Respiratory disorders sepsis

The most frequently reported adverse events (all causalities) in the therapeutic trials were visual disturbances, fever, rash, vomiting, nausea, diarrhea, headache, sepsis, peripheral edema, abdominal pain, and respiratory disorder. The treatment-related adverse events that most often led to discontinuation of voriconazole therapy were elevated liver function tests, rash, and visual disturbances. 

The most common mixed acid-base disorder is respiratory and metabolic alkalosis, which occurs in critically ill surgical patients with respiratory alkalosis caused by mechanical ventilation, hypoxia, sepsis, hypotension,... 

Investigators from the Department of Pediatrics in Johns Hopkins Hospital, after seeing a neonate who had marked leukocytosis temporally related to alprostadil, conducted a retrospective study of neonatal leukocytosis induced by alprostadil in 45 neonates (5). They concluded that alprostadil infusion is a predictable cause of leukocytosis in neonates with congenital heart disease. Alprostadil-induced leukocytosis was especially prominent in three patients with splenic disorders associated with the hetero-taxy syndrome. Many of the other adverse effects of alprostadil, including respiratory depression, hypotension, fever, and lethargy, were also associated with sepsis. The authors considered that it is reasonable to look for sepsis in infants receiving alprostadil, but that it is equally reasonable to withdraw empirical therapy once infection has been ruled out. Leukocytosis associated with alprostadil infusion has not been previously reported and is not listed in the alprostadil package insert. 

While the fall in serum bicarbonate is asymptomatic in most cases, special caution is required in patients already at risk of metabolic acidosis, such as those with respiratory acidosis, renal disease, frequent severe infections and sepsis, gastrointestinal disorders with recurrent dehydration, inborn errors of metabolism, or treatment with a ketogenic diet (44). 

The most commonly observed disease process leading to death of patients with EMS was progressive polyneuropathy (disease involving the peripheral nerves) and myopathy (disease of muscles) that produced complications of pneumonia and sepsis or respiratory failure due to weakness. Two-thirds of EMS patients died of these complications. Other causes of mortality were cardiomyopathy (disorder affecting the muscles of the heart), primary pulmonary disease, arrhythmia (deviation from the normal rhythm of the heart), and stroke. 

In adults, a severe form of lung injury can develop in association with sepsis, pneumonia, and injury to the lungs due to trauma or surgery. This catastrophic disorder is known as acute respiratory distress syndrome (ARDS) and has a mortality rate of more than 40%. In ARDS, one of the major problems is a massive influx of activated neurophils which damage both vascular endothelium and alveolar epithelium and result in massive pulmonary edema and impairment of surfactant function. Neutrophil proteinases (e.g., elastase) break down surfactant proteins. A potential therapeutic strategy in ARDS involves administration of both surfactant and antiproteinases (e.g., recombinant a I -antitrypsin). 

The combination of respiratory and metabolic alkalosis is the most common mixed acid-base disorder. This mixed disorder occurs frequently in critically ill surgical patients with respiratory alkalosis caused by mechanical ventilation, hypoxia, sepsis, hypotension, neurologic damage, pain, or drugs, and with metabolic alkalosis caused by vomiting or nasogastric suctioning and massive blood transfusions. It may also occur in patients with hepatic cirrhosis who hyperventilate, receive diuretics, or vomit, as well as in patients with chronic respiratory acidosis and an elevated plasma bicarbonate concentration... 

PPHN is associated with diverse cardiopulmonary disorders, including asphyxia, sepsis, meconium aspiration syndrome, congenital diaphragmatic hernia, respiratory distress syndrome, lung hypoplasia, and others, or can... 

At less than 2% in the clinical investigations acute renal failure, atrial fibrillation, cerebrovascular accident, sepsis, meningitis, psychotic disorder, suicidal ideation, respiratory distress, rhabdomyolysis, electrocardiogram abnormal, stupor, loss of consciousness, incoherent, clonic convulsion and grand mal convulsion. Rare instances of fatal pneumonia aspiration and suicide attempt were reported (<1%). 

New-onset respiratory muscle weakness may result from conditions that are unique to mechanically ventilated patients, such as ventilator-associated respiratory muscle dysfunction, sepsis-associated myopathy, and ICU-acquired paresis (63). New-onset respiratory muscle weakness may also result from conditions that are not unique to critically ill patients, such as acid-base disorders, electrolyte disturbances, decreased oxygen delivery, and medications (63). 

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