Sepsis acute respiratory distress syndrome

M29. Miller, E. J., Cohen, A. B and Matthay, M. A., Increased interleukin-8 concentrations in the pulmonary edema fluid of patients with acute respiratory distress syndrome from sepsis. Crit. Care Med. 24, 1448-1454 (1996). 

Progression of uncontrolled sepsis leads to evidence of organ dysfunction, which may include oliguria, hemodynamic instability with hypotension or shock, lactic acidosis, hyperglycemia or hypoglycemia, possibly leukopenia, disseminated intravascular coagulation, thrombocytopenia, acute respiratory distress syndrome, GI hemorrhage, or coma. 

Chronic Health Evaluation II >25, sepsis-induced multiple organ failure, septic shock, or sepsis-induced acute respiratory distress syndrome)... 

Infections Acute respiratory distress syndrome, sepsis... 

Polymorphonuclear neutrophils (PMN) have been implicated in the pathogenesis of post-traumatic and sepsis-related complications such as acute lung injury and acute respiratory distress syndrome (ARDS), a prominent form of end-organ damage that... 

Although the normal circulating levels of IL-8 are in the picomole range, they can be as high as 8nmol/L in sera of patients with sepsis or acute respiratory distress syndrome, implying the drain of surplus IL-8 molecules. 

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). 

Abraham E, Matthay MA, Dinarello CA, et al. Consensus conference definitions for sepsis, septic shock, acute lung injury and acute respiratory distress syndrome time for a reevaluation. Crit Care Med 2000 28 232-235. 

Eein AM. Acute lung injury and acute respiratory distress syndrome in sepsis and septic shock. Crit Care CUn 2000 16 289-317. 

Anzueto A, Baughman RP, Guntupalh KK, et al. Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. N Engl JMed 1996 334 1417-1421. 

Multiple studies have addressed the role of thyroid supplementation in critically ill patients with cardiac disease, sepsis, pulmonary disease (e.g., acute respiratory distress syndrome), or severe infection, or with burn and trauma patients. In spite of a very large number of published studies, it is very difficult to form clear recommendations for treatment with thyroid hormone in the intensive care unit. 

Meduri GU, Kanangat S. Glucocorticoid treatment of sepsis and acute respiratory distress syndrome time for a critical reappraisal [editorial comment]. Grit Care Med 1998 26 630-633. 

Indications for renal replacement therapy in the acute setting and for other disease processes are different from those for ESRD. A common mode of ESRD therapy in the outpatient setting is intermittent hemodialysis (IHD) where a patient receives intense treatment over the course of a few hours several times a week. Acute renal failure in the inpatient setting is often treated with continuous renal replacement therapy (CRRT), which is applied for the entire duration of the patient s clinical need and relies upon hemofiltration to a higher degree than IHD (Meyer, 2000). Other nonrenal indications for CRRT are based on the theoretical removal of inflammatory mediators or toxins and elimination of excess fluid (Schetz, 1999). These illnesses include sepsis and systemic inflammatory response syndrome, acute respiratory distress syndrome, congestive heart failure with volume overload, tumor lysis syndrome, crush injury, and genetic metabolic disturbances (Schetz, 1999). 

Chest wall compliance may be reduced in kyphoscoliosis, fibrothorax, or spinal cord injury and lung compliance may be reduced in pulmonary edema, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS) and COPD in the presence of hyperinflation. Airway secretions or bronchoconstriction may contribute to increased airway resistance. Respiratory drive and muscle function may be compromised by anesthetics, sedation, coma, or hypercapnia, and muscle dysfunction may occur in the presence of malnutrition, hypophosphatemia, disuse atrophy, sepsis, myopathies, or limited oxygen delivery (9). The factors that led to a tracheostomy must be optimized prior to decannulation. 

Casualties should be admitted and observed for at least 6 hours initially if symptoms persist past the period of exposure, particularly those with pre-existing respiratory disease, or smokers. No specific antidote to chlorine is available and treatment is generally supportive with close monitoring for signs of respiratory compromise, pulmonary oedema and secondary sepsis or acute respiratory distress syndrome (ARDS). 

The first effective and safe treatments for Alzheimer s, Parkinson s, chronic graft rejection, permanent graft acceptance, obesity, chronic obstructive pulmonary disease (COPD), adult respiratory distress syndrome (ARDS), sepsis, and vaccines [common cold, respiratory syncytial virus (RSV), severe acute respiratory syndrome (SARS), AIDS, malaria. Avian Influenza, radiation, contraception, emerging new infections] will be multibillion-dollar products [15,16]. 

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