Understanding circulatory failure in sepsis

Bloch, Andreas; Berger, David; Takala, Jukka

doi:10.1007/s00134-016-4514-1

Cited by 22 publications

(18 citation statements)

References 15 publications

(16 reference statements)

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“…Lower morality rate in our study compared to previous studies is likely due to the small sample size of our study. Previous studies also showed that septic cardiomyopathy was not limited to the left heart, as the right heart was often affected (18,19). In line with these findings, we found that the highest incidence of cardiac dysfunction in septic cardiomyopathy was due to left ventricular diastolic dysfunction (43%), followed by left ventricular systolic cardiomyopathy (25.8%), and right ventricular systolic dysfunction (11.8%).…”

Section: Distribution Of Different Types Of Septic Cardiomyopathysupporting

confidence: 90%

Elevated plasma histone H4 levels are an important risk factor for the development of septic cardiomyopathy

Lu¹,

Jiang²,

Zhu³

et al. 2019

Balkan Med J

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Background: Myocardial impairment is a major complication and an important prognostic predictor of sepsis. Therefore, early and accurate diagnosis as well as timely management of septic cardiomyopathy is critical to achieve favorable outcomes. Aims: To investigate the risk factors of septic cardiomyopathy. Study Design: Cross-sectional study Methods: This study performed between May 2016 and June 2018 recruited 93 septic patients from the intensive care unit. All patients received standardized treatments. Septic patients were divided into two groups: non cardiomyopathy (n=45) and septic cardiomyopathy group (n=48). Blood samples were collected and transthoracic echocardiography was performed within 24 hours of intensive care unit admission. Septic patients with one ultrasound abnormality but no history of heart disease were diagnosed as having septic cardiomyopathy. Plasma histones, cardiac troponin I, and N-terminal pro-brain natriuretic peptide were measured using ELISA. Sequential Organ Failure Assessment scores, vasopressor use, and the outcomes of intensive care unit stay were analyzed. Spearman rank analysis was used to determine the correlation between plasma histone H4 and other parameters. Binary logistic regression and receiver operating characteristic curve analysis were used to determine the risk factors for septic cardiomyopathy. Results: Compared with the non-cardiomyopathy group, the septic cardiomyopathy group had significantly higher plasma H4 and cardiac troponin I levels, a higher Sequential Organ Failure Assessment score, more frequent vasopressor use, and a higher mortality rate (p<0.05). Plasma histone H4 levels positively correlated with cardiac troponin I (r=0.577, p<0.001), N-terminal pro-brain natriuretic peptide (r=0.349, p=0.001), and Sequential Organ Failure Assessment scores (r=0.469, p<0.001). Binary logistic regression and receiver operating characteristic curve analyses revealed that elevated plasma histone H4 levels and vasopressor use were important risk factors for septic cardiomyopathy (p<0.05). Conclusion: Elevated plasma histone H4 levels could be used to predict septic cardiomyopathy in patients with sepsis.

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Section: Distribution Of Different Types Of Septic Cardiomyopathysupporting

confidence: 90%

Elevated plasma histone H4 levels are an important risk factor for the development of septic cardiomyopathy

Lu¹,

Jiang²,

Zhu³

et al. 2019

Balkan Med J

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“…High-Volume Hemofiltration HVHF was the targeted blood purification technique chosen to support kidney function, but also to control "cytokine storm". Particularly, in case of infection, cytokine release aggravates cell and organ damage and may lead to an outgoing vicious circle which is also known as "cytokine storm" [15,16]. The technique is an evolution of renal replacement therapies used in intensive care for AKI treatment [16] with a prescribed dose > 35 mL/kg/h [17,18].…”

Section: Polymixin B Hemoperfusionmentioning

confidence: 99%

“…Particularly, in case of infection, cytokine release aggravates cell and organ damage and may lead to an outgoing vicious circle which is also known as "cytokine storm" [15,16]. The technique is an evolution of renal replacement therapies used in intensive care for AKI treatment [16] with a prescribed dose > 35 mL/kg/h [17,18]. Most inflammatory mediators are by size middle-molecular-weight molecules (from 5 to 60 kDa) and are mainly removed by membrane adsorption, followed by convection which is more effective than diffusion in removing middle molecules [14,19].…”

Section: Polymixin B Hemoperfusionmentioning

confidence: 99%

Sequential Extracorporeal Therapy Collaborative Device and Timely Support for Endotoxic, Septic, and Cardiac Shock: A Case Report

Rosa¹,

Samoni²,

Ronco³

2019

Blood Purif

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We report a 49-year-old man, without prior medical history, consulted in the emergency department with a 5 day history of cough, fever, and dysuria. He was admitted to the intensive care unit due to septic shock. Critical care management was initiated, including mechanical ventilation and vasopressors. Endotoxic shock was suspected (endotoxin activity assay [EAA] 0.75), and 2 treatments with Polymyxin B hemoperfusion (Toraymyxin ® , Toray Medical Co., Ltd., Tokyo, Japan) were performed in 48 h, alternate with high-volume hemofiltration sessions. Initial blood cultures were positive for Neisseria meningitidis (serogroup B), and a lumbar puncture was deferred because of the coagulopathy and a bleeding risk. The circulatory efficiency significantly improved after the second procedure of hemoperfusion, and the treatment resulted in a marked decrease in the serum endotoxin level (EAA < 0.4). However, after 48 h, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 from admission. Continuous cytokine hemoadsorption (Cytosorb ® , Cytosorbent Corporation, Monmouth Junction, NJ, USA) was incorporated into a VA-ECMO circuit for 48 h without a considerable improvement. For this reason, a 72-h continuous veno-venous hemodialysis session was started in which a high cutoff filter was used. Tachycardia and myocardial dysfunction improved by day 6, and VA-ECMO was withdrawn on the tenth day. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to the department of respiratory medicine on day 80, he was discharged from our hospital on day 113. Sequential extracorporeal therapy may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic shock using catecholamines and blockers.

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“…In this setting, the infusion of very high catecholamine doses used to increase cardiac output and maintain perfusion before ECMO initiation might have contributed to the vicious circle that led to vasoconstriction and refractory cardiovascular failure. Considering the reversibility of myocardial depression associated with septic shock, 7,8 , we hypothesized that ECMO could help salvage these dying patients by restoring adequate perfusion to vital organs to reverse multiple organ failures and by buying time to achieve infection control by antibiotics. Indeed, all our survivors could be explanted without recourse to cardiac transplantation or switching to another cardiac assist device, and all recovered with a normal myocardial function within a few weeks.…”

mentioning

confidence: 99%

Role of VA ECMO in septic shock: Does it work?

Combes

2017

Qatar Medical Journal

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Understanding circulatory failure in sepsis

Cited by 22 publications

References 15 publications

Elevated plasma histone H4 levels are an important risk factor for the development of septic cardiomyopathy

Elevated plasma histone H4 levels are an important risk factor for the development of septic cardiomyopathy

Sequential Extracorporeal Therapy Collaborative Device and Timely Support for Endotoxic, Septic, and Cardiac Shock: A Case Report

Role of VA ECMO in septic shock: Does it work?

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