Background and objectives: Oxidative stress (OS) participates in the pathophysiology of septic shock, which leads to multiple organ failure (MOF), ischemia-reperfusion injury, and acute respiratory distress syndrome. Therefore, antioxidants have been proposed as therapy. Here, we evaluated the effect of antioxidant treatments in patients with septic shock with MOF and determined levels OS before and after treatment. This study was a randomized, controlled, triple-masked, and with parallel assignment clinical trial with a control group without treatment. Materials and Methods: It included 97 patients of either sex with septic shock. 5 treatments were used each in an independent group of 18 patients. Group 1 received vitamin C (Vit C), group 2 vitamin E (Vit E), group 3 n-acetylcysteine (NAC), group 4 melatonin (MT), and group 5 served as control. All antioxidants were administered orally or through a nasogastric tube for five days as an adjuvant to the standard therapy. Results: The results showed that all patients presented MOF due to sepsis upon admission and that the treatment decreased it (p = 0.007). The antioxidant treatment with NAC increased the total antioxidant capacity (p < 0.05). The patients that received Vit C had decreased levels of the nitrate and nitrite ratio (p < 0.01) and C-reactive protein levels (p = 0.04). Procalcitonin levels were reduced by Vit E (p = 0.04), NAC (p = 0.001), and MT (p = 0.04). Lipid-peroxidation was reduced in patients that received MT (p = 0.04). Conclusions: In conclusion, antioxidant therapy associated with standard therapy reduces MOF, OS, and inflammation in patients with septic shock.

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reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. carbon dioxide 30 [27][28][29][30][31][32][33][34][35] mmHg and median temperature 37.1 [36.8-37.3]°C. After removal of artefacts, the mean monitoring time was 22 h08 (8 h54). All patients had impaired cerebral autoregulation during their monitoring time. The mean IAR index was 17 (9.5) %. During H 0 H 6 and H 18 H 24 , the majority of our patients; respectively 53 and 71 % had an IAR index > 10 %. Conclusion According to our data, patients with septic shock had impaired cerebral autoregulation within the first 24 hours of their admission in the ICU. In our patients, we described a variability of distribution of impaired autoregulation according to time. ReferencesSchramm P, Klein KU, Falkenberg L, et al. Impaired cerebrovascular autoregulation in patients with severe sepsis and sepsis-associated delirium. Crit Care 2012; 16: R181. Aries MJH, Czosnyka M, Budohoski KP, et al. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit. Care Med. 2012.

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Objective: To determine the impact and usefulness of the combination of structural and functional biomarkers in the diagnosis of acute renal injury (AKI) and short-term prognosis of patients undergoing cardiac surgery (CS). Material and Methods. Prospective cohort study (March 2018 to December 2019). 63 adults older than 18 years old, on the Intensive Care Unit (ICU) were included. Interventions: Patients had undergone CS with extracorporeal circulation (ECC). Surgery was elective in 80% of cases; it was urgent in 18% and emergent in 3%. Exclusion criteria included chronic kidney disease, contrast medium application ≤24 hour before surgery, cancer, infectious and autoimmune diseases. On admission to the ICU, serum creatinine, urinary creatinine, urinary sediment, urinary NGAL, urinary cystatin, microalbuminuria and serum cystatin were measured. Results. AKI was found 31 cases (49%). ECC without renal damage was found when time of extracorporeal circulation was of 85 ± 25 minutes and with renal damage when it lasted 114 ± 32 (p = 0.0001). Serum creatinine has a likelihood ratio (LR) + of 5.5, the combination of serum cystatin c (cystatin C) and normalized NGAL, showed a better LR. In patients with severe irreversible AKI, the combination of cystatin C + NGAL adjusted to urinary creatinine (NGAL/uCr) + microalbuminuria had a LR+ of 18.75 and LR - of 0.26. Conclusions: The combination of biomarkers predicts and identifies severity of AKI and Biomarkers combination in Cardiac Surgery

Background: Septic shock is the most serious form of sepsis and can be due to several factors, such as hypovolemia, vascular hyporesponsiveness, myocardial dysfunction, or dysfunction of the circulation. Likewise, electrolyte levels have been associated with septic shock in intensive care units, although it has been underdiagnosed. Based on this, the purpose of the present work was to evaluate plasma ionic levels in patients with septic shock before and after treatment with different antioxidants. Methods: Plasma ionic levels were measured (Na+, K+, Cl- and ionized Ca2+ and Mg2+) in 194 subjects, 129 healthy control patients, 14 patients with septic shock without treatment and 51 patients with septic shock under treatment with 4 different antioxidants (N-acetyl cysteine, melatonin, vitamin C and vitamin E). Results: We found important differences when comparing the plasma ionic levels of K+, Ca2+ and Mg2+ between the control group versus in both groups with sepsis at the time of hospital admission. In patients with septic shock, there is a decrease in the serum levels of ionized Na+, K+, Cl- and Ca2+ and Mg2+. Antioxidant treatment as an adjunct to the standard management of patients with septic shock increases the electrolyte deficit. The correction of the magnesium deficit also leads to an increase in serum calcium and potassium levels. Conclusion: The management of antioxidant therapy in patients with septic shock within the first hours of admission can help to improve their ionic levels of Ca2+ and Mg2+, mainly in patients with lung damage.Clinical Trial gov registration: NCT03557229. Registered june 14, 2018. https://clinicaltrials.gov/ct2/show/NTC03557229?term=aISA+ALFREDO&draw=2&rank=1

The therapeutic approach to ARDS is based on a multimodal strategy that combines non-pharmacological strategies (protective ventilation, conservative fluid

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