BackgroundSepsis and septic shock are common problems in intensive care units (ICUs). The mortality of patients with sepsis or septic shock is high. We investigated if reduction in the serum concentration of the cytokines tumor necrosis factor α, interleukin (IL)-6 and IL-10, and the rate of change in the IL-6 level at 24 h after ICU admission were survival predictors for patients with sepsis and septic shock in a Vietnamese population.MethodsThis was a prospective study conducted at an ICU in Cho Ray Hospital, Vietnam, from October 2014 to October 2016. Patients diagnosed with sepsis or septic shock using validated international guidelines were enrolled. Plasma samples were collected upon (T0) and 24 h after (T24) ICU admission for measurement of cytokine concentrations. Blood tests were done to detect organ dysfunction. The duration of ICU stays, hospital stay, APACHE II and SOFA scores, and the in-hospital mortality were compared between survival and non-survival groups. Univariate logistic regression and multivariate analysis were done to determine the association between survival and IL-6 reduction at 24 h after ICU admission.ResultsA total of 123 patients were enrolled. The concentration (in pg/mL) of IL-6 at To was 413.3 in survivors and 530.0 in non- survivors. At T24, the IL-6 level was 65.4 for survivors and 286.9 for non-survivors. The survival rate was 39.0%. At T24, the concentrations of IL-6 and the reduction in IL-6 level were predictors of survival in patients with sepsis and septic shock. We found a significant association between IL-6 reduction and survival at ≥86% with Odds Ratio (OR) 5.67, 95% Confidence Interval (CI); 1.27–25.3, compared with an increase in the IL-6 rate of change.ConclusionsOur findings suggested that a reduction in the IL-6 level of ≥86% at 24 h from ICU admission is a survival predictor for patients with sepsis and septic shock in our population.
Background: The development of novel revascularization devices has improved procedural and clinical outcomes in acute ischemic stroke (AIS). A direct aspiration first pass technique (ADAPT) has been introduced as a rapid simple method for achieving good recanalization and clinical outcomes using large bore aspiration catheters in the treatment of AIS due to large vessel occlusion (LVO). Objectives: The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to LVO in the Vietnamese patient population. Materials and Methods: A retrospective analysis of a hospital database was conducted on all patients undergoing stroke therapy with the ADAPT technique at the institution from January 2017 to December 2017. Efficacy and safety were evaluated by the variables: revascularization rates (thrombolysis in cerebral infarction [TICI] score), time to revascularization, procedural complications, and clinical outcomes (modified Rankin scale [mRS] score) at the 90-day follow-up visit. Results: From the database review, 37 AIS patients treated with ADAPT were identified. The mean NIHSS score at presentation was 17.3 and improved to 8.9 at discharged. The average time arterial puncture to revascularization was 32.5 min. TICI 2b/3 revascularization was achieved in 30/37 (81.1%) patients, good clinical outcomes were achieved (mRS 0–2) in 21/37 (56.7%) patients, and mortality rate was 6/37 (16.2%) during follow-up. Conclusions: ADAPT utilizing large bore aspiration catheters appears to be a fast, simple, safe, and effective method for the management of AIS in the Vietnamese patient population.
BackgroundCandida spp. is a yeast that resides on the skin, in the gastrointestinal tract, urinary tract ... is the cause of opportunistic infection, causes disease in immunocompromised patients, patients treated with medical therapy and invasive surgery includes broadspectrum antibiotics, chemicals and organ transplants [1,2]. Candida spp. can thrive in the intestine, break down the intestinal wall and enter the bloodstream. There are many toxins of Candida in bloodstream infection, which are very dangerous for health and difficult to treat. Fungal infections of the bloodstream include several conditions such as Candida blood infection, endocarditis, meningitis and other forms of deep organ damages. Nearly 96% of fungal infections were caused by Candida spp. [3,4]. Mortality due to Candida has been reported up to 40-50% [5,6]. Candida spp. is the top four causes of sepsis in hospitals, accounting for 9% of the total number of pathogenic microorganisms [7]. In India, according to the study of Vibhor Tak and colleagues, 43% of fatality was caused by fungal infections [2], in the study of Ying-Lien Chena et al, this rate was 40 to 70% [8]. In Vietnam, studies on fungal infections are limited and have not been paid attention like bacterial infections, with little data on antifungal drug resistance. In this study, we investigated the causative agents of antifungal blood infections and the situation of antifungal drug resistance.
Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock.
Design: observational study.
Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%.
Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers).
Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.
Introduction: Antimicrobial resistance is an emerging global problem, particularly in developing countries. Cho Ray is one of the first hospitals in Vietnam to implement an antimicrobial stewardship program. We present the results of this program here, after two years of implementation.
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