Use of noninvasive measurement of the indocyanine green plasma disappearance rate in patients with septic shock.

OBJECTIVE: Our aim was to analyse the relation between serial values of the indocyanine green plasma disappearance rate (ICG-PDR) with hospital mortality in the first 48 hours of ICU admission in patients with septic shock. METHODS: A prospective observational study was carried out over 12 months of patients admitted to the ICU with septic shock. Each patient underwent noninvasive determination of ICG-PDR at 24 and 48 hours with the LiMON® module. Follow-up was performed until hospital discharge or exitus. RESULTS: 63 patients. Age 61.1±12.3 years. 60.3% men. SOFA score on admission 8.7±3.3, APACHE II score was 27.9±10.7 points. A total of 44.4% of patients died. The ICG-PDR values in the first 24 hours of ICU admission were lower in nonsurvivors: 10.5 (5.7-13.0)%/min vs. 15.9 (11.4-28.0)%/min, p <0.001. Furthermore, in nonsurvivors, there was no improvement in ICG-PDR between 24 h and 48 h, while in survivors, there was an increase of 25%: 15.9 (11.4-28.0)%/min and 20.9 (18.0-27.0)%/min, p=0.020. The silhouette measure of ICG-PDR cohesion and separation for the clusters analysed (nonsurvivors and survivors) was satisfactory (0.6). ICG-PDR<11.7%/min was related to in-hospital mortality, ICG-PDR> 18%/min to survival, and the interval between 11.7% and 18%/min covered a range of uncertainty. In the two-stage cluster, ICG-PDR, SOFA and APACHE II present satisfactory predictive scores 24 hours after patient admission. CONCLUSIONS: ICG-PDR in our setting is a useful clinical prognostic tool and could optimise the decision tree in patients with septic shock.

Edema pulmonar neurogénico y shock cardiogénico asociado a brote de esclerosis múltiple / Neurogenic pulmonary edema and cardiogenic shock secondary to acute multiple sclerosis exacerbation

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Nuevas alternativas terapéuticas para la sepsis grave en el paciente crítico. Revisión / New therapeutic alternatives for severe sepsis in the critical patient. A review

Introducción: La sepsis grave sigue teniendo elevadas morbilidad y mortalidad, a pesar de losesfuerzos realizados en la instauración de protocolos uniformes de actuación, debido, entreotros muchos factores, a la existencia de múltiples barreras para la implantación, así comosu tiempo de aplicación. Es por ello, que se sigue desarrollando e investigando sobre nuevasmedidas terapéuticas.Objetivo: Realizar una revisión de la literatura sobre las nuevas y futuras alternativas terapéuticasde que disponemos para el tratamiento de la sepsis en los pacientes críticos.Fuentes de datos y método de búsqueda: Se llevo a cabo una búsqueda limitada por tiempodesde 2004 hasta 2009, a través del metabuscador Trip Database en las páginas de medicinabasada en la evidencia (Cochrane Plus, National Guideline Clearinghouse, Clinical Evidence,REMI y PubMed) y base de datos de ensayos clínicos (ClinicalTrials.gov).Selección de los estudios: Se obtuvieron de la búsqueda 357 documentos, de los cuales seseleccionaron 48 que incluyen revisiones sistemáticas, metaanálisis, guías de práctica clínica,resúmenes estructurados de un artículo original y ensayos clínicos. El método empleado paraaplicar estos criterios se hizo mediante una revisión por pares.Extracción de datos: Un posterior análisis por dos revisores independientes.Conclusiones: En el periodo de estudio 2004-2009 no ha habido aportaciones con evidencia suficientecomo para realizar nuevas recomendaciones en el tratamiento de la sepsis. Aunque no seaporta la abundante evidencia que se˜nale la utilidad de estas medidas terapéuticas, probablementeel óxido nítrico inhalado, las estatinas y las inmunoglobulinas sean buenas alternativasen el tratamiento adyuvante de la sepsis. Tendremos que esperar, de todas maneras, los resultadosde los diferentes ensayos clínicos que se encuentran en marcha sobre las nuevas terapias.El futuro posiblemente podría estar en las células madre y la genoterapia (AU)

Background: Despite efforts to establish uniform protocols for the management of severe sepsis,this condition continues to have high morbidity and mortality. This is due, among other factors,to the many barriers for the development of the protocols and the application time. That iswhy new therapeutic measures are continuing to be investigated and developed.Objective: To review the literature on the new and future therapeutic alternatives available inthe management of sepsis in critically ill patients.Data source and search method: A search was made for articles consistent with evidencebasedmedicine guidelines published between 2004 and 2009 in different databases (CochranePlus Library, National Guideline Clearinghouse, Clinical Evidence, REMI and PubMed) and theNIH Clinical Trails database (ClinicalTrials.gov) using the TRIP meta-search engine.Study selection: A total of 357 documents were retrieved, selecting 48 of which included systematicreviews, meta-analyses, clinical practice guidelines, structured abstracts of originalarticles, and clinical trials. The selection criteria followed the peer review process.Data extraction: Data were extracted by two independent reviewers.Conclusions: Based on the 2004-2009 study period, sufficient evidence was not obtained tomake further recommendations on the treatment of sepsis. Although the abundant evidenceneeded to suggest the utility of these therapeutic measures, inhaled nitric oxide, statins, andimmunoglobulins are probably good options for the adjuvant treatment of sepsis. However, wemust wait for the results of different ongoing clinical trials on new treatment modalities. Stemcells and gene therapy will probably emerge as novel therapies in the future (AU)

[New therapeutic alternatives for severe sepsis in the critical patient. A review]. / Nuevas alternativas terapéuticas para la sepsis grave en el paciente crítico. Revisión.

BACKGROUND: Despite efforts to establish uniform protocols for the management of severe sepsis, this condition continues to have high morbidity and mortality. This is due, among other factors, to the many barriers for the development of the protocols and the application time. That is why new therapeutic measures are continuing to be investigated and developed. OBJECTIVE: To review the literature on the new and future therapeutic alternatives available in the management of sepsis in critically ill patients. DATA SOURCE AND SEARCH METHOD: A search was made for articles consistent with evidence- based medicine guidelines published between 2004 and 2009 in different databases (Cochrane Plus Library, National Guideline Clearinghouse, Clinical Evidence, REMI and PubMed) and the NIH Clinical Trails database (ClinicalTrials.gov) using the TRIP meta-search engine. STUDY SELECTION: A total of 357 documents were retrieved, selecting 48 of which included systematic reviews, meta-analyses, clinical practice guidelines, structured abstracts of original articles, and clinical trials. The selection criteria followed the peer review process. DATA EXTRACTION: Data were extracted by two independent reviewers. CONCLUSIONS: Based on the 2004-2009 study period, sufficient evidence was not obtained to make further recommendations on the treatment of sepsis. Although the abundant evidence needed to suggest the utility of these therapeutic measures, inhaled nitric oxide, statins, and immunoglobulins are probably good options for the adjuvant treatment of sepsis. However, we must wait for the results of different ongoing clinical trials on new treatment modalities. Stem cells and gene therapy will probably emerge as novel therapies in the future.