Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections.
...To provide an up-to-date, international picture of the extent and patterns of infection in ICUs.
The Extended Prevalence of Infection in Intensive Care (EPIC II) study, a 1-day, prospective, point prevalence study with follow-up conducted on May 8, 2007. Demographic, physiological, bacteriological, therapeutic, and outcome data were collected for 14,414 patients in 1265 participating ICUs from 75 countries on the study day. Analyses focused on the data from the 13,796 adult (>18 years) patients.
On the day of the study, 7087 of 13,796 patients (51%) were considered infected; 9084 (71%) were receiving antibiotics. The infection was of respiratory origin in 4503 (64%), and microbiological culture results were positive in 4947 (70%) of the infected patients; 62% of the positive isolates were gram-negative organisms, 47% were gram-positive, and 19% were fungi. Patients who had longer ICU stays prior to the study day had higher rates of infection, especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species. The ICU mortality rate of infected patients was more than twice that of noninfected patients (25% 1688/6659 vs 11% 682/6352, respectively; P < .001), as was the hospital mortality rate (33% 2201/6659 vs 15% 942/6352, respectively; P < .001) (adjusted odds ratio for risk of hospital mortality, 1.51; 95% confidence interval, 1.36-1.68; P < .001).
Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.
We evaluated effects of aerobic physical preconditioning on general performance and energy metabolism in skeletal muscle of septic rats. Forty-eight 10-wk-old male Wistar rats were randomly assigned ...to either Untrained or Trained groups. Aerobic exercise training protocol (AETP) consisted of an 8-week treadmill program. After AETP, performance was evaluated by graded treadmill and functional ambulation testing. Afterwards animals from both groups were randomly assigned to Sham or CLP surgery (cecal ligation and perforation), resulting in the following groups: Sham untrained (ShamU), CLP untrained (CLPU), Sham trained (ShamT), and CLP trained (CLPT). Two days after surgery, animals repeated the ambulation test, and were euthanized after this. Diaphragm, soleus and plantaris muscles were harvested. Mitochondrial electron transport chain enzyme (METC) and creatine kinase (CK) activity were measured. AETP led to significant improvement in performance of distance run and in skeletal muscle function of the Trained group. Forty-eight hours after surgery the CLPT group was able to maintain similar muscle performance as Sham groups. Dysfunction was shown in the diaphragm in METC complexes I and II-III and in locomotive soleus muscles in complex I; CK enzyme activity was significantly increased in sedentary CLPU group in soleus and plantaris muscle, but in the diaphragm there was only a tendency (p=0.07). CLPT animals that were submitted to AETP avoided all these negative results. Taken together our results provide evidence of the positive effects obtained with an aerobic physical preconditioning program on METC and CK enzyme activity related to the diaphragm and locomotive muscles mitigating sepsis-induced energy metabolism dysfunction.
The objective of this study was to evaluate the effects of two different mean arterial blood pressure (MAP) targets on needs for resuscitation, organ dysfunction, mitochondrial respiration and ...inflammatory response in a long-term model of fecal peritonitis.
Twenty-four anesthetized and mechanically ventilated pigs were randomly assigned (n = 8/group) to a septic control group (septic-CG) without resuscitation until death or one of two groups with resuscitation performed after 12 hours of untreated sepsis for 48 hours, targeting MAP 50-60 mmHg (low-MAP) or 75-85 mmHg (high-MAP).
MAP at the end of resuscitation was 56 ± 13 mmHg (mean ± SD) and 76 ± 17 mmHg respectively, for low-MAP and high-MAP groups. One animal each in high- and low-MAP groups, and all animals in septic-CG died (median survival time: 21.8 hours, inter-quartile range: 16.3-27.5 hours). Norepinephrine was administered to all animals of the high-MAP group (0.38 (0.21-0.56) mcg/kg/min), and to three animals of the low-MAP group (0.00 (0.00-0.25) mcg/kg/min; P = 0.009). The high-MAP group had a more positive fluid balance (3.3 ± 1.0 mL/kg/h vs. 2.3 ± 0.7 mL/kg/h; P = 0.001). Inflammatory markers, skeletal muscle ATP content and hemodynamics other than MAP did not differ between low- and high-MAP groups. The incidence of acute kidney injury (AKI) after 12 hours of untreated sepsis was, respectively for low- and high-MAP groups, 50% (4/8) and 38% (3/8), and in the end of the study 57% (4/7) and 0% (P = 0.026). In septic-CG, maximal isolated skeletal muscle mitochondrial Complex I, State 3 respiration increased from 1357 ± 149 pmol/s/mg to 1822 ± 385 pmol/s/mg, (P = 0.020). In high- and low-MAP groups, permeabilized skeletal muscle fibers Complex IV-state 3 respiration increased during resuscitation (P = 0.003).
The MAP targets during resuscitation did not alter the inflammatory response, nor affected skeletal muscle ATP content and mitochondrial respiration. While targeting a lower MAP was associated with increased incidence of AKI, targeting a higher MAP resulted in increased net positive fluid balance and vasopressor load during resuscitation. The long-term effects of different MAP targets need to be evaluated in further studies.
Microcirculatory abnormalities have been shown to be frequent in patients with septic shock despite "normalization" of systemic hemodynamics. Several studies have explored the impact of vasodilator ...therapy (prostacyclin, inhaled nitric oxide, topic acetylcholine, and nitroglycerin) on microcirculation and tissue perfusion, with contradictory findings.In this narrative review, we briefly present the pathophysiological aspects of microcirculatory dysfunction, and depict the evidence supporting the use of vasodilators and other therapeutic interventions (fluid administration, blood transfusion, vasopressors, and dobutamine) aiming to improve the microcirculatory flow in septic shock patients.
Mechanisms governing the inflammatory response during sepsis involve crosstalk between diverse signaling pathways, but current knowledge provides an incomplete picture of the syndrome. ...Microarray-based expression profiling is a powerful approach for the investigation of complex clinical conditions such as sepsis. In this study, we investigated whole-genome expression profiles in mononuclear cells from septic patients admitted in intensive care units with community-acquired pneumonia. Blood samples were collected at the time of sepsis diagnosis and seven days later since we aimed to evaluate the role of biological processes or genes possibly involved in patient recovery. Here we provide a detailed description of the study design, including clinical information, experimental methods and procedures regarding data analysis. Metadata corresponding to microarray results deposited in the database Gene Expression Omnibus (GEO) under the accession number GSE48080 are also described in this report. Our dataset allows the identification of genes possibly associated with host defense to infection as well as gene expression patterns associated with patient outcome.
This work describes the chemical composition of the stems of Astronium graveolens Jacq. (Anacardiaceae). The CH2Cl2 and EtOAc soluble fractions of this extract were subjected to chromatographic ...procedures that allowed obtaining the unreported dimers (7"R*, 8"S*) 2′, 4,4′, 5-tetrahydroxychalcone-(2 → 7", 8 → 8")-2′", 4", 4′"- trihydroxy-7", 8’’-dihydrochalcone and (7 S*,8 R*,7"S*,8"S*)-2′,4,4′,5,7-pentahydroxy-7,8-dihydrochalcone-(2→7",8→8")-2′",4",4’’’-7 ", 8 "- dihydrochalcone, the previously isolated chalcone dimer named matosine (7 S*,8 S*,7'' S*,8"R*)-2′,4,4′, 5,7-pentahydroxy-7,8-dihydrochalcone-(2→7", 8→8")-2′", 4", 4′"-trihydroxy-7", 8"- dihydrochalcone). Besides these specific chalcone dimers, sitosterol, sitosterol-3-O-β-D-glucoside, methyl gallate, gallic acid, and quercitrin were also isolated. These compounds were identified by mono and bidimensional NMR data analysis and HRMS. Methanolysis of triacylglycerides yielded a mixture of fatty acid methyl esters, which were identified by GC-MS. The profile indicated this fraction is composed of saturated (54.13 %) and unsaturated (46.21 %) fatty acids, and palmitic acid and oleic acid are the major components. The brine shrimp test of the extract showed that the soluble fraction CH2Cl2 of the stems exhibited high toxicity; meanwhile, the EtOAc soluble fraction presented moderate toxicity. The Elmann test indicated that the EtOAc was considered an expressive AChE inhibitor, and the chalcone dimers 1, 2, and 3 present excellent anticholinesterase activities inhibiting 83.88 %, 70.72 %, and 62.60 % AChE at concentrations of 500 µM, respectively.
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•New chalcone dimers were isolated from Astronium graveolens stem.•Astronium graveolens extracts and isolated chalcone dimers inhibit anticholinesterase enzyme.•Chalcone dimers were isolated for the first time in Astronium genus.
Noninvasive ventilation (NIV) is used in critically ill patients with acute respiratory failure (ARF) to avoid endotracheal intubation. However, the impact of NIV use on ARF patient's outcomes is ...still unclear. Our objectives were to evaluate the rate of NIV failure in hypoxemic patients with an arterial carbon dioxide partial pressure (PaCO2) < 45 mmHg or ≥ 45 mmHg at ICU admission, the predictors of NIV failure, ICU and hospital length of stay and 28-day mortality.
Prospective single center cohort study. All consecutive patients admitted to a mixed ICU during a three-month period who received NIV, except for palliative care purposes, were included in this study. Demographic data, APACHE II score, cause of ARF, number of patients that received NIV, incidence of NIV failure, length of ICU, hospital stay and mortality rate were compared between NIV failure and success groups.
Eighty-five from 462 patients (18.4 %) received NIV and 26/85 (30.6 %) required invasive mechanical ventilation. NIV failure patients were comparatively younger (67 ± 21 vs. 77 ± 14 years; p = 0.031), had lower arterial bicarbonate (p = 0.005), lower PaCO2 levels (p = 0.032), higher arterial lactate levels (p = 0.046) and APACHE II score (p = 0.034) compared to NIV success patients. NIV failure occurred in 25.0 % of patients with PaCO2 ≥ 45 mmHg and in 33.3 % of patients with PaCO2 < 45 mmHg (p = 0.435). NIV failure was associated with an increased risk of in-hospital death (OR 4.64, 95 % CI 1.52 to 14.18; p = 0.007) and length median (IQR) of ICU 12 days (8-31) vs. 2 days (1-4); p < 0.001 and hospital 30 (19-42) vs. 15 (9-33) days; p = 0.010 stay. Predictors of NIV failure included age (OR 0.96, 95 % CI 0.93 to 0.99; p = 0.007) and APACHE II score (OR 1.13, 95 % CI 1.02 to 1.25; p = 0.018).
NIV failure was associated with an increased risk of in-hospital death, ICU and hospital stay and was not affected by baseline PaCO2 levels. Patients that failed were comparatively younger and had higher APACHE II score, suggesting the need for a careful selection of patients that might benefit from NIV. A well-designed study on the impact of a short monitored NIV trial on outcomes is needed.
Severe sepsis is characterized by relative hypotension associated with a high cardiac output, peripheral vasodilation, and organ dysfunction. The renin-angiotensin-aldosterone system (RAAS) is ...primarily activated to increase blood pressure, but recently potential pro-inflammatory effects of angiotensin II have attracted interest because of the reported association between angiotensin II levels and organ failure and mortality in sepsis. RAAS antagonists could represent a new therapeutic option in this setting.
The role of RAAS activation in severe sepsis and septic shock, and the potential benefits (and risks) of using RAAS antagonists.
Insight into RAAS function in severe sepsis and the potential for RAAS inhibitors to be used as an adjunctive therapy in patients with severe sepsis, with discussion of promising results from animal models of sepsis.
Use of RAAS antagonists is an emerging therapeutic option in severe sepsis because these agents may reduce endothelial damage, organ failure, and mortality. However, timing of administration of RAAS antagonists is important because reduced RAAS function may contribute to refractive hypotension later on in septic shock and benefits of RAAS antagonists seem to be restricted to the early phases of sepsis.
Os instrumentos de pesquisa nos arquivos são ferramentas utilizadas para facilitar o acesso e a localização de documentos em acervos arquivísticos. Eles são criados com base na organização e na ...descrição realizadas pelos profissionais de arquivo, permitindo que os usuários possam realizar pesquisas com mais facilidade. Neste artigo estão apresentadas articulações conceituais no âmbito do processamento técnico dos arquivos, com base na revisão de literatura. Esses instrumentos de pesquisa são importantes para o acesso e uso desses documentos pela sociedade em geral. Os arquivos precisam ter uma preocupação constante com seus usuários, buscando garantir que eles tenham acesso aos documentos e informações que precisam de forma eficaz, além de garantir a segurança e preservação dos acervos.
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