scholarly journals Early enteral nutrition with advanced protein-calorie support in the intensive care of patients with multiple trauma as a mean for preventing multiple organ failure

2019 ◽  
Vol 0 (7.102) ◽  
pp. 11-17
Author(s):  
N.V. Matolinets
Keyword(s):  
Intensive Care ◽  
Enteral Nutrition ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Multiple Trauma ◽  
Multiple Organ ◽  
Early Enteral Nutrition

Cervical Spinal Cord Injury Shows Markedly Lower than Predicted Mortality (>72 Hours After Multiple Trauma) From Sepsis and Multiple Organ Failure

2018 ◽  
Vol 35 (4) ◽  
pp. 378-382
Author(s):  
Oliver Kamp ◽  
Oliver Jansen ◽  
Rolf Lefering ◽  
Renate Meindl ◽  
Christian Waydhas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Multiple Trauma ◽  
Injury Severity ◽  
Multiple Organ ◽  
Injury Pattern ◽  
Significant Difference ◽  
Cord Injury

Background: Sepsis and multiple organ failure (MOF) remain one of the main causes of death after multiple trauma. Trauma- and infection-associated immune reactions play an important role in the pathomechanism of MOF, but the exact pathways remain unknown. Spinal cord injury (SCI) may lead to an altered immune response, and some studies suggest a prognostic advantage for such patients having sepsis or multiple trauma. Yet these findings need to be evaluated in larger cohorts of trauma patients. Methods: Retrospective, multicenter study, using the data of the TraumaRegister DGU. Patients with and without SCI surviving the initial first 72 hours after trauma were matched according to injury pattern and age. Comparative analysis considered morbidity (sepsis, MOF) and hospital mortality. Results: The study population included 800 matched pairs. As intended by the matching process, patients with cervical SCI had an otherwise comparable injury pattern but a higher severity of trauma (mean Injury Severity Score: 36 vs 29, mean number of diagnosis: 5.6 vs 4.4). They had a higher rate of sepsis (15.9% vs 10.9%, P = .005) and MOF (35.9% vs 24.1%, P < .001) while mortality revealed no significant difference (9.5% vs 9.9%, P = .866). Conclusions: Cervical SCI leads to an increased rate of sepsis and MOF but appears to be favorable with respect to outcome of sepsis and MOF following multiple trauma. Further research should focus on the pathomechanisms and the possible arising therapeutic options.

scholarly journals A systematic review on the timing of artificial nutrition in acute pancreatitis

2008 ◽  
Vol 101 (6) ◽  
pp. 787-793 ◽  
Author(s):  
Maxim S. Petrov ◽  
Romana D. Pylypchuk ◽  
Antonina F. Uchugina
Keyword(s):  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Infectious Complications ◽  
Multiple Organ ◽  
Artificial Nutrition ◽  
Controlled Trials ◽  
Randomised Controlled

Artificial nutrition is an inherent part of management in acute pancreatitis. However, there is no consensus regarding the optimal time of the commencement of feeding in these patients. Our aim was to compare the effect of enteral v. parenteral nutrition with regard to the time points when they were administered in the randomised controlled trials. The search was undertaken in the Cochrane Central Register of Controlled Trials, MEDLINE and Science Citation Index as well as in the proceedings of major gastroenterology meetings. The summary estimate of the effect associated with artificial nutrition was calculated using a random-effects model and presented as a risk ratio (RR) and 95 % CI. A total of eleven randomised controlled trials were included. When started within 48 h of admission, enteral nutrition, in comparison with parenteral nutrition, resulted in a statistically significant reduction in the risks of multiple organ failure (RR 0·44; 95 % CI 0·23, 0·84), pancreatic infectious complications (RR 0·46; 95 % CI 0·27, 0·77) and mortality (RR 0·46; 95 % CI 0·20, 0·99). After 48 h of admission, enteral nutrition, in comparison with parenteral nutrition, did not result in a statistically significant reduction in the risks of multiple organ failure (RR 0·73; 95 % CI 0·33, 1·63), pancreatic infectious complications (RR 0·31; 95 % CI 0·07, 1·34) and mortality (RR 0·67; 95 % CI 0·22, 2·10). Enteral nutrition is more effective than parenteral nutrition in reducing the risk of multiple organ failure, pancreatic infectious complications and mortality in patients with acute pancreatitis. The magnitude of these benefits may depend on the timing of the commencement of nutrition.

A case of gonococcal necrotising fasciitis

Sexual Health ◽  
2014 ◽  
Vol 11 (3) ◽  
pp. 280
Author(s):  
Kudzai Nzenza Kanhutu ◽  
Denis D. Spelman ◽  
Michael D. Weymouth
Keyword(s):  
Intensive Care ◽  
Case Report ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Antimicrobial Therapy ◽  
Multiple Organ ◽  
Necrotising Fasciitis ◽  
Gonococcal Infection ◽  
Intensive Care Stay ◽  
Extended Course

This case report details the progress of a patient with severe disseminated gonococcal infection with associated necrotising fasciitis. His admission was punctuated by multiple surgical debridements and a prolonged intensive care stay due to multiple organ failure. An extended course of azithromycin-based antimicrobial therapy achieved a cure and the patient was eventually discharged home after 8 weeks. To our knowledge this is the first such case of histologically and microbiologically confirmed gonococcal necrotising fasciitis.

scholarly journals Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 79
Author(s):  
Dino Mijatovic ◽  
Ana Blagaic ◽  
Zeljko Zupan
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Multiple Organ Failure ◽  
Hemolytic Uremic Syndrome ◽  
Organ Failure ◽  
Hemolytic Anemia ◽  
Multiple Organ ◽  
Uremic Syndrome

Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).Case presentation: A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. In the next week of, what initially appeared as typical HUS, she developed MOF, including ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis.Conclusions: Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.

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