Abstract
Lipidose (formerly GR270773) is a protein-free phospholipid emulsion intended for the treatment of hospitalized patients with suspected or confirmed Gram-negative severe sepsis. Lipidose contains phosphatidylcholine, triglyceride and sodium cholate formulated to optimize delivery of the phospholipid component to the surface of high-density lipoprotein (HDL) and other lipoproteins, thereby enhancing the capacity of the patient's circulating lipoprotein pool to bind and neutralize microbial toxins. When Lipidose is infused into blood, the cholic acid is adsorbed onto serum albumin and the phospholipid selectively associates with lipoproteins. Bound and neutralized toxins are removed from the circulation by the liver and excreted along with the cholic acid into the bile. The LIPOS trial enrolled 1,400+ patients at 235 study centers in 31 countries to access Lipidose treatment at two dose levels. The LIPOS headline data presented only a small mortality benefit for the lower dose and no benefit from the higher dose [1]. A subgroup analysis was carried out to test the hypothesis of benefit in the subgroup with adequate liver function, using serum albumin levels as a measure of liver function, and adequate pre-existing HDL or total lipoprotein to accept phospholipid as predicted by the mechanism of action.
Highlights
During the course of systemic inflammation, most of the immune cell types get activated to a certain degree as part of, or contributing to, the cascade of physiopathological events
After the development of sepsis we detected in all patients significantly increased heart rate, respiratory rate per minute, leukocytosis, anemia, worse glucose metabolism and renal function (Table 1)
Free KDO in the used concentration was inactive in regulation of TLR4, CD11b and CD14 expression and did not induce tumor necrosis factor alpha (TNFa) release but its impact in biological activity was detected when KDO was applied as constituent of Re-LPS
Summary
During the course of systemic inflammation, most of the immune cell types get activated to a certain degree as part of, or contributing to, the cascade of physiopathological events. This study aimed to find out whether mean differences of 6-hour, 12-hour, and 24-hour lactate clearance were observed between nonsurvivors and survivors of acute phase mortality in severe sepsis and septic shock patients. Conclusion: A two-phase retrospective chart review study demonstrated that the SSST utilized at a community hospital in Miami had a sensitivity value of 41.49% and a specificity value of 90.53% when evaluating medical surgical patients These results indicate the tool is accurate in detecting patients that are not septic; it is not reliable in identifying patients who are truly septic. This study was aimed to address the association of achieving either one or two targets of microcirculatory end point resuscitation and early mortality in severe sepsis and septic shock patients. Conclusion: Achieving both lactate clearance and ScvO2 targets in 6 hours after onset of resuscitation associates with lowest early mortality risk in severe sepsis and septic shock patients. Other blood samples were collected in blood culture tubes for culturing to verify septicemia depending on the clinical evidence
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