Extracorporeal membrane oxygenation for refractory shock in fulminant meningococcal sepsis

Champion, MichaelP.; Murdoch, IanA.; Sajjanhar, T; Marsh, MichaelJ.

doi:10.1016/s0140-6736(96)90388-8

Cited by 11 publications

(5 citation statements)

References 3 publications

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“…There has been some recent interest in the use of ECMO to treat patients with severe refractory meningococcaemia 173 , in whom escalating doses of inotropes have failed to maintain blood pressure. Good outcomes were reported using veno-arterial ECMO for 43-48 hours, but as yet convincing evidence for benefit from ECMO and the indications for its use remain to be established.…”

Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

Acute Meningococcaemia: Recent Advances in Management (with Particular Reference to Children)

Kennedy

Duncan

1996

Anaesth Intensive Care

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Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

Acute Meningococcaemia: Recent Advances in Management (with Particular Reference to Children)

Kennedy

Duncan

1996

Anaesth Intensive Care

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“…If mechanical ventilation fails, despite the use of nitric oxide and/or surfactant, extra‐corporeal membrane oxygenation (ECMO) and carbon dioxide removal may be possible. A number of units have successfully used ECMO to treat infants with refractory septic shock, 33–35 however the requirement for anticoagulation carries a significant morbidity 6,9,17 …”

Section: Ventilatory Supportmentioning

confidence: 99%

Management of septic shock in childhood

Sparrow

Willis

2004

Emergency Medicine

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“…Venoarterial extracorporeal membrane oxygenation (ECMO) providing both circulatory and respiratory support has been applied in selected circumstances to rescue nonresponders to conventional support. ECMO has been successfully used to treat infants in septic shock; [68][69][70][71] however, because of the need for anticoagulation during ECMO, the potential risk of haemorrhage is a concern.…”

Section: Extracorporeal Techniquesmentioning

confidence: 99%

Management of Sepsis and Septic Shock in Infants and Children

Rosenstiel¹,

Rosenstiel

Adam³

2001

Paediatric Drugs

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Sepsis and septic shock constitute an important cause of morbidity and mortality in critically ill children. Thus, the systemic response to infection and its management remains a major challenge in clinical medicine. Apart from antibiotic administration, the majority of available therapies are limited to supportive strategies, although considerable efforts are being undertaken to devise innovative approaches that modulate host inflammatory responses. In suspected sepsis, 2 or 3 days' empiric antibiotic therapy should begin immediately after cultures have been obtained without awaiting results. Antibiotics should be re-evaluated when the results of the cultures and susceptibility tests are available. The initial antibiotic (combination) is determined by the likely causative agent, susceptibility patterns within a specific institution, CNS penetration, toxicity, and the patient's hepatic and renal function. The likely offending micro-organism in turn depends primarily on the patient's age, coexistence of any premorbid condition leading to impaired immune response, and the presenting signs and symptoms. Close attention to cardiovascular, respiratory, fluid and electrolyte, haematological, renal and metabolic/nutritional support is essential to optimise outcome. Fluid resuscitation is of utmost importance to overcome hypovolaemia on the basis of a diffuse capillary leak. Monitoring and normalisation of the heart rate is essential. In case of nonresponse to fluid resuscitation, inotropic and vasoactive agents are commonly used to increase cardiac output, maintain adequate blood pressure and enhance oxygen delivery to the tissue. Because respiratory distress syndrome is seen in about 40% of critically ill children with septic shock, increased inspired oxygen is essential. To provide optimal relief from respiratory muscle fatigue and facilitate the provision of positive airway pressure, early intubation and mechanical ventilation should be considered. Renal support is essential to avoid prolonged renal shutdown in hypoperfusion states. Haematological support comprises replacement therapy of clotting factors to overcome disseminated intravascular coagulation. Metabolic support may include glucose support, extraction of ammonia from the body and recognition of liver dysfunction. Nutritional support may modify the inflammatory host response, and early enteral feeding can improve outcome in critical illness. To date, glucocorticoid and non-glucocorticoid anti-inflammatory agents have not shown significant benefit in septic patients.

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Extracorporeal membrane oxygenation for refractory shock in fulminant meningococcal sepsis

Cited by 11 publications

References 3 publications

Acute Meningococcaemia: Recent Advances in Management (with Particular Reference to Children)

Acute Meningococcaemia: Recent Advances in Management (with Particular Reference to Children)

Management of septic shock in childhood

Management of Sepsis and Septic Shock in Infants and Children

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