Abstract:
:The definition of sepsis has been recently modified to accommodate emerging knowledge in the field, while at the same time being recognized as challenging, if not impossible, to define. Here, we seek to clarify the current understanding of sepsis as one that has been typically framed as a disorder of inflammation to one in which the competing interests of the microbiota, pathobiota, and host immune cells lead to loss of resilience and nonresolving organ dysfunction. Here, we challenge the existence of the idea of noninfectious sepsis given that critically ill humans never exist in a germ-free state. Finally, we propose a new vision of the pathophysiology of sepsis that includes the invariable loss of the host's microbiome with the emergence of a pathobiome consisting of both "healthcare-acquired and healthcare-adapted pathobiota." Under this framework, the critically ill patient is viewed as a host colonized by pathobiota dynamically expressing emergent properties which drive, and are driven by, a pathoadaptive immune response.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Alverdy JC,Krezalek MAdoi
10.1097/CCM.0000000000002172subject
Has Abstractpub_date
2017-02-01 00:00:00pages
337-347issue
2eissn
0090-3493issn
1530-0293pii
00003246-201702000-00023journal_volume
45pub_type
杂志文章abstract::This report describes an unusual hemolytic transfusion reaction. A group O donor was inadvertently transfused with 100 ml of group A red cells during the course of plasmapheresis. Granulocytopenia, thrombocytopenia, hypofibrinogenemia and low levels of factors V, VIII, and IX developed immediately after the infusion. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197501000-00003
更新日期:1975-01-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine the accuracy of clinical diagnoses compared to autopsy findings in critically ill patients in the current medical era. DESIGN:We conducted a retrospective, blinded review of matched medical records and postmortem findings in patients who died between June 2006 and ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182a275b1
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU). DESIGN:A prospective pre/post nonequivalent control group design was used for this performance improvement study. SETTING:Seventee...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000266533.06543.0C
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVES:To compare the plasma volume (PV) expanding effect of a fast infusion rate with that of a slow infusion rate of a fixed volume of 5% albumin, of the synthetic colloids, 6% hydroxyethyl starch 130/0.4 and 4% gelatin, and of 0.9% NaCl in a rat sepsis model and to compare the plasma-expanding effect among these...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318274157e
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVES:The objectives of the present study were to evaluate, in patients with persistent arterial hypotension in the immediate postcardiac surgery period, the effects of norepinephrine infusion on ventriculo-arterial coupling, its determinants: arterial elastance and end-systolic ventricular elastance, and to test ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002772
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:Although misperceptions about prognosis by surrogates in ICUs are common and influence treatment decisions, there is no validated, practical way to measure the effectiveness of prognostic communication. Surrogates' subjective ratings of quality of communication have been used in other domains as markers of ef...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000000719
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:To examine the frequency of obtaining Institutional Review Board (IRB) approval and informed consent in critical care research. DATA SOURCES AND DATA EXTRACTION:One-year retrospective review of original critical care research in humans published in seven journals, including American Journal of Respiratory an...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199809000-00035
更新日期:1998-09-01 00:00:00
abstract:OBJECTIVES:To determine the accuracy of intramucosal pH (pHi) calculated using arterial bicarbonate instead of mucosal capillary bicarbonate in the Henderson-Hasselbalch equation. DESIGN:Simulation of progressive ischemia in mucosal capillary blood. SETTING:University research laboratory. SUBJECTS:Normal human blood...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00028
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVE:To study the therapeutic effect of granulocyte colony-stimulating factor (G-CSF) on the mortality rate and host defense pattern in fulminant intra-abdominal sepsis. DESIGN:Prospective, randomized, controlled trial. SETTING:Research laboratory in a university hospital. SUBJECTS:Adult male Wistar rats. INTE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199605000-00016
更新日期:1996-05-01 00:00:00
abstract::We found that altering aspirating flow rate (ASR) and sample tubing length (STL) affected the response time and capnogram of 2 different side-stream capnometers. Increased flow rate shortened rise time, transit time, and total delay time (TDT), whereas increased STL increased transit and TDTs but not rise time. Increa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198408000-00015
更新日期:1984-08-01 00:00:00
abstract::The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000252917.25301.18
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:In children, like in adults, tracheal intubation is a painful procedure that may induce hypertension, tachycardia, and other undesirable hemodynamic disorders. Although premature neonates are very sensitive to pain and vulnerable to its long-term effects, the need for sedation before tracheal intubation is st...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000108883.58081.E3
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infecti...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/ccm.0b013e3181b9e8b3
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:The neuroprotective effects of the noble gas xenon are well known. Argon, in contrast to xenon, is abundant, inexpensive, and therefore widely applicable. In this study, we analyzed the possible neuroprotective role of argon in an in vivo rat model of acute focal cerebral ischemia. DESIGN:Controlled laborato...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31821209be
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. DESIGN:Observational, prospective, multiple-center study. SETTING:Four university hospitals and seven...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000157752.26180.f1
更新日期:2005-04-01 00:00:00
abstract::It has become accepted that nitric oxide serves important functions in biological systems as a second messenger. Another diatomic gaseous molecule, carbon monoxide (CO), is also rapidly gaining acceptance as a signaling agent. Some of the activities of CO are analogous to those of nitric oxide in the vascular system a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVES:Although highly active antiretroviral therapy has led to improved survival in HIV-infected individuals, outcomes for HIV-infected patients with sepsis in the post-highly active antiretroviral therapy era are conflicting. Access to highly active antiretroviral therapy and healthcare disparities continue to af...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001003
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVES:To compare the incidence of withdrawal or withholding of life support (WD/WHLS), and to identify similarities and differences in the process of the withdrawal of life support (WDLS) between teaching and community hospitals' intensive care units (ICUs). DESIGN:Prospective cohort study, with some data obtaine...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199802000-00018
更新日期:1998-02-01 00:00:00
abstract:OBJECTIVE:Conventional outcomes research provides only percentage risk of such end points as mortality rate, utilization of resources, and/or broad groupings of multiple organ system dysfunction. These prognostications generally are not applicable to individual patients. The purpose of the present study was to determin...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200205000-00014
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVES:We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004709
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care. DESIGN:A 3-yr (199...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00008
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVE:Exosomes are small, cell-released vesicles (40-100 nm in size) with the potential to transfer proteins, lipids, small RNAs, messenger RNAs, or DNA between cells via interstitial fluids. Due to their role in tissue homeostasis, exosomes have emerged as a new type of therapeutic and diagnostic (theranostic) too...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000002328
更新日期:2017-06-01 00:00:00
abstract::Computerized gamma scintigraphy revealed a significant (p less than 0.001) rising lung:heart radioactivity ratio, which has been called "slope of injury" or "slope index", with both 99mTechnetium-tagged human serum albumin (99mTc-HSA) and 99mTechnetium-tagged red blood cells (99Tc-RBC) after 0.05 or 0.2 ml/kg iv oleic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198201000-00008
更新日期:1982-01-01 00:00:00
abstract::Doppler ultrasound has been used extensively in assessing adequacy of circulation. We have found it to be convenient in the identification of blood flow, particularly in hypotensive states where percutaneous radial artery cannulation of the vessel is tedious and difficult to perform. The technique is simple, atraumati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197611000-00011
更新日期:1976-11-01 00:00:00
abstract:OBJECTIVES:Vital organ hypoperfusion significantly contributes to the dismal survival rates observed with manual cardiopulmonary resuscitation after cardiac arrest. The impedance threshold device is a valve which reduces air entry into lungs during chest recoil between chest compressions, producing a potentially benefi...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0b013e318170ba80
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:We hypothesized that the extent of injury and release of xanthine oxidase, an oxidant generator, into the circulation would be less in normal-flow hypoxia-reoxygenation than in equal duration no-flow ischemia-reperfusion. DESIGN:Randomized study. SETTING:University-based animal research facility. SUBJECTS:...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199806000-00034
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVES:To determine the incidence and characteristics of children with brain death in the pediatric intensive care unit (ICU), and to assess the incidence of the clinical triad (Turner's triad) of central diabetes insipidus, low glucose demand, and low CO2 production. DESIGN:Retrospective review of medical records...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199408000-00014
更新日期:1994-08-01 00:00:00
abstract::During a consecutive 17 month period, 15 trauma patients were diagnosed as having a myocardial contusion on the basis of abnormal ECG in 14 patients, elevated creatinine phosphokinase (CPK) in 13 patients, and elevated CPK-Muscle Brain (CPK-MB) isoenzyme determination in 11 patients. Using these screening modalities, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198201000-00005
更新日期:1982-01-01 00:00:00
abstract::The resolution time of pneumothorax in neonates requiring tube thoracotomy is not known. We found that 28%, 50%, and 83% of 54 pneumothoraces in 40 neonates resolved within 24, 96, and 168 h of tube thoracotomy, respectively. Pneumothoraces that persisted beyond 168 h were in infants requiring ventilatory assistance. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198505000-00010
更新日期:1985-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. DESIGN:Retrospective analysis of 49 consecutive patient...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000181730.02238.9b
更新日期:2005-10-01 00:00:00