EXTRACORPOREAL DETOXIFICATION METHODS IN THE PATHOGENETIC THERAPY OF OBSTETRIC SEPSIS

Vestnik ◽  
2021 ◽  
pp. 147-150
Author(s):  
С.Н. Ералина ◽  
Е.Л. Исмаилов ◽  
М.Е. Рамазанов ◽  
Б.Ж. Аджибаев ◽  
Д.К. Сейтпанов ◽  
...  
Keyword(s):  
Septic Shock ◽  
Renal Function ◽  
Urine Output ◽  
Clinical Signs ◽  
Complex Treatment ◽  
Rapid Elimination ◽  
Pathogenetic Therapy ◽  
Osmotic Balance ◽  
Sepsis And Septic Shock

Раннее включение НВВГФ в комплексном лечении сепсиса и септического шока приводит к снижению клинических признаков эндотоксикоза, стабилизации гемодинамики в более ранние сроки, что связано с быстрой элиминацией цитокинов, коррекцией осмотического равновесия, увеличением диуреза, благодаря более раннему протезированию гомеостатической функции почек. Early inclusion of NVHF in the complex treatment of sepsis and septic shock leads to a decrease in clinical signs of endotoxicosis, stabilization of hemodynamics at an earlier time, which is associated with rapid elimination of cytokines, correction of osmotic balance, increased urine output due to earlier prosthetics of homeostatic renal function.

scholarly journals Cardiorenal Syndromes and Sepsis

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
C. Chelazzi ◽  
G. Villa ◽  
A. R. De Gaudio
Keyword(s):  
Septic Shock ◽  
Renal Function ◽  
Severe Sepsis ◽  
Renal Replacement Therapy ◽  
Endothelial Dysfunction ◽  
Renal Impairment ◽  
Myocardial Function ◽  
Cardiorenal Syndrome ◽  
Kidney Perfusion ◽  
Sepsis And Septic Shock

The cardiorenal syndrome is a clinical and pathophysiological entity defined as the concomitant presence of renal and cardiovascular dysfunction. In patients with severe sepsis and septic shock, acute cardiovascular, and renal derangements are common, that is, the septic cardiorenal syndrome. The aim of this paper is to describe the pathophysiology and clinical features of septic cardiorenal syndrome in light of the actual clinical and experimental evidence. In particular, the importance of systemic and intrarenal endothelial dysfunction, alterations of kidney perfusion, and myocardial function, organ “crosstalk” and ubiquitous inflammatory injury have been extensively reviewed in light of their role in cardiorenal syndrome etiology. Treatment includes early and targeted optimization of hemodynamics to reverse systemic hypotension and restore urinary output. In case of persistent renal impairment, renal replacement therapy may be used to remove cytokines and restore renal function.

scholarly journals The alteration of renal function in sepsis and septic shock patients in pediatric intensive care unit

2011 ◽  
Vol 51 (2) ◽  
pp. 89
Author(s):  
Feiby Julianto ◽  
Adrian Umboh ◽  
Suryadi Tatura
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Renal Function ◽  
Intensive Care ◽  
Mortality Rate ◽  
Correlation Coefficient ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Sepsis Group ◽  
Sepsis And Septic Shock

Background Sepsis is a commonly seen emergency case in the pediatric intensive care unit.1 Severe sepsis mortality rate in developed country andin developing country such as Indonesia are 9% and 50-70%, respectively. Furthennore, the mortality rate in septic shock is 80%.2 Several researches documented increasing rate of acute kidney injury (AKI) incidence correlated 'With sepsis. Clinical intervention identification may decrease AKI and sepsis incidence.Objective To identify the correlation between incidence of AKI in sepsis and in septic shock patients who was treated in pediatric intensive care unit (PICU).Methods A cross sectional study was perfonned in 37 patients diagnosed as sepsis according ACCP/SCCM criteria for children aged 1 month to 13 years. The study was conducted in Pediatric Department, Prof. Dr. R.D. Kandou hospital from April 2009 to June 2009.Results From 37 sepsis patients, 27 were boys and 10 were girls. In the sepsis group (n=27) 10 had AKI, and in the septic shock group (n= 10) had AKI. Phi correlation coefficient applied to statistically analyzed sepsis in correlation with AKI (creatinin serum and GFR). Significant Phi correlation coefficient was (r=0.117; P> 0.05)Conclusions The study concludes that there is no correlation of renal function impainnent Mth sepsis and septic shock.

scholarly journals Effect of Vasopressin and its Analogs versus Catecholamines on the Renal Outcomes in Septic Shock:A Systematic Review and Meta-Analysis of Randomized Trials

2021 ◽  
Author(s):  
Amina Elmi Yusuf ◽  
Wei He ◽  
Rongjie YU ◽  
Liqun Sun
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Creatinine Level ◽  
Risk Ratio ◽  
Urine Output ◽  
Meta Analysis ◽  
Secondary Outcomes

Abstract Background: This current systematic review and meta-analysis aimed to evaluate the association of Vasopressin and its analogs and adverse renal outcomes compared to Catecholamines in adult patients with septic shock. Method: We performed a systematic review of the literature published from inception to March 31, 2021, using online databases of PubMed, Embase, Cochrane Library. Randomized controlled trials reporting any renal function and comparing Vasopressin and its analogs with Catecholamines among adult septic shock patients. Our primary outcomes relating to acute renal failure were acute kidney injury incidence and the need for Renal replacement therapy. Our secondary outcomes were three: Renal replacement therapy free-days and 48h post-administration change in creatinine level and urine output. We applied a fixed-effects model to estimate the risk ratio (RR) for (dichotomized outcomes) and standard mean difference (SMD) for (continues outcomes). Results: 18 trials met the inclusion criteria with a total of 4,024 patients. 13 studies were eligible for quantitative meta-analysis and 5 studies were eligible for qualitative data. For the primary outcome, Vasopressin or its agonist are associated with a lower AKI incidence (Risk ratio 0.93, 95% CI [0.86, 1.00], P = 0.04, I² = 5%) and a reduced need for renal replacement therapy (Risk ratio 0.84, 95% CI [0.73, 0.97], P = 0.02, I² = 11%). We found no statistical significance in the pooled estimates for the secondary outcomes: RRT free-days (28 or 30 days) (P = 0.65, I² = 0%), 48h creatinine level (P = 0.81, I² = 39%), and 48h urine output (P = 0.46, I² = 8%). Conclusions: Vasopressin and its analogs are associated with a reduced AKI incidence and a lower RRT use rate in septic shock compared to catecholamines. Furthermore, we did not find a significant effect of Vasopressin on the number of RRT- free days (up to 28 or 30 days) or in creatinine level and urinary output in 48 hours. However, due to the high mortality associated with S-AKI, large blinded RCTs addressing renal function impairment in septic shock are warranted.

scholarly journals Acute Kidney Injury and Septic Shock—Defined by Updated Sepsis-3 Criteria in Critically Ill Patients

2019 ◽  
Vol 8 (10) ◽  
pp. 1731 ◽  
Author(s):  
Vin-Cent Wu ◽  
Shih-Chieh Jeff Chueh ◽  
Jui-Ting Chang ◽  
Bang-Gee Hsu ◽  
Marlies Ostermann ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Risk Factor ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Acute Dialysis ◽  
Sepsis And Septic Shock

Sepsis is commonly associated with acute kidney injury (AKI), particularly in those requiring dialysis (AKI-D). To date, Sepsis-3 criteria have not been applied to AKI-D patients. We investigated sepsis prevalence defined by Sepsis-3 criteria and evaluated the outcomes of septic-associated AKI-D among critically ill patients. Using the data collected from a prospective multi-center observational study, we applied the Sepsis-3 criteria to critically ill AKI-D patients treated in intensive care units (ICUs) in 30 hospitals between September 2014 and December 2015. We described the prevalence, outcomes, and characteristics of sepsis as defined by the screening Sepsis-3 criteria among AKI-D patients, and compared the outcomes of AKI-D patients with or without sepsis using the Sepsis-3 criteria. A total of 1078 patients (median 70 years; 673 (62.4%) men) with AKI-D were analyzed. The main etiology of AKI was sepsis (71.43%) and the most frequent indication for acute dialysis was oliguria (64.4%). A total of 577 (53.3% of 1078 patients) met the Sepsis-3 criteria, and 206 among the 577 patients (19.1%) had septic shock. Having sepsis and septic shock were independently associated with 90-day mortality among these ICU AKI-D patients (hazard ratio (HR) 1.23 (p = 0.027) and 1.39 (p = 0.004), respectively). Taking mortality as a competing risk factor, AKI-D patients with septic shock had a significantly reduced chance of weaning from dialysis at 90 days than those without sepsis (HR 0.65, p = 0.026). The combination of the Sepsis-3 criteria with the AKI risk score led to better performance in forecasting 90-day mortality. Sepsis affects more than 50% of ICU AKI patients requiring dialysis, and one-fifth of these patients had septic shock. In AKI-D patients, coexistent with or induced by sepsis (as screened by the Sepsis-3 criteria), there is a significantly higher mortality and reduced chance of recovering sufficient renal function, when compared to those without sepsis.

scholarly journals Results of the use of selective adsorption of endotoxin in the complex treatment of surgical sepsis and septic shock.

2021 ◽  
Vol 38 (6) ◽  
pp. 16-24
Author(s):  
Alexey Vereshchagin ◽  
Ludmila Pavlovna Kotelnikova
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Selective Adsorption ◽  
Fatal Outcome ◽  
Significant Risk ◽  
Oxygenation Index ◽  
Complex Treatment ◽  
Selective Sorption ◽  
Average Value ◽  
Sepsis And Septic Shock

Objective. To estimate the results of the use of LPS-adsorption in the complex treatment of surgical or obstetric sepsis and septic shock and to determine the risk factors for the development of lethal outcomes. Materials and methods. Since 2014, twenty-nine patients with surgical or obstetric sepsis and septic shock have been treated at the Perm Regional Clinical Hospital using selective endotoxin adsorption in addition to conventional medical therapy. Endotoxin elimination was performed using hemoperfusion with the Alteco LPS Adsorber (Sweden). The patients were divided into two groups according to the final results of the treatment. The data of clinical and laboratory examinations were compared before and 24 hours after LPS elimination. Results. Based on the correlation analysis, the most significant risk factors for the development of fatal outcomes are identified. It was found that neither the initial scores on the APACHE, SOFA scale, nor the level of CRP, PCT, EAA have a significant correlation with the lethal outcome. The only indicator before LPS-adsorption that has a direct correlation of the average value with the fatal outcome is the initial dose of norepinephrine. In our study, the mortality rate depends on the decrease in SOFA scores and its components in 24 hours after the procedure. Patients with the lower score after LPS-adsorption would have lower mortality. The predictors of ineffectiveness of treatment, despite the LPS-adsorption, were an unreliable decrease in the dose of vasopressors and the level of PCT, light improvements in the oxygenation index, the presence of bacteremia, septic shock and the delayed procedure. Conclusion. In surviving patients with surgical sepsis and septic shock, the use of LPS-adsorption in complex treatment significantly improved the function of the cardiovascular and respiratory systems, reduced the level of PCT. The risk factors for the development of lethal outcomes were the initial severity of cardiovascular insufficiency, the selective sorption of endotoxin with a delay, the presence of bacteremia, septic shock, insignificant decrease in SOFA scores and the level of PCT after selective sorption of endotoxin.

Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 27-32
Author(s):  
Bien Le ◽  
Dai Huynh ◽  
Mai Tuan ◽  
Minh Phan ◽  
Thao Pham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Fluid Responsiveness ◽  
Statistical Significance ◽  
Venous Pressure ◽  
Fluid Bolus ◽  
Low Blood Pressure ◽  
Low Central Venous Pressure ◽  
Sepsis And Septic Shock

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock. Design: observational study. Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%. Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers). Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

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