Endotoxic Septic Shock: Diagnosis and Treatment DOI Open Access

Debra Foster,

John A. Kellum

International Journal of Molecular Sciences, Journal Year: 2023, Volume and Issue: 24(22), P. 16185 - 16185

Published: Nov. 10, 2023

Endotoxin, also referred to as lipopolysaccharide (LPS), is a potent stimulator of the inflammatory cascade which may progress sepsis and septic shock. The term endotoxic shock has been used for patients who have clinical phenotype that characterized by high endotoxin activity in addition burden organ failure; especially pattern failure including hepatic dysfunction, acute kidney injury, various forms endothelial dysfunction. Endotoxic target drug therapy decades with no success. A likely barrier their success was inability quantify bloodstream. Endotoxin Activity Assay (EAA) positioned change this landscape. In addition, medical devices using adsorptive technology an extra-corporeal circulation shown remove large quantities from Focusing on use EAA determine concentrations will allow be identified quickly these benefit most removal extracorporeal methods.

Language: Английский

Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment DOI Creative Commons

Sadudee Peerapornratana,

Carlos L. Manrique‐Caballero,

Hernando Goméz

et al.

Kidney International, Journal Year: 2019, Volume and Issue: 96(5), P. 1083 - 1099

Published: June 8, 2019

Language: Английский

Citations

1019
Management of acute kidney injury in patients with COVID-19 DOI Creative Commons
Claudio Ronco, Thiago Reis, Faeq Husain‐Syed

et al.

The Lancet Respiratory Medicine, Journal Year: 2020, Volume and Issue: 8(7), P. 738 - 742

Published: May 15, 2020

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. Most patients with COVID-19 have mild symptoms, but about 5% develop severe which can include acute respiratory distress syndrome, septic shock, and multiple organ failure. Kidney involvement is frequent, clinical presentation ranging from proteinuria to progressive kidney injury (AKI) necessitating renal replacement therapy (RRT). An understanding the pathophysiology mechanisms damage AKI in setting critical illness emerging, although further research needed identify at risk guide management strategies. As no specific treatment options exist for secondary COVID-19, intensive care largely supportive. Current approaches prevention AKI, identification potential indications use RRT sequential extracorporeal therapies, are based mainly on experience, strategies adapted empirically COVID-19. International collaborative cross-disciplinary obtain adequate evidence support current new management.

Language: Английский

Citations

616
COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup DOI Creative Commons
Mitra K. Nadim, Lui G. Forni, Ravindra L. Mehta

et al.

Nature Reviews Nephrology, Journal Year: 2020, Volume and Issue: 16(12), P. 747 - 764

Published: Oct. 15, 2020

Abstract Kidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as therapy). COVID-19-associated AKI (COVID-19 AKI) associated high mortality serves an independent risk factor for all-cause in-hospital death COVID-19. The pathophysiology mechanisms COVID-19 have not been fully elucidated seem be multifactorial, keeping other who are critically ill. Little about prevention management AKI. emergence regional ‘surges’ cases limit hospital resources, including dialysis availability supplies; thus, careful daily assessment available resources needed. In this Consensus Statement, Acute Disease Quality Initiative provides recommendations diagnosis, based on current literature. We make areas future research, which aimed at improving understanding underlying processes outcomes

Language: Английский

Citations

616
Kidney involvement in COVID-19 and rationale for extracorporeal therapies DOI Creative Commons
Claudio Ronco, Thiago Reis

Nature Reviews Nephrology, Journal Year: 2020, Volume and Issue: 16(6), P. 308 - 310

Published: April 9, 2020

The prevalence of direct kidney involvement in novel coronavirus disease (COVID-19) is low, but such a marker multiple organ dysfunction and severe disease. Here, we explore potential pathways damage discuss the rationale for extracorporeal support with various blood purification strategies patients who are critically ill COVID-19.

Language: Английский

Citations

530
Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup DOI Open Access
Alexander Zarbock, Mitra K. Nadim, Peter Pickkers

et al.

Nature Reviews Nephrology, Journal Year: 2023, Volume and Issue: 19(6), P. 401 - 417

Published: Feb. 23, 2023

Language: Английский

Citations

298
Prognostic and predictive enrichment in sepsis DOI Open Access
Natalja L. Stanski, Hector R. Wong

Nature Reviews Nephrology, Journal Year: 2019, Volume and Issue: 16(1), P. 20 - 31

Published: Sept. 11, 2019

Language: Английский

Citations

265
Sepsis—Pathophysiology and Therapeutic Concepts DOI Creative Commons
Dominik Jarczak, Stefan Kluge, Axel Nierhaus

et al.

Frontiers in Medicine, Journal Year: 2021, Volume and Issue: 8

Published: May 14, 2021

Sepsis is a life-threatening condition and global disease burden. Today, the heterogeneous syndrome defined as severe organ dysfunction caused by dysregulated host response to infection, with renewed emphasis on immune pathophysiology. Despite all efforts of experimental clinical research during last three decades, ability positively influence course outcome remains limited. Evidence-based therapy still consists basic causal supportive measures, while adjuvant interventions such blood purification or targeted immunotherapy largely remain without proof effectiveness so far. With this review, we aim provide an overview sepsis pathophysiology, update choice therapeutic approaches targeting different immunological mechanisms in septic shock, call for paradigm shift from pathogen potentially more promising angle.

Language: Английский

Citations

260
Signaling pathways and intervention therapies in sepsis DOI Creative Commons
Yunyu Zhang, Botao Ning

Signal Transduction and Targeted Therapy, Journal Year: 2021, Volume and Issue: 6(1)

Published: Nov. 25, 2021

Abstract Sepsis is defined as life-threatening organ dysfunction caused by dysregulated host systemic inflammatory and immune response to infection. Over decades, advanced understanding of host–microorganism interaction has gradually unmasked the genuine nature sepsis, guiding toward new definition novel therapeutic approaches. Diverse clinical manifestations outcomes among infectious patients have suggested heterogeneity immunopathology, while responses deteriorating function observed in critically ill imply extensively hyperactivated cascades defense system. From focusing on microorganism pathogenicity, research interests turned molecular basis responses. Though progress been made regarding recognition management incidence mortality rate remain high. Furthermore, trials therapeutics failed obtain promising results. As far we know, there was no systematic review addressing sepsis-related signaling pathways intervention therapy literature. Increasing studies succeeded confirm functions involved comment efficacy therapies amid sepsis. However, few these attempt elucidate underlining mechanism progression other integrate preliminary findings describe a broader view. This focuses important pathways, potential mechanism, pathway-associated Host-derived molecules interacting with activated cells possess pivotal role for sepsis pathogenesis dynamic regulation pathways. Cross-talk are also discussed detail. Lastly, strategies precisely targeting mentioned.

Language: Английский

Citations

191
Extracorporeal Blood Purification Therapies for Sepsis DOI Creative Commons
Céline Monard, Thomas Rimmelé, Claudio Ronco

et al.

Blood Purification, Journal Year: 2019, Volume and Issue: 47(Suppl. 3), P. 2 - 15

Published: Jan. 1, 2019

Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of immune system, which known to induce organ dysfunctions. Different therapies have been developed address certain steps dysregulation. Most available devices focus on a single target, such endotoxin that triggers cascade, or cytokine storm causes damages. However, highly adsorptive membrane named oXiris® unique 4-in-1 device combines and removal properties, renal replacement function, antithrombogenic properties. More recently, promising treatments pathogen itself cells are currently under investigation. In this review, we aim summarize, according their different extracorporeal techniques already use. We will also briefly introduce most recent still development. Because its ability remove both endotoxins cytokines, particularly discuss preheparinized membrane. present advantages, pitfalls, well therapeutic perspectives based experimental clinical data. Video Journal Club “Cappuccino with Claudio Ronco” https://www.karger.com/Journal/ArticleNews/223997?sponsor=52

Language: Английский

Citations

163
Prescription of CRRT: a pathway to optimize therapy DOI Creative Commons
Ayman Karkar, Claudio Ronco

Annals of Intensive Care, Journal Year: 2020, Volume and Issue: 10(1)

Published: March 6, 2020

Abstract Severe acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression to chronic disease (CKD), financial burden, and high mortality rate. Continuous renal replacement therapy (CRRT) a predominant form of (RRT) in the intensive care unit (ICU) due its accurate volume control, steady acid–base electrolyte correction, achievement hemodynamic stability. This manuscript reviews different aspects CRRT prescription critically ill patients severe AKI, multiorgan failure ICU. These include choice versus Intermittent extended hemodialysis (HD), life filter/dialyzer including assessment filtration fraction, anticoagulation regional citrate (RCA), prescribed delivered dose, vascular access management, timing initiation termination CRRT, AKI/sepsis adsorptive methods removing endotoxins cytokines.

Language: Английский

Citations

150