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Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock

World Journal of Critical Care Medicine 2016年第1期5卷 47-56页

作者： Jihad Mallat Malcolm Lemyze Laurent Tronchon Beno?t Vallet Didier Thevenin Department of Anesthesiology and Critical Care Medicine Centre Hospitalier du Dr. Schaffner de Lens

The mixed venous-to-arterial carbon dioxide(CO_2)tension difference[P(v-a) CO_2]is the difference between carbon dioxide tension(PCO_2) in mixed venous blood(sampled from a pulmonary artery catheter) and the PCO_2 in arterial blood.P(v-a) CO_2 depends on the cardiac output and the global CO_2 production,and on the complex relationship between PCO_2 and CO_2 *** and clinical studies support the evidence that P(v-a) CO_2 cannot serve as an indicator of tissue hypoxia,and should be regarded as an indicator of the adequacy of venous blood to wash out the total CO_2generated by the peripheral tissues.P(v-a) CO_2 can be replaced by the central venous-to-arterial CO_2 difference(△PCO_2),which is calculated from simultaneous sampling of central venous blood from a central vein catheter and arterial blood and,therefore,more easy to obtain at the *** the △PCO_2 during the resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a central venous oxygen saturation(SCVO_2) > 70%associated with elevated blood lactate *** high blood lactate levels is not a discriminatory factor in determining the source of that stress,an increased △PCO_2(> 6 mmHg)could be used to identify patients who still remain inadequately *** the △PCO_2 from the beginning of the reanimation of septic shock patients might be a valuable means to evaluate the adequacy of cardiac output in tissue perfusion and,thus,guiding the *** this respect,it can aid to titrate inotropes to adjust oxygen delivery to CO_2 production,or to choose between hemoglobin correction or fluid/inotrope infusion in patients with a too low ScvO_2 related to metabolic *** combination of P(v-a) CO_2 or △PCO_2 with oxygen-derived parameters through the calculation of the P(v-a) CO_2 or △PCO_2/arteriovenous oxygen content difference ratio can detect the presence of global anaerobic metabolism.

关键词： Venous-to-arterial carbon dioxide tension difference Carbon dioxide production Oxygen supply dependency Cardiac output tissue hypoxia Anaerobic metabolism Oxygen consumption Resuscitation septic shock

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Tuberculosis septic shock, an elusive pathophysiology and hurdles in management: A case report and review of literature

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World Journal of Critical Care Medicine 2019年第5期8卷 72-81页

作者： Rashmi Mishra Harish K Patel Rakesh Singasani Trupti Vakde Pulmonary and Critical Care Penn Highlands Healthcare Dubois PA 15801 United States Division of Gastroenterology Department of Medicine Bronx Care Health system Bronx NY 10457 United States Department of Medicine SBH Health System Bronx NY 10457 United States Division of Pulmonary and Critical Care Department of Medicine Bronx Care Health System Bronx NY 10457 United States

BACKGROUND Tuberculosis (TB) is a rare etiology of the septic shock. Timely administration of the anti-microbial agents has shown mortality benefit. Prompt diagnosis and a high index of suspicion are crucial to the management. We present three cases of TBSS with poor outcome in the majority despite timely and susceptible antibiotic administration. CASE SUMMARY Sixty-seven-year-old woman with latent TB presented with fever, cough, and shortness of breath. She was promptly diagnosed with active TB and started on the appropriate anti-microbial regimen;she had a worsening clinical course with septic shock and multi-organ failure after initiation of antibiotics. Thirty-threeyear- old man immunocompromised with acquired immune deficiency syndrome presented with fever, anorexia and weight loss. He had no respiratory symptoms, and first chest X-ray was normal. He had enlarged liver, spleen and lymph nodes suspicious for lymphoma. Despite broad-spectrum antibiotics, he succumbed to refractory septic shock and multi-organ failure. It was shortly before his death that anti-TB antimicrobials were initiated based on pathology reports of bone marrow and lymph node biopsies. Forty-nine-year-old woman with asthma and latent TB admitted with cough and shortness of breath. Although Initial sputum analysis was negative, a subsequent broncho-alveolar lavage turned out to be positive for acid fast bacilli followed by initiation of susceptible ant-TB regimen. She had a downward spiral clinical course with shock, multi-organ failure and finally death. CONCLUSION Worse outcome despite timely initiation of appropriate antibiotics raises suspicion of TB immune reconstitution as a possible pathogenesis for TB septic shock.

关键词： Tuberculosis septic shock Tuberculosis and immune reconstitution Tuberculosis in intensive care unit Case fatality for tuberculosis septic shock Case report

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Machine learning in data abstraction: A computable phenotype for sepsis and septic shock diagnosis in the intensive care unit

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World Journal of Critical Care Medicine 2019年第7期8卷 120-126页

作者： Prabij Dhungana Laura Piccolo Serafim Arnaldo Lopez Ruiz Danette Bruns Timothy J Weister Nathan Jerome Smischney Rahul Kashyap Department of Anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Multidisciplinary Epidemiology and Translational Research in Intensive Care Mayo ClinicRochesterMN 55905United States Department of Medicine Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMN 55905United States Anesthesia Clinical Research Unit Mayo ClinicMN 55905United States

BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data *** supervised machine learning method would help screen a large amount of electronic medical records(EMR)for efficient research *** To develop and validate a computable phenotype via supervised machine learning method for retrospectively identifying sepsis and septic shock in critical care *** A supervised machine learning method was developed based on culture orders,Sequential Organ Failure Assessment(SOFA)scores,serum lactate levels and vasopressor use in the intensive care units(ICUs).The computable phenotype was derived from a retrospective analysis of a random cohort of 100 patients admitted to the medical *** was then validated in an independent cohort of 100 *** compared the results from computable phenotype to a gold standard by manual review of EMR by 2 blinded *** was resolved by a critical care clinician.A SOFA score≥2 during the ICU stay with a culture 72 h before or after the time of admission was *** versions as V1 was defined as blood cultures with SOFA≥2 and Sepsis V2 was defined as any culture with SOFA score≥2.A serum lactate level≥2 mmol/L from 24 h before admission till their stay in the ICU and vasopressor use with Sepsis-1 and-2 were identified as septic Shock-V1 and-V2 *** In the derivation subset of 100 random patients,the final machine learning strategy achieved a sensitivity-specificity of 100%and 84%for Sepsis-1,100%and 95%for Sepsis-2,78%and 80%for septic Shock-1,and 80%and 90%for septic *** overall percent of agreement between two blinded reviewers had a k=0.86 and 0.90 for Sepsis 2 and septic shock 2 *** validation of the algorithm through a separate 100 random patient subset,the reported sensitivity and specificity for all 4 diagnoses were 100%-100%e

关键词： Machine learning Computable phenotype Critical care Sepsis septic shock

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Protective effects of artesunate on septic lung injury in mice via modulation of heme oxygenase-1

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China Medical Abstracts(Internal Medicine) 2016年第1期33卷 37-38页

作者：曹天辉 CCU Dept 2nd Affil HospHarbin Med Univ

Objective To investigate the effects of artesunate(AS)on septic lung injury in mice and to study the modulation of heme oxygenase-1(HO-1)in lung in order to clarify the mechanism of AS *** Sixty Kunming male mice were... 详细信息

关键词： artesunate septic oxygenase clarify Kunming protective edema saline puncture ligation

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Fatal septic shock caused by candida myocarditis associated with malignant lymphoma and Epstein-Barr virus mediated disorder

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Open Journal of Internal Medicine 2011年第2期1卷 24-28页

作者： Salah A. M. Said Bart J. F. Liebrand Nersing Bansraj Erik Eijken 不详

A 60-year-old man with known epilepsy was admitted to our hospital due to hypotension, fever and arrhythmia. He was treated medically and myocardial infarction was ruled out. Treatment of septic shock was established according to the guidelines of the early goal-guided therapy including vasopressors, inotropic agents, mechanical ventilation, and hemofiltration in combination with empirical treatment with antimicrobial drugs and hydrocortisone. The patient’s condition deteriorated rapidly into multiorgan failure resulting in a fatal outcome. Antemortem blood cultures were sterile. Autopsy findings were compatible with Epstein-Barr virus mediated lymphoproliferative disorder, malignant lymphoma, disseminated candidiasis and candida myocarditis. Post-mortem blood and tissue cultures were positive for growth of candida glabrata and candida albicans, respectively. The post-mortem examination documented Epstein-Barr virus mediated lymphoproliferative disorder and malignant small cell lymphoma associated with candida myocarditis. Prior to death, the patient did not receive antiviral or antifungal treatment. Fatal candida myocarditis associated with septic shock secondary to disseminated candidiasis in a 60-years old male patient with prior unknown immune compromised state caused by Epstein-Barr virus mediated lymphoproliferative disorder and malignant lymphoma is described.

关键词： septic Shock Candida Myocarditis Epstein-Barr Virus Mediated Lymphoproliferative Disorder Malignant Lymphoma Arrhythmia

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Wrist septic Arthritis Due to <i>Streptococcus pneumoniae</i>Revealing a Selective Immunoglobulin G4 Subclass Deficiciency: A Case Report

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Open Journal of Orthopedics 2015年第11期5卷 350-354页

作者： Atchi Walla Anani Abalo Malewé Kolou Service de Chirurgie Orthopédique et Traumatologique CHU Sylvanus Olympio Lomé Togo Service d’Immuno-Hématologie CHU Campus Lomé Togo

The pneumococcal septic arthritis is uncommon in healthy adults. In most cases, it occurs in patients with immune deficiency. Its exceptional location at the wrist can maintain doubt with rheumatic causes which are more frequent. IgG4 deficiency found in this patient was the only cause that could be impugned. We report the case of a young woman of 46 years without any evident cause of immunodeficiency and any particular risk factor, managed for septic arthritis of the wrist due to Streptococcus pneumoniae. This case without any apparent risk factors demonstrates that pneumococcal infection in a more distant articulation of the ENT is still possible. Scan has been a very significant contribution in confirming the positive diagnosis that leads to surgical drainage. The approach of the systematic search for the gateway must be done. In the study of the patient’s immune status, the realization of the protein profile could be interesting and then guide the practitioner in the decision to vaccinate the patient against Streptococcus pneumoniae if he was not. We recommend looking always for a cause of immunodeficiency including primary Ig defiencies even among adult.

关键词： Streptococcus pneumoniae septic Arthritis Wrist IgG4 Subclass Deficiency

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Synovial White Cell Count in the Diagnosis of septic Arthritis: Are Current Diagnostic Practices Appropriate?

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Open Journal of Orthopedics 2015年第12期5卷 400-403页

作者： Kalpa Perera Department of Surgery Eastern Health Box Hill Australia

Introduction & aims: septic arthritis is an emergency, potentially causing irreversible joint destruction and disability. Synovial WCC and polymorphonuclear cell percentage are the best predictors of septic arthritis likelihood. Yet, synovial white cell and differential count are not routinely assessed. We aim to investigate the incidence of failure to perform these tests, and to develop correct synovial fluid analysis practices. Method: This is a retrospective analysis of native joints having undergone arthrocentesis for suspicion of septic arthritis at Box Hill Hospital (BHH) during September 2011 and September 2013 inclusive. Recruitment was from the Eastern Health Decision Support Service (DSS), a database compiled from all systems within Eastern Health, of which BHH is a member. The study was limited to large joints, including hip, knee and shoulder. All prosthetic joints were excluded from the patient population. All patient histories were examined for suspicion of septic arthritis and subsequent arthrocentesis. Pathology records were accessed to determine incidence of cell count and differential. Results: One hundred and thirty-six cases of joint aspirations were identified within the time frame, of which sixty-seven fitted our criteria for evaluation. All but two cases were delivered using the DSS, which was limited to data compiled only until June 2013. The two remaining cases were identified with a manual search of the radiology and pathology databases from June to September 2013. 22 of the 67 joint aspirates studied did not have a cell count carried out. Four of these 22 cases had a diagnosis of septic arthritis. In five aspirates, there was a failure to confirm a definite diagnosis and they were thus conservatively treated as a septic joint. The remaining acute joints in which no cell count was done were gout (7 cases), pseudogout (5 cases) and rheumatoid arthritis (1 case). Cell counts were not routinely detected for a variety of reasons. Eleven aspirat

关键词： septic Arthritis Arthrocentesis Synovial White Cell Count

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Logistic regression analysis between the weaning outcome of patients with septic shock and EVLWI and ITBI

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China Medical Abstracts(Internal Medicine) 2014年第3期31卷 140-141页

作者：黄伟平 Emerge&Critical Care Dept Guangdong General Hosp

Objective To explore the values of extravascular lung water index(EVLW)and preload parameters in predicting the risk of weaning form mechanical ventilation in patients with septic *** A total of 93 septicshock patients with mechanical ventilation were enrolled from January 2011 to March 2012 in Guangdong General *** patients were treated under PiC CO-monitoring till they reached weaning *** that,

关键词： weaning septic ventilation Guangdong predicting sepsis enrolled breathing diastolic spontaneous

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Pancreatic injury in patients with septic shock: A literature review

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World Journal of Gastrointestinal Oncology 2016年第7期8卷 526-531页

作者： Anis Chaari Karim Abdel Hakim Kamel Bousselmi Mahmoud Etman Mohamed El Bahr Ahmed El Saka Eman Hamza Mohamed Ismail Elsayed Mahmoud Khalil Vipin Kauts William Francis Casey Department of Intensive Care King Hamed University Hospital

Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention.

关键词： septic shock Pancreas Lipase Amylase Prognosis

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Effect of Higher Mean Arterial Pressure with Norepinephrine on Tissue Oxygenation and Perfusion in Patients of septic Shock

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International Journal of Clinical Medicine 2012年第5期3卷 407-410页

作者： Sandeep Sharma Mridula Pawar Mohandeep Kaur Nidhi Srivastava Saurav Mustafi Department Of Anaesthesiology and Intensive Care P.G.I.M.E.R Dr Ram Manohar Hospital New Delhi.

The current survival sepsis guideline proposes the use of vasopressors and fluid resuscitation to maintain the mean arterial pressure (MAP) ≥ 65 mmHg. Titrating catecholamine infusion to achieve higher MAP has been demonstrated to improve tissue oxygenation, microcirculation, renal function and overall outcome of the patient in some studies and literature on actual hemodynamic goals is scarce. AIM: To study the influence of two MAP on tissue oxygenation and perfusion parameters in patients of septic shock on norepinephrine infusion. SUBJECT AND MATERIALS: Forty adult patients with the diagnosis of septic shock were enrolled. In all patients norepinephrine was titrated to first stabilize the MAP at 65 ± 5 mmHg (Set I), followed by MAP of 85 ± 5 mmHg (Set II). Heart rate (HR), Central venous oxygen saturation (SCVO2), Transcutaneous partial pressure of oxygen (PtcO2) by TCM 400/TINA (using miniature Clark electrode), Arterial partial pressure of oxygen(PaO2), PtO2/PaO2 ratio, Urine output and Serum Base deficit were recorded in each Set after 2 hrs of stabilization. RESULTS: There was a significant increase in transcutaneous partial pressure of oxygen PtcO2 (p tO2/PaO2 (p septic shock. These findings suggest that there is improvement in tissue oxygenation parameters using escalating doses of norepinephrine to achieve higher MAP without inherent adverse

关键词： Mean Arterial Pressure Norepinephrine septic Shock Tissue Oxygenation

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