Severe sepsis and septic shock represent a major healthcare challenge. Much of the improvement in mortality associated with septic shock is related to early recognition combined with timely fluid resuscitation and adequate antibiotics administration. The main goals of septic shock resuscitation include intravascular replenishment, maintenance of adequate perfusion pressure and oxygen delivery to tissues. To achieve those goals, fluid responsiveness evaluation and complementary interventions - i.e. vasopressors, inotropes and blood transfusion - may be necessary. This article is a literature review of the available evidence on the initial hemodynamic support of the septic shock patients presenting to the emergency room or to the intensive care unit and the main interventions available to reach those targets, focusing on fluid and vasopressor therapy, blood transfusion and inotrope administration.
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http://dx.doi.org/10.1016/j.bjan.2015.07.003 | DOI Listing |
Cureus
December 2024
Critical Care, Unidade Local de Saúde de Braga, Braga, PRT.
Community-acquired pneumonia (CAP) varies in clinical presentation, ranging from mild pneumonia characterized by fever and productive cough to severe pneumonia characterized by respiratory distress and sepsis. We present a 40-year-old woman who presents to the emergency room with dyspnea, pleuritic chest pain, productive cough with hemoptysis, and fever. On physical examination, the patient presents with tachypnea and hypotension, which proved refractory to fluid therapy.
View Article and Find Full Text PDFWorld J Pediatr Surg
December 2024
Pediatric Intensive Care Unit, Hospital Estadual de Diadema, São Paulo, Brazil.
Objective: We aimed to evaluate the characteristics, complications and outcomes of necrotizing pneumonia (NP) requiring surgical intervention.
Methods: We conducted a retrospective study of all children who underwent surgical therapy for NP from January 2010 to December 2023. Patients were analyzed based on two surgical approaches: anatomic resection (AR) or non-AR (NAR).
Crit Care
December 2024
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Background: Excessive exposure to adrenergic vasopressors may be harmful. Non-adrenergic vasopressors may spare adrenergic agents and potentially improve outcomes. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of non-adrenergic vasopressors in adult patients receiving vasopressor therapy for vasodilatory shock or perioperative vasoplegia.
View Article and Find Full Text PDFJ Cardiothorac Surg
December 2024
Izmir Faculty of Medicine, Department of Thoracic Surgery, University of Health Sciences Turkey, Izmir, Turkey.
Background: Intrapericardial pneumonectomy is a complex procedure indicated for large lung tumors where safe dissection of major vascular structures outside the pericardium is unfeasible or when the pericardium itself is invaded. Traditionally managed via open thoracotomy, recent advancements in VATS techniques now allow for intrapericardial pneumonectomy even in cases with extensive tumors or locally advanced disease. In this article, we detail the clinical outcomes and surgical considerations of six patients with non-small cell lung cancer who underwent VATS intrapericardial pneumonectomy.
View Article and Find Full Text PDFCrit Care
December 2024
Critical Care Department, Hospital Universitario Dr. Peset, Valencia, Spain.
Rapid multiplex molecular syndromic panels (RMMSP) (3 or more pathogens and time-to-results < 6 h) allow simultaneous detection of multiple pathogens and genotypic resistance markers. Their implementation has revolutionized the clinical landscape by significantly enhancing diagnostic accuracy and reducing time-to-results in different critical conditions. The current revision is a comprehensive but not systematic review of the literature.
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