OBJECTIVES Sepsis treatment guidelines recommend macrocirculatory hemodynamic optimization; however, microcirculatory dysfunction is integral to sepsis pathogenesis. We aimed to test the hypothesis that following macrocirculatory optimization, inhaled nitric oxide would improve microcirculation in patients with sepsis and that improved microcirculation would improve lactate clearance and multip...

Pontes-Arruda and colleagues addressing eicosapenta enoic acid/γ-linolenic acid (EPA/GLA) use in septic patients [1]. First, I did not fi nd an adequate sample size calculation and we should know whether a type I error could have occurred. Another major concern is the inclusion imbalance among sites, which is not mentioned in the results or as a study limitation. Th e authors recognized that on...

Organ dysfunction and failure are important for burned patients as they increase morbidity and mortality. Recent evidence has suggested that organ injuries are occurring earlier after burns, and are more common than previously thought. In this study we have assessed the extent to which liver function, assessed by the plasma disappearance rate of indocyanine green (PDR(ICG)), is affected in pati...

At the moment, the diagnosis of sepsis is established based on the criteria of the presence of a clinical manifestation of systemic inflammatory response syndrome/SIRS, infection, and organ dysfunction. In the last two years, the idea to add several additional parameters to these criteria has developed, with the proposition to use the acronym PIRO (P: predisposition, I: infection, R: response a...

OBJECTIVES Failure to recognize shock contributes to inadequate early resuscitation in many children with sepsis. Serum lactate levels are used to identify adult patients with septic shock, but physical examination diagnosis alone is recommended in pediatric sepsis. The authors sought to test the utility of lactate testing in pediatric emergency department (ED) patients with systemic inflammato...

OBJECTIVES To determine whether treatment with a protocolized sepsis guideline in the emergency department was associated with a lower burden of organ dysfunction by hospital day 2 compared to nonprotocolized usual care in pediatric patients with severe sepsis. DESIGN Retrospective cohort study. SETTING Tertiary care children's hospital from January 1, 2012, to March 31, 2014. SUBJECTS Pa...

BACKGROUND Some humans fed a low-choline diet develop hepatosteatosis, liver and muscle damage, and lymphocyte apoptosis. The risk of developing such organ dysfunction is increased by the presence of single-nucleotide polymorphisms (SNPs) in genes involved in folate and choline metabolism. OBJECTIVE We investigated whether these changes that occur in the expression of many genes when humans a...

INTRODUCTION Continuous venovenous hemodiafiltration, generally used in patients with acute renal failure, enables elimination of humoral mediators of systemic inflammatory response and sepsis from blood. This effect should improve treatment results in patients with multiple organ dysfunction, but evidence of improved survival is insufficient. OBJECTIVES Describe the effect of continuous veno...

Liver dysfunction plays a significant role in the Intensive Care Unit (ICU) patients’ morbidity and mortality. Metabolic, hemodynamic and inflammatory factors contribute in liver damage. Hemorrhagic shock, septic shock, multiple organ dysfunction, acute respiratory dysfunction, metabolic disorders, myocardial dysfunction, infection from hepatitis virus, and therapeutic measures such as blood tr...

This retrospective cohort study investigated the outcomes and prognostic factors in nonagenarians (patients 90 years old or older) with acute respiratory failure. Between 2006 and 2016, all nonagenarians with acute respiratory failure requiring invasive mechanical ventilation (MV) were enrolled. Outcomes including in-hospital mortality and ventilator dependency were measured. A total of 173 non...