• Tuberculosis and Respiratory Diseases
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• 제67권6호
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• pp.491-498
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• 2009

Severe sepsis and septic shock are major healthcare problems with high mortality, ranging from 20% to 60%, affecting millions of individuals around the world each year. The speed and appropriateness of therapy administered in the initial hours after severe sepsis develops have an important impact on the outcome. In 2004, an international guideline that the bedside clinician could use to improve the outcomes in severe cases of sepsis and septic shock was published. Several landmark studies recently demonstrated that therapeutic strategies may reduce mortality substantially. The "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock: 2008", using a new evidence-based methodology system for assessing the quality of evidence and the strength of the recommendations, was updated. The revised version is based on an updated search into 2007. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improving the outcomes of critically ill patients. We review the treatment guidelines of sepsis and septic shock.

• Tuberculosis and Respiratory Diseases
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• 제70권1호
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• pp.51-57
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• 2011

Background: Early recognition and treatment of sepsis would improve patients' outcome. But it is difficult to distinguish between sepsis and non-infectious conditions in the acute phase of clinical deterioration. We studied serum level of procalcitonin (PCT) as a method to diagnose and to evaluate sepsis. Methods: Between 1 March 2009 and 30 September 2009, 178 patients had their serum PCT tested during their clinical deterioration in the medical intensive care unit. These laboratories were evaluated, on a retrospective basis. We classified their clinical status as non-infection, local infection, sepsis, severe sepsis, and septic shock. Then, we compared their clinical status with level of PCT. Results: The number of clinical status is as follows: 18 non-infection, 33 local infection, 39 sepsis, 26 severe sepsis, and 62 septic shock patients. PCT level of non-septic group (non-infection and local infection) and septic group (sepsis, severe sepsis, septic shock) was $0.36{\pm}0.57$ ng/mL and $18.09{\pm}36.53$ ng/mL (p<0.001), respectively. Area under the curve for diagnosis of sepsis using cut-off value of PCT >0.5 ng/mL was 0.841 (p<0.001). Level of PCT as clinical status was statistically different between severe sepsis and septic shock ($^*severe$ sepsis; $4.53{\pm}6.15$ ng/mL, $^*septic$ shock $34.26{\pm}47.10$ ng/mL, $^*p$ <0.001). Conclusion: Level of PCT at clinical deterioration showed diagnostic power for septic condition. The level of PCT was statistically different between severe sepsis and septic shock.

• YAKHAK HOEJI
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• 제51권1호
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• pp.44-50
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• 2007

Acute septic shock is one of inflammatory diseases mediated by pro-inflammatory cytokines such as tumor necrosis factor (TNF)-${\alpha}$. In this study, we examined the pathological difference and mechanism of lipopolysaccharides isolated from E. coli (E-LPS) or S. abortus (S-LPS) on inducing acute septic shock in ICR mouse. All mice were died by intraperitoneal treatment of S-LPS with 0.75 mg/kg, whereas E-LPS treated with even 3 mg/kg only showed 30% of mice lethal, indicating that S-LPS may be more feasible in triggering a strong septic shock condition. The secretion pattern of TNF-${\alpha}$, a critical pro-inflammatory cytokine in septic shock condition, was also distinct between E-LPS- and S-LPS-treated groups. Thus, S-LPS strikingly increased serum level of TNF-${\alpha}$ (6 ng/ml) at 1 h, while E-LPS just displayed at 2 ng/ml level. However the interaction of S-LPS with LPS receptor toll like receptor (TLR)-4, was not stronger than that of E-LPS, according to experiments with macrophage cell line RAW264.7 cells. Thus, E-LPS rather than S-LPS strongly enhanced the production of TNF-${\alpha}$. Interestingly, S-LPS more strongly up-regulated splenocyte proliferation, compared to E-LPS group, whereas there was no difference between S- or E-LPS treated groups in proliferation of Balb/c- or C57BL/6-originated splenic lymphocytes. Therefore, our data suggest that S-LPS is a more active endotoxin and that the strong septic shock-inducing effect of S-LPS seems due to the enhancement of early TNF-${\alpha}$ production and S-LPS-sensitive lymphocyte proliferation.

• Clinical Nutrition Research
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• 제13권1호
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• pp.1-7
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• 2024

Nutritional support in critically ill patients is an essential aspect of treatment. In particular, the benefits of enteral nutrition (EN) are well recognized, and various guidelines recommend early EN within 48 hours in critically ill patients. However, there is still controversy regarding EN in critically ill patients with septic shock requiring vasopressors. Therefore, this case report aims to provide basic data for the safe and effective nutritional support in septic shock patients who require vasopressors. A 62-year-old male patient was admitted to the intensive care unit with a deep neck infection and mediastinitis that progressed to a septic condition. Mechanical ventilation was initiated after intubation due to progression of respiratory acidosis and deterioration of mental status, and severe hypotension required the initiation of norepinephrine. Due to hemodynamic instability, the patient was kept nil per os. Subsequently, trophic feeding was initiated at the time of norepinephrine dose tapering and was gradually increased to achieve 75% of the energy requirement through EN by the 7th day of enteral feeding initiation. Although there were signs of feeding intolerance during the increasing phase of EN, adjusting the rate of EN resolved the issue. This case report demonstrates the gradual progression and adherence to EN in septic shock patient requiring vasopressors, and the progression observed was relatively consistent with existing studies and guidelines. In the future, further case reports and continuous research will be deemed necessary for safe and effective nutritional support in critically ill patients with septic shock requiring vasopressors.

• Journal of Yeungnam Medical Science
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• 제35권2호
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• pp.248-252
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• 2018

Puerperal sepsis is one of the leading causes of maternal morbidity and mortality worldwide. Postpartum pelvic infections can cause various complications, including wound infections and necrotizing fasciitis. Several microorganisms are known to cause such infections; however, no study has reported on Staphylococcus caprae, a coagulase-negative staphylococcus that is isolated frequently from animals and infrequently from human specimens, as a causative agent. Here, we report a rare case of septic shock complicated by necrotizing fasciitis after a cesarean section. This is the first report of a human isolate of S. caprae in association with puerperal sepsis and necrotizing fasciitis.

• YAKHAK HOEJI
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• 제48권1호
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• pp.82-87
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• 2004

Mungbean trypsin inhibitor (MBTI) was isolated and purified from Mung bean which has been used as a galenic and traditional food. MBTI and poly(ethylene glycol) were conjugated by using water soluble carbodiimide. We evaluated the therapeutic value of the MBTI and MBTI-PEG conjugate using animal models, sublethal septic shock model in guinea pig caused by pseudomonal elastase, shock model in rat caused by lipopolysaccharide, and the vascular permeability test by using pseudomonal elastase. In two shock model in guinea p Is and in rat, hypotesion shock was inhibited by pretreatment of MBTI. And also the vascular permeability caused by pseudomonal elastase reduced by pretreatment of MBTI. Also, therapeutic value of the MBTI-PEG conjugate was evaluated by using the sublethal septic shock model caused by pseudomonal elastase. The MBTI-PEG conjugate was more effective than native MBTI against pseudomonal elastase induced septic shock in guinea pig model.

• Journal of Medicine and Life Science
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• 제17권3호
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• pp.80-85
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• 2020

Urinary tract infections are among the most common infectious diseases and are the major causes of mortality and morbidity. These diseases result in many severe hospitalizations each year. Severe sepsis and septic shock are common and life-threatening medical conditions, and large cases are associated with urinary tract infection. The medical term "severe sepsis" is defined as sepsis complicated by hypotension, organ dysfunction, and tissue hypoperfusion, whereas "septic shock" is defined as sepsis complicated either by hypotension that is refractory to fluid resuscitation or by hyperlacteremia. A recent multicenter-study in Korea reported that the rate of in-hospital mortality associated with severe sepsis and septic shock was > 34%. Among the causative diseases, urogenital tract infection showed a high correlation. Moreover, it is very important that clinicians detect severe sepsis and septic shock early and treat them properly. The principles of initial treatment include provision of sufficient hemodynamic resuscitation and early administration of appropriate antibiotic therapy to mitigate uncontrolled infection. Initial resuscitation includes the use of vasopressors and intravenous fluids, and it is a key to achieve the target of initial resuscitation. Supportive care in the intensive care unit, such as glucose control, stress ulcer prophylaxis, blood transfusion, deep vein thrombosis prophylaxis, and renal replacement therapy, is also significant. We have summarized the key components in the treatment of severe sepsis and septic shock in patients with urinary tract infection. Urologists should be aware that appropriate early treatment is necessary to prevent fatal outcomes in these patients.

• Journal of Life Science
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• 제12권5호
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• pp.528-534
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• 2002

A kypsin inhibitor was isolated and purified from Mung bean (Vigna radiata L. wilczek) which has been used as a galenic and traditional food. In addition, we evaluated the pharmacological effect of the mung bean trypsin inhibitor (MBTI) using septic shock induced guinea pig model. Purification was carried out by Sephadex G-50 gel filtration, DEAE-cellulose ion exchange chromatography, and trypsin affinity column. The molecular weight of MBTI was estimated to be about 8,000 Da by 20% SDS-PACE under reducing condition. The chemically determined partial amino acid sequences of the purified MBTI perfectly coincide with those of previously reported MBTI which is BBI type trypsin inhibito. (Bowman-birk inhibitor type). These results suggest that the purified MBTI is authentic. Hypotension shock was prevented by the pretreatment of the MBTI (10 mg/kg of the body weight) on the septic shock guinea pig model caused by psedomonal elastase.

• Tuberculosis and Respiratory Diseases
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• 제81권4호
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• pp.305-310
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• 2018

Background: Mannose-binding lectin (MBL) deficiency leads to increased susceptibility to infection. We investigated whether serial changes in MBL levels are associated with the prognosis of patients diagnosed with septic shock, and correlated with cytokine levels. Methods: We enrolled 131 patients with septic shock in the study. We analyzed the serum samples for MBL and cytokine levels at baseline and 7 days later. Samples on day 7 were available in 73 patients. Results: We divided the patients with septic shock into four groups according to serum MBL levels (< $1.3{\mu}g/mL$ or ${\geq}1.3{\mu}g/mL$) on days 1 and 7. Patients with low MBL levels on day 1 and high MBL levels on day 7 showed a favorable prognosis for 28-day survival (odds ratio, 1.96, 95% confidence interval, 1.10-2.87; p=0.087). The high MBL group on day 7 showed a significant decrease in monocyte chemoattractant protein 1, interleukin (IL)-$1{\beta}$, IL-6, IL-8, interferon-${\gamma}$, and granulocyte macrophage colony-stimulating factor levels compared with the low MBL group on day 7. Conclusion: The increase in MBL levels of patients with septic shock may suggest a favorable prognosis and attenuate pro-inflammatory and anti-inflammatory responses.

• Journal of Evidence-Based Herbal Medicine
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• 제3권1호
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• pp.35-41
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• 2010

From the roots of Angelica dahurica Bentham et Hooker (Umbelliferae), three known coumarin derivatives have been isolated and identified as 8-(2-hydroxy-3-methoxy-3-methylbutyloxy) psoralen, 5,8-di(2,3-dihydroxy-3-methylbutyloxy) psoralen, 9-[3-($\beta$-D-glucopyranosyloxy)-2-hydroxy-3-methylbutoxy]-7H-furo[3,2-g][1]benzopyran-7-one. This is the first report of the occurrence of these compounds in this plant. These three compounds were tested for activity in septic shock model. Among these compounds, 2 showed relatively strong preventive activity against septic shock.