1/37. Purulent pericarditis misdiagnosed as septic shock.BACKGROUND: Septic shock is common, with approximately 200,000 cases recognized annually. This syndrome is so well characterized that when a patient is febrile and in shock, septic shock may be diagnosed without regard to alternative possibilities. Purulent pericarditis is a relatively rare disorder in which fever and hypotension are common. Classic signs and symptoms, such as chest pain, pericardial friction rub, pulsus paradoxus, and elevation of jugular venous pressure, are seen in only 50%. methods: In this report, we describe four patients in whom purulent pericarditis and pericardial tamponade was initially misdiagnosed as septic shock. During a 3-month period, three men and one woman (mean age, 44.5 years) came to Kern Medical Center with purulent pericarditis and pericardial tamponade. These cases represented 13% of patients admitted with a diagnosis of septic shock. RESULTS: All patients were bacteremic, and the classic findings of pericardial tamponade were absent or relatively subtle. Hemodynamic findings of elevated systemic vascular resistance, low cardiac output, and normal pulmonary artery occlusion pressure were critical to the diagnosis. CONCLUSIONS: Consideration of purulent pericarditis is important in cases diagnosed as septic shock. Clinicians should be aware that patients with purulent pericarditis may not exhibit classic signs and symptoms, and a high index of suspicion is necessary for appropriate management.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/37. Severe non-infectious circulatory shock related to hypopituitarism.The authors report a case of refractory non-infectious circulatory shock with catecholamine and massive fluid loading-resistant features related to hypopituitarism. A 76-year-old man was admitted for shock after suffering from gastroenteritis for 3 days. He was pale and had sparse axillary and pubic hair and small testes. Right catheterization showed shock with low preload pressure and a low oxygen extraction ratio relevant for septic shock. Ultrasound tomography revealed a distended gallbladder due to a stone without peritoneal effusion. A non-inflammatory hydrops of the gallbladder was removed surgically. No microorganism was isolated. Cerebral computed tomography (CT) scan showed a pituitary mass. In the post-surgical period the shock became uncontrollable. Cortisol replacement therapy was instituted and clinical and hemodynamic improvement occurred after 2 h. Hormonal screening on admission before catecholamine administration showed a major decrease in all the hypothalamic-pituitary hormone concentrations. The patient died on day 15 with multiple organ failure. hypopituitarism, probably owing to pituitary adenoma, was the only disease identified in this case. hormone replacement therapy dramatically improved the clinical and hemodynamic status, although the role of an abdominal sepsis could not be eliminated. Arguments that pituitary hormone deficiency might increase the hemodynamic consequences of adrenal deficiency are discussed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/37. The application of immobilized polymyxin b fiber in the treatment of septic shock associated with severe acute pancreatitis: report of two cases.The elimination of endotoxin by direct hemoperfusion over immobilized polymyxin b fiber (PMX-F) was carried out in two patients who developed septic shock associated with severe acute pancreatitis. Parameters such as blood pressure, body temperature, and plasma endotoxin level improved after PMX-F treatment, and the infected lesions were successfully and safely removed by surgery. Although an aggressive operative strategy of debridement with ultimate closure over drains is generally associated with low mortality in patients with this devastating disease, we often hesitate to perform this operation due to the poor condition of the patient in the acute period, with multiple organ failure and/or septic shock status, and also because of the difficulty in diagnosing the pancreatic infection. In this situation, endotoxin elimination using PMX-F is a useful tool for treating secondary pancreatic infections to help the patient recover in preparation for surgery, or for treating perioperative endotoxemia.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/37. hypertension-hyponatremia syndrome in neonates: case report and review of literature.hypertension hyponatremia syndrome occurred in a 32-week male neonate following septicemic shock on Day 9. The systolic blood pressure rose from 60 to 85 mmHg as the serum sodium dropped from 136 to 121 mmol/L associated with natriuresis, polyuria, and dehydration. Convulsions occurred at a systolic blood pressure of 102 mmHg. Investigations for hypertension revealed hyper-reninemia without cardio/renovascular or neuroendocrine abnormalities. Salt supplementation and antihypertensive therapy with captopril led to resolution of natriuresis and hyponatremia. review of literature revealed associated renovascular pathology in all neonatal cases of the syndrome reported so far. Renal ischemia from possible renal microthrombi may have been the triggering event in our case. Decline in renin levels during follow-up favors this hypothesis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/37. Angiotensin for septic shock unresponsive to noradrenaline.Two children with severe septic shock are reported. One had meningococcal septicaemia and the other escherichia coli septicaemia. They remained hypotensive despite high concentrations of conventional inotropes and vasopressors. In one child, using a pulmonary artery catheter, extended haemodynamic variables were measured. To restore blood pressure, in both cases, an infusion of angiotensin ii was used; there was significant improvement in clinical status, resulting in a rapid reduction in the concentration of inotropes required. Both patients successfully survived their septic episodes. angiotensin ii in cases of severe refractory septic hypotension in the paediatric population offers an extra therapeutic manoeuvre.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/37. Toxic shock syndrome following laparoscopic cholecystectomy.Toxic shock syndrome has been described in three clinical situations: pediatric abscesses; menses, especially among women using highly absorbent tampons; and after surgery. The syndrome is marked by the sudden onset of fever, a sunburn-like rash, and hypotension, and is associated with recovery of toxin-producing staphylococcus aureus, usually from small amounts of serous or seropurulent fluid. The syndrome usually begins 1 to 2 days after the procedure. To date, no cases have been reported after laparoscopic surgery. We describe a case of postoperative toxic shock syndrome in a 41-year-old woman who underwent laparoscopic cholecystectomy. She required a second operation, antimicrobial therapy, and blood pressure support and eventually recovered fully. culture of the operative bed yielded S. aureus that produced enteroxin B. Surgeons should investigate vigorously any fever and hypotension developing in the first 24 to 48 hours after laparoscopy. Toxic shock syndrome should be considered in the differential diagnosis.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/37. yersinia enterocolitica sepsis in an adolescent with Cooley's anemia.Human infections due to yersinia enterocolitica have been reported worldwide, predominantly in europe. However, there have been few reports of yersinia enterocolitica infection in taiwan. We report a case of Y. enterocolitica sepsis in a 15-year-old Taiwanese girl with Cooley's anemia and insulin-dependent diabetes mellitus. She presented at admission with fever, shock and consciousness disturbance. She had symptoms of abdominal pain, vomiting and diarrhea for three days before admission. blood pressure stabilized after intravenous normal saline rescue. Blood culture yielded Y. enterocolitica 2 days later and ceftriaxone was administered according to the results of sensitivity tests. She recovered well after a course of antibiotic treatment. Though Y. enterocolitica sepsis is rare in taiwan, clinicians should be aware of its tendency to develop in patients with Cooley's anemia, fever and enterocolitis and that its clinical course may include sepsis leading to shock.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/37. Cardiac rescue with enoximone in volume and catecholamine refractory septic shock.In December 2000 and February 2001, two children with suspected meningococcal disease were admitted to our pediatric intensive unit. Their Glasgow Meningococcal Septicaemia Prognostic score was 12 points. General treatment including antibiotics, steroids in case of meningitis, and fluid replacement, was performed. Despite appropriate volume replacement, intubation and ventilation, noradrenaline and adrenaline continuous infusions < or =1.0 microg/kg/min, and additional bolus infusions, cardiac output deteriorated within minutes in both children. calcium and bicarbonate were given without sustained effect. echocardiography demonstrated no pericardial effusion and shortening fraction was <10%. External cardiac massage had to be performed immediately in one case for electromechanical uncoupling. Both patients received a bolus of enoximone 2 mg/kg and 5 mg/kg body weight, respectively, followed by a continuous infusion of 20-23 microg/kg/min. Thereafter, both children had an adequate blood pressure and their shortening fraction increased to >30%. Within minutes, the catecholamine infusion could be reduced in both patients. The children completely recovered from their life-threatening situations. In patients with severe prolonged catecholamine and volume refractory endotoxin shock in waterhouse-friderichsen syndrome, even with electromechanical uncoupling and complete myocardial arrest, enoximone can immediately restore myocardial contractility.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/37. Terlipressin for catecholamine-resistant septic shock in children.OBJECTIVE: To report the effects of terlipressin treatment in four paediatric patients with catecholamine-resistant hypotensive septic shock. DESIGN AND SETTING: Case report in the pediatric intensive care unit of a university hospital. patients: Four children with severe septic shock and hypotension resistant to high doses of norepinephrine and other cathecolamines. INTERVENTIONS: Terlipressin was added to the standard treatment, by intravenous bolus at a dose of 0.02 mg/kg every 4 h during a maximum time of 3 days. MEASUREMENT AND RESULTS: In all cases, terlipressin induced a rapid and sustained improvement in mean arterial pressure, which allowed the lessening or even withdrawal of norepinephrine infusion. No related adverse effects were detected. CONCLUSION: Terlipressin might be considered, at least as a rescue therapy, for hypotension resistant to catecholamines in children with septic shock. Further studies are needed to confirm the beneficial effects found in our patients. The optimal administration schedule remains to be elucidated.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/37. Terlipressin as rescue therapy for intractable hypotension during neonatal septic shock.OBJECTIVE: To report the successful use of terlipressin in an 8-day-old infant for treatment of intractable hypotension caused by septic shock. DESIGN: Descriptive case report. SETTING: An 18-bed pediatric intensive care unit at a tertiary care children's hospital. Patient: An 8-day-old child with intractable hypotension due to septic shock after heart surgery. INTERVENTIONS: General supportive intensive care including mechanical ventilatory support, volume replacement, and inotropic support with dopamine 20 microg.kg(-1).min(-1), milrinone 0.75 microg.kg(-1).min(-1), and epinephrine 0.8 microg.kg(-1).min(-1). MEASUREMENTS AND MAIN RESULTS: Terlipressin (7 microg/kg per dose twice daily) was added as rescue therapy because of profound intractable hypotension. Shortly after the beginning of treatment, blood pressure and perfusion dramatically improved. CONCLUSIONS: There is circumstantial evidence that the administration of terlipressin caused the increase in blood pressure. We suggest that terlipressin should be considered as rescue therapy when high-dose catecholamine therapy does not result in sufficient perfusion pressure. Further investigation is needed to prove terlipressin's effectiveness and safety in infants and children.- - - - - - - - - - ranking = 1.5keywords = pressure (Clic here for more details about this article) |
| | Next -> |