Một cụ bà 78 tuổi, nặng 100kg, đã được cứu sống ngoạn mục từ tình trạng 'chín phần tử vong'. Bệnh nhân bị sốc nhiễm trùng dẫn đến ngưng tim, ngưng thở nhưng đã qua cơn nguy kịch nhờ nỗ lực hồi sức tích cực của đội ngũ y bác sĩ đa chuyên khoa.
#y_tế #sức_khỏe #cứu_sống #bệnh_nhân #sốc_nhiễm_trùng #ngưng_tim
#healthcare #health #medical #patient #septicshock #cardiacarrest #Vietnam
https://vietnamnet.vn/cuu-nguoi-phu-nu-nang-100kg-chin-phan-tu-vong-2469464.html
Bacterial endotoxins from Gram-negative bacteria cause fever, inflammation, and septic shock via lipid A activation. #BacterialEndotoxin #LPS #GramNegative #Sepsis #SepticShock #LipidA #Microbiology #Immunology #Pathophysiology #USMLE #MedicalEducation
Learn key differences between bacterial exotoxins and endotoxins and their clinical effects. #Exotoxins #Endotoxins #BacterialToxins #Microbiology #Pathogenesis #GramNegative #GramPositive #LPS #ToxinMechanism #USMLE #MedicalEducation #ClinicalMicrobiology #SepticShock #BacterialVirulence
Learn how major bacterial exotoxins cause disease — from Clostridium botulinum to Shigella dysenteriae. Understand their targets, mechanisms, and clinical effects for high-yield USMLE microbiology preparation.
@razvan @BakkeHK Not at all. The purpose of using #albumin in #SepticShock is precisely to prevent or mitigate #glycocalyx damage. If oncontic pressure gradient was the purpose, any synthetic colloid would do the job (actually, they won’t, because of the altered endothelial layer, as you suggested)
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00697-1
https://link.springer.com/article/10.1007/s00134-022-06740-y
The endothelial glycocalyx comprises a complex layer of membrane-bound proteoglycans, secreted glycosaminoglycans, glycoproteins, glycolipids and bound plasma proteins such as albumin and antithrombin associated with the endothelial surface. The glycocalyx plays an important role in vascular homeostasis, regulating vascular permeability and cell adhesion, and acts as a mechanosensor for hemodynamic shear stresses; it also has antithrombotic and anti-inflammatory functions. Plasma proteins such as albumin are physiologically bound within the glycocalyx, thus contributing to stability of the layer. Albumin is the major determinant of plasma colloid osmotic pressure. In addition, albumin transports sphingosine-1-phosphate which has protective endothelial effects, acts as a free radical scavenger, and has immunomodulatory and anti-inflammatory effects. This review examines the physiological function of the endothelial glycocalyx and the role of human albumin in preserving glycocalyx integrity and the microcirculation.
#Albumin Should Be Remembered When Patients With #SepticShock Are Resuscitated
“Although no significant difference in 28-day mortality rate or 90-day mortality rate was observed between the use of albumin and #crystalloids, #colloids appeared to be more effective than crystalloids in stabilizing hemodynamic end points”
I couldn't agree more. Sometimes you have to find what to do at the moment. It is safe and may help.
https://journal.chestnet.org/article/S0012-3692(23)00654-2/fulltext
Background Sepsis and septic shock are frequently accompanied by coagulopathy. Since the sepsis-induced coagulopathy (SIC) score was first described, subsequent studies from Asia revealed a SIC prevalence of 40–60%. In Europe, however, SIC prevalence in patients fulfilling sepsis criteria according to the third international consensus definition (SEPSIS-3) has not yet been evaluated. Methods The Critical Care Trials Group of the German Sepsis Competence Network (SepNet) conducted a secondary analysis of two randomized controlled trials. Only patients fulfilling sepsis criteria according SEPSIS-3 were included in this secondary analysis. In a two step approach, SIC prevalence was determined in 267 patients with sepsis but not septic shock (at the time of inclusion) from the “Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis” (HYPRESS) trial. Then, we estimated SIC prevalence in 1,018 patients from the “Effect of Sodium Selenite Administration and Procalcitonin-Guided Therapy on Mortality in Patients With Severe Sepsis or Septic Shock” (SISPCT) trial using a simplified SIC score based on the platelet-SIC-subscore (PSSC). Study aims were to assess (i) the prevalence of SIC in patients with SEPSIS-3, (ii) the association of SIC with 90-day mortality and morbidity, (iii) the time when patients become SIC positive during the course of sepsis, and (iv) the value of the PSSC for predicting SIC. Results In the HYPRESS trial, SIC prevalence was 22.1% (95% confidence interval [CI] 17.5–27.5%). The estimated SIC prevalence in the SISPCT trial was 24.2% (95% CI 21.6–26.9%). In the HYPRESS trial, SIC was associated with significantly higher 90-day mortality (13.9% vs. 26.8%, p = 0.027) and morbidity. Logistic regression analysis adjusted for age, sex, treatment arm, and (SIC-adapted) SOFA score confirmed the negative association of SIC with survival (p = 0.011). In the SISPCT trial, increased PSSCs were associated with higher 90-day mortality (PSSC 0: 34.4%, PSSC 1: 40.5%, PSSC 2: 53.3%; p < 0.001). In both trials, SIC was already present at sepsis diagnosis or occurred during the following 4 days. Conclusions SIC is a clinically relevant complication of sepsis. Although it might be less frequent than previously reported, its occurrence is associated with higher morbidity and mortality and should be interpreted as an early warning sign.
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