Speciality
Spotlight

 




 

Critical Medicine – Emergency Medicine

 

 





Sepsis

  

  • J
    Schroder, V Kahlke, K-H Staubach et al 1998. (Univ of Kiel, Germany; Univ of
    Lubeck, Germany; Ctr of Research, Borstel, Germany et al): Gender Differences in Human Species. Arch Surg 133: 1200 -1205. 

       

    Sepsis appears to have a better prognosis in women than in men. The survival advantage of women may be related to their higher levels of anti-inflammatory mediators such as IL-10
    (interleukin). (The relative proportions of pro-inflammatory and anti-inflammatory mediators may be an important therapeutic target).

        

    Are testosterone antagonists beneficial ?

      

  • MM,
    for the Ibuprofen in Sepsis Study group [Vanderbilt
    Univ., Nashville, Tenn] Arons

    Effects of Ibuprofen on the Physiology and
    Survival of Hypothermic 
    Sepsis

    Crit Care Med 
    27:699-707, 1999

       

    Patients
    whose response to sepsis is hypothermic rather than
    febrile have a poor prognosis. It has been suggested
    that patients with hypothermic 
    sepsis represent a clinically and
    biochemically distinct subgroup. This hypothesis was
    studied, along with the response to ibuprofen
    treatment in patients with hypothermic sepsis.

      

    The multicenter trial included 455 patients
    admitted to the ICU with severe sepsis and a known
    or suspected serious infection. 
    Patients with hypothermic sepsis were
    identified, and their clinical and physiologic
    findings were compared with those of patients with
    febrile sepsis. 
    Plasma cytokines measured included tumor
    necrosis factor [TNF –alpha] and interleukin
    [IL]-6, along with the lipid mediators thromboxane
    B2[TxB], and prostacyclin. Hypothermic patients were
    randomized to receive ibuprofen [10 mg/kg IV over 30
    to 60 minutes every 6 hours for 8 doses, to a
    maximum of 800 gm] or to receive a placebo.

      

    Ten percent
    of all patients with sepsis were hypothermic, with a
    temperature below 35.5 degrees celsius. 
    The mortality rate was double in these
    patients compared to the rest [70% vs 35%], and they
    had significant baseline elevations of urinary TxB,
    metabolites, prostacyclin, and serum TNF-alpha and
    IL-6, compared with the febrile group.

      

    Twenty-four patients with hypothermic sepsis were
    assigned to ibuprofen and twenty two placebo. The
    30-day morality was 54% in those receiving ibuprofen
    vs 90% in those on placebo. 
    Ibuprofen treatment was also associated with
    a trend toward increased number of days free from
    major organ system failures.

       

    About ten percent of the patients with sepsis
    have hypothermia instead of a febrile response. Such
    patients have an increased mortality. 
    Treatment with ibuprofen may reduce
    mortality, but prospective confirmation of these
    findings is needed.




         


 



 

 

Speciality Spotlight

 

 

Sepsis
  

  • J Schroder, V Kahlke, K-H Staubach et al 1998. (Univ of Kiel, Germany; Univ of Lubeck, Germany; Ctr of Research, Borstel, Germany et al): Gender Differences in Human Species. Arch Surg 133: 1200 -1205. 
       
    Sepsis appears to have a better prognosis in women than in men. The survival advantage of women may be related to their higher levels of anti-inflammatory mediators such as IL-10 (interleukin). (The relative proportions of pro-inflammatory and anti-inflammatory mediators may be an important therapeutic target).
        
    Are testosterone antagonists beneficial ?
      

  • MM, for the Ibuprofen in Sepsis Study group [Vanderbilt Univ., Nashville, Tenn] Arons
    Effects of Ibuprofen on the Physiology and Survival of Hypothermic  Sepsis
    Crit Care Med  27:699-707, 1999
       
    Patients whose response to sepsis is hypothermic rather than febrile have a poor prognosis. It has been suggested that patients with hypothermic  sepsis represent a clinically and biochemically distinct subgroup. This hypothesis was studied, along with the response to ibuprofen treatment in patients with hypothermic sepsis.
      
    The multicenter trial included 455 patients admitted to the ICU with severe sepsis and a known or suspected serious infection.  Patients with hypothermic sepsis were identified, and their clinical and physiologic findings were compared with those of patients with febrile sepsis.  Plasma cytokines measured included tumor necrosis factor [TNF –alpha] and interleukin [IL]-6, along with the lipid mediators thromboxane B2[TxB], and prostacyclin. Hypothermic patients were randomized to receive ibuprofen [10 mg/kg IV over 30 to 60 minutes every 6 hours for 8 doses, to a maximum of 800 gm] or to receive a placebo.
      
    Ten percent of all patients with sepsis were hypothermic, with a temperature below 35.5 degrees celsius.  The mortality rate was double in these patients compared to the rest [70% vs 35%], and they had significant baseline elevations of urinary TxB, metabolites, prostacyclin, and serum TNF-alpha and IL-6, compared with the febrile group.
      
    Twenty-four patients with hypothermic sepsis were assigned to ibuprofen and twenty two placebo. The 30-day morality was 54% in those receiving ibuprofen vs 90% in those on placebo.  Ibuprofen treatment was also associated with a trend toward increased number of days free from major organ system failures.
       
    About ten percent of the patients with sepsis have hypothermia instead of a febrile response. Such patients have an increased mortality.  Treatment with ibuprofen may reduce mortality, but prospective confirmation of these findings is needed.


         

 

 

By |2022-07-20T16:42:16+00:00July 20, 2022|Uncategorized|Comments Off on Sepsis

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