Elevated levels of the brain-specific S100B protein are present in many septic patients and reflect the severity of SAE. [ncbi.nlm.nih.gov]

Key historical findings are presented, and the reciprocal interactions between the brain and the immune system are examined. [books.google.com]

• Multiple Organ Dysfunction Syndrome

  Central nervous system dysfunction as the first manifestation of multiple organ dysfunction syndrome in stem cell transplant patients. Bone Marrow Transplant 2000 ; 25 : 79 –83 ↵ Haire W. [ajnr.org]

  Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of Sequential Organ Failure Assessment scores in decision making. [journals.plos.org]

  Organ Damage Sepsis can evolve to multiple organ dysfunction syndrome (MODS), which has a mortality rate of between 30% and 50% (Nesseler, 2012). Damage to the vascular endothelium causes both edema and the collection of neutrophils and macrophages. [atrainceu.com]

• Acutely Ill Patient

  Vincent JL, Sakr Y, Sprung CL et al Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53 CrossRef PubMed Google Scholar 4. [link.springer.com]

  In Europe, severe sepsis affects 90.4 cases per 100 000 adult residents per year and an overall hospital mortality of 36% described in the last Sepsis Occurrence in Acutely ill Patients (SOAP) study [ 1 ]. [journals.plos.org]

• Anemia

  Transplantation was present in 46 of 49 patients (solid organ, 20; allo-BMT, 26), and 3 patients received cyclosporine for treatment of marrow disease (pure red cell aplasia, aplastic anemia). [ajnr.org]

  […] count is 3 when there is a significant risk of bleeding or If surgery or invasive procedures are planned, transfusion may occur with platelet counts ≥50,000/mm 3 (Dellinger et al., 2013b) The guidelines recommend against the use of erythropoietin for anemia [atrainceu.com]

• Pallor

  It is also worth noting that Hillary Clinton’s skin color has a certain pallor or skin discoloration which is consistent with sepsis due to poor blood perfusion of the skin which again is itself is due to the plunging blood pressure. http://www.medicinenet.com [thehayride.com]

• Hyperthermia

  BBB damage may be numbered among the contributors of SAE, which aetiology is certainly multifactorial: an interplay between the toxic mediators involved in sepsis and the indirect effects of hyperthermia, hypossia and hypoperfusion. [ncbi.nlm.nih.gov]

• Labored Breathing

  Thus, septic patients often have tachypnea, labored breathing, crackles on auscultation, hypoxemia, and hypercapnia. If ARDS develops, a chest film usually shows diffuse bilateral pulmonary infiltrates. [atrainceu.com]

• Dyspnea

  Ask a septic patient about chest pain, dyspnea, and productive cough. Be alert to tachypnea. [atrainceu.com]

• Hypotension

  Hypotension This is perhaps the most straightforward clinical feature. All EPs are acutely aware of hypotension and will treat it aggressively. [emdocs.net]

  Blood Pressure Hypotension is a serious sign in sepsis. [atrainceu.com]

  Data on potentially modifiable contributing factors (severe hypoxia, systemic hypotension, metabolic disturbances, use of sedative agents, antibiotics and steroids) to SAE are scarce. [esicm.org]

  Taken together the evidence suggests that H 2 O 2 exerts a significant microangiopathic effect contributing to the development of microcirculatory dysfunction and the progression to refractory hypotension and fatal septic shock. [wjgnet.com]

  Blood transfusions Infection Constipation Azotemia Starvation Excess dietary protein Portosystemic shunt (iatrogenic and spontaneous) Impaired toxin clearance Dehydration due to excessive fluid restriction, excessive diuresis or paracentesis, diarrhea Hypotension [clinicaladvisor.com]

• Tachycardia

  Well if someone is at risk of going into shock, elevated pulse or tachycardia is the first indication of presyncope or of a full blown syncopal episode. [thehayride.com]

  When the shock is septic, it can also present with tachycardia, tachypnea, fever, and a high white blood cell count (Gaieski, 2013). [atrainceu.com]

  The sustained high fever, highly amplified protein synthesis, tachycardia and tachypnea characteristic of a septic immune response requires supra-physiological energy supplies. [wjgnet.com]

• Uremia

  Also known as: Hepatic stupor, hepatic coma, porto-systemic encephalopathy, hepato-cerebral encephalopathy Similar conditions: HE should be differentiated from other similar conditions such as sepsis-associated encephalopathy, uremia-induced mental status [clinicaladvisor.com]

  […] lesions, such as subdural hematoma, intracranial bleeding, stroke, tumor, and abscess Infections, such as meningitis, encephalitis, and intracranial abscess Metabolic encephalopathy, such as hypoglycemia, electrolyte imbalance, anoxia, hypercarbia, and uremia [clevelandclinicmeded.com]

• Encephalopathy

  After excluding 91 patients, 232 patients were assigned to either a sepsis-associated encephalopathy group or sepsis without encephalopathy group. [ncbi.nlm.nih.gov]

• Confusion

  Patients underwent a daily cognitive assessment with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test. RESULTS: Twenty-one patients (55%) were found to present confusion. [ncbi.nlm.nih.gov]

  It can range from slight confusion to coma and can be, although rarely, accompanied by focal neurological signs. [scitechnol.com]

  This condition can cause mild confusion to deep coma. Wernicke encephalopathy Also known as Wernicke’s disease, this condition is a result of vitamin B-1 deficiency. [healthline.com]

   Defined as brain dysfunction due to sepsis and SIRS  Also called sepsis-associated delirium  Clinically, acute impairment in the level of consciousness and confusion (manifested by alteration in attention, disorientation and concentration up to [slideshare.net]

  […] consciousness that consists of three types: Type B: HE associated with portal-systemic bypass without intrinsic hepatocellular damage Type C: HE associated with end-stage liver disease (ESLD) or cirrhosis with portal-systemic shunt HE can range from minimal confusion [clinicaladvisor.com]

• Cognitive Impairment

  Definitions CCC — Long-term cognitive impairment in critically ill patients Journal articles Ebersoldt M, Sharshar T, Annane D. [lifeinthefastlane.com]

  Moreover, sepsis survivors can suffer from long-term cognitive impairments that impact their quality of life. [clinicaltrials.gov]

  It is characterized as an acute impairment of cognition, with a fluctuating course, impaired attention, and altered level of consciousness. [alvinandassociateslnc.com]

  It is unclear, however, how much of the risk for cognitive impairment after sepsis is due to pre-existing cognitive impairment, frailty, or lingering sedation effects, he said. [mdedge.com]

  Long-term sequelae of severe sepsis: cognitive impairment and structural brain alterations - an MRI study (LossCog MRI). [link.springer.com]

• Stupor

  "The first manifestation of SAE is an acute change in mental status, ranging from inattention, disorientation, agitation, somnolence, stupor and coma," the authors write. There is no specific treatment for SAE. [news-medical.net]

  SAE can also lead to stupor and coma. This is the most common encephalopathy in the ICU. [alvinandassociateslnc.com]

  Arousable by loud voice commands, but immediately lapses into stupor without further response. MAP failed to improve with further increase in norepinephrine. CPP < 50 despite increase of ventilatory rate in an effort to decrease ICP. [rense.com]

  The overall incidence rate ratio (IRR) for seizures among sepsis survivors was about 5, but was higher for those who also had neurologic dysfunction (such as encephalopathy, delirium, coma, or stupor) during their index hospitalization than in those without [mdedge.com]

• Altered Mental Status

  Clinical features of SAE include change in mental status (altered mental status/ AMS), disturbances in mental processes, agitation, disorientation, impaired attention, hypersomnolence, delirium or coma. [clinicaltrials.gov]

  The main sign of SAE is an altered mental status. Electroencephalography is the more sensitive diagnostic test, and allows the grading of the severity of cerebral dysfunction that is related to outcome. [ncbi.nlm.nih.gov]

  Like altered mental status, and unlike lactate, tachypnea does not require a blood test. [emdocs.net]

  mental status and seizures of 1 day duration. [neurologyindia.com]

  Neurotoxicity developed 6 days after positive cultures with altered mental status and blood pressure 128/80 mm Hg. [ajnr.org]

When seizure activity must be ruled out, an EEG may be helpful in the initial workup of a patient with cirrhosis and altered mental status. EEG studies are not required to make a confident diagnosis of HE. [clevelandclinicmeded.com]

METHODS: All patients received standard goal-directed resuscitation treatment. Patients with pre-existing or acute neurological disorders were excluded. [ncbi.nlm.nih.gov]

Found useful in animal model. 20.  Experimental treatment-Magnesium, glutamate release inhibitor riluzole or an antioxidant treatment, selective antagonists of pro-inflammatory cytokine receptors  Coupled plasma filtration adsorption, an extracorporal [slideshare.net]

SAE is potentially reversible, but it always worsens the prognosis. Pathophysiology of SAE is not still completely understood, and it is probably multifactorial. [ncbi.nlm.nih.gov]

They concluded that their metabolomic model was better in early identification of bad prognosis. [journals.plos.org]

"The spectrum of septic encephalopathy: definitions, etiologies, and mortalities." Jama 275.6 (1996): 470-473. Flierl, Michael A., et al. "Pathophysiology of septic encephalopathy—an unsolved puzzle." [derangedphysiology.com]

Interestingly - in patients - elevated procalcitonin was associated with delirum in both infectious and non-infectious etiologies. [pulmccm.org]

Definitions, etiologies, and mortalities. JAMA. 1996;275(6):470–3 CrossRef PubMed Google Scholar 7. Sonneville R, Verdonk F, Rauturier C et al. Understanding brain dysfunction in sepsis. [link.springer.com]

Pathophysiology There is not a single clear etiology that accounts for the occurrence of HE. [clinicaladvisor.com]

Etiology of cortical and white matter lesions in cyclosporin-A and FK-506 neurotoxicity. AJNR Am J Neuroradiol 2001 ; 22 : 1901 –14 ↵ Schwartz RB, Bravo SM, Klufas RA, et al. [ajnr.org]

However, the incidence, epidemiology, and pathogenesis of sepsis-associated encephalopathy remain controversial. The purpose of this study was to investigate the epidemiological features and risk factors for sepsis-associated encephalopathy. [ncbi.nlm.nih.gov]

Leng, Iris (committee member) Santos, Cesar (committee member) date 2009-08-07T14:13:06Z (accessioned) 2010-06-18T19:00:03Z (accessioned) 2009-08-07T14:13:06Z (available) 2010-06-18T19:00:03Z (available) 2009-08-07T14:13:06Z (issued) degree Clinical Epidemiology [wakespace.lib.wfu.edu]

Página 93 - Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. ‎ [books.google.es]

Sanford, JP (1985) Epidemiology and overview of the problem. In: Septic Shock pp. 1–11, Root, RK, Sande, MA (Eds) Churchill Livingstone, New York. [cambridge.org]

Although the pathophysiology of SAE is incompletely understood, it is thought to involve endothelial activation, blood-brain barrier leakage, inflammatory cell migration, and neuronal loss with neurotransmitter imbalance. [ncbi.nlm.nih.gov]

Further research into the pathophysiology, management and prevention of SAE is needed. This Review discusses the epidemiology and clinical presentation of SAE. [ncbi.nlm.nih.gov]

Current philosophy in sepsis management is drifting towards reactivating surviving “dysfunctional/hibernating” cells, including immune system’s own, rather than preventing the non-reachable acute destructive wave of immune activation. [research.pasteur.fr]

Página 220 - American Thoracic Society: Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. Am J Respir Crit Care Med 1995;153:1711. ‎ [books.google.es]