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Management of the Sick Child
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Shock is a condition of hypoperfusion of vital organs and is identified during assessment of ‘C – Circulation’ in the ABCDE approach. Untreated, a child in shock will die quickly. Signs of shock include cold extremities, weak, fast or slow pulse, and capillary refill time >3 seconds. The main causes of shock in refugee and migrant settings are hypovolaemia and sepsis; other causes – haemorrhagic, anaphylactic and cardiogenic shock – occur less frequently. Hypovolaemic shock involves dehydration and low circulating volume usually caused by severe vomiting and diarrhoea or insensible fluid losses secondary to severe burns. Haemorrhagic shock is caused by catastrophic haemorrhage reducing organ perfusion. Septic shock is defined clinically in low-resource settings by the presence of signs of shock plus fever or hypothermia without severe dehydration.
Steroids in Septic Shock
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Septic shock is a state of dysregulated response to an infection, resulting in circulatory, cellular and metabolic abnormalities associated with life-threatening organ dysfunction. Corticosteroids may dampen pro-inflammatory over-activity, improve cardiovascular function and response to catecholamines [1]. Early studies on high dose steroids demonstrated a reduction in mortality by 25–30% (2); however, follow-up studies found no difference possibly attributable to secondary infections [3, 4]. Subsequently, lower doses have been suggested to be beneficial in treating a presumed critical illness-related corticosteroid deficiency (CIRCI), but it remains unclear whether steroids improve patient-centered outcomes in septic shock.
Septic shock
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Bryan E. Freeman, Michael R. Foley
Septic shock is a subdivision of severe sepsis and is defined as sepsis-induced hypotension (as defined above) that is unresponsive to fluid resuscitation, accompanied by hypoperfusion abnormalities or organ dysfunction. This definition still applies to patients who have been treated with vasopressors, as hypoperfusion abnormalities and organ dysfunction may not occur until after treatment (7).
Elevated sTREM2 and NFL levels in patients with sepsis associated encephalopathy
Published in International Journal of Neuroscience, 2023
Günseli Orhun, Figen Esen, Vuslat Yilmaz, Canan Ulusoy, Elif Şanlı, Elif Yıldırım, Hakan Gürvit, Perihan Ergin Özcan, Serra Sencer, Nerses Bebek, Erdem Tüzün
Detailed clinical and demographic features of SAE patients (8 men, 3 women; average age ± standard deviation, 50.3 ± 11.9) are listed in Table 1. All patients developed alterations in the level of consciousness and behavioral symptoms. The most common neurological symptom was delirium (9 patients). Other clinical presentations included coma in one patient and generalized tonic-clonic seizures in one patient. None of the patients had focal neurological deficits. Brain MRI was normal in 2 patients, showed white matter lesions in 6 patients and brain atrophy in 3 patients. EEG was performed in 6 patients revealing diffuse slow waves in all examinations. Days between the onset of sepsis and the development of acute encephalopathy ranged between 2 and 12 (7.5 ± 3.8) days. All patients underwent mechanical ventilation and sedation. During their follow-up, all patients developed septic shock (with an average duration of 7.0 ± 5.1 days). Two patients died after discharge and 5 patients were lost to follow-up.
The BCL2/BAX/ROS pathway is involved in the inhibitory effect of astragaloside IV on pyroptosis in human umbilical vein endothelial cells
Published in Pharmaceutical Biology, 2022
Yi Su, Xin Yin, Xin Huang, Qianqian Guo, Mingyuan Ma, Liheng Guo
Sepsis is a disorder of the host response to infections and leads to life-threatening organ dysfunction; it affects millions of people each year and is one of the major causes of death worldwide (Coopersmith et al. 2018). The pathophysiological features of septic shock are vasodilation, increased vascular permeability, decreased blood volume and ventricular dysfunction. The normal endothelium can limit the bacterial spread and orchestrate leukocyte recruitment and bacterium elimination (Joffre et al. 2020). However, endothelial phenotypic changes and endothelial dysfunction are important factors in sepsis, often leading to hypotension, insufficient organ perfusion, shock and death, partly due to acute vascular dysfunction and leakage (Russell et al. 2018). In addition, endothelial barrier dysfunction and microvascular leakage are important causes of organ failure in sepsis and sepsis-related complications such as acute lung injury (Opal and van der Poll 2015). Endothelial injury is a common pathophysiological feature of septic shock.
Addition of terlipressin to norepinephrine in septic shock and effect of renal perfusion: a pilot study
Published in Renal Failure, 2022
Jinlong Wang, Mengjuan Shi, Lili Huang, Qing Li, Shanshan Meng, Jingyuan Xu, Ming Xue, Jianfeng Xie, Songqiao Liu, Yingzi Huang
Patients in the terlipressin group received a fixed dose of terlipressin added to usual care. We dissolved terlipressin (0.86 mg) in 43 mL of 5% glucose solution (terlipressin concentration 20 μg/mL). Terlipressin was intravenously pumped at a fixed dose of 1.3 μg/kg/hour for 24 h. We adjusted the norepinephrine dose to maintain a MAP greater than 65 mmHg. Then, clinicians set the target MAP based on the clinical characteristics of the patients, and the norepinephrine dose was adjusted based on the target. Terlipressin was discontinued if the systolic blood pressure was greater than 160 mmHg for 30 min. Patients in the usual care group were treated with standard care. Norepinephrine was used as the vasoactive drug to maintain MAP. Septic shock was treated according to the international guidelines for the management of sepsis and septic shock, such as infection source control, fluid resuscitation, and the use of antibiotics [14].