Extracorporeal cytokine hemadsorption for the treatment of refractory septic shock. Report of two cases

Indexación: Scopus.If Septic shock (SS) evolves to refractory SS, mortality could reach 90%, despite giving an optimal treatment. Nowadays, extracorporeal devices which adsorb inflammatory cytokines are available, reducing the systemic inflammatory response syndrome. These devices can be used with continuous renal replacement therapy or conventional hemodialysis. We report two diabetic females aged 50 and 58 years, who underwent a total colectomy and amputation of diabetic foot and who developed a SS with high requirements of vasoactive drugs (norepinephrine and adrenaline) to maintain a mean arterial pressure about 60 mmHg. Both were subjected to hemodialysis, connected to a cytokine hemadsorption device. The most important finding was the progressive reduction of vasopressor doses, effect that was observed nine hours after the beginning of the hemadsorption and lasted until its removal at 26 hours. Both patients survived. © 2018, Sociedad Medica de Santiago. All rights reserved.https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872018000600796&lng=en&nrm=iso&tlng=e

Sublittoral soft bottom communities and diversity of Mejillones Bay in northern Chile (Humboldt Current upwelling system)

The macrozoobenthos of Mejillones Bay (23°S; Humboldt Current) was quantitatively investigated over a 7-year period from austral summer 1995/1996 to winter 2002. About 78 van Veen grab samples taken at six stations (5, 10, 20 m depth) provided the basis for the analysis of the distribution of 60 species and 28 families of benthic invertebrates, as well as of their abundance and biomass. Mean abundance (2,119 individuals m-2) was in the same order compared to a previous investigation; mean biomass (966 g formalin wet mass m-2), however, exceeded prior estimations mainly due to the dominance of the bivalve Aulacomya ater. About 43% of the taxa inhabited the complete depth range. Mean taxonomic Shannon diversity (H', Log e) was 1.54 ± 0.58 with a maximum at 20 m (1.95 ± 0.33); evenness increased with depth. The fauna was numerically dominated by carnivorous gastropods, polychaetes and crustaceans (48%). About 15% of the species were suspensivorous, 13% sedimentivorous, 11% detritivorous, 7% omnivorous and 6% herbivorous. Cluster analyses showed a significant difference between the shallow and the deeper stations. Gammarid amphipods and the polychaete family Nephtyidae characterized the 5-mzone, the molluscs Aulacomya ater, Mitrella unifasciata and gammarids the intermediate zone, while the gastropod Nassarius gayi and the polychaete family Nereidae were most prominent at the deeper stations. The communities of the three depth zones did not appear to be limited by hypoxia during non-El Niño conditions. Therefore, no typical change in community structure occurred during El Niño 1997–1998, in contrast to what was observed for deeper faunal assemblages and hypoxic bays elsewhere in the coastal Humboldt Current system

(Sub)millimetre interferometric imaging of a sample of COSMOS/AzTEC submillimetre galaxies

We investigate the environment of 23 submillimetre galaxies (SMGs) drawn from a signal-to-noise (S/N)-limited sample of SMGs originally discovered in the James Clerk Maxwell Telescope (JCMT)/AzTEC 1.1 mm continuum survey of a Cosmic Evolution Survey (COSMOS) subfield and then followed up with the Submillimetre Array and Plateau de Bure Interferometer at 890 mu m and 1.3 mm, respectively. These SMGs already have well-defined multiwavelength counterparts and redshifts. We also analyse the environments of four COSMOS SMGs spectroscopically confirmed to lie at redshifts z(spec) > 4 : 5, and one at z(spec) = 2 : 49 resulting in a total SMG sample size of 28. We search for overdensities using the COSMOS photometric redshifts based on over 30 UV-NIR photometric measurements including the new UltraVISTA data release 2 and Spitzer/SPLASH data, and reaching an accuracy of sigma(Delta z/(1+z)) = (1 + z) = 0 : 0067 (0 : 0155) at z 3.5). To identify overdensities we apply the Voronoi tessellation analysis, and estimate the redshift-space overdensity estimator delta(g) as a function of distance from the SMG and/or overdensity centre. We test and validate our approach via simulations, X-ray detected groups or clusters, and spectroscopic verifications using VUDS and zCOSMOS catalogues which show that even with photometric redshifts in the COSMOS field we can e ffi ciently retrieve overdensities out to z approximate to 5. Our results yield that 11 out of 23 (48%) JCMT/AzTEC 1.1 mm SMGs occupy overdense environments. Considering the entire JCMT/AzTEC 1.1 mm S = N >= 4 sample and taking the expected fraction of spurious detections into account, this means that 35-61% of the SMGs in the S/N-limited sample occupy overdense environments. We perform an X-ray stacking analysis in the 0.5-2 keV band using a 32 '' aperture and our SMG positions, and find statistically significant detections. For our z 2 subsample yields an average flux of (1.3 +/- 0.5) x 10(-16) erg s(-1) cm(-2) and a corresponding total mass of M-200 = 2 x 10(13) M-circle dot. Our results suggest a higher occurrence of SMGs occupying overdense environments at z >= 3 than at z <3. This may be understood if highly star-forming galaxies can only be formed in the highest peaks of the density field tracing the most massive dark matter haloes at early cosmic epochs, while at later times cosmic structure may have matured su ffi ciently that more modest overdensities correspond to su ffi ciently massive haloes to form SMGs.Peer reviewe

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

A model for predicting mortality among critically ill burn victims

All casualties admitted to our intensive care burn unit (ICBU) with a diagnosis of thermal or inhalation injury were studied. Age, total and full-thickness body surface area (BSA) burned, presence of inhalation injury, gender, mechanism of injury, delay to ICBU admission and mechanical ventilation during the first 72 h were recorded. The 851 participants were randomly divided into derivation (671) and validation (180) sets. From univariate and multivariate logistic regression analyses a mortality predictive equation was derived. Mortality was 17.6%. In univariate analysis, all variables were significantly associated with mortality except mechanism of injury and delay to ICBU admission. In multivariate analysis, age, total and full-thickness BSA burned, female gender and early mechanical ventilation were independently associated with mortality.1.880 JCR (2014) Q2, 80/198 Surgery, 24/62 Dermatology; Q4, 21/27 Critical care medicineUE

Natriuretic peptide-driven fluid management during ventilator weaning: A randomized controlled trial

Rationale: Difficult weaning from mechanical ventilation is often associated with fluid overload. B-type natriuretic peptide (BNP) has been proposed as a tool for predicting and detecting weaning failure of cardiovascular origin. Objectives: To investigate whether fluid management guided by daily BNP plasma concentrations improves weaning outcomes compared with empirical therapy dictated by clinical acumen. Methods: In a randomized controlled multicenter study, we allocated 304 patients to either a BNP-driven or physician-driven strategy of fluid management during ventilator weaning. To standardize the weaning process, patients in both groups were ventilated with an automatic computer-driven weaning system. The primary end point was time to successful extubation. Measurements and Main Results: In the BNP-driven group, furosemide and acetazolamide were given more often and in higher doses than in the control group, resulting in a more negative median (interquartile range) fluid balance during weaning (-2,320 [-4,735, 738] vs. -180 [-2,556, 2,832] ml; P < 0.0001). Time to successful extubation was significantly shorter with the BNP-driven strategy (58.6 [23.3, 139.8] vs. 42.4 [20.8, 107.5] h; P = 0.034). The BNP-driven strategy increased the number of ventilator-free days but did not change length of stay or mortality. The effect on weaning time was strongest in patients with left ventricular systolic dysfunction. The two strategies did not differ significantly regarding electrolyte imbalance, renal failure, or shock. Copyright © 2012 by the American Thoracic Society