Habilitationsschrift--Breslau.

No description available.

RESUMEN Objetivo: Comparar los sistemas de puntaje MEDS (Mortality in Emergency Department Sepsis), SOFA (Sepsis-related Organ Failure Assessment), APACHE II (Acute Physiology and Cronic Health Evaluation) y CURB-65 (Confusion, Urea, nitrogen, Respiratory rate, Blood pressure, 65 years of age and older) para pronóstico de mortalidad y complicaciones en pacientes sépticos. Materiales y métodos: Se realizó un estudio de evaluación prospectiva de prueba diagnóstica. Se evaluaron un total de 308 pacientes que ingresaron al servicio de emergencia de un hospital peruano de los cuales 265 pacientes cumplieron con los criterios de inclusión y exclusión. Para el análisis estadístico se utilizó el programa STATA versión 11. Se realizaron la comparación de los puntajes, análisis de la curva ROC (receiver operating characteristic) y la comparación de áreas bajo la curva ROC para cada puntaje. Resultados: Se incluyeron 265 pacientes con una media de edad de 63 (±20) años. 44.5% presentó sepsis severa y 21.5% shock séptico. 155 (58.4%) pacientes fallecieron y/o presentaron complicaciones. En el análisis multivariado se encontró como variables asociadas significativamente a mortalidad y complicaciones a la edad, oliguria, alteración del estado mental, injuria pulmonar aguda y el uso de inotrópicos. Con respecto al análisis de las curvas ROC, el área bajo la curva ROC fue 0.74 para SOFA, 0.73 para MEDS, 0.73 para APACHE II y 0.67 para CURB 65 siendo este último significativamente inferior a las tres primeras. Conclusión: Los scores MEDS, SOFA y APACHE II son scores adecuados para predecir mortalidad y complicaciones en pacientes sépticos. En contraparte, el score CURB 65 es menos apropiado y no debe ser usado rutinariamente para evaluar el pronóstico de pacientes sépticos.

The immuno-inflammatory host response in critically ill patients with sepsis and inflammatory conditions is driven by the expression of compounds acting as, or producing inflammatory mediators, including cytokines, reactive oxygen species and adhesion molecules. Their production is in part controlled by the transcription factor, nuclear factor <span style='font-family: Symbol'>kB (NF<span style='font-family:Symbol'>kB).  NF<span style='font-family:Symbol'>kB is a primary intracellular transcription factor, which transduces extracellular signals to the nucleus and responds to cellular oxidative stress. NF<span style='font-family:Symbol'>kB activation was assessed in circulating leucocytes from critically ill patients on the intensive care unit.  NF<span style='font-family:Symbol'>kB was activated in mononuclear and polymorphonuclear leucocytes in all the patients studied, and was significantly greater than in healthy subjects (p=0.01, p=0.001).  NF<span style='font-family:Symbol'>kB activation in mononuclear leucocytes increased markedly in those patients who died whilst remaining constant in those patients who survived. The effect of administration of the intracellular antioxidant N-acetylcysteine, on NF<span style='font-family:Symbol'>kB activation and circulating concentrations of cytokines and adhesion molecules was investigated in patients with sepsis.  In patients who survived and received N-acetylocysteine, mononuclear leucocyte NF<span style='font-family:Symbol'>kB activation decreased significantly (p=0.016). In contrast there was no change in NF<span style='font-family:Symbol'>kB activation in mononuclear leucocytes from patients who received the placebo infusion. Additionally, circulating concentrations of interleukin (IL)-8 were found to decrease in those surviving patients receiving N-acetylcysteine. The effect of IL-10 on NF<span style='font-family:Symbol'>kB activation, coupled to 1<span style='font-family:Symbol'>kB<span style='font-family:Symbol'>a degradation, in leucocytes and tissues in endotoxaemic rats, was investigated.  NF<span style='font-family:Symbol'>kB activation was increased with a corresponding reduction in 1<span style='font-family:Symbol'>kB<span style='font-family:Symbol'>a concentrations, in liver (p=0.02) and lung (p=0.004) samples from rats receiving combined LPS and IL-10. NF<span style='font-family:Symbol'>kB activation may have a central role in the mortality and sepsis.  N-acetylcysteine attenuates mononuclear leucocyte NF<span style='font-family:Symbol'>kB activation and related IL-8 production in human sepsis, whereas, IL-10 administration resulted in paradoxical increases in NF<span style='font-family:Symbol'>kB activation.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 5 uppsatser.

Ulm, Univ., Diss., 2008.

No description available.

Le sepsis, état pathologique lié à une réaction inflammatoire systémique suite à une infection, est lapremière cause de mortalité dans les unités de réanimation médicale et de soins intensifs hospitaliers.Parmi les pistes thérapeutiques envisagées, l’hypothermie est un bon candidat. En effet, l’hypothermiemodérée induite augmente la durée de survie de rats septiques. Ce travail avait pour objectifd’apporter des éléments permettant de comprendre et d’identifier les mécanismes responsables decet effet bénéfique. Pour cela, différentes fonctions couramment affectées lors du sepsis(inflammation, stress oxydant, défaillance rénale, capacités de transport de l’oxygène par le sang etéquilibre acide-base) ont été étudiées sur des rats septiques en hypothermie modérée (34°C). Lesrésultats obtenus révèlent que l’hypothermie modérée ralentit de manière significative la production decytokines pro-inflammatoires et tend à exercer une diminution de la production radicalaire systémiquechez les rats septiques. L’apparition de l’acidose métabolique et la défaillance rénale sont égalementretardées. Enfin, alors que le sepsis en normothermie conduit à une diminution de la coopérativité etde l’affinité de l’hémoglobine pour l’oxygène, synonymes d’une adaptation face à des modificationspotentiellement délétères, en hypothermie modérée, ces paramètres ne sont pas modifiés. Cesrésultats concourent à penser que l’hypothermie modérée en ralentissant l’évolution du sepsis permetd’augmenter la durée de survie des rats septiques. Ainsi, l’hypothermie pourrait constituer une pistepour traiter les patients atteints de sepsis sévère dans le but de temporiser l’inflammation et decontrôler l’agression retardant ainsi les défaillances d’organes. / Despite numerous studies over the past twenty years, sepsis, a pathologic state related to a systemicinflammatory response following infection, remains the main cause of death in intensive care units.Among the therapeutic approaches proposed, hypothermia is a good candidate. Indeed, mild inducedhypothermia increased the survival duration of septic rats. This work aimed to provide elements tounderstand and identify the mechanisms responsible for this beneficial effect. Consequently, variousfunctions commonly affected during sepsis (inflammation, oxidative stress, renal failure, oxygen bloodcapacity and acid-base balance) were studied on septic rats maintained in mild induced hypothermia(34°C). The results showed that mild hypothermia significantly slows the cytokine proinflammatoryproduction and tends to exert a decrease in the radical systemic production of septic rats. Theappearance of metabolic acidosis and renal failure are also delayed. Finally, while in normothermiasepsis led to a decrease in the cooperativity and oxygen haemoglobin affinity, synonymous of anadaptation when faced with potential deleterious changes, in mild hypothermia, these parameters arenot modified. These results suggest that by reducing the development of sepsis, mild inducedhypothermia increases the survival duration of septic rats. Thus, hypothermia may be an option fortreating patients with severe sepsis by stalling inflammation and controlling aggression, therebydelaying organ failure.

Interrupting the Sepsis Process with an Evidence-Based Education Intervention by Martha Olson MSN, Walden University, 2013 MS, Southwest Minnesota State University, 2003 BSN, The University of Iowa, 1998 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2015 Abstract Sepsis is a concern, especially for the vulnerable populations. The early signs of sepsis are vague and often difficult to detect, but when detected early, are treatable with antibiotics and fluid resuscitation. When a nurse is unaware of the early signs, treatment is delayed and multiorgan failure may progress quickly. To teach nurses about changes in patient condition and thus increase their confidence in identifying sepsis, an educational intervention, guided by adult learning theory and social learning theory, was created using a PowerPoint presentation, simulation, and debriefing. The purpose of this project was to educate nurses working in a critical access hospital on the early signs of sepsis, laboratory values, and the 2012 Surviving Sepsis Campaign Guidelines. The education was implemented and evaluated using a pre-post survey which demonstrated an increased confidence level in early sign and symptom recognition, identification of laboratory values, and implementation of the guidelines for treating sepsis. Descriptive statistics revealed that the confidence level improved following the education session in all 3 areas. Interrupting sepsis based on evidence-based practice improves the outcomes for the patient with sepsis. It also improves nurses' confidence in identifying sepsis in the early stages via clinical changes and laboratory values.

Sepsis is one of the leading causes of death in U.S. hospitals, resulting from organ dysfunction caused by an inappropriate inflammatory reaction to an infection. Timely treatment with empiric antibiotics in the emergency department is crucial to facilitate positive patient outcomes. The Surviving Sepsis Campaign (SSC) recommends initiating empiric antibiotic therapy within one hour of presentation to the emergency department. Some emergency departments have implemented sepsis management protocols to guide care and ensure timely treatment. The purpose of this study is to determine the effect of a formal sepsis protocol in the emergency department on the time to antibiotic administration. A literature review was conducted using CINAHL, Cochrane Database, Health Source: Nursing/Academic Edition, and MEDLINE. Results from one systematic review, eight quasi-experimental studies, and four quality improvement projects suggested that implementation of a sepsis management protocol in an emergency department may decrease the time to antibiotic administration. (< 10 = spell out) Eleven of the 13 articles reported decreased time to antibiotic administration by as much as 8-193 minutes compared to pre-protocol. One study met the SSC goal of 1 hour and reported a median administration time of 17 minutes. Time to antibiotics was influenced by protocols based on published sepsis guidelines, inclusion of antibiotic guidelines, nurse-initiated treatment, and education for emergency clinicians regarding sepsis management. Emergency departments should implement sepsis protocols adapted to their local institution to decrease time to antibiotic administration and reduce mortality of sepsis patients. Further research on how sepsis protocols affect antibiotic administration time is needed.