Endotoxin and Cytokine Sequential Hemoadsorption in Septic Shock and Multi-Organ Failure

2021 ◽  
pp. 1-4
Author(s):  
Juan Carlos Ruiz-Rodríguez ◽  
Luis Chiscano-Camón ◽  
Clara Palmada ◽  
Adolf Ruiz-Sanmartin ◽  
Marcos Pérez-Carrasco ◽  
...  
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
New Jersey ◽  
Case Report ◽  
Organ Failure ◽  
Inflammatory Mediators ◽  
Polymyxin B ◽  
Blood Purification ◽  
Source Control ◽  
Usual Therapy

The mortality of septic shock remains high [Ann Intensive Care. 2017;7:19], so apart from usual therapy based on source control and antibiotics, some patients may need rescue therapies. Blood purification systems may play a role by facilitating the nonspecific removal of inflammatory mediators and microbiological toxins. There are different hemoadsorption systems, we describe in this case report the sequential use of Polymyxin B (PMX) endotoxin-adsorbing column (Toraymixin PMX-20R; Toray, Tokyo, Japan) and Cytosorb® (Cytosorbents Corp., New Jersey, USA).

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 Recurring septic shock in a patient with blunt abdominal and pelvic trauma: how mandatory is source control surgery?: a case report

2017 ◽  
Vol 11 (1) ◽  
Author(s):  
Antonella Frattari ◽  
Giustino Parruti ◽  
Rocco Erasmo ◽  
Luigi Guerra ◽  
Ennio Polilli ◽  
...  
Keyword(s):  
Septic Shock ◽  
Case Report ◽  
Pelvic Trauma ◽  
Source Control

scholarly journals Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

2019 ◽  
Vol 11 (12) ◽  
pp. 422-432
Author(s):  
Jin Joo Kim ◽  
Young Jun Park ◽  
Ki Yoon Moon ◽  
Jin Hyeong Park ◽  
Yong Ki Jeong ◽  
...  
Keyword(s):  
Septic Shock ◽  
Polymyxin B ◽  
Source Control ◽  
Polymyxin B Hemoperfusion

scholarly journals A Case Report: Diabetic Ketoacidosis in Patient with type 1 Diabetes Mellitus with Complication Septic Shock and AKI Stage III on HD Triggered by Perianal Abscess

2021 ◽  
Vol 1 (1) ◽  
pp. 26-30
Author(s):  
Muhammad Ikhsan Kartawinata ◽  
Yusni Puspita
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Diabetic Ketoacidosis ◽  
Perianal Abscess ◽  
Electrolyte Imbalance ◽  
Source Control ◽  
Undiagnosed Diabetes ◽  
High Glucose Level

Introduction. Diabetic ketoacidosis (DKA) is an acute, life-threatening complication in diabetes mellitus. Infection is a common precipitating cause of diabetic ketoacidosis (DKA) in known diabetic patient, and diabetic ketoacidosis (DKA) often presents as the first symptom of an undiagnosed diabetes. diabetic ketoacidosis (DKA) is diagnosed with combination of hyperglicaemia, acidosis metabolic and ketonuria. Case Presentation. A 27 years old male patient, admitted to Intensive Care Unit with decrease level of consciousness (GCS 3), he was intubated and present with respiratory distress, metabolic acidosis, high glucose level, ketonuria with renal failure as a target organ. Patient known has perianal abscess as a triggered of diabetic ketoacidosis (DKA), turn into septic shock and underwent debridement surgery to source control the infection. The patient was treated in intensive care unit for 9 days, and sent to ward with GCS 15 an no sequelae of organ failure. The treatment of diabetic ketoacidosis (DKA) should include correcting the often substantial hypovolemia, the hyperglycemia, electrolyte imbalance and the triggering factor of diabetic ketoacidosis (DKA). Conclusion. Prompt surgical intervention, antibacterial therapy, rapid restoration of glycemic control are crucial to prevent mortality in diabetes mellitus patients complicated with abscess.

scholarly journals Blood Purification and Mortality in Sepsis and Septic Shock

2019 ◽  
Vol 131 (3) ◽  
pp. 580-593 ◽  
Author(s):  
Alessandro Putzu ◽  
Raoul Schorer ◽  
Juan Carlos Lopez-Delgado ◽  
Tiziano Cassina ◽  
Giovanni Landoni
Keyword(s):  
Septic Shock ◽  
Relative Risk ◽  
Conventional Therapy ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Polymyxin B ◽  
The United States ◽  
Blood Purification ◽  
Lower Mortality ◽  
Sepsis And Septic Shock

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. We performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting. Methods Electronic databases were searched for pertinent studies up to January 2019. We included randomized controlled trials on the use of hemoperfusion, hemofiltration without a renal replacement purpose, and plasmapheresis as a blood purification technique in comparison to conventional therapy in adult patients with sepsis and septic shock. The primary outcome was mortality at the longest follow-up available. We calculated relative risks and 95% CIs. The grading of recommendations assessment, development and evaluation methodology for the certainty of evidence was used. Results Thirty-seven trials with 2,499 patients were included in the meta-analysis. Hemoperfusion was associated with lower mortality compared to conventional therapy (relative risk = 0.88 [95% CI, 0.78 to 0.98], P = 0.02, very low certainty evidence). Low risk of bias trials on polymyxin B immobilized filter hemoperfusion showed no mortality difference versus control (relative risk = 1.14 [95% CI, 0.96 to 1.36], P = 0.12, moderate certainty evidence), while recent trials found an increased mortality (relative risk = 1.22 [95% CI, 1.03 to 1.45], P = 0.02, low certainty evidence); trials performed in the United States and Europe had no significant difference in mortality (relative risk = 1.13 [95% CI, 0.96 to 1.34], P = 0.15), while trials performed in Asia had a positive treatment effect (relative risk = 0.57 [95% CI, 0.47 to 0.69], P < 0.001). Hemofiltration (relative risk = 0.79 [95% CI, 0.63 to 1.00], P = 0.05, very low certainty evidence) and plasmapheresis (relative risk = 0.63 [95% CI, 0.42 to 0.96], P = 0.03, very low certainty evidence) were associated with a lower mortality. Conclusions Very low-quality randomized evidence demonstrates that the use of hemoperfusion, hemofiltration, or plasmapheresis may reduce mortality in sepsis or septic shock. Existing evidence of moderate quality and certainty does not provide any support for a difference in mortality using polymyxin B hemoperfusion. Further high-quality randomized trials are needed before systematic implementation of these therapies in clinical practice.

scholarly journals Rescue stem cell allograft in intensive care unit patients during septic shock with multi-organ failure

2019 ◽  
Vol 54 ◽  
pp. 122-124
Author(s):  
Perrine Leprêtre ◽  
Thomas Clavier ◽  
Anne-Lise Ménard ◽  
Steven Grange ◽  
Christophe Girault ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Stem Cell ◽  
Intensive Care ◽  
Organ Failure ◽  
Multi Organ Failure

scholarly journals Polymyxin B and low-dose hydrocortisone treatment in a patient with uroseptic shock in a rural health unit

2021 ◽  
Vol 2021 (11) ◽  
Author(s):  
Toshio Arai ◽  
Yuichiro Mori ◽  
Saori Yoshizaki ◽  
Ryo Ando ◽  
Shunsuke Natori ◽  
...  
Keyword(s):  
Septic Shock ◽  
Low Dose ◽  
Polymyxin B ◽  
Percutaneous Nephrostomy ◽  
Upper Urinary Tract ◽  
Source Control ◽  
Extended Spectrum Beta Lactamase ◽  
Ureter Obstruction ◽  
Old Japanese ◽  
Medical Wards

ABSTRACT Sepsis has a high mortality rate; thus, in the intensive care unit, early diagnosis and adjunctive treatments are crucial. However, generally, most patients with sepsis from rural area initially visit the emergency department at a rural hospital and are managed in general medical wards in Japan. Here we report on an 81-year-old Japanese female manifesting septic shock caused by the upper urinary tract infection of extended-spectrum beta-lactamase-producing Escherichia coli secondary to the left ureter obstruction by the urothelial carcinoma. Broad-spectrum antibiotics were administered. Although critical for the source control of infection, drainage of the ureteropelvic junction could not be performed immediately because of catecholamine-resistant hypotension. Hence, we administered polymyxin B-immobilized fiber column direct hemoperfusion, followed by low-dose hydrocortisone administration. After 8 hours of infusion, she recovered from the septic shock and successfully underwent emergency percutaneous nephrostomy. This presented strategy may provide a new resolution of catecholamine-resistant patients in urosepsis.

scholarly journals Case Report: 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 ◽  
Case Report ◽  
Multiple Organ Failure ◽  
Hemolytic Uremic Syndrome ◽  
Organ Failure ◽  
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. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included 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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