SIRS/sepsis articles Flashcards
Inflammatory cytokine and C-reactive protein concentrations in dogs with systemic inflammatory response syndrome
Gommeren et al JVECC 2018
Dogs with SIRS had sig. elevated CRP levels and decreased during tx and hospitalization
CRP, IL-6, TNF-a can’t predict outcome
The influence of inflammation and hematocrit on clot strength in canine thromboelastographic hypercoagulability
Marschner et al JVECC 2018
HCT, CRP, and IL-8 (inflammation) associated w/ overall clot strength in hypercoagulable tracing.
Ratio between Cyt D TEG MA and standard TEG MA may reflect plt activity
Retrospective evaluation of plasma cholesterol concentration in septic dogs and its association with morbidity and mortality: 51 cases (2005–2015)
Hardy et al JVECC 2018
55% survival
Cholesterol level was not diff. b/w survivors and all nonsurvivors
Low plasma cholesterol associated w/ poor prognosis – lower in those who died despite tx vs survivor
Cut off 174 mg/dL 75% Sp 50% Sn in predicting in hospital mortality
Determining prognosis in canine sepsis by bedside measurement of cell-free DNA and nucleosomes
Letendre and Goggs jvecc 2018
In septic dogs, high cfDNA conc relative to neut count associated w/ nonsurvival
Evaluation of the placement and maintenance of central venous jugular catheters in critically ill dogs and cats
Reminga et al 2018
51% placement complication- dysrhythmias, hematoma, CVJC placement failure and malposition
Risk factor associated w/ multiple attempts: incr aged (10.5 vs 7.5y), smaller size (4 vs 8kg), lower BCS (4/9 vs 5/9)
The longer it is in place, the greater # of complications.
Indwelling complications- mechanical obstruction, skin irritation, malposition, inflammation
Risk factor of indwelling complications: longer indwelling time (5v3 days) and admin of irritant meds
A preliminary investigation into the prognostic relevance of symmetric dimethylarginine in critically ill dogs
Köster et al jvecc 2018
SDMA no diff in CI vs control, survivor vs non survivor
Retrospective evaluation of 4 methods for outcome prediction in overt disseminated intravascular coagulation in dogs (2009–2014): 804 cases
Gogg et al jvecc 2018
In-house RI system accurately predicted mortality
- modified Wiinberg using IH RI
- 3/5 parameters: aPTT, PT, fibrinogen, D-dimer and platelet count
- 72%Sn and 81% Sp
Overall DIC mortality was 63%
Comparison of biomarkers adiponectin, leptin, C-reactive protein, S100A12, and the Acute Patient Physiologic and Laboratory Evaluation (APPLE) score as mortality predictors in critically ill dogs.
Köster et al jvecc 2019
Leptin = only biomarker that correlated to APPLEcomplete
APPLEcomplete and illness <1d associated w/ outcome
APPLE highest in dogs w/ infectious, immune-mediated dz, and bite wounds
Cardiovascular biomarkers in dogs with systemic inflammatory response syndrome.
Gommeren et al jvecc 2019
“myocardial hibernation” = increased end-diastolic and end-systolic ventricular volumes, and systolic and diastolic ventricular dysfunction
-protective mechanism of the body during systemic inflammation
proBNP and cTnT increased significantly in dogs with SIRS
Nonsurvivor had higher cTnT
Postmortem evaluation of renal tubular vacuolization in critically ill dogs.
Schmid, et al jvecc 2019
RTV noted in 85% of dogs and mostly localized to medullary rays
Cumulative 6% HES dose and presenting Cr sig. predictors of RTV severity
Retrospective evaluation of the route and timing of nutrition in dogs with septic peritonitis: 68 cases (2007-2016).
Kristin M Smith et al jvecc 2019
Patients receiving PN had higher % RER earlier on but had decr odds of survival and incr LOH
Dogs receiving PN were more severely ill which may have contributed to results
Clinical use of cryopoor plasma continuous rate infusion in critically ill, hypoalbuminemic dogs.
Christine A Culler, et al jvecc 2019
Pre- and post-infusion alb correlated w/ CPP rate where COP correlated w/ HES rate
Survivors younger than nonsurvivors
Successful management of persistent tachycardia using esmolol in 2 dogs with septic shock.
Beer et al jvecc 2019
Combo of esmolol + norepi can incr SV and maintain MAP, CO, and CI
Retrospective evaluation of 24 cases of gastrostomy tube usage in dogs with septic peritonitis (2009-2016).
Hansen et al jvecc 2019
75% survived to discharge
50% had complications, 33% had GT- related complications
Nonsurvivors had longer time b/w GT placement to eating and GT dwell time
Effect of peritoneal lavage on bacterial isolates in 40 dogs with confirmed septic peritonitis.
Marshall et al jvecc 2019
87.5% survival
1/3 less likely to develop MDR aerobic bacteria post-lavage
98% received appropriate ABX
Organisms: Escherichia coli, Clostridium perfringens, and Enterococcus faecalis
Evaluation of the host cytokine response in dogs with sepsis and noninfectious systemic inflammatory response syndrome.
Robert Goggs and Jo-Annie Letendre. jvecc 2019
Septic dogs had increased concentrations of HMGB-1 and inflammatory cytokines (IL-6, CXCL8, and KC-like)
Increased CCL2 concentration is a negative prognostic indicator in dogs with sepsis
Prognostic indicators in cats with septic peritonitis (2002-2015): 83 cases.
Scotti et al jvecc 2019
70% survival
Mostly GI perf (49%) rest primary SP (22%)
Higher BG = worse px
Appropriate ABX 4.4x more likely to survive
Retrospective evaluation of outpatient canine parvovirus treatment in a shelter-based low-cost urban clinic
Kimberly Perley ScB, et al jvecc 2020
83% survival with outpatient tx
Increasing # of days w/ Cx prior to tx and incr BW during tx were associated w/ survival
Hypothermia (<37C) @ presentation associated w/ nonsurvival
Identification of risk factors for recurrent secondary septic peritonitis following initial surgical treatment of secondary septic peritonitis in dogs
Fink et al 2020 jvecc
10% had RSSP - had lower albumin and higher PCV prior to 1st sx.
Dog @ higher risk of RSSP if more likely to be GI sepsis and if d/t GIFB.
RSSP survival rate 42.9%
A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units
Galina M. Hayes BVSc, PhD, DACVS, DACVECC, et al jvecc 2020
Maintaining ICU patient:technician ratio at ≤4 to reduce errors
Clinical evaluation of hyperimmune plasma for treatment of dogs with naturally occurring parvoviral enteritis
Rachel A. Acciacca et al, jvecc 2020
HIP 10 mL/kg vs saline 10 mL/kg during first 6h then tx’d with standard protocol
HIP had lower SI @ 24h, lower plasma lactate @ 24h. No diff in LOH or mortality.
Delayed type III hypersensitivity reaction with acute kidney injury in two dogs following administration of concentrated human albumin during treatment for hypoalbuminemia secondary to septic peritonitis
Mazz et al, jvecc 2020
2 septic peritonitis dogs with delayed-type III hypersensitivity after 25% HSA
11 and 18 days after initial infusion –> inappetence, V+, lameness to urticaria, peripheral angioedema, petechiae; both developed azotemia, hypoAlb, proteinuria
Histopath = immune complex deposit and vasculitis
Noise levels in an academic veterinary intensive care unit
Dornbusch et al jvecc 2020
Average decibel level is 77 – higher than WHO recommended levels
Loudest 6-9a and 6-9p
Prognostic value of dyslipidemia for sick dogs hospitalized in the intensive care unit of a veterinary teaching hospital
Austin K. Viall et al, javma 2018
Hypocholesterolemia and hypertriglyceridemia, alone or in combination were negative prognostic indicators for survival of dogs
Evaluation of serum cortisol concentration as a prognostic indicator for nonsurvival to hospital discharge in critically ill dogs
Harry Swales, et al javma 2020
Nonsurvivor had higher serum cortisol (8.5 vs 4.5) – cutoff at 7.6
Multifactorial cause in incr SC: incr activity of HPA, incr catecholamine release, proinflammatory cytokines, ACTH-independent adrenal steroidogenesis
Prognostic value of serum total thyroxine concentration at admission to an intensive care unit for critically ill dogs
Dana J. Neiman et al javma 2020
No sig. association b/w serum TT4 and survival to discharge or LOH
Older dogs less likely to survive than young dogs
Evaluation of a new chest physiotherapy technique in dogs with airway fluid accumulation hospitalized in an intensive care unit
Céline Pouzot-Nevoret et al, jvecc 2018
Prolonged slow expiration (PSE): manual compression of thorax aimed at achieving distal airway flow limitation at low lung volume to facilitate lung clearance
Assisted cough (AC)- brief pressure applied to trachea to facilitate large airway clearance
No sig. in SpO2 before or after CP session
No different in survival b/w group
Well tolerated w/ minimal discomfort
Incidence of hypochloremic metabolic alkalosis in dogs and cats with and without nasogastric tubes over a period of up to 36 hours in the intensive care unit
Annie Chih et al jvecc 2018
Intermittent NGT aspiration was not associated w/ development of HCMA up to 36h post placement
Evaluation of serum 25-hydroxyvitamin D (25-OH-D) concentrations in a heterogeneous canine ICU population.
Dava M Cazzolli et al jvecc 2019
25-OH-D = Calcifediol
Low level found in 25% of CI dogs and esp. in nonsurvivors
Weak correlation b/w 25-OH-D to APPLEfast, albumin,
Immune Function in Critically Ill Dogs
D. Hoffman et al jvim 2018
Evaluated constitutive + LPS induced TNF-a, IL-6 and IL-10 production, phagocytosis of E. coli and resp burst capacity
CI have immune dysfunction- reduced respiratory burst function and cytokine production despite upregulation of TLR-4
Use of 2-dimensional speckle-tracking echocardiography to assess left ventricular systolic function in dogs with systemic inflammatory response syndrome.
Andrea Corda, jvim 2019
SIRS dog had lower ejection fraction, compared to healthy dog
Evaluation of plasma angiopoietin-2 and vascular endothelial growth factor in healthy dogs and dogs with systemic inflammatory response syndrome or sepsis.
Maya König, et al jvim 2019
Ang-2 and VEGF are regulator of endothelial permeability
Found that Ang-2 was higher in SIRS and septic dogs, higher in non-survivor, predicted -ve outcome reasonably (AUC 0.75)
-cutoff plasma concentration of 25.3 ng/mL
Plasma VEGF higher in septic than SIRS dog, and higher in non-survivor, poor ability to predict -ve outcome
Serum procalcitonin concentrations in dogs with induced endotoxemia
Frankie Easley et al jvim 2020
PCT increased after experimentally induced sepsis
Why? Incr CALC-I gene expression and incr PCT production by extra-thyroidal tissues
Serum D‐lactate concentrations in dogs with parvoviral enteritis
Emilee C. Venn et al jvim 2020
D-lactate higher in dogs w/ CPV compared to healthy control
NEJM 2018
Adjunctive glucocorticoid therapy in patients with septic shock
hydrocortisone CRI didn’t lower 90d mortality compared to placebo in septic shock patients undergoing MV
NEJM 2018
CRIC-TRIGGERSEP: Hydrocortisone + fludrocortisone for adults with septic shock
90d all cause mortality lower in those who received hydrocortisone + fludrocortisone than placebo
SPICE III: Early Sedation with Dexmedetomidine in Critically Ill Patients.
NEJM 2019
For those undergoing MV, those who received early dexmed had similar 90d mortality than those who didn’t
More adverse event in dexmed group (bradycardia, hypotension)
CCM 2019
Renal Outcomes of Vasopressin and Its Analogs in Distributive Shock: A Systematic Review and Meta-Analysis of Randomized Trials.
Use of vasopressin or its analogue associated w/ reduced need for RRT and AKI incidence
Highly biased
CCM 2019
Vasopressin Versus Norepinephrine for the Management of Septic Shock in Cancer Patients: The VANCS II Randomized Clinical Trial.
Ludhmila Abrahão Hajjar et al
In cancer patients with septic shock, vasopressin as first-line vasopressor therapy was not superior to norepinephrine in reducing 28-day mortality rate.
CCM 2019
Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock.
Failure to reach 30by3 was associated with increased odds of in-hospital mortality, irrespective of comorbidities
Predictors of inadequate resuscitation: elderly, obese, end-stage renal dz, heart dz, or documented volume overload
CCM 2019
The Restrictive IV Fluid Trial in Severe Sepsis and Septic Shock (RIFTS): A Randomized Pilot Study.
restrictive <60 mL/kg IV
restrictive therapy can reduce the amount of IVF given
small sample size but no diff in mortality, organ failure or adverse effects
CCM 2020
Beneficial Effects of Vasopressin Compared With Norepinephrine on Renal Perfusion, Oxygenation, and Function in Experimental Septic Acute Kidney Injury
Using vasopressin had more sustained improvement in renal function w/o worsening renal ischemia, hypoxia, or reducing mesenteric BF compared to norepi
