Deficiency of prostacyclin production in meningococcal shock.

Heyderman, Robert S.; Klein, Nigel; Shennan, Graham I.; Levin, Michael

doi:10.1136/adc.66.11.1296

Cited by 43 publications

(14 citation statements)

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“…Concentrations of protein C, protein S and antithrombin III are low in plasma [11], the endothelial production of prostacyclin is impaired [14], thrombomodulin is down-regulated on the endothelial surface [18], while procoagulant molecules such as tissue factor are increased on monocytes [27]. This leads to deposition of fibrin with histologically demonstrable widespread microthromboses [10].…”

Section: Introductionmentioning

confidence: 99%

4G/5G promoter polymorphism in the plasminogen-activator-inhibitor-1 gene in children with systemic meningococcaemia

et al. 2005

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Section: Introductionmentioning

confidence: 99%

4G/5G promoter polymorphism in the plasminogen-activator-inhibitor-1 gene in children with systemic meningococcaemia

et al. 2005

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“…A milrinona ou a amrinona pode ser usada por causa de suas propriedades vasodilatadoras em pacientes com sín-drome de baixo débito resistente a nitrovasodilatadores ou com toxicidade associada a nitrovasodilatadores (toxicidade ao cianeto ou isotiacianato a partir do nitroprussiato ou à metemoglobina a partir da nitroglicerina) 20,62,63 . Outros vasodilatadores utilizados e citados no tratamento de choque séptico neonatal e pediátrico incluem prostaciclina, fentolamina, pentoxifilina e dopexamina [120][121][122][123] .…”

Section: Terapia Vasodilatadoraunclassified

Parâmetros de prática clínica para suporte hemodinâmico a pacientes pediátricos e neonatais em choque séptico

Carcillo¹,

Fields²

2002

J. Pediatr. (Rio J.)

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Background: the Institute of Medicine has called for the development of clinical guidelines and practice parameters to develop "best practice" and potentially improve patient outcome. Objective: to provide American College of Critical CareMedicine clinical guidelines for hemodynamic support of neonates and children with septic shock. Setting: individual members of the Society of Critical CareMedicine with special interest in neonatal and pediatric septic shock were identified from literature review and general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (1998-2001).Methods: the Medline literature database was searched with the following age specific keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, and extracorporeal membrane oxygenation. More than 30 experts graded literature and drafted specific recommendations by using a modified Delphi method. More than 30 more experts then reviewed the compiled recommendations. The task force chairman modified the document until <10% of experts disagreed with the recommendations.Results: only four randomized controlled trials in children with septic shock could be identified. None of these randomized trials led to a change in practice. Clinical practice has been based, for the most part, on physiologic experiments, case series, and cohort studies. Despite relatively low American College of Critical Care Medicinegraded evidence in the pediatric literature, outcomes in children have improved from 97% mortality in the 1960s to 60% in the 1980s and 9% mortality in 1999. U.S. hospital survival was three fold better in children compared with adults (9% vs. 27% mortality) in 1999. Shock pathophysiology and response to therapies is age specific. For example, cardiac failure is a predominant cause of death in neonates and children, but vascular failure is a predominant cause of death in adults. Inotropes, vasodilators (children), inhaled nitric oxide ResumoIntrodução: o Institute of Medicine requisitou o desenvolvimento de diretrizes e parâmetros de prática clínica para promoção da "melhor prática", a fim de melhorar potencialmente a evolução de pacientes. (neonates), and extracorporeal membrane oxygenation can be more important contributors to survival in the pediatric populations, whereas vasopressors can be more important contributors to adult survival. Objetivo: fornecer ao Conclusion:American College of Critical Care Medicine adult guide lines for hemodynamic support of septic shock have little application to the management of pediatric or neonatal septic shock. Studies are required to determine whether American College of Critical Care Medicine guidelines for hemodynamic support of pediatric and neonatal septic shock will be implemented and associated with improved outcome.J Pediatr (Rio J) 2002;78(6):449-66: hemodynamic support, septic shock, sepsis, persisten pulmonary hypertension, nitric oxide.

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“…Epoprostenol, a vasodilating prostaglandin, is a logical choice since epithelium treated with meningococcal endotoxin is deficient in prostacyclin. [133] Prostacyclin also inhibits platelet adhesion and could prevent the micro-thrombi found in patients with meningococcal disease. Although epoprostenol has been shown to be beneficial in adults with septic shock, [134] no trials of its use in patients with meningococcal disease have been performed, although it is widely used.…”

Section: Epoprostenol (Prostacyclin)mentioning

confidence: 99%

Recognition, Treatment and Complications of Meningococcal Disease

Riordan

Thomson

1999

Pediatric Drugs

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Meningococcal disease remains a major cause of death in young children. A decrease in mortality requires recognition and treatment of the disease at a number of stages in the illness. Life-threatening meningococcal disease usually presents as septicaemia rather than meningitis. The cardinal feature of meningococcal septicaemia is the purpuric rash. Many parents recognise the rash and seek medical advice because of it. When primary care physicians recognise the rash, the administration of parenteral penicillin may decrease mortality. However, antibacterials are not given promptly if there is no rash or if the disease presents in an atypical form. In hospital, antibacterial therapy with a third-generation cephalosporin should be given. Disease severity needs to be assessed by a valid method, such as the Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS). This can identify those patients who need intensive care and/or might benefit from new therapies. The 2 life-threatening complications are septic shock and meningoencephalitis with raised intracranial pressure. Despite numerous case reports of success with potential new treatments, none has been proven safe and/or effective by controlled trials. Although it is tempting to focus on new treatments, the early recognition of severe meningococcal disease by parents, primary care physicians and junior hospital doctors is equally, if not more, important as a potential means of decreasing mortality.

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Deficiency of prostacyclin production in meningococcal shock.

Cited by 43 publications

References 13 publications

4G/5G promoter polymorphism in the plasminogen-activator-inhibitor-1 gene in children with systemic meningococcaemia

4G/5G promoter polymorphism in the plasminogen-activator-inhibitor-1 gene in children with systemic meningococcaemia

Parâmetros de prática clínica para suporte hemodinâmico a pacientes pediátricos e neonatais em choque séptico

Recognition, Treatment and Complications of Meningococcal Disease

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