The Nonspecific Pulmonary Inflammatory Reactions Leading to Respiratory Failure After Shock, Gangrene, and Sepsis

Clowers, George H. A.; Zuschneid, Wilhelm; Dragacevic, Slobodan; Turner, Murdo

doi:10.1097/00005373-196809000-00040

Cited by 33 publications

(5 citation statements)

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“…We could not determine if it led to lung or diaphragm injury, distress, and ultimately intubation or if hypotension and distress were caused by the patient's illness. 13,14 Breathing frequency, heart rate, and S pO 2 explained only a small part of the variability of distress. This suggests that the physicians relied heavily on other observations such as the subjects' facial expressions and use of accessory muscles.…”

Section: Discussionmentioning

confidence: 97%

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Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

et al. 2014

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BACKGROUND: When deciding whether mechanical ventilation is indicated, physicians integrate their findings on physical examination in a gestalt known as respiratory distress. Despite its importance, this gestalt is poorly understood. This study aims to describe the association between the rating of the severity of respiratory distress and vital signs, severity of illness, use of mechanical ventilation, and death. A prospective observational study with 1,134 consecutive subjects with uncertain triage evaluated by a critical care consult team was carried out in a public inner city teaching hospital. METHODS: After the initial evaluation of each patient, a critical care physician rated the level of respiratory distress. We recorded vital signs, diagnosis, and laboratory results and calculated the Acute Physiology and Chronic Health Evaluation (APACHE) II score. We recorded if mechanical ventilation was initiated by 72 h and if the subject died during the hospitalization. RESULTS: The most common diagnoses were respiratory illnesses. Higher distress levels were associated with higher breathing frequency (20, 22, 27, and 30 breaths/min, P < .001) and heart rate (96, 101, 109, and 116 beats/min, P < .001) and lower S pO 2 (97, 95, 93, and 92%, P < .001). These variables explain only a small portion of the variance of distress. Distress correlated weakly with the APACHE II score (r ‫؍‬ 0.22, P ‫؍‬ .001). Blood pressure, temperature, Glasgow coma scale score, and laboratory data were unrelated to the levels of distress. However, higher levels of distress correlated with intubation rates (5, 13, 27, and 41%, P < .001). The area under the receiver operating characteristic curve for respiratory distress predicting intubation (0.72) was larger than that for breathing frequency (0.65). Distress was an independent predictor of intubation but not of death. CONCLUSIONS: A physician's rating of respiratory distress is independently predictive of intubation in 72 h. Vital signs explain only a small proportion of variance in distress; the other observations contributing to a physician's rating of distress must be determined.

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Section: Discussionmentioning

confidence: 97%

“…[12][13][14][15] We excluded patients with impending intubation because the evaluating physician could have been postponing an inevitable intubation until circumstances were optimal. This criterion allowed us to include subjects with a wide range of diagnoses whose course was uncertain.…”

Section: Subjectsmentioning

confidence: 99%

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

et al. 2014

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“…Accordingly, epirubicin does not normalise the serological markers of organ lesion in Atm -/mice or decrease the levels of inflammatory mediators. The lung is not only the most common site of infection leading to sepsis but also respiratory dysfunction/failure (independently of where the infection originated) occurs often, at a very early stage in the pathophysiology of sepsis [35][36][37][38] and can possibly initiate a cascade of events leading to multiple organ failure that carries a very high mortality rate [39]. Interestingly, key molecular steps of sepsis protection induced by epirubicin, including the activation of DNA damage responses and autophagy pathways, take place in the lung [18,40].…”

Section: Tolerance As An Emerging Defence Strategymentioning

confidence: 99%

Sepsis: the need for tolerance not complacency

et al. 2016

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Sepsis is a life-threatening condition that arises as a systemic inflammatory response syndrome to an infection. Its uncontrolled progression can in frequent cases lead to multiple organ failure, which is still associated with high mortality rates. Modern antibiotics made clear that the infection is only an initiating, and not always necessary, event of this syndrome as many patients with sepsis die despite effective eradication of the inciting pathogen. This observation critically contributed to a paradigm shift that focused the pathogenesis of sepsis on the host and not on the pathogen. However, therapeutic strategies based on the inhibition of proinflammatory critical mediators of sepsis or immunostimulation have so far failed to improve sepsis outcome and, therefore, this condition urgently needs transformative therapeutic ideas and strategies. Here we argue that the induction of tolerance, a defence strategy that minimises the impact of an infection on organ function without directly affecting the pathogen burden, is perhaps the missing but essential element to add to the current components of sepsis care and treatment.

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“…,32 133 200 Είδικώτερον ή χορήγησις μεγάλων «φαρμακολογικών» δόσεων συνθετικών γλυκοκορτικοστεροειδών έπί τής καταπληξίας, ύπεστηρίχθη κατά τά τελευταία έτη, πολλαί δέ κλινικοί καί πειραματικοί μελέται διαπραγματεύονται τους πιθα νούς μηχανισμούς δράσεως αυτών,. 35 125 133 ,43 151 ,77 178 193 ' Η ευνοϊκή έπίδράσις τών συνθετικών γλυκοκορτικοστεροειδών έπί τής σηπτικής καί καρδιογενοϋς καταπληξίας είναι σήμερον γενικώς παραδεκτή. Ταύτα χορηγούνται ουχί ώς θεραπεία υποκαταστάσεως -καθ' οσον δέν μειοΰται ή παραγωγή τών κορτικοστεροειδών, άλλα τουναντίον, αυξάνει έπί καταπληξίας, 105 ,42 ' 43 -άλλα διά τάς φαρμακολογικός των ιδιότητας.…”

Section: εισαγωγηunclassified

“…65 75 96 216 Προσέτι ή δυνατότης μετρήσεως διά διαφόρων ραδιενεργών ισοτόπων τών διαμερισμάτων τοΰ αρδευτικού συστήματος τοϋ οργα νισμού οδηγεί εις τήν άμεσον άντίληψιν τών προκαλουμένων διαταραχών έκ της επιδράσεως τοϋ όλιγαιμικοϋ επεισοδίου. 183 Οϋτω, τό έξωκυττάριον ύγρόν μετράται τη βοήθεια σεσημασμένου θειϊκοΰ ανιόντος (S 35 ), τά ερυθρά αιμοσφαίρια διά σημάνσεως των μέ (Cr 51 ), τό δέ πλάσμα τοΰ αίματος διά σημάνσεως της λευκωματίνης αύτοϋ μέ (Γ 31 ) ή (Γ 25 ). 144 Ή μέτρησις διά μικροηλεκτροδίων της μεταβολής του δυναμικού της μεμβράνης (PD) τών κυττάρων τών σκελετικών μυών, άποτελεΤ εύαίσθητον δείκτην της κυτταρικής λειτουργίας αυτών, έπί μεθαιμορραγικής καταπληξίας.…”

Section: η επιδρασις της μεθαιμορραγικης καταπληξιας επι των σκελετικων μυωνunclassified

Η Επιδρασις Της Μεθυλπρεδνιζολονης Επι Της Μεθαιμορραγικης Καταπληξιας. (Πειραματικη Εργασια Επι Κυνων)

Αλφαρασ-Μελαινησ¹

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The Nonspecific Pulmonary Inflammatory Reactions Leading to Respiratory Failure After Shock, Gangrene, and Sepsis

Cited by 33 publications

References 0 publications

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

Sepsis: the need for tolerance not complacency

Η Επιδρασις Της Μεθυλπρεδνιζολονης Επι Της Μεθαιμορραγικης Καταπληξιας. (Πειραματικη Εργασια Επι Κυνων)

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