Abstract:
OBJECTIVES:Although the mortality of severe sepsis is easily quantified, the actual cause and timing of death from severe sepsis are less defined. We used the INDEPTH (International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa activated) database to investigate the reported cause of death in patients with severe sepsis. DESIGN:Retrospective database analysis. PATIENTS:Data from 4459 patients with severe sepsis (drotrecogin alfa activated, n = 3228; placebo, n = 1231) included in five clinical trials conducted in tertiary care institutions in 28 countries. MEASUREMENTS AND MAIN RESULTS:We examined the cause of death and the pattern of Sequential Organ Failure Assessment scores near the time of death. We also evaluated the time course of biomarker levels at this late stage. A total of 1201 (27.0%) patients died during the 28-day study period. The main causes of death were as follows: sepsis-associated multiple organ failure (43.1%), refractory septic shock (22.6%), and respiratory failure (13.0%). There were no significant differences in the distributions of cause of death between drotrecogin alfa activated and placebo patients, so that all patients were combined for analysis. The mean cardiovascular Sequential Organ Failure Assessment score increased from 2.4, 4 days before death, to 2.9, 1 day before death, and the mean respiratory Sequential Organ Failure Assessment score increased from 2.6, 4 days before death, to 2.9, 1 day before death. The increase in these individual Sequential Organ Failure Assessment scores was more prominent in patients who died early (day 0-5). Protein C levels decreased and interleukin-6 levels increased in the days before death. CONCLUSION:Patients with severe sepsis typically die of multiple organ failure, refractory shock, or respiratory failure. Persistent, more than worsening, organ failure is the more common pattern before death.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Vincent JL,Nelson DR,Williams MDdoi
10.1097/CCM.0b013e31820eda29subject
Has Abstractpub_date
2011-05-01 00:00:00pages
1050-5issue
5eissn
0090-3493issn
1530-0293journal_volume
39pub_type
杂志文章abstract:OBJECTIVE:To investigate relationships between acute adrenergic stress, plasma catecholamine concentrations, and beta 2-adrenergic receptors. DESIGN:Prospective, descriptive study. SETTING:Emergency medical service at a university hospital. PATIENTS:Twenty-seven patients with out-of-hospital cardiac arrest (n = 11),...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199704000-00015
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of monoclonal antibody to tumor necrosis factor (TNF)-alpha on the hemodynamic alterations and survival rate in rats subjected to intestinal ischemia/reperfusion. DESIGN:Prospective, randomized study. SETTING:Animal laboratory of an institute for research in traumatology. SUBJECTS:M...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199609000-00020
更新日期:1996-09-01 00:00:00
abstract::Clonidine may be a source of serious toxicity when ingested by toddlers. We describe 11 cases of clonidine ingestion by toddlers (mean dose 0.15 mg/kg; range 0.01 to 0.57). The source of the clonidine was a grand-parent in six of 11 cases. Symptoms included altered level of consciousness (n = 11), miosis (n = 5), brad...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199010000-00014
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVE:Anesthetic preconditioning appears to be a viable strategy to treat ischemic cerebral injury. Here we investigated 1) whether the protection conferred by sevoflurane preconditioning sustains in time; 2) whether sevoflurane preconditioning diminishes mitochondrial dysfunction following cerebral ischemia; and 3...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318258fb90
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVES:a) To determine whether pentoxifylline has a preventive effect on the decrease in PaO2 that is caused by oleic acid, and whether pentoxifylline facilitates normalization of PaO2 from the decreased state. b) To examine whether pentoxifylline can attenuate an increase in pulmonary vascular permeability that is...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199502000-00023
更新日期:1995-02-01 00:00:00
abstract::The records of 101 drowning or near-drowning victims admitted to Children's Hospital of Los Angeles (CHLA) between January 1975 and June 1978 were reviewed. The admission Glasgow coma score could be assigned retrospectively to 94 patients. A low score (less than 5) predicted a high risk group of patients with 80% mort...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1981-07-01 00:00:00
abstract:OBJECTIVE:To define the relative needs of the staffs of rural, community hospitals for training in advanced cardiac life support (ACLS), identify weaknesses, and modify a standard ACLS course to meet these needs. DESIGN:Prospective assessment of knowledge and skills relating to the practice of ACLS. SETTING:Rural, co...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00006
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVES:The association between tobacco smoke exposure and critical illness is not well studied, largely because obtaining an accurate smoking history from critically ill patients is difficult. Biomarkers can provide quantitative data on active and secondhand cigarette smoke exposure. We sought to compare cigarette ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181fa4196
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVES:Our goal was to "reverse translate" the human response to surgical sepsis into the mouse by modifying a widely adopted murine intra-abdominal sepsis model to engender a phenotype that conforms to current sepsis definitions and follows the most recent expert recommendations for animal preclinical sepsis resea...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003926
更新日期:2019-11-01 00:00:00
abstract::The Hemoccult slide test is used frequently to test for the presence of occult blood in samples of gastric juice obtained from critically ill patients. The purpose of this study was to investigate the accuracy of this test to determine the presence of blood in human gastric juice at various pH values. Gastric aspirate...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198210000-00016
更新日期:1982-10-01 00:00:00
abstract:OBJECTIVE:To assess the mortality rate and complications in a population of surgical patients with severe adult respiratory distress syndrome (ARDS) treated with positive end-expiratory pressure (PEEP) of > 15 cm H2O in an attempt to reduce intrapulmonary shunt to approximately 0.20 and reduce FIO2 to < 0.50. DESIGN:R...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199509000-00008
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVE:To compare the effectiveness and safety of the hemoglobin-based nitric oxide scavenger, pyridoxalated hemoglobin polyoxyethylene, against placebo in patients with vasopressor-dependent distributive shock. DESIGN:Multicenter, randomized, placebo-controlled, open-label study. SETTING:Sixty-one participating I...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0000000000000554
更新日期:2015-01-01 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
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:OBJECTIVE:To determine the frequency, etiology, and risk factors of ventilator-associated pneumonia (VAP) and purulent tracheobronchitis (TBX) in patients who have undergone heart surgery. To study the predictive role of systematic surveillance cultures. DESIGN:Prospective study. SETTING:Heart surgery intensive care ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000084807.15352.93
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Hypertonic saline is the recommended therapy to shrink swollen brain cells in patients with acute hyponatremia accompanied by seizures. OBJECTIVES:In the absence of hypertonic saline, hypertonic mannitol will shrink the cell volume. Because mannitol is excreted rapidly, our aim was to ensure that it would b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00037
更新日期:2000-06-01 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::A meta-analysis was performed of 15 randomized studies on the prophylaxis with cimetidine and/or ant-acids of upper GI bleeding acquired in the ICU. There were eight comparisons of a group receiving cimetidine with a control group, nine comparisons of a group receiving antacids with a control group, and ten comparison...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-198909000-00003
更新日期:1989-09-01 00:00:00
abstract:OBJECTIVE:To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition. DESIGN:Prospective, randomized clinical trial. SETTING:Department of surgery in a university hospital. PATIENTS:Two hundred and fifty-seven patients with cancer of the stomach (n = 1...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200102000-00003
更新日期:2001-02-01 00:00:00
abstract:OBJECTIVE:To investigate the interaction and involvement of hydrogen sulfide and transient receptor potential vanilloid type 1 in the pathogenesis of sepsis. Hydrogen sulfide has been demonstrated to be involved in many inflammatory states including sepsis. Its contribution in neurogenic inflammation has been suggested...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181c0df00
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:Recent studies have demonstrated the therapeutic effectiveness and pharmacologic mechanisms of hyperbaric oxygen therapy (HBOT) in the treatment of a systemic shock state. To elucidate the in vivo role of HBOT during sepsis, we evaluated the effects of HBOT on intestinal mucosal injury and bacterial transloca...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000132898.27101.6c
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVE:To determine the activation of nuclear factor-[kappa]B in peripheral blood CD14+ monocyte/macrophages and CD3+, CD4+, and CD8+ T cells in children with sepsis. DESIGN:Observational study. SETTING:University hospital. PATIENTS:Twenty-six children with sepsis (nine females and 17 males, aged between 10 days ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000284502.38701.e6
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVES:To quantitate duplex Doppler measurements of splanchnic perfusion to determine if these measurements are reproducible in euvolemic humans and if such measurements are sensitive to mild degrees of systemic hypovolemia. DESIGN:Prospective, nonrandomized, controlled trial. SETTING:Clinical research center. P...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199503000-00013
更新日期:1995-03-01 00:00:00
abstract::This report is intended to familiarize the reader with the current legislation concerning state definitions of death, the pertinent judicial decisions concerning termination of life support and the current status of medical/ethical committees. However, it is of paramount importance to all health care personnel to beco...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract:OBJECTIVES:With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. DES...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001200
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVE:Heptafluoropropane is an inert gas commercially used as propellant for inhalers. Since heptafluoropropane can be detected in low concentrations, it could also be used as a tracer gas to measure functional residual capacity and ventilation homogeneity. The aim of the present study was to validate functional re...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000220065.93507.AB
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVES:Anxiety results from the anticipation of a threat and might be associated with poor outcome in the critically ill. This study aims at showing that anxiety at admission in critically ill patients is associated with new organ failure over the first 7 days of ICU hospitalization independently of baseline organ ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004495
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:During cardiopulmonary resuscitation (CPR), elimination of CO2 was shown to be limited by low tissue perfusion, especially when very low perfusion pressures were generated. It has therefore been suggested that sodium bicarbonate (NaHCO3), by producing CO2, might aggravate the hypercarbic component of the exi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199808000-00027
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVES:To develop a predictive equation to estimate the frequency of blood drawing for intensive care unit (ICU) laboratory tests and to evaluate variations in ICU blood sampling practices after adjusting for patient and institutional factors. DESIGN:Prospective, inception, cohort study. SETTING:Forty-two ICUs in...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-199705000-00006
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVE:To determine the effects of accidental injury of varying severity on interleukin (IL)-1 alpha, IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), and endotoxin release. DESIGN:Prospective, multi-unit, longitudinal study. SETTING:Emergency Departments and intensive care units of two university hospitals. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199306000-00010
更新日期:1993-06-01 00:00:00