When All Else Fails: Novel Use of Angiotensin II for Vasodilatory Shock A Case Report

Angiotensin (AT) II is an endogenous hormone that acts on venous and arterial smooth muscle to cause vasoconstriction. Recent trials have sparked great interest in its ability to be used as a vasopressor for catecholamine-refractory hypotension. Herein, we describe the successful use of AT II in a patient with a colonic perforation with septic shock refractory to conventional treatment. After AT II initiation, there was an immediate reduction in catecholamine requirement, and the patient survived.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports Source Type: research

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Authors: Winiszewski H, Daguindau E, Chaignat C, Piton G, Bouiller K, Lepiller Q, Klopfenstein T PMID: 31530415 [PubMed - as supplied by publisher]
Source: Medecine et Maladies Infectieuses - Category: Infectious Diseases Tags: Med Mal Infect Source Type: research
Conclusion: All ICU patients exhibit lymphopenia, regardless of the nature (septic or sterile) of the initial medical condition. Specific distribution of circulating ILCs, with an excess of ILC1, and a lack of ILC3, may characterize septic shock during the first 3 days of the disease.
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
A 44-year-old woman developed acute anuric renal failure in the context of septic shock after hysteroscopy and intrauterine device placement for abnormal uterine bleeding. Aminoglycoside and nonsteroidal anti-inflammatory drug use were likely contributing factors. In the past, she had had a deep venous thrombosis episode on oral contraception that led to a diagnosis of Factor V Leiden heterozygosity. Computed tomography with contrast of the abdomen and pelvis showed abnormal enhancement of the renal medulla, and the renal cortex did not take on contrast (Figure  1).
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Nephrology Image Source Type: research
Bacterial infections are more frequent and severe in patients with advanced liver disease and, therefore, in liver transplant candidates. The increased risk of infection in these patients parallels the severity of the immune dysfunction associated with cirrhosis, featured by systemic inflammation and progressive immunodeficiency. Other factors contribute to this risk, such as genetic polymorphisms, proton-pump inhibitor overuse, the numerous invasive procedures and hospitalizations these patients go through, or the immunosuppressive effects of malnutrition or alcohol abuse. Bacterial infections have a great impact on disea...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
Raising public awareness of sepsis, a potentially life-threatening dysregulated host response to infection, to hasten its recognition has become a major focus of physicians, investigators, and both non-governmental and governmental agencies. While the internet is a common means by which to seek out healthcare information, little is understood about patterns and drivers of these behaviors. We sought to examine traffic to Wikipedia, a popular and publicly available online encyclopedia, to better understand how, when, and why users access information about sepsis. Clickstream analysis suggests that most sepsis and septic shoc...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
Develop and implement a machine learning algorithm to predict severe sepsis and septic shock and evaluate the impact on clinical practice and patient outcomes. Our machine learning algorithm can predict, with low sensitivity but high specificity, the impending occurrence of severe sepsis and septic shock. Algorithm-generated predictive alerts modestly impacted clinical measures. Next steps include describing clinical perception of this tool and optimizing algorithm design and delivery.
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
Rapid fluid resuscitation has become standard in sepsis care, despite " low-quality " evidence and absence of guidelines for populations " at risk " for volume overload. Our objectives include as follows: 1) identify predictors of reaching a 30 mL/kg crystalloid bolus within 3 hours of sepsis onset (30by3); 2) assess the impact of 30by3 and fluid dosing on clinical outcomes; 3) examine differences in perceived " at-risk " volume-sensitive populations, including end-stage renal disease, heart failure, obesity, advanced age, or with documentation of volume " overload " by bedside exami...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
Sepsis and septic shock are medical emergencies resulting in significant morbidity and mortality. Intravenous (IV) vitamin C, thiamine, and hydrocortisone have shown promise in reducing hospital mortality. The Memphis Veterans Affairs Medical Center (VAMC) similarly implemented this regimen, called the vitamin C protocol, for patients presenting in sepsis or septic shock in the intensive care unit (ICU). Although no significant mortality benefit was observed, the vitamin C protocol was not associated with patient harm. In this Veteran population, there was reduced ICU length of stay, suggesting possible benefit. Though fur...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
Authors: Acar A, Niemeyer D, Groß-Fengels W, Bachmann M, Wiest G Abstract A 47-year-old man presented with fever, weight loss and pulmonary consolidations and cavitation in the x-ray of the thorax. The comprehensive diagnostics resulted pulmonary epitholoid cell granulomas, therefore an immunosuppressive therapy was applied on suspicion of sarcoidosis. Progressivly the pulmonary infiltration increased and cerebral and abdominal abscesses were determined with microbiological detection of Nocardia farcinica. Despite antibiotic therapy, the patient died in a septic shock with multiple organ failure.Nocardiosis i...
Source: Pneumologie - Category: Respiratory Medicine Tags: Pneumologie Source Type: research
Pneumocystis jirovecii pneumonia (PcP) occurs exclusively in immunocompromised patients. About 50% of PcP is HIV related, the other half is associated with immunosuppression for other reasons [1]. If PcP progresses to an acute respiratory distress syndrome (ARDS) requiring intensive care and invasive mechanical ventilation, the prognosis is generally poor [1] and mortality is about 80% if additional veno-venous extracorporeal membrane oxygenation (VV-ECMO) support is necessary [1]. Despite lack of clear evidence [2], VV-ECMO has become an integral part in the rescue therapy of severe ARDS. Moreover, some centres start VV-E...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: Research letters Source Type: research
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