Septic shock complications

Appropriate empiric anti-infective therapy decreases 28-day mortality compared to inappropriate empiric therapy (24% versus 39%).22 23,30 Additionally, appropriate therapy administered within 1 hour of sepsis recognition also decreases complications and mortality.22-23,30 Empiric anti-infective therapy should include one, two, or three drugs, depending on the site of infection and causative pathogens (Table 79-3). Anti-infective clinical trials in sepsis and septic shock patients are scarce and have not demonstrated differences among agents therefore, factors that determine selection are ... 

Stress-induced adrenal insufficiency complicates 9% to 24% of septic patients and is associated with increased mortality. Adrenal-insuffident patients are identified by a adrenocorticotropic hormone (ACTH) stimulation test. Patients are given 250 meg ACTH and a cortisol level is checked within 30 to 60 minutes. Responders are defined as a greater than 9-mcg/dL increase in cortisol and non-responders as a less than 9-mcg/dL increase in cortisol. Septic shock patients refractory to resuscitation and vasopressors, and with adrenal insufifidency (non-responders to the ACTH test) should be administered intravenous hydrocortisone 200 to 300 mg per day in three divided doses for 7 days.24,44... 

Septic shock is frequently complicated by massive activation of the coagulation system. This can occur concomitantly with biphasic change in the fibrinolytic system, involving both activation and inhibition of plasminogen activation. The net result of the altered hemostatic state in sepsis is widespread microvascular trom-bosis. The early events leading to these disturbances are incompletely understood,... 

Septic shock 1) shock associated with sepsis, usually associated with abdominal and pelvic infection complicating trauma or operations 2) shock associated with septicemia caused by Gram-negative bacteria. 

NO also seems to play a role in the hypotension of septic shock. Septic shock is a life-threatening clinical condition occurring as a complication of bacterial infections and characterized by hypotension, shock, organ failure, and death. In severe Gramnegative bacterial infections, increased urinary excretion of nitrates, an oxidative byproduct of NO, has been described bacterial wall lipopolysaccharides activate the NOS enzyme. 

Albumin. A significant decrease in the albumin level is characteristic of a septic shock, which is a frequent AP complication. A decrease in the oncotic blood pressure, a pancreatic circulation deficiency, as well as water overaccumulation in lungs and respiratory insufficiency (ARDS) are observed. 

As the management of liver transplantation has improved, absolute and relative contraindications have been established. Relative contraindications may question the success of LT in some cases. Obesity leads to an increased rate of postoperative complications, but it does not influence the survival rate. (396, 403) (s. tab. 40.16) Contraindications should also be considered in urgent LT due to acute liver failure - possibly accompanied by necrotizing pancreatitis, septic shock and problems with assisted respiration. Visceral inversion is not deemed to be a contraindication a successful LT was indeed carried out under such conditions by G.B. Rlintmalm et al. in 1993. 

Hemodjmamic and cardiac complications are the major limitations of high-dose aldesleukin and have been described in both adults (19,20) and children (21). Significant hypotension requiring meticulous maintenance therapy with intravenous fluids or low-dose vasopressors was observed in most patients (22). The clinical findings were very similar to the hemodynamic pattern seen in early septic shock. Aldesleukin-induced increases in plasma nitrate and nitrite concentrations correlated with the severity of hypotension (23). 

Soon after the introduction of propofol in 1989, clusters of infections related to its use were reported, and there have since been several reports (77,78). The complications include hypotension, tachycardia, septic shock, convulsions, and death. Ethylenediaminetetra-acetic acid (EDTA) was added to the formulation to retard microbial growth. However, there have been concerns over the effects of this additive on trace element homeostasis, particularly when it is used in intensive care units for long-term sedation. Five randomized controlled trials have been reviewed, and minimal or no effects have been found on zinc, magnesium, or calcium homeostasis. However, there is no evidence to suggest that cluster infection has been or will be reduced with this formulation and there is still a need for care with sterility when using this product. 

Shock is the most ominous complication associated with sepsis, and mortality occurs in approximately half the patients with septic shock. Severe hypotension appears to be caused in part by the release of... 

Staphylococcus aureus has long been recognized as a major human pathogen and remains a frequent cause of morbidity and mortality (I). According to the National Nosocomial Surveillance System (NNIS), S. aureus is the most common cause of nosocomial infections (2). These infections include pneumonia, surgical site, and bloodstream infections, which can be complicated by endocarditis, osteomyelitis, or septic shock (1). The versatile tissue tropism... 

Rarer complications of plastic tube stents include tracheobronchial ulceration with secondary hemorrhage, perforation of the tracheobronchial wall with secondary mediastinitis and septic shock, tumor overgrowth at the proximal or distal stent margin. 

A recently published multicenter study by Livraghi et al. (Livraghi et al. 2003) reported the complication rates after treating 2320 patients with a total number of 3554 lesions. Six deaths (0.3%) were noted, including two fatalities caused by multiorgan failure following intestinal perforation. One case of septic shock following Staphylococcus... 

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