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Santos, Rui Pedro Lopes dos. "Marcadores bioquímicos de sepsis." Master's thesis, [s.n.], 2014. http://hdl.handle.net/10284/4489.
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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências FarmacêuticasA sepsis é uma reação sistémica grave que leva muitas vezes o paciente à morte. É uma complexa cadeia de inventos que envolve processos inflamatórios e não inflamatórios, reações humorais e celulares e anormalidades circulatórias. Esta resposta origina-se não só pela presença de um agente patogénico mas principalmente pela resposta exuberada do organismo a esse agente externo que provoca lesões em tecidos e órgãos e que é a maior causa dos problemas. Devido à sua agressividade, é necessário um rápido diagnóstico, e para tal, tem-se recorrido a biomarcadores específicos para este quadro. Biomarcadores são entidades objetivamente medidas e avaliadas como um indicador de processos biológicos normais, processos patológicos ou resposta farmacológicas a uma determinada terapêutica. Sepsis is a severe systemic reaction that often leads the patient to death. It is a complex chain of invents involving inflammatory and non-inflammatory processes, humoral and cell reactions and circulatory abnormalities. This response arises not only by the presence of a pathogen but mainly by exaggerated body's response to this foreign agent that causes lesions in tissue and organs and is the major cause of the problems. Due to its aggressive, rapid diagnosis is needed and for this it has been resorted to specific biomarkers for this illness. Biomarkers are characteristics objectively measured and evaluated as an indicator of normal biological processes, pathological processes, or pharmacological response to a particular therapy.
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Radhakrishnan, Jayachandran. "Functional genomics of severe sepsis and septic shock." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:2b2afd65-82e0-4847-b7ae-960635b7e884.
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Sepsis is the systemic inflammatory response to an infection. Severe sepsis with multi organ failure is one of the commonest causes of admission to intensive care units, and is associated with poor early and late outcomes. The pathophysiology of sepsis is complex, and poorly understood. This is reflected in the limited and contentious treatment options for sepsis. Genetic factors have been shown to be associated with the risk of and subsequent outcomes from infection. However, clear associations with bacterial sepsis are rare, and even when associations are present their functional effects are often unknown. Gene expression signatures in sepsis are investigated in this project using serial samples obtained from patients admitted to intensive care units with community-acquired pneumonia or faecal peritonitis. The evolving gene expression signatures that define the response to sepsis were identified with large changes seen in genes coding for ribosomal proteins RPS4Y1 and RPS26P54. The differences in the sepsis response between the two diagnostic classes were examined. The gene expression predictors of mortality in sepsis were determined and include genes from the class II MHC HLA-DRB4, HLA-DRB5 and the T cell differentiation protein MAL. The effects of important covariates on gene expression were investigated and their impact on survival related expression determined. The findings were confirmed in a validation cohort. A novel clustering of samples representing distinct inflammatory patterns in a clinically homogeneous population of sepsis patients was identified and related to differences in clinical behaviour. The biological relevance of the differentially expressed genes was ascertained by identifying enriched gene sets. The gene expression changes in sepsis were examined in the context of related clinically relevant immune phenomena: the sterile systemic inflammatory response in patients undergoing elective cardiac surgery and the phenomenon of endotoxin tolerance in PBMCs derived from healthy volunteers. The results highlight the complexities of clinical sepsis and identify hypotheses for future investigations.
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Svärdh, Elinor, and Sandra Persson. "Hur påverkas livet efter sepsis eller septisk chock?" Thesis, Högskolan i Skövde, Institutionen för hälsovetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-18384.
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Bakgrund: Sepsis och septisk chock är ett akut livshotande tillstånd där en tidig behandlingär livsavgörande. Många människor drabbas och fler människor överlever idag jämfört medför några år sedan. Detta leder till fler komplikationer och konsekvenser som kan påverkamänniskans vardagliga liv exempelvis nedsatt ADL. Vid akut sjukdom genomgår människanen traumatisk upplevelse som kan påverka hälsa, välbefinnande och livskvalitet.Syfte: Syftet med denna studie är att, ur ett patientperspektiv, beskriva upplevelser av hurlivet påverkas efter sepsis eller septisk chock.Metod: Studien är en kvalitativ innebördsanalys. Informanter kontaktades viaFacebookgruppen, Sepsisforum. Informanterna beskrev hur deras liv påverkades efter sepsisoch septisk chock. Analysen framställde fyra teman vilket lade grund till resultatet i studien.Resultat: Resultatet belyser fyra teman; oro och rädsla hos personer skapar lidande, enobeskrivlig trötthet, att inte klara av vardagen och uppnå hälsa, bristande eftervård ochvårdpersonalens ansvar.Konklusion: Komplikationerna som kan uppstå efter sepsis eller septisk chock är mångaoch kan vara livslånga. Detta påverkar personen på olika sätt såsom livskvalité och hälsa.Vården har ett stort ansvar och eftervården behöver utvecklas.
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Furebring, Mia. "C5a Receptor Expression in Severe Sepsis and Septic Shock." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5832.
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Motzkus, Christine. "Recent Trends in Sepsis Mortality, Associations between Initial Source of Sepsis and Hospital Mortality, and Predictors of Sepsis Readmission in Sepsis Survivors." eScholarship@UMMS, 2017. https://escholarship.umassmed.edu/gsbs_diss/891.
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Background: Sepsis, a leading cause of US deaths, is associated with high mortality, although advances in early recognition and treatment have increased survivorship. Many aspects of sepsis pathophysiology and epidemiology have not been fully elucidated; the heterogeneous nature of infections that lead to sepsis has made fully characterizing the underlying epidemiology challenging.
Methods: The University HealthSystem Consortium (UHC) from 2011-2014 and the Cerner HealthFacts® database from 2008-2014 were used. We examined associations between infection source and in-hospital mortality in the UHC dataset, stratified by age and presenting sepsis stage. We examined recent temporal trends in present-on-admission (POA) sepsis diagnoses and mortality and predictors of 30-day sepsis readmissions following sepsis hospitalizations using the HealthFacts® dataset.
Results: Patients with sepsis due to genitourinary or skin, soft tissue, or bone sources had lower mortality than patients with sepsis due to respiratory sources regardless of age or presenting sepsis stage. Overall diagnoses of sepsis increased from 2008-2014; however, POA diagnoses and case fatality rates decreased. Factors that predicted re-hospitalization for sepsis included discharge to hospice, admission from or discharge to a skilled nursing facility, and abdominal infection.
Conclusion: Further investigation will reveal more detail to explain the impact of infection source on in-hospital sepsis mortality for all age groups and sepsis stages. Decreasing mortality rates for all POA sepsis stages and all age groups suggest current approaches to sepsis management are having broad impact. Sepsis survivors are at significant risk for re-hospitalization; further studies are needed to understand the post discharge risks and needs of survivors.
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Motzkus, Christine. "Recent Trends in Sepsis Mortality, Associations between Initial Source of Sepsis and Hospital Mortality, and Predictors of Sepsis Readmission in Sepsis Survivors." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/891.
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Background: Sepsis, a leading cause of US deaths, is associated with high mortality, although advances in early recognition and treatment have increased survivorship. Many aspects of sepsis pathophysiology and epidemiology have not been fully elucidated; the heterogeneous nature of infections that lead to sepsis has made fully characterizing the underlying epidemiology challenging.
Methods: The University HealthSystem Consortium (UHC) from 2011-2014 and the Cerner HealthFacts® database from 2008-2014 were used. We examined associations between infection source and in-hospital mortality in the UHC dataset, stratified by age and presenting sepsis stage. We examined recent temporal trends in present-on-admission (POA) sepsis diagnoses and mortality and predictors of 30-day sepsis readmissions following sepsis hospitalizations using the HealthFacts® dataset.
Results: Patients with sepsis due to genitourinary or skin, soft tissue, or bone sources had lower mortality than patients with sepsis due to respiratory sources regardless of age or presenting sepsis stage. Overall diagnoses of sepsis increased from 2008-2014; however, POA diagnoses and case fatality rates decreased. Factors that predicted re-hospitalization for sepsis included discharge to hospice, admission from or discharge to a skilled nursing facility, and abdominal infection.
Conclusion: Further investigation will reveal more detail to explain the impact of infection source on in-hospital sepsis mortality for all age groups and sepsis stages. Decreasing mortality rates for all POA sepsis stages and all age groups suggest current approaches to sepsis management are having broad impact. Sepsis survivors are at significant risk for re-hospitalization; further studies are needed to understand the post discharge risks and needs of survivors.
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Pereira, Flavia Helena. "Estudo da correlação entre temperatura corporal e dosagem de óxido nítrico plasmático em pacientes com sepse, sepse grave e choque séptico." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-16112010-100238/.
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O choque séptico é a complicação mais comum da sepse e responsável por um grande número de casos de morte em unidades de terapia intensiva. Em pacientes com diagnóstico de sepse, a febre é um dos sinais mais comuns, entretanto a hipotermia pode ocorrer e geralmente está associada a infecções severas, prognóstico pior e alta mortalidade. A confluência de vários fatores contribui para a deterioração da condição clínica do paciente que evolui para choque séptico. Um dos principais fatores é a aumentada síntese de óxido nítrico, que pode mediar alterações na função cardiovascular e termorregulatória. O enfermeiro é capaz de detectar o início dos sinais clínicos desses quadros, que incluem: complicação do quadro pulmonar (com presença de taquipnéia), sudorese fria, confusão mental, oligúria, taquicardia, hipotensão arterial e alteração da temperatura corporal. A detecção desses sinais pode ser facilmente realizada com instrumentos apropriados e exame físico. Neste estudo, o objetivo foi correlacionar os valores de temperatura e as concentrações plasmáticas de óxido nítrico em pacientes com diagnóstico de sepse, sepse grave e choque séptico. Nossos dados mostram que existe uma correlação negativa (p<0.0037; r2=0,1593; Coeficiente de Pearson -0,3991) entre os valores de temperatura corporal e os valores de concentração plasmática de nitrato em pacientes com diagnóstico de choque séptico. Estes dados mostram que quanto mais baixa a temperatura corporal, mais altas são as concentrações plasmáticas de nitrato.Septic shock is the most common complication of sepsis and responsible for a large number of cases of death in intensive care units. In patients with sepsis, fever is one of the most common signs, but hypothermia can occur and is usually associated with severe infections, worse prognosis and high mortality. The confluence of several factors contributing to the deterioration of the clinical condition of patients who progress to septic shock. A key factor is the increased synthesis of nitric oxide may mediate changes in cardiovascular and thermoregulatory function. The nurse is able to detect the onset of clinical signs in these tables, which include: a complication of pulmonary symptoms (presence of tachypnea), cold sweating, mental confusion, oliguria, tachycardia, hypotension, and changes in body temperature. The detection of these signals can be easily accomplished with appropriate instruments and physical examination. In this study, we aimed to correlate the temperature and plasma concentrations of nitric oxide in patients with sepsis, severe sepsis and septic shock. Our data show that there is a negative correlation (p <0.0037, r2 = 0.1593, Pearson´s coefficient of -0.3991) between the values of body temperature and the values of plasma nitrate in patients with septic shock. These data show that the lower body temperature, the higher plasma concentrations of nitrate.
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Saha, Dhanonjoy C. "The effects of endotoxin and monophosphoryl lipid A on monocyte activity." Thesis, University of Surrey, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337003.
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Wilson, Susan. "Lipopolysaccharide-activated signal transduction in cardiac and vascular smooth cells." Thesis, University of Strathclyde, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367047.
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Yates, Amanda Marie. "Prediction of sepsis." Thesis, University of the West of England, Bristol, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429692.
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Berthelson, Helén, and Fredrik Eliasson. "Näringstillförsel och omvårdnadsdokumentation vid svår sepsis och septisk chock : En journalgranskning." Thesis, Kristianstad University College, School of Health and Society, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-5534.
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Background: Insufficient nutritional support is associated with prolonged hospitalisation, impaired wound healing and impaired survival for patients in intensive care. In severe sepsis and septic chock, calculation of nutritional need is complicated since the metabolism is affected by decease. Aim: The aim of the study was to investigate nutritional support and to examine the quality of nursing documentation of nutritional status and nutritional support in patient records in severe sepsis and septic chock. Method: The study was conducted as a retrospective investigation where 64 patient records were studied. The quality of documentation was examined in 10 patient records using an examinational model.
Findings: Calculation of average nutritional support showed insufficient supply particularly in the two first days of intensive care. During the next five days nutritional supply was higher but individual variation was seen, why a clear picture of nutritional support is hard to detect. Examining the quality of nursing documentation revealed that most records contained nutritional status and treatment, while anamnesis, nutritional goals and nutritional diagnoses were rare. Conclusion: The study is of limited significance, but could be used to map out the present regimen of nutritional support. Future nursing research could include the caloric need and the amount of enteral support patients in severe sepsis and septic shock tolerates.
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Arkader, Ronaldo. ""Avaliação da procalcitonina como marcador de sepse e de choque séptico em pacientes pediátricos"." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-25072005-155453/.
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Sepse bacteriana é a maior causa de morbimortalidade na faixa etária pediátrica e neonatal. A detecção precoce do quadro séptico é difícil, devido os sinais iniciais da doença serem inespecíficos. A possibilidade da existência de exame laboratorial capaz de identificar precocemente quadros sépticos melhoraria o prognóstico desses pacientes. Várias proteínas de fase aguda foram estudadas como marcadores de infecção sendo a proteína C reativa (PCR) a mais utilizada. A procalcitonina (PCT), um pró-hormônio, encontra-se elevado precocemente em quadros sépticos em crianças e adultos. Estudo prospectivo com 14 crianças submetidas à cirurgia cardíaca com circulação extra-corpórea (CEC), com dosagens seriadas de procalcitonina e proteína C reativa, serviram como modelo de resposta inflamatória sistêmica sem infecção com dosagens antes da CEC, após a CEC no primeiro, segundo e terceiro dia após cirurgia, enquanto 14 crianças com sepse/choque séptico dosagens seriadas de PCT e PCR foram obtidas sequencialmente antes do tratamento antibioticoterápico e a cada dia até o terceiro dia. Em crianças sépticas a PCT demonstrou ser superior a PCR como marcador de sepse assim como para diferenciar quadros inflamatórios sistêmicos.Bacterial sepsis is a major cause of morbidity and mortality in neonates and children. Early detection of bacterial sepsis is difficult because the first signs of this disease may be minimal or nonspecific. The availability of a laboratory test to accurately and rapidly identify septic neonates and children would be of great value in improving the outcome of these patients. Several acute-phase proteins have been used for the diagnosis of bacterial sepsis and C reactive protein (CRP) is the usual marker. It has been reported that the concentration of procalcitonin (PCT), a pro-hormone, is markedly higher in children and adults with sepsis. In a prospective study, 14 children were enrolled after cardiac surgery with cardiopulmonary bypass (CPB), these group represent the non infected children with inflammatory response. Blood samples were obtained before CPB, after CPB, on the first, second and third day after surgery. Another group with 14 children with sepsis or septic shock were enrolled, and blood samples were obtained before antibiotic start, on the first, second and third days. In septic children PCT concentration is a better diagnostic marker of sepsis and to differentiate inflammatory response than CRP.
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Castro, Renata Sayuri Ansai Pereira de [UNESP]. "Análise da sepse neonatal tardia em prematuros de muito baixo peso após a implantação do protocolo de sepse na unidade." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/150183.
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Introdução: A sepse e choque séptico são importantes causas de morbimortalidade no período neonatal. A implantação de protocolos permite uma condução sequencial e rápida na sepse/ choque, o que pode melhorar o prognóstico desses pacientes. Objetivo: Investigar nos prematuros de muito baixo peso (PT-MBP) se o quadro séptico está sendo conduzido de forma sistematizada de acordo com o protocolo e se essa sistematização melhorou o prognóstico em curto prazo. Métodos: Estudo retrospectivo, do tipo coorte realizado na UTI Neonatal do Hospital das Clinicas da Faculdade de Medicina de Botucatu no período de janeiro de 2013 a dezembro de 2015, após aprovação do CEP. Foram selecionados todos os recém-nascidos (RN) prematuros com peso ao nascer inferior a 1500g (muito baixo peso), internados na UTI, nascidos ou não no Serviço, que sobreviveram por mais de 72 horas de vida. Foram incluídos todos os prematuros menores de 34 semanas e que apresentaram diagnóstico de sepse / choque séptico na Unidade. Não foram incluídos aqueles com malformações múltiplas e infecções congênitas. Variáveis estudadas: maternas, gestacionais, neonatais e variáveis do protocolo de choque da Unidade. Os recém-nascidos (RN) foram comparados inicialmente em dois grupos: sepse e choque séptico; para a avaliação do protocolo foram estudados apenas os que evoluíram para choque: com protocolo VS sem protocolo. Desfechos: displasia broncopulmonar (DBP), hemorragia periintraventricular (HPIV) grave, retinopatia da prematuridade (ROP) ≥ estágio 2 e óbito. Estatística: testes paramétricos e não paramétricos, com significância se p<0,05. Resultados: Dentre os 271 PT-MBP admitidos, a incidência de sepse tardia foi de 34%, e do choque séptico foi de 14%. A mortalidade entre os pacientes sépticos foi de 27,5%, e no choque foi de 61%. Abordagem sistematizada do choque de acordo com o protocolo ocorreu em 61% dos casos e os prematuros que não seguiram protocolo apresentaram maior mortalidade (80% x 48%; p=0,047). Não houve diferença significativa em relação às demais comorbidades, porém elas foram mais frequentes no grupo não seguiu o protocolo: DBP (75% vs 33%; p=0,262), HPIV grave (40% vs 22%; p=0,225), ROP ≥ 2 (50% vs 29%; p=1,000). Conclusão: Prematuros com choque séptico apresentaram alta mortalidade e pior prognóstico. Não seguir protocolo aumentou o percentual de morte. Prematuros com choque séptico sem abordagem sistematizada apresentaram pior prognóstico em curto prazo, embora sem diferença significativa, porém com alta relevância clínica. Assim, a abordagem sistematizada do choque pode melhorar o prognóstico desses RN.
Introduction: Sepsis and septic shock are important causes of morbidity and mortality in the neonatal period. Protocol implantation allows sequential and rapid conduction of sepsis / shock, which may improve patient prognosis. Objective: To investigate in the very low birth weight preterm infants if septic disease is being conducted in a systematized manner according to the protocol and if this systematization has improved the prognosis in the short term. Methods: Retrospective cohort study performed at the neonatal intensive care unit (NICU) of the Clinic Hospital Botucatu Medical School from January 2013 to December 2015. All preterm infants with birth weight less than 1500g, admitted in the NICU with more than 72 hours of life were selected and included whose with diagnosis of sepsis / septic shock. Those with multiple malformations and congenital infections were excluded. Variables studied: maternal, gestational, neonatal and variables of the shock protocol. The neonates were initially compared in two groups: sepsis and septic shock; for an evaluation of the protocol it was studied only those who evolved to shock: protocol VS non-protocol. Outcomes: Bronchopulmonary dysplasia (BPD), Grade III or IV intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) ≥ stage 2 and death. Statistical: parametric and non-parametric tests, with significance if p <0.05. Results: Among the 271 very low birth weight preterm admitted, the incidence of late onset neonatal sepsis and septic shock was 34% and 14%, respectively. Mortality among sepsis neonates was 27.5%, while in the shock group was 61%. Systematic approach according to the protocol occurred in 61% of the cases and the preterm infants who did not follow the protocol presented higher mortality (80% x 48%, p = 0.047). There were no statistically difference in the others comorbidities, but they were more frequent in the non-protocol group: BPD (75% vs 33%; p=0,262), Grade III or IV IVH (40% vs 22%, p = 0.225), ROP ≥ 2 (50% vs 29%, p = 1,000). Conclusion: Preterm infants with septic shock had high mortality and worse prognosis. Not following the protocol increased the percentage of death. Preterm infants with septic shock without systematic approach had worse prognosis in the short term, although without significant difference. Therefore, sequential conduction may be useful to improve prognosis in neonates.
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Isopo, Elyse Diana. "Disseminating the Sepsis Bundle: Evaluating an Evidence-Based Education Module." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4792.
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Due to increasing incidence and noncompliance with sepsis at a local hospital, an educational deficit was identified on the sepsis bundle in the medical intensive care unit. The purpose of this project was to develop and validate a sepsis bundle education program for all frontline staff in the MICU at a local University Hospital. The goal was for the educational tool to be validated by a multidisciplinary team to increase awareness, education, and ultimately, compliance with the severe sepsis and septic shock guidelines. The diffusion of innovation theory was utilized to support the process of change by encouraging the use of screening tools and best practice guidelines. The research question asked whether the education program meets critical care expert panel standards to educate frontline MICU staff on the sepsis bundle. The research design included a 5-member panel of experts in critical care, utilizing the Likert scale to review the proposed educational project on the sepsis bundle. Results are averaged from each reviewer. Results from the review included a unanimous '5' rating on every issue identified, equating to strongly agree on the Likert scale. This rating supported the validity of the educational project, the use of evidence-based practice and that the educational material was clear and easy to follow. Utilizing this validated tool will guide the education of sepsis, severe sepsis, and septic shock and promote social change by increasing education, awareness, recognition and early deployment of the sepsis bundle to improve patient outcomes.
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Smith, Fiona Susan. "The regulation of hepatic nitric oxide synthesis and inhibition of glucose output during endotoxic shock." Thesis, University of Sussex, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263207.
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Fredriksson, Katarina. "Muscle mitochondria in sepsis /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-910-6/.
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Vasconcelos, P. R. L. de. "Hepatic metabolism during sepsis." Thesis, University of Oxford, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.233530.
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Davies, Nathan Alun. "Nitric oxide in sepsis." Thesis, University of Essex, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285823.
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Worthington, Tony. "Serodiagnosis of staphylococcal sepsis." Thesis, Aston University, 2000. http://publications.aston.ac.uk/12356/.
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The coagulase-negative staphylococci are the most frequent cause of sepsis associated with indwelling intravascular catheters. Current microbiological investigations to support the diagnosis of catheter-related sepsis (CRS) include the culture of blood and catheter tips, however positive results may reflect specimen contamination, or colonisation of the catheter rather than true sepsis. Previous serological approaches to assist in the diagnosis of CRS based on cellular staphylococcal antigens have been of limited value. In this current study, the serodiagnostic potential of an exocellular antigen produced by 7 strains of coagulase-negative staphylococci cultured in brain heart infusion broth was investigated. Antigenic material isolated by gel permeation from liquid culture was characterised by immunological techniques and chemical analysis. Characterisation of the exocellular antigen revealed a novel glycerophosphoglycolipid, termed lipid S. which shared antigenic determinants with lipoteichoic acid, but differed by comprising a glycerophosphate chain length of only 6 units. In addition, lipid S was immunologically distinct from diphosphatidyl glycerol, a constituent cell membrane phospho lipid. An indirect enzyme linked immunosorbent assay (ELISA) based on lipid S was subsequently developed and used to determine serum antibody levels (IgM and IgG) in 67 patients with CRS due to staphylococci, and 67 patients with a central venous catheter (CVC) in situ who exhibited no evidence of sepsis. The sensitivity and specificity of the lipid S IgG ELISA was 75% and 90% respectively whilst the IgM assay had sensitivity and specificity of 52% and 85%. The addition of GullSORereagent to the EL1SA procedure to remove competing serum IgG and rheumatoid factor did not significantly improve the performance of the IgM assay. The serological response in serial serum samples of 13 patients with CRS due to staphylococci was investigated. Elevated levels of antibody were detected at an early stage of infection, prior to the isolation of microorganisms by standard culture methods, and before the clinical presentation of sepsis in 3 patients. The lipid S ELISA was later optimised and a rapid 4-hour assay developed for the serodiagnosis of CRS. Serum IgG levels were determined in 40 patients with CRS due to staphylococci and 40 patients with a CVC in situ who exhibited no evidence of sepsis. The sensitivity and specificity of the rapid IgG assay was 70% and 100% respectively. Elevated serum antibody levels in patients with endocarditis, prosthetic joint infection and pyogenic spondylodiscitis due to Gram-positive cocci were also detected with the lipid S ELISA suggesting that the assay may facilitate the diagnosis of these infections. Unexpected increased levels of anti-lipid S IgG in 31% of control patients with sciatica suggested a possible microbial aetiology of this condition. Further investigation of some of these patients by culture of microdiscectomy tissue removed at operation, revealed the presence of low-virulent microorganisms in 37% of patients of which Propionibacterium aeries accounted for 85% of the positive culture isolates. The results suggested a previously unrecognised association between P. acnes and sciatica, which may have implications for the future management of the condition.
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Edwards, Sian Elizabeth. "Sepsis in maternity care." Thesis, University of Bristol, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.707715.
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LEFEBVRE, LEBLEU NATHALIE. "Microcirculation et sepsis severe." Lille 2, 1994. http://www.theses.fr/1994LIL2M257.
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Léon, Karelle. "L'hypothermie modérée induite chez un modèle murin : une solution thérapeutique au sepsis ?" Thesis, Brest, 2012. http://www.theses.fr/2012BRES0030.
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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’organesDespite 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
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Hedman, Susanna, and Karin Sällin. "Att vårda patienter med sepsis och septisk chock på akutmottagning. Sjuksköterskors erfarenheter." Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-67691.
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Eklund, Lisbeth, Maud Feldt, and Ann-Margret Persson. "Sepsis - en vanlig och allvarlig sjukdom : Sjuksköterskans specifika omvårdnad av patienter med sepsis." Thesis, Kristianstad University College, School of Health and Society, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-5078.
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Bakgrund: Sepsis är vanligt förekommande inom sjukvården och många patienter blir svårt sjuka och dör i svår sepsis eller septisk chock. Det är ett tillstånd som anses föreligga vid infektion och minst två SIRS-kriterier. Symtomen kan vara diffusa och svåra att identifiera. Sjuksköterskan har en viktig roll att observera försämring för att så snabbt som möjligt identifiera en sannolik sepsis. Vid tidig diagnos och behandling minskar sjuklighet och dödlighet. Syfte: Att beskriva sjuksköterskans specifika omvårdnad av patienter med sepsis. Metod: En litteraturstudie baserad på tolv vetenskapliga artiklar publicerade mellan år 1998-2008. Resultat: Analysen resulterade i fyra huvudkategorier; bedömning, specifik omvårdnad, specifik omvårdnad genom akutteam och kunskap som redskap i omvårdnaden. Specifik omvårdnad kan leda till ett gynnsamt och snabbare omhändertagande av patienter med sepsis. Diskussion och slutsats: Det krävs ökad kunskap om omvårdnad vid sepsis. Med en bred kunskap om sepsis kan sjuksköterskan ge en säkrare och tryggare omvårdnad och minska lidandet för patienten och kostader för samhället.
Background:Sepsis is common within the health care and numerous patients become severely ill and die from severe sepsis or septic chock.Sepsis is acondition which is thought to occur at infection and at least two SIRS-criterions. The symptoms can be diffuse and difficult to identify. The nurse has an important role to observe deterioration in order to quickly as possible identify a probable sepsis. At an early diagnose and treatment the mortality and morbidity decreases. Purpose: To describe the nurse-specific care of patients with sepsis.Method: A literature study based on twelve scientific articles published between years 1998-2008. Result: The analysis resulted in four main categories;assessment, specific nursing,specific nursing by an emergency team and knowledge as a tool within nursing. Specific nursing can lead to a beneficial and faster treatment of patients with sepsis. Discussion and conclusion: It is necessary with an increased knowledge of nursing of sepsis. With a wide knowledge of sepsis the nurse is able to establish a more secure and safer nursing and ease the suffering for the patient and also decrease the costs for the society.
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Gibot, Sébastien. "Triggering receptor expressed on myeloid cells-1 : implications diagnostiques et thérapeutiques au cours du sepsis." Nancy 1, 2004. http://www.theses.fr/2004NAN11307.
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Au cours du sepsis, l'expression membranaire du Triggering Receptor Expressed on myeloid cells (TREM)-1 ainsi que la production de sa forme soluble (sTREM-1) sont fortement majorées tant chez la souris que chez l'homme. Ces phénomènes dépendent de la présence de ligands bactériens, ne sont pas reliés à la production de TNF-alpha et découlent d'un mécanisme impliquant P13K. STREM atténue la production de cytokines chez la souris. La modulation de la voie de TREM-1 réduit mais sans totalement l'inhiber la production de cytokines et protège l'animal du décès. L'utilisation d'un peptide modulateur pourrait constituer une thérapeutique intéressante.
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Pettersson, Jonas, and Kristian Pettersson. "Vårdsituationen vid sepsis : En litteraturöversikt om tidig upptäckt och behandling av patienter med sepsis." Thesis, Mittuniversitetet, Institutionen för hälsovetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-16284.
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Introduktion: Sepsis är en sjukdom med hög dödssiffra och förekomsten fortsätter att öka. År 2004 introducerades Surviving Sepsis Campaign i syfte att förbättra sepsisvården. Följsamheten har dock visat sig vara låg. Syfte: Syftet var att beskriva hur sjukvårdspersonal identifierar sepsis hos patienter samt att belysa vikten av tidig vård för att minska sjukdomens dödlighet. Metod: Elva artiklar med kvantitativ design analyserades och sammanställdes i form av en litteraturöversikt. Resultat: I resultatet framkom att SSC:s riktlinjer har potential att sänka mortaliteten markant, men att bristfällig följsamhet i användandet av dessa råder. Med hjälp av olika verktyg kunde sepsis upptäckas och behandlas tidigare, vilket var en viktig faktor i arbetet med sepsis. Kunskapsnivån hos hälso- och sjukvårdspersonal vad gäller sepsis, dess symtom, behandling och definitioner var otillräcklig. Diskussion: Vårdsituationen för patienter med sepsis var bristfällig. SSC:s riktlinjer med tillhörande verktyg visades kunna hjälpa personalen att minska mortaliteten. Implementeringen av dessa var dock otillräcklig. Tidig vård var mycket viktigt, men det kan vara svårt att upptäcka sepsis i dess tidigaste skeden varför högre kunskapsnivåer hos personalen erfordrades. Slutsats: Både vårdsituationen och hälso- och sjukvårdspersonalens kunskap om sepsis var till synes bristfällig, men det finns verktyg och riktlinjer som kan förbättra vården. Vårdpersonal bör bli bättre på att implementera dessa verktyg och riktlinjer.
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Sancho, Rodríguez Natalia. "Biomarcadores de sepsis en sangre de cordón para el diagnóstico de sepsis neonatal precoz." Doctoral thesis, Universidad de Murcia, 2012. http://hdl.handle.net/10803/117585.
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La sepsis neonatal precoz actualmente es una importante causa de morbilidad y mortalidad en el período neonatal, y su rápido diagnóstico puede ayudar a instaurar un tratamiento antibiótico eficaz.
El objetivo de este trabajo es estudiar la relación de diferentes marcadores de sepsis, tanto bioquímicos como hematológicos, en muestras de sangre de cordón procedentes de neonatos; que previamente fueron clasificados en grupos de estudio en función de la presencia o ausencia de factores de riesgo (infeccioso, prematuridad, otras causas, o sepsis neonatal precoz confirmada).
Los marcadores bioquímicos de sepsis (PCR, PCT e IL-6) y hematológicos en sangre de cordón no han resultado de utilidad en el diagnóstico de sepsis neonatal precoz, y los datos clínicos continúan siendo los más determinantes. Las nuevas técnicas de biología molecular en sangre de cordón fueron indicativas de la presencia de sospecha de infección en aquellos neonatos con uno o varios factores de riesgo infeccioso.Early-onset neonatal sepsis is currently a major cause of morbidity and mortality in the neonatal period, and its rapid diagnosis can help to establish an effective antibiotic treatment. The objective of this work is to study the relationship of different markers of sepsis, both biochemical and haematological, in cord blood samples taken from infants; that were previously classified in groups according to the presence or absence of risk factors (infectious, prematurity, other causes, or confirmed early neonatal sepsis). Biochemical markers sepsis (CRP, PCT and IL-6) and haematological in cord blood have not proved useful in the diagnosis of early neonatal sepsis, and clinical data continue to be the most decisive. New techniques of molecular biology in cord blood were indicative of the presence of suspected infection in those neonates with one or several factors of risk of infection.
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Andreasson, Helena, and Christina Möller. "Sepsis - Empirisk studie om sjuksköterskans upplevelser och reaktioner av att vårda patienter med sepsis." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26194.
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A qualitative study with an aim to examine the experience and reaktions nurses had while caring for patients with sepsis.En kvalitativ studie med syftet att undersöka vilka upplevelser och reaktioner sjuksköterskor hade i samband med vård av patienter med sepsis.
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Jeremias, Isabela Casagrande. "Investigação das alterações imunológicas em camundongos submetidos ao modelo animal de sepse por ligação e perfuração cecal (CLP) com alterações cerebrais." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5165/tde-06112015-143205/.
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A sepse é caracterizada por um desequilíbrio entre a resposta pró- e anti-inflamatória às infecções. Um dos principais componentes da resposta do hospedeiro no choque séptico são as interações recíprocas entre o sistema imune e o sistema nervoso central, desta forma o objetivo deste estudo foi investigar o desenvolvimento de alterações neurológicas e sua associação com alterações imunológicas em fases iniciais e tardias após a sepse por ligação e perfuração cecal (CLP). Dividimos em três experimentos: agudo, crônico e efeito da ACh na evolução tardia da sepse. No experimento agudo utilizamos camundongos Balb/c, induzimos sepse por CLP em diferentes gravidades (leve, moderado e grave), 6 horas após o CLP foi realizado teste comportamental SHIRPA e logo após os animais foram sacrificados. No experimento crônico os camundongos Balb/c foram submetidos ao CLP leve, o SHIRPA foi realizado 6 horas e 15 dias após o CLP e os animais foram sacrificados 15 dias após o CLP. No experimento dos efeitos da ACh utilizamos camundongos Balb/c que receberam a droga donepezila (5 mg/kg/dia, oralmente) sete dias antes do CLP leve até o dia do sacrifício e os camundongos homozigotos mutantes VAChT KD também submetidos ao CLP leve. O teste comportamental SHIRPA foi realizado 6 horas após o CLP e os animais sacríficos 15 dias após o CLP. O plasma, o baço e o hipocampo foram removidos em todos os experimentos. Os níveis do S100? foram medidos no plasma. Os baços foram pesados, e por citometria de fluxo foi caracterizado os linfócitos (linfócitos T citotóxicos, linfócitos T auxiliares, linfócitos B, células T reguladoras e células Th17) e morte celular (Apoptose inicial, necrose e apoptose tardia). Os níveis de citocinas no baço, hipocampo e plasma foram determinados por ELISA. Nossos resultados mostram que no experimento agudo, 6 horas após o CLP a encefalopatia é diferente dependendo da gravidade da sepse, e o perfil de linfócitos no baço não é alterado por nenhuma gravidade da sepse. No entanto, a ativação de células do baço foi indicada no nosso estudo por variações na quantidade de citocinas no baço. No experimento crônico observamos que 15 dias após o CLP os animais apresentam encefalopatia séptica, e esta está correlacionada com a diferenciação e morte celular de linfócitos do baço, o que leva a um alto perfil imunossupressor. No experimento da ACh mostramos que a estimulação da transmissão colinérgica, utilizando donepezila, diminui a inflamação, por aumentar linfócitos, morte linfocitária e diminuir citocinas pró-inflamatória. E, ao contrário, a diminuição da transmissão colinérgica, experimento VAChT KD, observouse uma diminuição de linfócitos, sem morte celular e aumento da inflamação. Desta forma, concluímos que a alteração neurológica nos animais com sepse está associada com as alterações imunológicas tardias e que a ACh tem um importante papel no perfil imunológico 15 dias após o CLPSepsis is characterized by an imbalance between pro- and anti-inflammatory responses to infection. One of the main components of the host response in septic shock are the reciprocal interactions between the immune system and the central nervous system, so the aim of this study was to investigate the development of neurological disorders and their association with immunological changes in early and late stages after sepsis by cecal ligation and puncture (CLP). We divided in three experiments: acute, chronic and chronic ACh. In acute experiment we use Balb/c mice, induce sepsis by CLP in different severities (mild, moderate and severe), 6 hours after CLP was conducted behavioral test SHIRPA and after the animals were sacrificed. In the chronic experiment Balb/c mice were subjected to CLP mild, the SHIRPA was performed 6 hours and 15 days after CLP, and animals were sacrificed 15 days after CLP. In chronic ACh experiment use Balb/c mice that received the drug Donepezil (5 mg/kg/day, orally) seven days before the CLP mild until the day of sacrifice and use too mice homozygous mutants KD VAChT also submitted to CLP mild. The SHIRPA behavioral test was performed 6 hours after CLP and the animals were sacrificed 15 days after CLP. The plasma, spleen and hippocampus were removed in all experiments. The levels of S100? were measured in plasma. The spleens were weighed, and flow cytometry was characterized lymphocytes (cytotoxic T lymphocytes, helper T lymphocytes, B lymphocytes, regulatory T cells and Th17 cells) and cell death (apoptosis initial, necrosis and DNA fragmentation). Cytokine levels in the spleen, hippocampus and plasma were determined by ELISA. Our results show that in the acute experiment, 6 hours after CLP encephalopathy is different depending on the severity of sepsis, since the profile of the spleen lymphocytes is not changed by any severity of sepsis. However, the spleen cell activation was shown in this study by variations in the quantity of cytokines in the spleen. In the chronic experiment we observed that 15 days after CLP animals have septic encephalopathy, and this correlates with cell differentiation and the death of spleen lymphocytes, which leads to a high immunosuppressive profile. Since in the chronic ACh experiment have shown that stimulation of cholinergic transmission, using donepezil, reduces inflammation by increasing lymphocytes, lymphocyte death and decreasing proinflammatory cytokine. And, conversely, the reduction in cholinergic transmission, KD VAChT experiment, we observed a decrease of lymphocytes, and increase cell death without inflammation. Thus, we conclude that the neurological deficits in animals with sepsis is associated with immunological late changes and ACh plays an important role in the immune profile 15 days after CLP
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Molander, Tobias, and Kin Tran. "Kvalitetsgranskning av svenska ambulanssjukvårdens behandlingsriktlinjer rörande patienter med svår sepsis och septisk chock." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-16687.
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Svår sepsis och septisk chock är sjukdomstillstånd som kan orsaka ett stort lidande för patienten genom att de är förknippade med hög mortalitet och morbiditet. Tidig identifiering och adekvat antibiotikabehandling är avgörande för prognosen. Detta ställer höga krav på ambulanssjukvårdens kvalitet. Ambulanssjukvården har behandlingsriktlinjer som ska utgöra beslutsunderlag och kvalitetssäkring för den givna vården. De potentiella vinsterna med en behandlingsriktlinje blir dock aldrig bättre än kvaliteten på behandlingsriktlinjen i sig. Studiens syfte var att granska och värdera kvaliteten på den svenska ambulanssjukvårdens behandlingsriktlinjer rörande patienter med misstänkt svår sepsis och septisk chock. En kvantitativ metod nyttjades och en totalundersökning av behandlingsriktlinjer i svensk ambulanssjukvård genomfördes, där respektive ambulansorganisation i Sveriges tjugoen landsting kontaktades. Svarsfrekvensen var 76%. Utav dessa kunde nio inkluderades i studien (N = 9). De erhållna prehospitala behandlingsriktlinjerna granskades därefter med hjälp av AGREE II-instrumentet. Resultatet belyser dels att flera organisationer helt saknar behandlingsriktlinjer rörande patienter med misstänkt svår sepsis och septisk chock (33% av alla tjugoen kontaktade landsting. 44% av de sexton som svarade) samt att de övriga behandlingsriktlinjerna har metodologiska brister i rapporteringen kring hur behandlingsriktlinjerna togs fram. Detta utgör ett hinder för att behandlingsriktlinjerna ska kunna utgöra den kvalitetssäkring de är avsedda att vara. Bristerna kan härledas till ambulanssjukvårdens organisation och skulle eventuellt kunna avhjälpas genom centralt utvecklade nationella behandlingsriktlinjer finansierade av vårdgivaren.Program: Specialistsjuksköterskeutbildning med inriktning mot ambulanssjukvård
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Sümnig, Ariane. "Prospektive Surveillance der neonatalen Sepsis." [S.l.] : [s.n.], 2004. http://deposit.ddb.de/cgi-bin/dokserv?idn=972508554.
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Singh, Suveer. "Microcirculatory dysfunction in experimental sepsis." Thesis, Imperial College London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312340.
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Davis, Jonathan. "Molecular techniques in neonatal sepsis." Thesis, Queen's University Belfast, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601144.
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Preterm births are becoming more common worldwide, leading to an increase in the complications of prematurity. Preterm babies are specifically at risk of infection, defined as late onset sepsis after the third day of life. Ideally, infection should be prevented but if this is not possible rapid and accurate detection is necessary so that treatment can be started early_ Symptoms of infection in term and preterm infants are non-specific. Current methods of diagnosis are dependent on culturing organisms in blood, but this can be problematic and diagnostic performance in neonates is not good. Alternative methods may prove to be more efficient. The aim of this study was to determine if molecular methods can improve the diagnosis of infection in neonates. Success of the molecular assay was judged based on comparison with blood culture and CRP. ability to quantify bacterial copy number and to specifically identify pathogens. Infants whom clinicians thought were infected had additional blood sampled at the time of routine investigations for infection. Clinical and routine laboratory data were also recorded. Molecular analysis of the samples was performed using a reverse transcriptase real~ time PCR 16S rRNA assay. 16S rRNA is a universal sequence present in all bacteria. Infants were judged to be infected based on a previously validated culture~ independent clinical scoring system. Eighty four infants were included in the analysis. 16S reran proved to be more sensitive and specific than blood culture and CRP. The assay could quantify the number of bacteria present in the infection ("bacterial load"). A number of less common bacteria and Human Parechovirus were identified and further correlation is required to determine the pathogenicity of these organisms . In summary. molecular methods can enhance the diagnosis of late onset neonatal sepsis, provide quantitative information, on bacterial load and provide insights into the nature of bacteria causing the disease process.
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Oeser, Clarissa Caroline. "Molecular diagnostics in neonatal sepsis." Thesis, St George's, University of London, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.676095.
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Bacterial sepsis is a frequently occurring disease in the first weeks of life, posing a significant threat particularly to those born prematurely. The incidence of sepsis is determined by laboratory surveillance, only taking into account culture positive episodes of sepsis. However, in up to 80% of neonates treated for sepsis, blood cultures fail to grow an organism. Therefore a variety of molecular techniques have been trialled to overcome these diagnostic difficulties. To describe the current incidence and causal pathogens of neonatal sepsis in Europe in this thesis, systematic literature reviews on neonatal bacterial and fungal infections were conducted. The review highlighted in particular the discrepancy between incidences of culture positive and clinical sepsis. A further literature review assessed molecular diagnostic techniques that have been employed to determine pathogens of neonatal sepsis. Based on the results obtained from the systematic reviews, a series of molecular tests, including quantitative multiplex PCRs, a 16S rDNA broad range PCR and a Candida multiplex PCR were developed. These tests were applied to two sets of samples obtained from neonates with suspected and confirmed early and late onset sepsis in Europe, collected in two separate clinical trials. Results identified a large amount of bacteria (74% in EOS and 50% in LOS), however failed to detect all cultured pathogens. A large number of samples were positive for CoNS and Enterobacteriacae in both sample sets. In particular, in EOS, S. pneumoniae was shown to be more predominant than anticipated from the literature, and in LOS Enterococci were more prevalent. Of concern is a high number of polymicrobial infections detected by PCR. Universal definitions for clinical sepsis need to be established to enable surveillance and comparison across countries. Molecular diagnostics have the potential to become an important additional tool to describe the epidemiology of neonatal sepsis.
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Mertens, Kathrin. "Zinc in inflammation and sepsis." Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=204050.
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Sepsis is the major cause of mortality on intensive care units (ICU) with ~36,000 deaths annually in the UK. Sepsis is a systemic, dysregulated activation of the innate immune system in response to an infection characterised by excessive inflammatory mediator production and oxidative stress. Mitochondrial dysfunction is implicated in sepsis-‐induced organ dysfunction and death. Zinc is an essential micronutrient with a multitude of biological functions, including anti-‐inflammatory and antioxidant properties. A relationship has been established between zinc deficiency and severity of sepsis, in which zinc deficiency negatively influences the processes of sepsis leading to organ damage and ultimately death. This study investigated the effect of zinc on sepsis-‐related mechanisms to evaluate its importance for sepsis pathophysiology. The relationship between zinc levels and sepsis-‐related molecular mechanisms were investigated in an endothelial cell culture model of sepsis and in blood samples obtained from patients on ICU with and without sepsis. The in vitro study showed no evidence of zinc as an antioxidant or anti-‐inflammatory agent in endothelial cells exposed to lipopolysaccharide and peptidoglycan, however mitochondrial baseline function was increased in a zinc concentration-‐dependent manner. Plasma zinc levels were far below normal in all patients and patients with sepsis had lower levels compared to non-‐infected patients, possibly because they were overall more severely ill. No clear correlations could be established between plasma zinc and markers of inflammation, oxidative stress or disease severity. The lack of anti-inflammatory and antioxidant properties of zinc in the endothelial sepsis model, and the lack of clear correlations between zinc and markers of disease severity, inflammation and oxidative stress in the clinical study, challenges the concept of the importance of zinc in the pathophysiology of sepsis. The prolonged reduction of plasma zinc in all ICU patients prompts to consideration of zinc supplementation to replenish plasma levels and assure sufficient availability to maintain tissue functions.
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Borgström, Josephine, and Emma Hult. "Jag har sepsis, identifiera den!" Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-25263.
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Sepsis är ett livshotande tillstånd som kan drabba patienter inom hela sjukvården där sjuksköterskans arbete är av stor betydelse. Dödligheten vid sepsis är oroväckande hög och är därmed ett viktigt område att uppmärksamma. Syftet med litteraturöversikten var att belysa hur sjuksköterskan med hjälp av omvårdnadsinsatser kan identifiera patienter med sepsis på en somatisk vårdavdelning. Metod: en litteraturöversikt med systematisk ansats har genomförts i databaserna PubMed och Cinahl. Resultatet baseras på tio kvantitativa artiklar där fyra teman uppkommit som innefattade sjuksköterskans kompetens, utbildning, samverkan och fysiologiska parametrar och instrument. Den slutsats som framkom var att det krävs hög kompetens hos sjuksköterskan, god samverkan och tillgängliga instrument för att tidig identifiering av patienter med sepsis ska kunna vara möjligt.Sepsis is one of the most life-threatening conditions that can affect patients in the whole healthcare sector. Therefore it is important to early identify the symptoms, where the nurse's work is of great importance. The mortality rate for sepsis is alarmingly high and is an important area to touch. The aim of this literature review was to highlight how nurses with nursing care can identify patients with sepsis in a somatic ward. Method: a literature review with a systematic approach has been implemented in the databases PubMed and Cinahl. The results are based on ten quantitative articles that four themes emerged as including nursing skills, education, collaboration and physiological parameters and tools. The conclusion that emerged was that it required great competence of the nurse; good interaction and available instruments for early identification of patients with sepsis should be possible.
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Blidal, Tünde, and Elise Schüler. "Livet efter Sepsis : En litteraturöversikt." Thesis, Högskolan Kristianstad, Fakulteten för hälsovetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-19490.
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Bakgrund: Globalt drabbas 30 miljoner människor varje år av sepsis varav ca 5 miljoner människor dör. Forskning har fokuserat på överlevnad och den kunskapen har gjort att fler överlever. En tredjedel av de personer som överlevt sepsis drabbas av restsymtom och en sjättedel får kvarstående men för livet. Livskvalitet är en subjektiv upplevelse av välbefinnande och är beroende av flera faktorer. Hälso- och sjukvården ska bedriva personcentrerad omvårdnad och se patienten i sin helhet. Syfte: Syftet var att beskriva livskvalitet hos patienter som överlevt sepsis. Metod: Studien har genomförts som en litteraturöversikt och rymmer 18 artiklar. Datainsamling har skett i databaserna Cinahl Complete, PubMed samt PsycINFO. Resultat: Totalt 17 kvantitativa artiklar och en kvalitativ artikel inkluderades i litteraturöversikten. Resultatet visar att personer som överlevt sepsis blir påverkade inom fyra domäner; fysisk-, kognitiv-, psykisk- och social livskvalitet. Diskussion: Personer som överlever sepsis har ökad risk för fysisk, kognitiv, psykisk och social påverkan på livskvaliteten och söker i stor utsträckning vård. Det är viktigt att sjuksköterskan har kunskap kring de restsymtom som personerna kan drabbas av, en förståelse för det den gått igenom och en uppfattning om hur detta kan påverka deras livskvalitet.
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Amistad, Rowena. "Barriers to Implementation and Strategies to Improve Adherence to the Sepsis Bundles." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7449.
Full textAbstract:
Sepsis is associated with high mortality and morbidity. Immediate recognition and treatment is crucial to prevent complications that can be highly detrimental and cause a significant impact on the U.S. healthcare economy. Numerous studies have been conducted to improve patient outcomes and lower healthcare costs from sepsis and septic shock. Many of these studies were focused on exploring healthcare providers' knowledge and compliance to the Surviving Sepsis Campaign (SSC) guidelines. This study aimed to explore and identify barriers to the implementation of the sepsis bundles and strategies to enhance healthcare providers' adherence to these bundles. A systematic review of articles was conducted using the ACE Star Model of Knowledge Transformation. Studies such as randomized controlled trials (RTC's), systematic reviews, retrospective studies, and prospective observational studies conducted in Intensive Care Units (ICUs) within the past 10 years were utilized, guided by the American Association of Critical Care Nurses' (AACN's) grading system. Sources of evidence were obtained from PubMed, CINAHL, and GoogleScholar. The results of this study are aimed at helping support the evidence-based clinical practice among providers caring for patients with sepsis and septic shock in an ICU setting using evidence-based guidelines. The results of this study provide an opportunity for healthcare systems to relieve financial burdens from sepsis and thus contribute to pos
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Demaret, Julie. "Altérations des polynucléaires neutrophiles au cours des états septiques sévères." Thesis, Lyon, 2016. http://www.theses.fr/2016LYSE1137/document.
Full textAbstract:
La réponse immuno-inflammatoire au cours du choc septique associe une importante réponse inflammatoire initiale responsable de l'état de choc et le développement secondaire d'altérations du système immunitaire. Les polynucléaires neutrophiles (PNN) jouent un rôle central dans la réponse immunitaire. Des données récentes de la littérature décrivent également un rôle immunosuppresseur jusqu'alors méconnu pour ces cellules. Nous avons exploré leur possible implication dans la physiopathologie du choc septique.Le but de ce travail était l'exploration des altérations phénotypiques, fonctionnelles et transcriptomiques des PNN lors de la phase immunosuppressive du choc septique. Nos résultats montrent une diminution de la capacité de migration des PNN ainsi qu'une diminution de la production de composés bactéricides (myéloperoxydase, lactoferrine) alors que la réponse aux cytokines et la phagocytose n'apparaissent pas altérées. Le contenu en myéloperoxydase et la présence de PNN immatures CD10dimCD16dim étaient indépendamment associés à une mortalité plus élevée. De manière intéressante, CD177 était le gène le plus différentiellement exprimé entre les patients et les volontaires sains. CD177 et CD10 étaient inversement corrélés. Ainsi, la diminution du chimiotactisme, la perte de myéloperoxydase, la présence de cellules immatures et leurs liens avec la mortalité pourraient contribuer au contexte d'immunosuppression présent chez les patients septiques. Au final, les pistes d'exploration futures convergent vers la population de PNN immatures et le rôle spécifique du CD177 dans les états septiques sévèresSevere septic syndromes deeply impair innate and adaptive immunity and are responsible for sepsis-induced immunosuppression. While neutrophils represent the first line of defense against infection, little is known about their phenotype and functions few days after sepsis, when the immunosuppressive phase is maximal (i.e., between day 3 and 8). The objective of this study was thus to perform a global evaluation of neutrophil alterations in immunosuppressed septic patients based on phenotypic, functional and transcriptomic studies. Our results highlight a markedly altered neutrophil chemotaxis (functional and chemokine receptor expressions), oxidative burst, lactoferrin content and an increased number of circulating immature granulocytes (i.e., CD10dimCD16dim). In contrast, phagocytosis and activation capacities were conserved. It is interesting to note that a diminished myeloperoxidase expression appeared as the best predictor to identify a group of septic shock patients at high risk of death. Similarly, patients with lower proportions of CD10dimCD16dim granulocytes had a significant better survival compared with patients presenting a higher percentage. CD177 mRNA, coding for an activation molecule in chemotaxis but also known to be overexpressed in immature cells, had the highest fold change modulation between patients and controls. Considering the potential dual roles of CD177 neutrophil (i.e., maturation / chemotaxis), its participation in septic shock pathophysiology deserves further investigation. To conclude, circulating neutrophils present with phenotypic, functional and morphological alterations few days after sepsis onset. These dysfunctions may participate in the deleterious role of sepsis-induced immunosuppression. The present results open new perspectives in the mechanisms favoring nosocomial infections after septic shock. They deserve to be further investigated in a larger clinical study and in animal models recapitulating these alterations
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Noritomi, Danilo Teixeira. "Caracterização físico-química da acidose metabólica em pacientes com sepse grave ou choque séptico." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5159/tde-06112009-143314/.
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Acidose metabólica é um fenômeno comum e clinicamente significativo em pacientes com sepse grave ou choque séptico. Entretanto, sua composição não é bem estabelecida. Neste estudo, descrevemos a composição da acidose metabólica em pacientes com sepse grave ou choque séptico desde sua internação em unidade de terapia intensiva (UTI) até os quinto dia de internação em unidade de terapia intensiva (UTI). Na admissão à UTI, a acidose metabólica foi um fenômeno muito freqüente. Ela era composta principalmente pelo componente derivado dos íons inorgânicos (dado principalmente pela diferença sódio cloro), seguido em magnitude pelo componentes decorrentes de ânions não mensuráveis e lactato e atenuada por hipoalbuminemia. A magnitude da acidose metabólica e hipercloremia foram maiores entre os pacientes não-sobreviventes (considerando a mortalidade hospitalar). Em análise multivariada o grau de acidose por íons inorgânicos, além do escore de gravidade APACHE II e nível inicial de creatinina sérica, esteve associada a mortalidade hospitalar. Ao longo do período de estudo, os pacientes sobreviventes apresentaram melhora da acidose metabólica por diminuição dos níveis de ânions não-mensuráveis e lactato. Os não sobreviventes mantiveram a mesma magnitude de acidose metabólica e apresentaram queda do pH por aumento da PCO2Metabolic acidosis is frequently found in patients with severe sepsis and septic shock. Several studies have shown that the amount of metabolic acidosis measured by the standard base excess (SBE) at hospital admission and its evolution throughout the first days of intensive care unit (ICU) stay are correlated with clinical outcome. However, the precise composition of the metabolic acidosis in patients with severe sepsis and septic shock is not well known. In this study, we have described the composition of metabolic acidosis in patients with severe sepsis or septic shock at ICU admission and throughout the first five days of ICU stay, by applying the quantitative physicochemical methodology. Metabolic acidosis was extremely frequent at admission to the ICU. Its main component was attributable to the inorganic ion difference disturbance (mainly determined by the Na Cl difference), followed in magnitude by unmeasured anions and lactate´s components. Hypoalbuminemia represented the most frequent and important alkalinizing component. The degree of metabolic acidosis and hyperchloremia was more pronounced in the non-survivors group (according to hospital mortality). In a multivariate analysis the degree of metabolic acidosis due to disturbances in innorganic ion difference was associated to hospital mortality. Acidosis in survivors was corrected during the study period due to a decrease in lactate and SIG levels, whereas non-survivors did not correct their metabolic acidosis and suffered a decrease in the pH due to an increase in PCO2 levels
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Harral, Kristine Lynette. "Implementing a Sepsis Protocol in a Long-term Care Hospital." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6900.
Full textAbstract:
Sepsis is life-threatening organ dysfunction caused by a response to infection that causes multiorgan failure. This condition causes high mortality and morbidity rates and leaves permanent disabilities. The purpose of this project was to create a sepsis protocol and an education training program for clinical staff in a hospital setting where no sepsis protocol was in place. The practice-focused question examined whether an educational program would improve clinical staff perception of their knowledge of the early recognition and management of sepsis. A literature review was conducted to identify an evidence-based practice protocol; the results were used to develop the education program for the clinical staff at the site. Malcolm Knowles's theory of adult learning framed the project that included a team of 9 content experts consisting of physicians, physician assistants, and an educator who reviewed and approved the protocol and education program prior to implementation. The education program was then presented to 45 staff members including physicians, licensed vocational nurses, registered nurses, physician assistants, and nurse practitioners. Results of a 14-item knowledge test before and after the education program were examined for percent correct; results were compared using a paired-samples t test. Participant knowledge increased significantly (p <.05) from 20% correctly answering 10 of the 14 questions on the pretest to 87% answering all of the posttest questions correctly. The results of this project may promote positive social change by supporting clinical staff in early recognition and treatment of sepsis thereby reducing the morbidity and mortality that accompanies sepsis.
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Andrade, José Antenor Araújo de. "Efeito da deficiência de tiamina sobre a inflamação, estresse oxidante e migração celular em modelo experimental de sepse." Universidade do Estado do Rio de Janeiro, 2012. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=5769.
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A sepse é uma condição de elevada letalidade muito frequente em pacientes graves e pode estar associada à deficiência de vitamina B1 ou tiamina. Sendo a tiamina fundamental para produção de energia, restauração do poder redutor e síntese de ribose e desoxirribose celulares, o objetivo deste estudo foi avaliar o efeito da deficiência de tiamina sobre a resposta inflamatória, através da medida de interleucinas, o estresse oxidante, pela determinação do 4-hidróxi 2-nonenal (4-HNE) um produto de peroxidação de lipídeos de membrana e a migração celular em modelo experimental de sepse. Em um primeiro experimento foi determinada a concentração de pirofosfato de tiamina (PPT) no sangue de camundongos c57bl6 alimentados com ração completa e com ração deficiente em tiamina, para determinação do tempo necessário para a indução de deficiência dessa vitamina. Em um segundo experimento foi utilizada a ligadura e perfuração cecal (CLP) como modelo de sepse em quatro grupos: SHAM ração completa, SHAM ração deficiente em tiamina, CLP ração completa, CLP ração deficiente em tiamina. As concentrações de PPT no sangue foram determinadas por cromatografia líquida de alta eficiência. As dosagens séricas e no líquido peritoneal de TNF-α, IL-1β, IL-6, KC e MCP-1/CCL2 foram realizadas por ELISA. O nível de 4-hidroxi,2-nonenal (4-HNE) no fígado foi avaliado por Western Blot. Contagem de leucócitos no sangue e no líquido peritoneal foi feita por microscopia óptica. Foi avaliada a concentração de bactérias no líquido peritoneal. Nos animais alimentados com ração completa a concentração média de PPT foi 303 42,6 nM, e a deficiência de tiamina foi induzida após 10 dias de ingestão da ração pobre em tiamina, quando observou-se concentração de 12,5 2,4 nM. No lavado peritoneal dos animais submetidos à CLP e privados de tiamina observou-se nível significativamente maior de TNF-α e MCP-1. A IL-1β foi menor no sangue do mesmo grupo. A expressão de 4-HNE foi maior nos grupos privados de tiamina. Quanto à celularidade sanguínea, observou-se apenas maior contagem de mononucleares no grupo submetido à CLP e privado de tiamina. No líquido peritoneal, a contagem de leucócitos totais, mononuleares e monócitos foi mais elevada nos grupos CLP, mas sem relação com o tipo de dieta. No entanto, no líquido peritoneal o grupo CLP deficiente em tiamina revelou população bacteriana significativamente menor que o grupo alimentado com ração completa e os grupos sham. Concluiu-se que a deficiência de tiamina associou-se com aumento da morte bacteriana na cavidade peritoneal, aumento do estresse oxidante, e mudanças na resposta inflamatória.
Palavras-chave: Tiamina. Sepse. Estresse oxidante. Inflamação. Modelo de sepse.A sepse é uma condição de elevada letalidade muito frequente em pacientes graves e pode estar associada à deficiência de vitamina B1 ou tiamina. Sendo a tiamina fundamental para produção de energia, restauração do poder redutor e síntese de ribose e desoxirribose celulares, o objetivo deste estudo foi avaliar o efeito da deficiência de tiamina sobre a resposta inflamatória, através da medida de interleucinas, o estresse oxidante, pela determinação do 4-hidróxi 2-nonenal (4-HNE) um produto de peroxidação de lipídeos de membrana e a migração celular em modelo experimental de sepse. Em um primeiro experimento foi determinada a concentração de pirofosfato de tiamina (PPT) no sangue de camundongos c57bl6 alimentados com ração completa e com ração deficiente em tiamina, para determinação do tempo necessário para a indução de deficiência dessa vitamina. Em um segundo experimento foi utilizada a ligadura e perfuração cecal (CLP) como modelo de sepse em quatro grupos: SHAM ração completa, SHAM ração deficiente em tiamina, CLP ração completa, CLP ração deficiente em tiamina. As concentrações de PPT no sangue foram determinadas por cromatografia líquida de alta eficiência. As dosagens séricas e no líquido peritoneal de TNF-α, IL-1β, IL-6, KC e MCP-1/CCL2 foram realizadas por ELISA. O nível de 4-hidroxi,2-nonenal (4-HNE) no fígado foi avaliado por Western Blot. Contagem de leucócitos no sangue e no líquido peritoneal foi feita por microscopia óptica. Foi avaliada a concentração de bactérias no líquido peritoneal. Nos animais alimentados com ração completa a concentração média de PPT foi 303 42,6 nM, e a deficiência de tiamina foi induzida após 10 dias de ingestão da ração pobre em tiamina, quando observou-se concentração de 12,5 2,4 nM. No lavado peritoneal dos animais submetidos à CLP e privados de tiamina observou-se nível significativamente maior de TNF-α e MCP-1. A IL-1β foi menor no sangue do mesmo grupo. A expressão de 4-HNE foi maior nos grupos privados de tiamina. Quanto à celularidade sanguínea, observou-se apenas maior contagem de mononucleares no grupo submetido à CLP e privado de tiamina. No líquido peritoneal, a contagem de leucócitos totais, mononuleares e monócitos foi mais elevada nos grupos CLP, mas sem relação com o tipo de dieta. No entanto, no líquido peritoneal o grupo CLP deficiente em tiamina revelou população bacteriana significativamente menor que o grupo alimentado com ração completa e os grupos sham. Concluiu-se que a deficiência de tiamina associou-se com aumento da morte bacteriana na cavidade peritoneal, aumento do estresse oxidante, e mudanças na resposta inflamatória.Sepsis is a prevalent condition in critically ill patients and may be associated with thiamine deficiency (TD). Since thiamine is important for energy production, redactor power recovering and ribosis and desoxirribosis synthesis, the aim of this study was to evaluate TD effect in inflammation, oxidative stress and cell recruitment in a sepsis model. Thiamine pyrophosphate (TPP) normal concentration was determined in blood of c57bl6 mice fed with AIN93G chow and also in animals fed with similar AIN93G chow without thiamine in order to determine the time required to produce TD. Another experiment was carried out with cecal ligation and puncture (CLP) as the sepsis model with four groups: SHAM with AIN93G complete chow, SHAM with TD chow, CLP with AIN93G complete chow and CLP with TD chow. TPP blood concentrations were determined by HPLC/Fluorescence. Blood and peritoneal liquid TNF-alpha, IL-1, IL-6, KC and MCP-1/CCL2 determinations were performed by ELISA. The expression of 4-HNE was performed by Western Blot. Blood and peritoneal liquid leukocytes counting were performed by optical microscopy. Peritoneal liquid bacterial concentration was determined. Blood TPP mean concentration in AIN93G complete chow was 287.9 27.8 nM and TD occurred in 10 days in TD chow group and blood concentration in this group was 12.5 2.4 nM. Peritoneal liquid TNF-alpha and MCP-1 concentrations were significantly greater in CLP with TD chow group than the other groups. Blood IL1-β was lower in the same group. Liver 4-HNE expression was highest in TD groups. Blood mononuclear number was greater in CLP TD chow group the others. Peritoneal liquid leukocites, mononuclears and neutrophils numbers were detected in greater number in the same group. However, peritoneal liquid bacterial concentration was significantly lower in the same group. In coclusion TD was associated with greater bacterial killing in peritoneal liquid, greater oxidative stress and change in inflammatory response.
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Tibo, Luiz Henrique Soares 1985. "Caracterização de efeito causado por citotoxina secretada por Escherichia coli associada à sepse em células endoteliais humanas." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/317299.
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Orientador: Tomomasa YanoDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia
Made available in DSpace on 2018-08-27T12:09:55Z (GMT). No. of bitstreams: 1 Tibo_LuizHenriqueSoares_M.pdf: 5939486 bytes, checksum: b93497f16ad2e0392928acc05650e417 (MD5) Previous issue date: 2015
Resumo: O sobrenadante de cultivo de Escherichia coli isolada de pacientes com sepse (SEPEC) causou alongamento e perda de junção intercelular em células endoteliais de veia umbilical humana (HUVEC) em menos de 18 horas de incubação. O fator citotóxico envolvido foi purificado em sistema de cromatografia líquida (FPLC) a partir do sobrenadante da amostra SEPEC 15 e, através de eletroforese desnaturante (SDS-PAGE), foi observado que este fator tem massa molecular de aproximadamente 150kDa e é formado por pelo menos duas subunidades. Ensaios de transcitose em Transwell e a monitoração da permeabilidade de monocamada de células HUVEC, por meio de medições da resistência elétrica transendotelial (TEER), indicaram que este fator citotóxico auxilia a passagem de SEPEC através de monocamada de células HUVEC, cultivadas em insertos Transwell, no período de 30 minutos. Porém, quando incubadas com a citotoxina por mais de 30 minutos, as células HUVEC morrem devido à citotoxicidade do fator citotóxico. Estes resultados sugerem que esta citotoxina pode ser um importante fator de virulência de SEPEC, auxiliando o acesso deste patógeno à corrente sanguínea
Abstract: The culture supernatant of Escherichia coli isolated from patients with sepsis (SEPEC) caused elongation and loss of intercellular junction in endothelial cells of human umbilical vein (HUVEC) in less than 18 hours of incubation. The cytotoxic factor involved was purified by liquid chromatography system (FPLC) from the SEPEC 15 sample supernatant and, by denaturing electrophoresis (SDS-PAGE), it was found that this factor has a molecular mass of approximately 150kDa and is formed by the least two subunits. Transwell Transcytosis assays and monitoring the permeability of HUVEC monolayer by measurements of transendothelial electrical resistance (TEER) indicated that this cytotoxic factor helps SEPEC passing through HUVEC monolayer cells cultured in Transwell inserts, in a 30 minutes period. However, when incubated with cytotoxin for more than 30 minutes, the HUVEC cells die due to the cytotoxicity of the cytotoxic factor. These results suggest that this cytotoxin can be an important virulence factor of SEPEC, assisting this pathogen access to the bloodstream
Mestrado
Microbiologia
Mestre em Genética e Biologia Molecular
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Bhat, Sundeep Ram. "Lactate Clearance Predicts 28-Day Survival Among Patients with Severe Sepsis and Septic Shock." Yale University, 2009. http://ymtdl.med.yale.edu/theses/available/etd-03182009-143432/.
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Severe sepsis and septic shock comprise a significant number of emergency department (ED) admissions annually. With the advent of early goal directed therapies, early identification and intervention have become paramount in this population. Few studies, however, have examined the role of serum lactate as a predictor of mortality or endpoint to resuscitation among this population. We aimed to show that improved lactate clearance is associated with decreased 28-day in-hospital mortality. We retrospectively examined data from the Yale Sepsis Registry for patients with severe sepsis or septic shock who had lactate levels that were measured initially in the ED and subsequently when the patient arrived on the floor. This study received institutional review board approval. Lactate clearance was calculated as a percentage, and comparison between patients who cleared lactate and those who did not were made for mortality data as well as baseline characteristics and interventions required between the two groups. 207 patients (110 male) with mean age and standard deviation (SD) of 63.17 ± 17.9 years were examined. 136 patients (65.7%) were diagnosed with severe sepsis and 71 patients (34.3%) had septic shock. Of those with identified sources of infection, pneumonia was the most common (54 patients, 26.1%). There were 171 patients in the clearance group and 36 patients in the non-clearance group, all of whom had a mean time of 9 hours 8 minutes ± 4 hours 6 minutes between lactate measurements. 28-day mortality rates were 15.2% (26 patients) in the lactate clearance group and 36.1% (13 patients) in the non-clearance group (p<0.01). Vasopressor support within 72 hours of admission was initiated among 61.1% (22 patients) in the non-clearance group compared with 36.8% (63 patients) in the clearance group (p<0.01). Mechanical ventilation was required for 36.3% (62 patients) in the clearance group and 66.7% (24 patients) in the non-clearance group (p=0.001). Rates of severe sepsis, mean number of SIRS and organ dysfunction criteria, and initial creatinine were similar between the two groups; however, only 86.1% (31 patients) in the non-clearance group received intravenous fluids in the ED compared with 98.8% (169 patients) in the clearance group (p=0.002). 33.3% (12 patients) in the non-clearance group had chronic obstructive pulmonary disease (COPD) compared with 15.2% (26 patients) in the clearance group (p<0.05). The mean Mortality in Emergency Department Sepsis (MEDS) scores were 8.78 ± 3.96 for the clearance group and 10.4 ± 4.48 for the non-clearance group (95% CI, -3.1 to -.14, p<0.05). These results show significantly higher mortality rates among patients who do not clear their lactate in the ED. Additionally, these patients require vasopressor support and mechanical ventilation more often. Lactate clearance was significantly associated with receipt of fluids and may also reflect lower MEDS score. Our findings suggest lactate clearance could be used as an endpoint for ED resuscitation and in stratifying mortality risk among patients with severe sepsis or septic shock. Future studies might seek to prospectively validate these findings and incorporate multivariate analysis to determine factors affecting lactate clearance.
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Olson, Martha. "Interrupting the Sepsis Process with an Evidence-Based Education Intervention." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/596.
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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.
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Song, Yang. "Rodent model to study severe sepsis." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27920.
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Background. The sepsis syndrome is characterized by such clinical changes as hypotension, hypothermia or fever, metabolic acidosis, pulmonary hemorrhage, and death within several hours to days. Antibiotics are a mainstay of treatment and have been repeatedly demonstrated to improve survival in both human studies and animal models of sepsis. Appropriate fluid resuscitation is an important component of the initial therapy for severe sepsis. The antibody against TNF-alpha has improved survival in certain models of sepsis (Reinhart et al. 2001).
Hypothesis. Timing of antibiotics is pivotal in survival outcome of sepsis and early fluid resuscitation is crucial in the maintenance of survival rates.
Materials & methods. Male Balb/c mice (23--25g) received the cecal ligation and puncture. During the surgery, 1/3 cecum was ligated and 2 18G needle punctures were made from which feces were expressed. During antibiotic treatment strategies, cefotaxime was firstly given at different time points (0, 3, 6 & 12h post-surgery) and thereafter every 6 hours for up to 72 hours. All the mice were given 1ml 0.9% saline fluid at 0 hour post-surgery and continuously every 6 hours for up to 72 hours. For fluid resuscitation 1ml 0.9% saline fluid was started at 0, 3, 6, 9 or 12 hours post-surgery respectively by subcutaneous injection and continuously every 6 hours for up to 72 hours. All the mice were given cefotaxime at 0 hour post-surgery and continuously every 6 hours. Finally, we repeated cefotaxime 12 hours (Group 1) and fluid 12 hours post-surgery (Group 2) groups. Anti-TNF-alpha monoclonal antibody was given at 6 hours post-surgery for both groups.
Results. After surgery, untreated mice showed signs of sepsis, such as anorexia, hypothermia and dehydration, and the mortality was 100% within the first 30 hours. The mortalities in cefotaxime 6 & 12 hours post-surgery groups were nearly 100% while cefotaxime 0 & 3 hours post-surgery groups were 0% and 25% respectively. The mortality in fluid resuscitation 12 hours post-surgery group was nearly 100% whereas the other groups (0, 3, 6 & 9 hours) were 12.5% respectively. The mortality of group 1 decreased significantly (Fisher's exact test) compared to the same treatment group without anti-TNF-alpha while the mortality of group 2 did not.
Discussion. This model provides consistent results of sepsis, which could enable us to control for treatment factors that are not controllable in human sepsis. In this model we can clearly show the impact of timing of antibiotics on survival. Despite early antibiotics administration (time 0), mortality of this model is still high when fluid resuscitation is delayed. Anti-TNF-alpha can decrease the mortality under condition that fluid resuscitation are given at an early time point.
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Lorenz, Linda. "Intrapartum fever and early neonatal sepsis." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-66805.
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Duncan, David Jonathan. "Mechanisms of myocardial depression during sepsis." Thesis, University of Leeds, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446060.
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Burnham, Katie. "Functional genomics of the sepsis response." Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:cb98af40-1b66-4966-a643-ae8dfec2c122.
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Sepsis is defined as a dysregulated immune response to infection causing organ dysfunction, and is a major area of unmet clinical need. Although conventionally considered a unified disease with a common pathway to organ failure and death, substantial clinical and molecular heterogeneity is seen, which has limited efforts to understand pathophysiology and improve therapeutic strategies. Sepsis is associated with global changes in gene expression, and genetic variants are known to affect the response to infection. This thesis therefore uses an integrated functional genomics approach to investigate disease mechanisms and variation in the sepsis response. Data are presented for 551 patients admitted to intensive care with sepsis due to community acquired pneumonia (CAP) or faecal peritonitis (FP). The sepsis response is explored using genome-wide gene expression and proteomics data, and molecular quantitative trait loci (QTL) are mapped in the context of disease. Comparisons with cardiac surgery patients are performed to identify shared and specific aspects of the host response. The host transcriptomic response was largely shared across sources of sepsis, although some specificity relating to viral infection and interferon signalling was observed and validated in prospectively recruited patients. Expression-based sepsis response signature (SRS) subgroups previously described in CAP were validated, and were additionally observed in FP. SRS1 is associated with higher early mortality, and shows enrichment of pathways relating to T cell exhaustion, cell death, and endotoxin tolerance. Differences between SRS groups were also observed in the FP plasma proteome. Serial sampling enabled the investigation of temporal changes in gene expression and protein abundance within patients. Lastly, disease-relevant expression QTL were identified, and interactions with source of sepsis and SRS determined, highlighting the potential impact of regulatory variation on the sepsis response. This thesis demonstrates the benefit of an integrative functional genomics approach to explore heterogeneity in sepsis, and highlights opportunities for patient stratification and personalised medicine.
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Pereira, Dulce Maria Monteiro. "Procalcitonina como marcador de sepsis neonatal." Master's thesis, [s.n.], 2011. http://hdl.handle.net/10284/2406.
Full textAbstract:
Trabalho apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências FarmacêuticasA procalcitonina é uma proteína, produzida nas células C da tiróide, no fígado, macrófagos, pulmão e pâncreas, sendo que a origem parece estar dependente das substâncias estimularas da sua produção. O facto desta ser uma pró-hormona da calcitonina, em nada influencia a produção de PCT, apresentando estas valores diferentes e não correlacionáveis com a primeira perante situações clínicas distintas (Carrol et al., 2002). A procalcitonina é um marcador de fase aguda usado para detectar infecções, sobretudo de origem bacteriana, dado que nas infecções de outra origem, os seus valores de concentração não se alteram significativamente (Bargues et al., 2007). Após uma estimulação imunológica, os valores de procalcitonina aumentam significativamente nas primeiras 3 a 4 horas, atingindo o seu pico máximo ao fim de 6 horas, normalizando 2 a 3 dias após a resolução da infecção. Possui um tempo de semi-vida de 25 a 30 horas. Devido à sua rápida cinética é, assim, possível considerar a procalcitonina um marcador precoce de sepsis. Tem igualmente uma adequada janela de diagnóstico (Carrol et al., 2002). A procalcitonina tem funções biológicas, como mediador da resposta inflamatória estando descrito, por vários autores, ser, então, um marcador importante no diagnóstico e na previsão do outcome da sepsis (Carrol et al., 2002). Também parece ser consensual o elevado valor preditivo negativo (Joram et al; 2006; Kordek et al., 2003). Todas estas características atribuídas à procalcitonina poderão fazer com que este marcador contribua para o uso racional de antibióticos, sobretudo no período neonatal onde caracteristicamente existe uma maior dificuldade no diagnóstico destas situações clínicas. As principais limitações do uso da procalcitonina como marcador de sepsis neonatal é o facto de poder surgir alterada em situações de não sepsis como, por exemplo, diabetes gestacional, asfixia fetal, hipocalcemia, síndrome da aspiração mecónio, doença hemolítica, doença da membrana hialina, hipoglicemia, ressuscitação pós-parto, hemorragia intracraniana, pré-eclampsia materna, amnionite clínica e hipertensão, bem como a administração de tensioactivo intratraqueal, ruptura prolongada de membranas e quando a progenitora está colonizada com Streptococcus grupo B (Lam e Ng, 2008). Procalcitonin is a protein produced in the thyroid C cells in the liver, macrophages, lung and pancreas, although the main source seems that is dependent of the stimulating substances of its production. The fact of the procalcitonin be a pro-hormone of calcitonin doesn’t have any influence in the production of procalcitonin, presenting these different values and won’t be correlated with distinct clinical situations (Carrol et al., 2002). Procalcitonin is an acute phase marker used to detect infections mainly of bacterial origin, considering that in infections with another source the concentrations values do not change significantly (Bargues et al., 2007). After an immunologic stimulation the procalcitonin values considerably increase during the first 3 to 4 hours, reaching its peak at the end of 6 hours and may return to suffer an increase during the subsequent 24 hours if there is a stimulus. Having a long half-life between 25 to 30 hours and normalizing 2 to 3 days after the resolution of the infection. Due to its kinetics is possible to consider the procalcitonin is a sepsis precocious marker as well as having an adequate diagnostic window (Carrol et al., 2002). It has biological functions as a mediator of the inflammatory response, being written by a number of authors, to be, then, one important marker in the diagnostic and in the outcome of sepsis prevision (Carrol et al., 2002). It also seems to be consensual the elevated negative (Joram et al; 2006; Kordek et al., 2003). All these characteristics may contribute to the rational use of antibiotics mainly in the neonatal period where typically exists one major difficulty in diagnostic of these clinical situations. Its main limitations as marker of neonatal sepsis is the fact that it can arise changed in situations of no sepsis, for example, gestational diabetes, fetal asphyxia, hyaline membrane disease, resuscitation postpartum and others (Lam e Ng, 2008).