Degree Of Organ Dysfunction Research Articles

AN ORGAN-SPECIFIC APPROACH TO THE MANAGEMENT OF GESTATIONAL HYPERTENSION - EVIDENCE VS. TRADITION.

The management of hypertensive disease in pregnancy is currently guided by practice recommendations based largely on observational data from a half century ago and has changed only superficially since that time. These recommendations are both narrowly prescriptive (women without traditional features of severe disease should all be delivered at exactly 37 weeks and 0 days,) and at the same time frustratingly ambiguous (the presence of epigastric pain unresponsive to repeat analgesics precludes expectant management at any gestational age, regardless of laboratory studies.) Guidelines which ignore recent data from the obstetric, pediatric and internal medicine literature too often lead practitioners to be more aggressive than necessary in the delivery of very premature pregnancies, and, conversely, more complacent than patient safety would support in prolonging pregnancy with advanced fetal maturity. We present here an alternative, organ-specific based approach to the management of gestational hypertension which allows and encourages practitioners to formulate a management plan based on a thoughtful and, when possible, evidence- based synthesis of the continuous variables of blood pressure, degree of organ dysfunction and response to treatment, gestational age, and patient balancing of maternal and fetal/neonatal risks. Such clinical care is more complex and nuanced than simply basing life-altering critical management decisions, including timing of delivery, on whether the patient does, or does not have any one of the conditions described by box 4 of the current American College of Obstetricians and Gynecologists practice guidelines. Nonetheless, we believe this approach will not only improve care but will also open the door to useful investigations into prevention and management of the various entities traditionally considered as the same disease process.

Comparison of Clinical Characteristics of Viral and Bacterial Sepsis in Children: a Single-Center Retrospective Analysis

Abstract Objective This study aimed to elucidate the characteristics of viral sepsis in children by comparing viral and bacterial sepsis. Methods We conducted a retrospective cohort study in the pediatric intensive care unit (PICU) of a single pediatric hospital. Patients aged <15 years who were admitted for sepsis to the PICU between January 2011 and December 2019 were included. Sepsis was diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria, and the degree of organ dysfunction was evaluated using the Pediatric Sequential Organ Failure Assessment (pSOFA) score. The mortality rate was compared as a primary endpoint between patients with viral sepsis and those with bacterial sepsis. Results We included 28 patients with viral sepsis and 52 patients with bacterial sepsis. The pSOFA scores for viral and bacterial sepsis were 10 (interquartile range [IQR]: 6.75–14) and 9 (IQR: 7–11) points, respectively, with no significant difference between groups. Respiratory disorders were significantly more prevalent in the viral sepsis group. Mortality between patients with viral (n = 8; 29%) and bacterial (n = 7; 13%) sepsis in the PICU showed no significant difference. When analyses were restricted to patients with septic shock, mortality was significantly higher due to viral (70%) than bacterial (27%) sepsis. Conclusion In pediatric patients, sepsis due to viral and bacterial infections is associated with similar rates of mortality and organ dysfunction.

Probable fluoxetine-induced hepatomegaly: a case report

Depressive disorder is a common behavioural, psychiatric disorder. Among various antidepressants selective serotonin reuptake inhibitors (SSRIs) are preferred drugs for the treatment of depression. When second-generation antidepressants SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat depression, 0.5–1% of patients develop mildly altered liver function without any symptoms. Various degrees of organ dysfunction are linked with drug-induced liver injury, which is unpredictable and might result from exposure to a drug. We reported suspected fluoxetine-induced hepatomegaly secondary to nine weeks of treatment with an SSRI fluoxetine. Upon cessation of the agent, the patient recovered symptomatically. The evidence is vital that the hepatomegaly in this patient was caused by fluoxetine.

Novel biomarkers for the assessment of disease activity in patients with sarcoidosis: a case-control study.

The prognosis of sarcoidosis is challenging and largely depends on the persistence of disease activity and the degree of organ dysfunction. Various biomarkers have been evaluated for diagnosis, disease activity assessment, and prognosis. This study aimed to determine if the ratios of monocytes to high-density lipoprotein cholesterol (MHR), platelets to lymphocytes (PLR), neutrophils to lymphocytes (NLR), and lymphocytes to monocytes ratio (LMR) could be used as novel sarcoidosis activity markers. In a case-control study, 54 patients with biopsy-confirmed sarcoidosis were divided into two groups; group 1: consisted of 27 patients with active sarcoidosis who were newly diagnosed and treatment-naive, and group 2: consisted of 27 patients with inactive sarcoidosis who had been on treatment for at least 6 months. All patients were subjected to a comprehensive history, physical examination, laboratory tests, chest imaging, spirometry, and screening for extrapulmonary organ involvement by means of electrocardiogram and eye examination. The mean age of the patients was 44 ± 11 years (79.6% were females & 20.4% were males). MHR, NLR, and LMR were significantly higher in patients with active sarcoidosis than in an inactive disease with a cut-off value of 8.6, a sensitivity of 81.5%, and a specificity of 70.4% (P-value < 0.001), a cut-off value of 1.95, sensitivity of 74% and specificity of 66.7% (P-value 0.007) and a cut-off value of < 4, a sensitivity of 81.5%, and a specificity of 85.2% (P-value < 0.001), respectively. In contrast, PLR was not statistically significant between active and inactive sarcoidosis patients. The lymphocytes monocytes ratio is a highly sensitive and specific biomarker that could be used to assess the disease activity in sarcoidosis patients.

Gestational hypertension and “severe” disease: time for a change

Our understanding and management of gestational hypertension and its variants are substantially hindered by a reliance on antiquated terminology and on practice recommendations based largely on tradition rather than outcomes-based evidence. Unsurprisingly, gestational hypertension remains a major contributor to maternal and neonatal morbidity and mortality rates, with little improvement seen over the past half century except as it relates to better newborn care. Reliance on a binary classification of vastly disparate types and degrees of organ dysfunction (severe or not severe) and the use of nonphysiological and largely arbitrary gestational age cutoffs are particularly problematic. If this situation is to improve, it will be necessary to abandon current misleading terminology and non-evidence-based traditional practice patterns and start again, building on management approaches validated by outcomes-based data.

SARS-CoV-2 and the digestive tract - Organoids to model gastrointestinal infection

SARS-CoV-2 is a novel human pathogenic coronavirus whose predilection for the respiratory tract has given rise to a rapid pandemic spread via airborne particles. Organ-specific susceptibility is substantially determined by the density of cell surface expression of ACE2, which is exploited by viral spike protein as a receptor molecule to mediate adhesion and, thus, to permit internalization of the viral genome into the host cell. Based on an ample data set derived from clinical studies and case reports, evidence suggests that distinct cell populations of the digestive and olfactory-gustatory system are equally equipped with membrane-bound ACE2, rendering them "vulnerable" to SARS-CoV-2. Numerous reports on concomitant gastrointestinal complaints and laboratory abnormalities are thought to reflect a relevant degree of organ dysfunction and underscore the tropism of SARS-CoV-2 for the digestive tract. Organoids are three-dimensional in vitro replicas of organ tissue which, owing to their organotypic complex cellular composition and functional resemblance to primary cells, are particularly appreciated for basic research in the field of infectious diseases. This review specifically addresses the involvement of digestive organs by SARS-CoV-2 and outlines the significant contribution of organoid- and primary-cell culture-based models to gaining a deeper understanding of the underlying pathophysiological processes.

Female-Specific Association of Plasma N-Terminal Pro-Brain Natriuretic Peptide With Organ Dysfunction and Prognosis in Sepsis: A Retrospective Study.

The plasma level of N-terminal pro-brain natriuretic peptide is regulated by sex hormones. It has been controversial whether N-terminal pro-brain natriuretic peptide is a prognosis marker for sepsis. The aim of this study is to examine the sex-dependent association of plasma N-terminal pro-brain natriuretic peptide with organ dysfunction and mortality of sepsis patients. In this retrospective study, the association between plasma N-terminal pro-brain natriuretic peptide concentration on the day of sepsis diagnosis and the degree of organ dysfunction, occurrence of septic shock, or 30-day mortality in both male and female patients was analyzed. This study was conducted in the Sepsis Laboratory at the Huaihe Hospital of Henan University in China. Diagnoses of sepsis, and septic shock, were based on the recently revised criteria (Sepsis 3.0). All sepsis patients (517) hospitalized in the respiratory ICU of the Huaihe Hospital from June 2016 to December 2019 were enrolled in this study. None. No significant difference was found in the age, occurrence rate of septic shock, 30-day mortality, or degree of organ dysfunction between male and female patients. Median concentration of plasma N-terminal pro-brain Natriuretic peptide was higher by 93.48% in female than male patients. A significant association was found between N-terminal pro-brain natriuretic peptide and septic shock or 30-day mortality in female, but not in male patients of community- or hospital-acquired sepsis. N-terminal pro-brain natriuretic peptide levels correlated to functional deficiencies of the cardiac and nervous systems, only in female patients. The plasma N-terminal pro-brain natriuretic peptide level is a female-specific prognosis indicator of septic shock and mortality.

Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study

BackgroundWe evaluated the characteristics and outcomes of culture-negative versus culture-positive septic shock.MethodsWe performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.ResultsOf 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 h (aerobic 10.2 h and anaerobic 9.0 h). The most common site of culture-positive infection was the hepatobiliary tract (39.5%), while for the culture-negative it was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p = 0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.ConclusionPatients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with a degree of organ dysfunction, it was not an independent predictor of death.

Covid-19 Complicated by Hemorrhagic Necrotizing Pancreatitis: A Case Report

COVID-19 is an infectious disease that has been shown to cause an aggressive, viral pneumonia. In addition to worsening pulmonary function, the COVID-19 illness course may also be complicated by hypercoagulability and varying degrees of organ dysfunction. Here we describe a case of COVID-19 complicated by multi-organ dysfunction and acute necrotizing pancreatitis.

Pulmonary versus Extrapulmonary Acute Respiratory Distress Syndrome: Clinical Characteristics and Outcome

Abstract Background: Acute respiratory distress syndrome is a clinical syndrome characterized by a refractory hypoxemia due to an inflammatory and high permeability pulmonary edema secondary to direct or indirect lung insult (pulmonary and extrapulmonary form). These two categories of ARDS patients are different regarding the respiratory mechanics, lung recruitment, gas exchange, and positive end-expiratory pressure response. Aim of Study: The aim of this work was to compare the clinical characteristics and outcomes between the two major ARDS subtypes; pulmonary and extrapulmonary. Patients and Methods: A prospective study was conducted during the period from July 2014 to January 2016 in Intensive Care Unit, El-Hussein University Hospital. It included 60 patients diagnosed as ARDS. They were subclassified into pulmonary and extrapulmonary ARDS groups according to the cause of lung injury. Both groups were compared regarding the clinical features, response to treatment and clinical outcome. Results: Patients with extrapulmonary ARDS developed more deteriorated liver and renal functions and arterial blood gases with a better response to elevated levels of PEEP and vasopressors with a mortality rate of 75%. In patients with pulmonary ARDS, mild organs dysfunction were developed with a better response to low levels of PEEP and a mortality rate of 25%. Conclusion: Subdivision of ARDS into pulmonary and extrapulmonary categories has worthy effect on both treatment and clinical outcome. Additionally, they are different in the degree of organ dysfunction and severity of clinical pictures. Recommendation: Proper assessment of patients with ARDS at admission to put them within a major category whether pulmonary or extrapulmonary ARDS. This simple classification will help physician to decide on treatment and to predict prognosis.

Перигравидарный менеджмент ревматических заболеваний

Management of inflammatory rheumatic diseases in preconception period, pregnancy and breastfeeding has undergone significant changes over the past few years. Modern therapy, including biological and targeted synthetic disease modifying drugs, has significantly improved the control of rheumatic diseases, which has led to an increase in the patients’ number planning a pregnancy with serious diseases. When consulting such patients, it is necessary to discuss the possible time of conception (regarding the activity of the disease), the effect of the disease on pregnancy and pregnancy on the disease, as well as the potential need to change the regimen of medications during pregnancy and breastfeeding. This review summarizes information on the effects of pregnancy on various rheumatic diseases and vice versa, changes in therapy and monitoring of patients with rheumatic diseases before, during and after pregnancy. Women with inflammatory rheumatic diseases need advice on drug therapy before planning pregnancy, during pregnancy, and breastfeeding. Safe disease-modifying drugs that can be taken during pregnancy are hydroxychloroquine, sulfosalazine, azathioprine, and cyclosporine. Glucocorticoids and non-steroidal anti-inflammatory drugs can also be taken up to 32 weeks of gestation. Most inhibitors of tumor necrosis factor (anti-TNF) are also safe during pregnancy. During pregnancy, a clear monitoring of the activity of the disease is necessary, control of the level of autoantibodies, especially anti-SSA / Ro and anti-SSB / La and antiphospholipid antibodies, an assessment of the degree of organ dysfunction, especially kidney damage. Presented are modern approaches to optimizing the management of inflammatory rheumatic disease during pregnancy. For patients with inflammatory rheumatic diseases, a successful pregnancy outcome is optimized by creating an individual plan to suppress disease activity using a targeted approach. Key words: pregnancy, rheumatic diseases, treatment, lactation, management tactics, drugs.

473. Impact of Adjunctive Clindamycin in Invasive β-Hemolytic Streptococcal Infections: A Propensity Score-matched Analysis of 1956 β-lactam Treated Patients from 118 US Hospitals

BackgroundClindamycin suppresses invasive β-hemolytic streptococcal (iBHS) toxin production and its cidality, unlike β-lactams, is independent of bacterial inoculum. Evidence favoring the use of adjunctive clindamycin in iBHS is predominantly from in vitro and animal studies. Clinical studies, limited to single-center series or active surveillance, have yielded mixed results. Furthermore, its role in infections caused by non–group A or B β-hemolytic streptococci (NABS) remains poorly defined. Previously we were unable to demonstrate a clindamycin survival benefit in patients with group A streptococci (GAS) bacteremia. Here we examined the impact of adjunctive clindamycin on survival among patients with either invasive GAS or NABS infections from all sites.MethodsClinical characteristics, in vitro susceptibility and antibiotic therapy were examined for unique inpatient encounters with iBHS (GAS + NABS) infections in the Cerner HealthfactsTM Database. β-Lactam treated cases receiving clindamycin were matched 1:1 to non-clindamycin cases by propensity of receiving clindamycin using nearest neighbor propensity score matching with downstream adjustment using logistic regression. In-hospital mortality, length of stay (LOS) and Sequential Organ Failure (SOFA) score trajectory was compared based on the matched sample.ResultsOf 1,956 inpatients with iBHS infection treated with β-lactams at 118 hospitals between 2000 and 2015, 459 (23.5%) received adjunctive clindamycin. Propensity score matching generated 389 case-pairs with good covariate balance (Table 1, Figure 1). In-hospital mortality did not differ between matched clindamycin and non-clindamycin cases (7.2% vs. 8.0%, P = 0.66, aOR 0.88, [95% CI .49–1.57]) (Figure 2). Receipt of clindamycin early (within 24h vs. no clindamycin) also did not display a survival advantage (aOR 1.04 [0.51–2.14]). On day 4 of therapy Median SOFA score (P = 0.586) and SOFA delta (day 0–day 4) were similar between the two groups (P = 0.13; Figure 3). Amongst survivors, median [IQR] LOS was greater in the clindamycin group (8[5,12] vs. 6[4,9]; P = 0.001)ConclusionAdjunctive clindamycin was not associated with decreased mortality or degree of organ dysfunction among patients with iBHS infection already treated with β-lactams. Figure 2: Odds Ratio of In-Hospital Mortality Abbreviations: GAS: Group A Streptococcus , ICU: intensive care unit, iβHS: invasive β-Hemolytic streptococcus, NABS: Non group A β-Hemolytic streptococci , OR: odds ratioFigure 2 Legend: The figure reports the odds ratios (ORs) of in-hospital mortality and 95% confidence intervals in the unmatched and unadjusted analysis, matched and unadjusted analysis, and primary analysis of all propensity-matched pairs with downstream adjustment with logistic regression for proven ißHS, vasopressor use and ICU (within 24h of culture sampling), as well as sensitivity analyses on propensity matched pairs of 2:1 match and subgroup analysis on propensity matched pairs of (1) proven ißHS alone (2) probable ißHS alone (3) ICU admission (within 24h of culture sampling) (4) patients receiving vasopressor therapy (within 24h of culture sampling) (5) Group A ißHS alone (6) Non Group A ißHS alone. There was no statistically significant difference in the ORs for in-hospital mortality between clindamycin and propensity-matched non-clindamycin cases in the primary analysis (*) as well as all sensitivity and subgroup (†) analyses.Figure 3: SOFA Score Trajectory by Survival Status Abbreviations: B: Non-Clindamycin cases, BC: Clindamycin CasesFigure 3 Legend: SOFA score by day of therapy of clindamycin and non-clindamycin matched cases based on survival status from day zero (day prior to antibiotic therapy) to day four of therapy. The linear mixed models were used to assess the time trends and the clindamycin effect on the longitudinal SOFA scores. SOFA trajectory was examined for the post matching sample. Square root transformation was applied to the SOFA score to meet the normality assumption Mean Baseline SOFA scores prior to therapy were similar amongst clindamycin and non-clindamycin subjects (mean [standard deviation(SD)] SOFA score: 1.88[2.48] vs. 1.96[2.60]; p= 0.634). On day 4 of therapy SOFA scores were similar between remaining 310 clindamycin and 286 non-clindamycin hospitalized patients (mean[SD] SOFA score: 1.79[2.88] vs. 1.67 [2.49]; p=0.586). The SOFA delta (day 0 SOFA score - day 4 SOFA score) was similar between the two groups (p=0.1331). When examined amongst survivors only, SOFA scores on day 4 of therapy were similar between and 272 non-clindamycin and 310 clindamycin hospitalized patients (mean[SD] SOFA score: 1.45 [2.20] vs. 1.52 [2.44])This work was funded in part by the Intramural Research Program of the National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Diseases.The opinions expressed in this abstract are those of the authors and do not represent any position or policy of the National Institutes of Health, the United States Department of Health and Human Services, or the United States government.Disclosures All authors: No reported disclosures.

Treatment Options For Relapsed/refractory Systemic Light-Chain (AL) Amyloidosis: Current Perspectives.

Systemic immunoglobulin light chain (AL) amyloidosis is a disorder characterized by the production of clonal serum free light chains that misfold, aggregate, and deposit in vital organs. Treatment of this disease is typically targeted at the abnormal plasma cell clone in the bone marrow which is the source of the amyloidogenic light chain. First-line therapies in this disease are well established, but in the relapsed or refractory setting, there are many treatment options, including immunomodulatory agents, proteasome inhibitors, alkylating agents, and monoclonal antibodies. Decisions regarding treatment choice should be made by a multidisciplinary team with consideration of the patient’s functional status, disease stage, degree of organ dysfunction, and potential treatment toxicities. Herein we review the current treatment options available for patients with relapsed or refractory AL amyloidosis.

Does chest compression during cardiopulmonary resuscitation provide sufficient cerebral oxygenation?

Background/aim Some of the patients suffering from cardiac arrest (CA) remain in a chronic unconscious state in intensive care units (ICUs). The primary aim of this study was to evaluate the efficacy of chest compression (CC) on cerebral oxygenation during cardiopulmonary resuscitation (CPR). As a secondary goal, we attempted to determine the effects of regional cerebral oxygen saturation (rSO2) values on consciousness and the survival rate using the Full Outline of Unresponsiveness (FOUR) scoring method.Materials and methodsThis observational preliminary study was carried out with 20 patients with CA who were hospitalized in ICUs. The rSO2 values measured by near-infrared spectroscopy were recorded during CA. FOUR scoring was used to determine the neurological status, severity of disease, and degree of organ dysfunction in survivors.Results Return of spontaneous circulation (ROSC) was gained in 8 (40%) of 20 patients. Maximum rSO2 values were higher in survivors than in nonsurvivors (P = 0.005). The mean FOUR score before CA was 11.50 ± 0.8 in survivors, whereas this value was 7.87 ± 0.7 for 1 week after ROSC (P < 0.0001). There was a significant positive correlation between the minimum and mean rSO2 values and the mean 1-week FOUR scores in survivors (r = 0.811, r = 0.771 and P = 0.015, P = 0.025, respectively).Conclusion Our results suggest that the maximum rSO2 values affect ROSC while the minimum and mean rSO2 values affect the post-cardiac arrest neurological outcome.

Multiple Organ Dysfunction (MODS) in Sepsis

Sepsis is one of the life-threatening condition affecting many children. A continuum of severity from sepsis to septic shock and MODS exists. The emergence of MODS as a clinical entity is one of the hallmark challenges of the modern era of critical care medicine. The clinical process usually begins with infection, which potentially leads to sepsis and organ dysfunction. Despite advances in pediatric intensive care and the widespread use of protocols and standard guidelines, sepsis remains a leading cause of mortality. Focus shifted from one organ to multiorgan support as these children die of multiorgan dysfunction and not the primary disease. MODS reflects a continuum of dysfunction rather than a dichotomous state of normal function versus failure which is potentially reversible, and the degree of organ dysfunction could change over time. The current consensus criteria of pediatric sepsis based on the concept of SIRS do not play an effective role in identifying clinically hazardous patients. It is strongly desirable that pediatric sepsis should be redefined on the basis of organ dysfunction scoring. This review intends to summarize sepsis and organ dysfunction and discusses potential directions for future research.

NURSING CONSIDERATIONS OF SCORING SYSTEMS IN THE CRITICALLY ILL PATIENTS

General illness severity scores are widely used in the ICU to predict outcome, characterize disease severity and degree of organ dysfunction, and assess resource use. In this article we review the most commonly used scoring systems in each of these three groups. We examine the history of the development of the initial major systems in each group, discuss the construction of subsequent versions, and, when available, provide recent comparative data regarding their performance. Importantly, the different types of scores should be seen as complementary, rather than competitive and mutually exclusive. It is possible that their combined use could provide a more accurate indication of disease severity and prognosis. All these scoring systems will need to be updated with time as ICU populations change and new diagnostic, therapeutic and prognostic techniques become available.

Multi-organ dysfunction syndrome as the first presentation of acute brucellosis, a case report and literature review

Multiple organ dysfunction syndrome (MODS) is a continuous process with incremental degrees of physiologic derangements in individual organs. The alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure. MODS, as defined, is a clinical syndrome characterized by the development of progressive and potentially reversible physiologic dysfunction in two or more organs or organ systems that are induced by a variety of acute insults, including sepsis. The cornerstone in the management remains correction of the triggering agent. The clinical scenario of a young male who presented with progressive shortness of breath, renal failure, and epistaxis (MODS) at presentation is discussed in this report. The diagnosis of this patient was clinically quite challenging. On evaluation, he proved to have multi-organ failure due to Brucella melitensis. The patient improved with conventional B. melitensis treatment. The Brucella infection is a male predominant disease and frequently presents with typical symptoms of fever, fatigue, etc., and the diagnosis often is straightforward, but the reports of atypical presentation have been described in the literature. The heaviest disease burden of B. melitensis lies in countries of the Mediterranean basin and Arabian Peninsula. However, the disease is not uncommon in India, Mexico, and Central America. Hence, clinicians need to be aware of this clinical entity all over the globe. The report of the case and brief review of literature are presented in this report.

Selective Digestive Decontamination Attenuates Organ Dysfunction in Critically Ill Burn Patients.

To evaluate whether selective decontamination of the digestive tract (SDD) attenuates organ dysfunction in critically ill burn patients. The effect of SDD on the development and progression of organ dysfunction, as an important determinant of mortality in burned patients, is still unknown. We asked whether organ dysfunction is mitigated by treatment with SDD. Patients with burns >20% of total body surface or suspected inhalation injury from a randomized placebo-controlled trial were analyzed to determine the relationship between treatment received (placebo or SDD) and the severity of organ dysfunction as measured by the area under the curve of the Sequential Organ Failure Assessment (SOFA) score (and its individual components) from day 1 to day 7 of admission. One hundred seven patients (53 in the SDD group and 54 in the placebo group) were included. Survival was significantly higher in SDD-treated patients (48 of 53, 90.6%) than in placebo-treated patients (39 of 54, 72.2%, P = 0.013). Total (P < 0.01) and respiratory (P < 0.01), cardiovascular (P = 0.04) and hematological (not reaching statistical significance, P = 0.07) organ dysfunction was associated with mortality after adjusting for predicted mortality. In multivariate logistic regression, SDD treatment was independently associated with total (P < 0.01), respiratory (P = 0.02), and hematological (P < 0.01) dysfunction over the first week postinjury. The beneficial effect of SDD on mortality in critically ill burned patients is accompanied by a reduction in the degree of organ dysfunction. SDD seems to be a valuable therapeutic strategy to prevent organ dysfunction and, more specifically, respiratory and hematological dysfunction in severely ill burn patients.

QSOFA does not replace SIRS in the definition of sepsis.

qSOFA does not replace SIRS in the definition of sepsis.

Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients.

BackgroundMiddle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection.MethodsRetrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples.ResultsDuring the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11–302.1, P = 0.04).ConclusionsMERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1303-8) contains supplementary material, which is available to authorized users.