INTRODUCTION Mechanisms underlying inotropic failure in septic shock are incompletely understood. We previously identified the presence of exosomes in the plasma of septic shock patients. These exosomes are released mainly by platelets, produce superoxide, and induce apoptosis in vascular cells by a redox-dependent pathway. We hypothesized that circulating platelet-derived exosomes could contri...

DESIGN The objectives were to characterize the prognostic factors and evaluate the impact of inappropriate empiric antibiotic treatment and systemic response on the outcome of critically ill patients with community-acquired bloodstream infection (BSI). PATIENTS A prospective, multicenter, observational study was carried out in 339 patients admitted in 30 ICUs for BSI. RESULTS Crude mortalit...

BACKGROUND/AIMS Acute kidney injury (AKI) during septic shock, which is one of the most common clinical syndromes in the intensive care unit (ICU), has a high mortality rate and poor prognosis, partly because of a poor understanding of the pathogenesis of renal dysfunction during septic shock. Although ischemic injury of the kidney has been reported to result from adenosine triphosphate (ATP) d...

Abnormal oxygen utilisation is one of the features of septic shock. Some studies have observed that patients that survive septic shock tend to have higher cardiac output and oxygen delivery compared to those that do not. It has been proposed that higher than normal (or "supra-normal") levels of cardiac output and oxygen deliver should be the goal in the management of septic shock. However, rand...

One of the rationales for the use of vasopressin in septic shock has been its potential cardioprotective mechanisms. Lower heart rates, higher arterial pressures, and fewer norepinephrine doses during vasopressin therapy were hypothesized to protect the heart from myocardial ischemia. In a prospective sub-study of the VASST (Vasopressin in Septic Shock Trial) project, Mehta and colleagues speci...

Methods This study adopted retrospective analysis. As the basis for management of septic shock, 13 main elements were combined as the management bundle of septic shock, which contained antibiotics followed culture sampling, standard precaution, infusion therapy adjusted with echocardiogram, early goal-directed original infusion methods, lactate clearance, open lung strategy, analgesia and sedat...

Despite advances in antimicrobial therapy and medical support, septic shock remains a leading cause of death. Emerging adjunctive therapy for septic shock can be divided into those directed against bacterial components, those directed against host-derived inflammatory-mediators and those designed to limit tissue damage. All trials of new adjunctive therapies for sepsis and septic shock conducte...

PURPOSE OF THE REVIEW Vasopressin is one of the most important endogenously released stress hormones during shock. In this review, studies published in the past year that add to our understanding of the use of vasopressin in the ICU are discussed. RECENT FINDINGS Endogenous vasopressin levels are inappropriately low in adults with severe sepsis but not in children with meningococcal septic sh...