibility criteria. Odds ratios (ORs) and associated 95% confidence intervals (CIs) for mortality at the longest reported time interval were calculated for each study. Using random effects modeling, the pooled OR (95% CI) for mortality with a PLR-guided resuscitation strategy was 0.82 (0.52 -1.30). The included studies were not blinded and they ranged from having low to high risk of bias using the Cochrane Risk of Bias Tool. Conclusion: Our analysis showed there was no statistically significant difference in mortality among septic shock patients treated with PLR-guided resuscitation vs. those with standard care.

scholarly journals A Lethal Case ofSphingomonas paucimobilisBacteremia in an Immunocompromised Patient

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Nata Pratama Hardjo Lugito ◽  
Cucunawangsih ◽  
Andree Kurniawan
Keyword(s):  
Septic Shock ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Severe Infection ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
Premature Neonate ◽  
Hospital Environment ◽  
Indwelling Catheters ◽  
Stage Renal Disease

Sphingomonas paucimobilisis a yellow-pigmented, glucose nonfermenting, aerobic, Gram negative bacillus of low pathogenicity. This organism was found in the implantation of indwelling catheters, sterile intravenous fluid, or contaminated hospital environment such as tap and distilled water, nebulizer, ventilator, and hemodialysis device. A 55-year-old female was hospitalized for diabetic foot ulcer in the presence of multiple comorbidities: diabetes mellitus, colonic tuberculosis, end-stage renal disease, and indwelling catheters for central venous catheter and hemodialysis. The patient passed away on the 44th day of admission due to septic shock. The organism found on blood culture on the 29th day of admission was multidrug resistantS. paucimobilis. Severe infection and septic shock due toS. paucimobilishave been reported particularly in immunocompromised patients, but there has been only one reported case of death in a premature neonate with septic shock. This is the first reported lethal case ofS. paucimobilisbacteremia in an adult patient.

Duplex Sonography of Normal Renal Allografts

1989 ◽  
Vol 30 (1) ◽  
pp. 53-56 ◽  
Author(s):  
B. Schwaighofer ◽  
F. Kainberger ◽  
F. Fruehwald ◽  
P. Huebsch ◽  
N. Gritzmann ◽  
...  
Keyword(s):  
Blood Flow ◽  
Resistive Index ◽  
Duplex Sonography ◽  
Invasive Technique ◽  
Flow Measurements ◽  
Renal Allografts ◽  
Significant Difference ◽  
Main Renal Artery ◽  
Long Term Follow Up ◽  
Blood Flow Measurements

Thirty-five patients with normal renal allografts as well as 10 healthy volunteers with normal native kidneys were examined by duplex sonography. Blood flow measurements were performed in the main renal artery as well as in segmental, interlobar and arcuate arteries. In both groups the normal range of variation in blood flow was defined by using the resistive index (RI). Doppler wave forms and RI of main renal arteries were both similar to those of their branches. In renal allografts as well as in native kidneys the blood flow pattern showed a rapid up-slope in systole followed by a gradual down-slope in early diastole, with a persistent flow throughout diastole. In addition, there was no significant difference in the RI between allografted and native kidneys. The interobserver variability was less than 10 per cent. The mean RI was 0.68 using all data points. Vascular rejection in 11 patients could be discriminated significantly (p<0.001). Duplex sonography is useful in evaluating renal blood flow. This simple and non-invasive technique seems to be useful in long-term follow-up of renal allograft recipients.

Targeting individual hemodynamics to maintain renal perfusion during pneumoperitoneum in a porcine model

Surgery ◽  
2007 ◽  
Vol 142 (3) ◽  
pp. 350-356 ◽  
Author(s):  
Sebastian V. Demyttenaere ◽  
Ali Taqi ◽  
Gerry N. Polyhronopoulos ◽  
Simon Bergman ◽  
Donna D. Stanbridge ◽  
...  
Keyword(s):  
Porcine Model ◽  
Renal Perfusion
Sign in / Sign up

Export Citation Format

Share Document