Fluid Bolus Over 15–20 Versus 5–10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial*

Objectives: To compare the effect of administration of 40–60 mL/kg of fluids as fluid boluses in aliquots of 20 mL/kg each over 15–20 minutes with that over 5–10 minutes each on the composite outcome of need for mechanical ventilation and/or impaired oxygenation—increase in oxygenation index by 5 from baseline in the initial 6 and 24 hours in children with septic shock. Design: Randomized controlled trial. Setting: Pediatric emergency and ICU of a tertiary care institute. Patients: Children (
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

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Introduction: We hypothesized that aromatic microbial metabolites (AMM), such as phenyllactic (PhLA), p-hydroxyphenylacetic (p-HPhAA), and p-hydroxyphenyllactic (p-HPhLA) acids, contribute to the pathogenesis of septic shock. Methods: Clinical and laboratory data of patients with community-acquired pneumonia were obtained on intensive care unit admission and the next day. Patients were divided into two groups based on septic shock presence or absence. The levels of AMM (PhLA, p-HPhAA, p-HPhLA, and their sum, ∑3AMM), catecholamine metabolites (3,4-dihydroxymandelic [DHMA], 3,4-dihydroxyphenylacetic [DOPAC], and hom...
Source: Shock - Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Conclusion: Minimized daily hydrocortisone dosage of 100 mg could lower the occurrence of hyperglycemia without increasing mortality in septic shock, compared with the currently recommended dosage of 200 mg/day.
Source: Shock - Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
ConclusionsNo experimental separation was observed in this randomized, controlled feasibility trial. Early lactate clearance, coupled with substantial fluid administration before randomization, suggests that patients were already resuscitated before arrival in the ICU. Future trials of echocardiogram-guided sepsis resuscitation will likely need to enroll in the emergency department.Trial registrationThis study was retrospectively registered atclinicaltrials.gov (identifier NCT02354742, title Echo vs EGDT in severe sepsis and septic shock) on February 3, 2015. Registration was completed before review or analysis of any data.
Source: Journal of Intensive Care - Category: Intensive Care Source Type: research
Publication date: Available online 10 August 2018Source: IDCasesAuthor(s): kida Yohei, Oiwa Takehiro, Deguchi RyusukeAbstractA 61-year-old woman was evaluated because of 2 days of anuria, fever, anorexia, and progressive decline in mental status. On admission, she appeared confused with a GCS score of E2V2M4, and her blood ammonia level was elevated (176 μg/dL). Abdominal computed tomography showed bilateral hydronephrosis and bladder fullness with wall thickness in spite of indwelling bladder catheter. Her catheter was obstructed by blood clot. Blood cultures, blood clot culture, and one urine culture all yielde...
Source: IDCases - Category: Infectious Diseases Source Type: research
CONCLUSION: Early physical rehabilitation may improve functional recovery at hospital discharge, especially in patients with high initial severity scores. PMID: 30091317 [PubMed - in process]
Source: Yonsei Medical Journal - Category: Universities & Medical Training Authors: Tags: Yonsei Med J Source Type: research
Conclusion: Prolonged polymyxin therapy might be associated with better clinical outcomes than 2-h polymyxin therapy in patients with septic shock. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=491744.Blood Purif 2018;46:309 –314
Source: Blood Purification - Category: Hematology Source Type: research
AbstractWe compared epinephrine and dopamine as a first-line vasoactive drug in 40 neonates (enrolled in two gestational age strata ≤ 306/7 and ≥ 310/7 weeks) with fluid-refractory septic shock. Epinephrine or dopamine was initiated at 0.2 or 10 μg/kg/min, respectively. If shock persisted after 15 min, epinephrine or dopamine was increased to 0.3 or 15 μg/kg/min, respectively (16–30 min), and thereafter to 0.4 or 20 μg/kg/min (31–45  min). Proportion of neonates achieving ‘reversal of shock’ (defined as systolic and diastolic BP> &th...
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research
The mortality rate due to severe sepsis is approximately 30 –60%. Sepsis readily progresses to septic shock and multiple organ dysfunction, representing a significant problem in the pediatric intensive care uni...
Source: BMC Pediatrics - Category: Pediatrics Authors: Tags: Research article Source Type: research
Condition:   Septic Shock Intervention:   Sponsor:   Region Skane Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Septic shock is the leading cause of death in intensive care units. The pathophysiological complexity of this syndrome contributes to an absence of specific treatment. Several preclinical studies in murine mod...
Source: Intensive Care Medicine Experimental - Category: Surgery Authors: Tags: Research Source Type: research
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