Effect of treatment with low doses of hydrocortisone and fl udrocortisone on mortality in patients with septic shock.. Abnormal vascular tone, defective oxygen transport and myocardial f
Trang 122 Moine P , Abraham E Immunomodulation and sepsis: impact of the
pathogen Shock 2004 ; 22 : 297 – 308
23 Yu SL , Chen HW , Yang PC , et al Differential gene expression in
gram - negative and gram - positive sepsis Am J Respir Crit Care Med
2004 ; 169 : 1135 – 1143
24 Webb SR , Gascoigne NRJ T - cell activation by superantigens Curr
Opin Immunol 1994 ; 6 : 467 – 475
25 Pinsky MR , Matuschak GM Multiple systems organ failure: failure of host defense homeostasis Crit Care Clin 1989 ;
5 : 199 – 220
26 Sugerman HJ , Peyton JWR , Greenfi eld LJ Gram - negative sepsis
Curr Probl Surg 1981 ; 18 : 405 – 475
27 Van Bebber PT , Boekholz WKF , Goris RJ , et al Neutrophil function
and lipid peroxidation in a rat model of multiple organ failure J
Surg Res 1989 ; 47 : 471 – 475
28 Daryani R , Lalonde C , Zhu D , et al Effect of endotoxin and a burn
injury on lung and liver lipid peroxidation and catalase activity J
Trauma 1990 ; 30 : 1330 – 1334
29 Moore FA , Haenel JB , Moore EE , et al Incommensurate oxygen consumption in response to maximal oxygen availability predicts
postinjury multiple organ failure J Trauma 1992 ; 33 : 58 – 65
30 Poggetti RS , Moore FA , Moore EE , et al Liver injury is a reversible
neutrophil - mediated event following gut ischemia Arch Surg 1992 ;
127 : 175 – 179
31 Demling RH , Lalonde C , Ikegami K Physiologic support of the
septic patient Surg Clin North Am 1994 ; 74 : 637 – 658
32 Fearon DT , Ruddy S , Schur PH , et al Activation of the properdin pathway of complement in patients with gram - negative bacteremia
N Engl J Med 1975 ; 292 : 937 – 940
33 Schirmer WJ , Schirmer JM , Naff GB , et al Systemic complement activation produces hemodynamic changes characteristic of sepsis
Arch Surg 1988 ; 123 : 316 – 321
34 Tracey KJ , Lowry SF , Cerami A The pathophysiologic role of
cachectin/TNF in septic shock and cachexia Ann Institut Pasteur
Immunol 1988 ; 139 : 311 – 317
35 Hesse DG , Tracey KJ , Fong Y , et al Cytokine appearance in human
endotoxemia and primate bacteremia Surg Gynecol Obstet 1988 ;
166 : 147 – 153
36 Michie HR , Manogue KR , Spriggs DR , et al Detection of circulating
tumor necrosis factor after endotoxin administrations N Engl J Med
1988 ; 318 : 1481 – 1486
37 Michie HR , Spriggs DR , Manogue KB , et al Tumor necrosis factor and endotoxin induce similar metabolic responses in human beings
Surgery 1988 ; 104 : 280 – 286
38 Tracey KJ , Lowry SF , Fahey TJ III , et al Cachectin/tumor necrosis factor induces lethal shock and stress hormone responses in the dog
Surg Gynecol Obstet 1987 ; 164 : 415 – 422
39 Mayoral JL , Schweich CJ , Dunn DL Decreased tumor necrosis factor production during the initial stages of infection correlates
with survival during murine gram - negative sepsis Arch Surg 1990 ;
125 : 24 – 27
40 Tracey KJ , Beutler B , Lowry SF , et al Shock and tissue injury induced
by recombinant human cachectin Science 1986 ; 234 : 470 – 474
41 Remick DG , Kunkel RG , Larrick JW , et al Acute in vivo effects of
human recombinant tumor necrosis factor Lab Invest 1987 ; 56 :
583 – 590
42 Beutler B , Milsark IW , Cerami AC Passive immunization against cachectin/tumor necrosis factor protects mice from lethal effect of
endotoxin Science 1985 ; 229 : 869 – 871
2 Martin GS , Mannino DM , Eaton S , et al The epidemiology of sepsis
in the United States from 1979 through 2000 N Engl J Med 2003 ;
348 : 1546
3 Rangel - Frausto MS , Pittet D , Hwang T , Woolson RF , Wenzel RP
The dynamics of disease progression in sepsis: Markov modeling
describing the natural history and the likely impact of effective
anti-sepsis agents Clin Infect Dis 1998 ; 27 : 185 – 190
4 Centers for Disease Control and Prevention National Center for
Health Statistics Mortality Patterns – United States, 1990 Monthly
Vital Stat Rep 1993 ; 41 : 5
5 Centers for Disease Control and Prevention Progress in chronic
disease prevention Chronic disease reports: deaths from nine types
of chronic disease – United States, 1986 MMWR 1990 ; 39 : 30
6 Annane D , Aegerter P , Jars - Guincestre MC , Guidet B Current
epi-demiology of septic shock: the CUB - Rea Network Am J Respir Crit
Care Med 2003 ; 1687 : 165 – 172
7 Friedman G , Silva E , Vincent JL Has the mortality of septic shock
changed with time? Crit Care Med 1998 ; 26 : 2078 – 2086
8 Brun - Buisson C , Doyon F , Carlet J , et al Incidence, risk factors, and
outcome of severe sepsis and septic shock in adults A multicenter
prospective study in intensive care units JAMA 1995 ; 274 :
968 – 974
9 Annane D , Sebille V , Charpentier C , et al Effect of treatment with
low doses of hydrocortisone and fl udrocortisone on mortality in
patients with septic shock JAMA 2002 ; 288 : 862 – 871
10 Wheeler AP , Bernard GR Treating patients with severe sepsis N
Engl J Med 1999 ; 340 : 207 – 214
11 Gibbs CE , Locke WE Maternal deaths in Texas, 1969 to 1973 A
report of 501 consecutive maternal deaths from the Texas Medical
Association ’ s Committee on Maternal Health Am J Obstet Gynecol
1976 ; 126 : 687 – 692
12 Levy MM , Fink MP , Marshall JC , et al 2001 SCCM/ESICM/ACCP/
ATS/SIS international sepsis defi nitions conference Intens Care Med
2003 ; 29 : 530 – 538
13 Marshall JC , Cook DJ , Christou NV , et al Multiple organ
dysfunc-tion score a reliable descriptor of a complex clinical outcome Crit
Care Med 1995 ; 23 : 1638 – 1652
14 Beutler B Inferences, questions and possibilities in toll - like receptor
signaling Nature 2004 ; 430 : 257 – 263
15 Parrillo JE Pathogenetic mechanisms of septic shock N Engl J Med
1993 ; 328 : 1471 – 1477
16 Lynn WA , Cohen J Science and clinical practice: management of
septic shock J Infect 1995 ; 30 : 207 – 212
17 Kwaan HM , Weil MH Differences in the mechanism of shock
caused by infections Surg Gynecol Obstet 1969 ; 128 : 37 – 45
18 Cleary PP , Kaplan EL , Handley JP , et al Clonal basis for resurgence
of serious Streptococcus pyogenes disease in the 1980s Lancet 1992 ;
339 : 518 – 521
19 Hoadley DJ , Marck EJ Case records of the Massachusetts General
Hospital Weekly clinicopathological exercises Case 28 - 2002 A
35 - year - old long - term traveler with a rapidly progressive soft - tissue
infection N Engl J Med 2002 ; 347 : 831
20 Nathan L , Peters MT , Ahmed AM , et al The return of life -
threaten-ing puerperal sepsis caused by group A streptococci Am J Obstet
Gynecol 1993 ; 169 : 571
21 Wang JE , Dahle MK , McDonald M , Foster SJ , Aasen AO ,
Thiemermann C Peptidoglycan and lipoteichoic acid in gram -
pos-itive bacterial sepsis: receptors, signal transduction, biological
effects, and synergism Shock 2003 ; 20 : 402 – 414
Trang 265 Bone RC Sepsis syndrome: new insights into its pathogenesis and
treatment Infect Dis Clin North Am 1991 ; 5 : 793 – 805
66 Bone RC , Sibbald WJ , Sprung CL The ACCP - SCCM consensus conference on sepsis and organ failure Chest 1992 ; 101 :
1481 – 1483
67 Rangel - Frausto MS , Pittet D , Costigan M , et al The natural history
of the systemic infl ammatory response syndrome (SIRS) JAMA
1995 ; 273 : 117 – 123
68 Roman - Marchant O , Orellana - Jimenez CE , de Backer D , Melot C ,
Vincent JL Septic shock of early or late onset: does it matter? Chest
2004 ; 126 : 173 – 178
69 Parker MM , Parillo JE Septic shock: hemodynamics and
pathogen-esis JAMA 1983 ; 250 : 3324 – 3327
70 Parrillo JE , Burch C , Shelhamer JH , et al A circulating myocardial depressant substance in humans with septic shock: septic shock patients with a reduced ejection fraction have a circulating factor
that depresses in vitro myocardial cell performance J Clin Invest
1985 ; 76 : 1539
71 Marksad AK , Ona CJ , Stuart RC , et al Myocardial depression in septic shock: physiologic and metabolic effect of a plasma factor on
an isolated heart Circ Shock 1979 ; 1 (Suppl): 35
72 Porembka DT Cardiovascular abnormalities in sepsis New Horiz
1993 ; 2 : 324 – 341
73 Parker MM , Shelhamer JH , Bacharach SL , et al Profound but
reversible myocardial depression in patients with septic shock Ann
Intern Med 1984 ; 100 : 483 – 490
74 Ognibene FP , Parker MM , Natanson C , et al Depressed left ven-tricular performance: response to volume infusion in patients with
sepsis and septic shock Chest 1988 ; 93 : 903 – 910
75 Parrillo JE Cardiovascular dysfunction in septic shock: new insights
into a deadly disease Int J Cardiol 1985 ; 7 : 314
76 Lee W , Clark SL , Cotton DB , et al Septic shock during pregnancy
Am J Obstet Gynecol 1988 ; 159 : 410 – 416
77 Monif GRG , Baer H Polymicrobial bacteremia in obstetric patients
Obstet Gynecol 1976 ; 48 : 167 – 169
78 Tewari K , Wold SM , Asrat T Septic shock in pregnancy associated
with legionella pneumonia: Case report Am J Obstet Gynecol 1997 ;
176 : 706 – 707
79 Holm SE Invasive group A streptococcal infections N Engl J Med
1996 ; 335 : 590 – 591
80 Gibbs RS , Jones PM , Wilder CJ Antibiotic therapy of endometritis
following cesarean section: treatment successes and failures Obstet
Gynecol 1978 ; 52 : 31 – 37
81 Duff P Pathophysiology and management of postcesarean
endo-myometritis Obstet Gynecol 1986 ; 67 : 269 – 276
82 Balk RA , Bone RC The septic syndrome: defi nition and clinical
implications Crit Care Clin 1989 ; 5 : 1 – 8
83 Ledger WJ , Norman M , Gee C , et al Bacteremia on an obstetric
gynecologic service Am J Obstet Gynecol 1975 ; 121 : 205 – 212
84 Blanco JD , Gibbs RS , Castaneda YS Bacteremia in obstetrics: clinic
course Obstet Gynecol 1981 ; 58 : 621 – 625
85 Bryan CS , Reynolds KL , Moore EE Bacteremia in obstetrics and
gynecology Obstet Gynecol 1984 ; 64 : 155 – 158
86 Reimer LG , Reller LB Gardnerella vaginalis bacteremia: a review of
thirty cases Obstet Gynecol 1984 ; 64 : 170 – 172
87 Chow AW , Guze LB Bacteroidaceae bacteremia: clinical experience
with 112 patients Medicine 1974 ; 53 : 93 – 126
88 Lowthian JT , Gillard LJ Postpartum necrotizing fasciitis Obstet
Gynecol 1980 ; 56 : 661 – 663
43 Tracey KJ , Fong Y , Hesse DG , et al Anti - cachectin/TNF monoclonal
antibodies prevent septic shock during lethal bacteriaemia Nature
1987 ; 330 : 662 – 664
44 Yamamoto M , Takeda K , Akira S TIR domain - containing adaptors
defi ne the specifi city of TLR signaling Mol Immunol 2004 ; 40 :
861 – 868
45 Lynn WA , Golenbock DT Lipopolysaccharide antagonists Immunol
Today 1992 ; 13 : 271 – 276
46 Hageman JR , Caplan MS An introduction to the structure and
function of infl ammatory mediators for clinicians Clin Perinatol
1995 ; 22 : 251 – 261
47 Okusawa S , Gelfand JA , Ikejima T , et al Interleukin 1 induces a
shock - like state in rabbits: synergism with tumor necrosis factor and
the effect of cyclooxygenase inhibition J Clin Invest 1988 ; 81 :
1162 – 1172
48 Tabor DR , Burchett SK , Jacobs RF Enhanced production of
monokines by canine alveolar macrophages in response to endotoxin
induced shock (42681) Proc Soc Exp Biol Med 1988 ; 187 : 408 – 415
49 Jacobs RF , Tabor DR , Lary CH , et al Interleukin - 1 production by
alveolar macrophages and monocytes from ARDS and pneumonia
patients compared to controls Am Rev Respir Dis 1988 ; 137 : 228
50 Hollenberg SM , Cunnion RE Endothelial and vascular smooth
muscle function in sepsis J Crit Care 1994 ; 9 : 262 – 280
51 Sharshar T , Gray F , Lorin G , et al Apoptosis of neurons in
cardio-vascular autonomic centres triggered by inducible nitric oxide
syn-thase after death from septic shock Lancet 2003 ; 362 : 1799 – 1805
52 Dinerman JL , Lowenstein CJ , Snyder SH Molecular mechanisms of
nitric oxide regulation: potential relevance to cardiovascular disease
Circ Res 1993 ; 73 : 217 – 222
53 Hack CE , Zeerleder S The endothelium in sepsis: source of and a
target for infl ammation Crit Care Med 2001 ; 29 : S21 – 27
54 Sriskandan S , Cohen J Science and clinical practice: the
pathogen-esis of septic shock J Infect 1995 ; 30 : 201 – 206
55 Bonney RJ , Humes JL Physiological and pharmacological regulation
of prostaglandin and leukotriene production by macrophages J
Leukoc Biol 1984 ; 35 : 1 – 10
56 Goetzl EJ , Payan DG , Goldman DW Immunopathogenic roles of
leukotrienes in human diseases J Clin Immunol 1984 ; 4 : 79 – 84
57 Jacobs RF , Tabor DR Immune cellular interactions during sepsis
and septic injury Crit Care Clin 1989 ; 5 : 9
58 Lee W , Cotton DB , Hankins GDV , et al Management of septic shock
complicating pregnancy Obstet Gynecol Surv 1989 ; 16 : 431
59 Siegel JH , Greenspan M , del Guercio LRM Abnormal vascular tone,
defective oxygen transport and myocardial failure in human septic
shock Ann Surg 1967 ; 165 : 504 – 517
60 Sibbald WJ , Fox G , Martin C Abnormalities of vascular reactivity
in the sepsis syndrome Chest 1991 ; 100 : S155 – S159
61 Altura BM , Gebrewold A , Burton RW Failure of microscopic
meta-arterioles to elicit vasodilator responses to acetylcholine, bradykinin,
histamine and substance P after ischemic shock, endothelial cells
Microcirc Endothel Lymphat 1985 ; 2 : 121 – 127
62 Duff JH , Groves AC , McLean AP , et al Defective oxygen
consumption in septic shock Surg Gynecol Obstet 1969 ; 128 :
1051 – 1060
63 Knuppel RA , Rao PS , Cavanagh D Septic shock in obstetrics Clin
Obstet Gynecol 1984 ; 27 : 3 – 10
64 Levi M , ten Cate H , van der Poll T , et al Pathogenesis of
dissemi-nated intravascular coagulation in sepsis JAMA 1993 ; 270 :
975 – 979
Trang 3severe sepsis, regardless of causative micro - organism Crit Care
2004 ; 8 : 82 – 90
109 Shorr AF , Thomas SJ , Alkins SA , et al D - dimer correlates with proinfl ammatory cytokine levels and outcomes in critically ill
patients Chest 2002 ; 121 : 1262 – 1268
110 Nguyen HB , Rivers EP , Knoblich BP , et al Early lactate clearance is associated with improved outcome in severe sepsis and septic shock
Crit Care Med 2004 ; 32 : 1637 – 1642
111 Nguyen HB , River EP , Abrahamian FM , et al Severe sepsis and septic shock; review of the literature and emergency department
management guidelines Ann Emerg Med 2006 ; 48 : 28 – 54
112 Cockerill 3rd FR , Wilson JW , Vetter EA , et al Optimal testing
parameters for blood cultures Clin Infect Dis 2004 ; 38 : 1724 – 1730
113 Lamy B , Roy P , Carret G , et al What is the relevance of obtaining multiple blood samples for culture? A comprehensive model to
opti-mize the strategy for diagnosing bacteremia Clin Infect Dis 2002 ; 35 :
842 – 850
114 Christ - Crain M , Jaccard - Stolz D , Bingisser R , et al Effect of procal-citonin - guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster - randomised, single - blinded
intervention trial Lancet 2004 ; 363 : 600 – 607
115 Gattas DJ , Cook DJ Procalcitonin as a diagnostic test for sepsis: health technology assessment in the ICU J Crit Care 2003 ; 18 :
52 – 58
116 Colonna M , Facchetti F TREM - 1 (triggering receptor expressed on
myeloid cells): a new player in acute infl ammatory responses J Infect
Dis 2003 ; 187 : S397 – S401
117 Gibot S , Cravoisy A , Levy B , Bene MC , Faure G , Bollaert PE Soluble triggering receptor expressed on myeloid cells and the diagnosis of
pneumonia N Engl J Med 2004 ; 350 : 451 – 458
118 Gibot S , Kolopp - Sarda MN , Bene MC , et al Plasma level of a trig-gering receptor expressed on myeloid cells - 1: its diagnostic accuracy
in patients with suspected sepsis Ann Intern Med 2004 ; 141 : 9 – 15
119 Annane D , Sebille V , Troche G , Raphael JC , Gajdos P , Bellissant E
A 3 - level prognostic classifi cation in septic shock based on cortisol levels and cortisol response to corticotropin JAMA 2000 ; 283 :
1038 – 1045
120 Cooper MS , Stewart PM Corticosteroid insuffi ciency in acutely ill
patients N Engl J Med 2003 ; 348 : 727 – 734
121 Sam S , Corbridge TC , Mokhlesi B Cortisol levels and mortality in
sepsis Clin Endocrinol (Oxf) 2004 ; 60 : 29
122 Rivers E , Nguyen B , Havstad S , et al Early goal - directed therapy in
the treatment of severe sepsis and septic shock N Engl J Med 2001 ;
345 : 1368 – 1377
123 Angus DC , Linde - Zwirble WT , Lidicker J , et al Epidemiology of severe sepsis in the United States: analysis of incidence, outcome,
and associated costs of care Crit Care Med 2001 ; 29 : 1303
124 Bernard GR , Wheeler AP , Russell JA , et al The effects of ibuprofen
on the physiology and survival of patients with sepsis The Ibuprofen
in Sepsis Study Group N Engl J Med 1997 ; 336 : 912
125 Sasse KC , Nauenberg E , Long A , et al Long - term survival after
intensive care unit admission with sepsis Crit Care Med 1995 ; 23 :
1040
126 Zeni F , Freeman B , Natanson C Anti - infl ammatory therapies to
treat sepsis and septic shock: a reassessment Crit Care Med 1997 ;
25 : 1095
127 Dellinger RP , Carlet JM , Masur H , et al Surviving sepsis campaign
guidelines for management of severe sepsis and septic shock Crit
Care Med 2004 ; 32 : 858 – 873
89 Mariona FG , Ismail MA Clostridium perfringens septicemia
follow-ing cesarean section Obstet Gynecol 1980 ; 56 : 518 – 521
90 Cavanagh D , Knuppel RA , Shepherd JH , et al Septic shock and the
obstetrician/gynecologist South Med J 1982 ; 75 : 809 – 813
91 Lloyd T , Dougherty J , Karlen J Infected intrauterine pregnancy
presenting as septic shock Ann Emerg Med 1983 ; 12 : 704 – 707
92 Duff P Pyelonephritis in pregnancy Clin Obstet Gynecol 1984 ; 27 :
17 – 31
93 Cunningham FG , Lucas MJ , Hankins GD Pulmonary injury
com-plicating antepartum pyelonephritis Am J Obstet Gynecol 1987 ; 156 :
797 – 807
94 Clark SL , Cotton DB , Lee W , et al Central hemodynamic assessment
of normal term pregnancy Am J Obstet Gynecol 1989 ; 161 :
1439 – 1442
95 Rackow EC , Fein IA , Leppo J Colloid osmotic pressure as a
prog-nostic indicator of pulmonary edema and mortality in the critically
ill Chest 1977 ; 72 : 709 – 713
96 Rackow EC , Fein IA , Siegel J The relationship of the colloid
osmotic - pulmonary artery wedge pressure gradient to pulmonary
edema and mortality in critically ill patients Chest 1982 ; 82 :
433 – 437
97 Weil MH , Henning RJ , Morissette M , et al Relationship between
colloid osmotic pressure and pulmonary artery wedge pressure in
patients with acute cardiorespiratory failure Am J Med 1978 ; 64 :
643 – 650
98 Hankins G , Clark S , Uckan E Intrapulmonary shunt (QS/QT) and
position in healthy third - trimester pregnancy Am J Obstet Gynecol
1996 ; 174 : 322A
99 Weinstein MP , Murphy JR , Reller LB , et al The clinical signifi cance
of positive blood cultures: a comparative analysis of 500 episodes of
bacteremia and fungemia in adults II Clinical observations, with
special reference to factors infl uencing prognosis Rev Infect Dis
1983 ; 5 : 54 – 70
100 Freid MA , Vosti KL The importance of underlying disease in
patients with gram - negative bacteremia Arch Intern Med 1968 ; 121 :
418 – 423
101 Metcalfe J , Ueland K Maternal cardiovascular adjustments to
preg-nancy Prog Cardiovasc Dis 1974 ; 16 : 363 – 374
102 Fletcher AP , Alkjaersig NK , Burstein R The infl uence of pregnancy
upon blood coagulation and plasma fi brinolytic enzyme function
Am J Obstet Gynecol 1979 ; 134 : 743 – 751
103 Pritchard JA , MacDonald PC , Gant NF , eds Maternal adaption to
pregnancy In: Williams Obstetrics , 20th edn Norwalk, CT : Appleton
Century - Crofts , 1997
104 Beller JF , Schmidt EH , Holzgreve W , et al Septicemia during
preg-nancy: a study in different species of experimental animals Am J
Obstet Gynecol 1985 ; 151 : 967 – 975
105 Bech - Jansen P , Brinkman CR 3rd , Johnson GH , et al Circulatory
shock in pregnant sheep II: Effects of endotoxin on fetal and
neo-natal circulation Am J Obstet Gynecol 1972 ; 113 : 37 – 43
106 Morishima HO , Niemann WH , James LS Effects of endotoxin on
the pregnant baboon and fetus Am J Obstet Gynecol 1978 ; 131 :
899 – 902
107 Shoemaker WC , Montgomery ES , Kaplan E , et al Physiologic
pat-terns in surviving and nonsurviving shock patients Use of sequential
cardiorespiratory variables in defi ning criteria for therapeutic goals
and early warning of death Arch Surg 1973 ; 106 : 630 – 636
108 Kinasewitz GT , Yan SB , Basson B , et al Universal changes in
bio-markers of coagulation and infl ammation occur in patients with
Trang 4148 Bollaert PE , Bauer P , Audibert G , et al Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine - resistant
septic shock Chest 1990 ; 98 : 949 – 953
149 Desjars P , Pinaud M , Poptel G , et al A reappraisal of norepinephrine
therapy in human septic shock Crit Care Med 1987 ; 15 : 134 – 137
150 Meadows D , Edwards JD , Wilkins RG , et al Reversal of intractable
septic shock with norepinephrine therapy Crit Care Med 1988 ; 16 :
663 – 666
151 MacKenzie SJ , Kapadia F , Nimmo GR , et al Adrenaline in treatment
of septic shock: effects on hemodynamics and oxygen transport
Intens Care Med 1991 ; 17 : 36 – 39
152 Moran JL , O ’ Fathartaigh MS , Peisach AR , et al Epinephrine as an
inotropic agent in septic shock: a dose - profi le analysis Crit Care
Med 1993 ; 21 : 70
153 De Backer D , Creteur J , Silva E , et al Effects of dopamine, norepi-nephrine, and epinephrine on the splanchnic circulation in septic
shock Which is best? Crit Care Med 2003 ; 31 : 1659 – 1667
154 Martin C , Papazian L , Perrin G , et al Norepinephrine or dopamine
for the treatment of hyperdynamic septic shock? Chest 1993 ; 103 :
1826 – 1831
155 Marik PE , Mohedin M The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in
hyperdynamic sepsis JAMA 1994 ; 272 : 1354 – 1357
156 Lucas CE A new look at dopamine and norepinephrine for
hyper-dynamic septic shock Chest 1994 ; 105 : 7 – 8
157 Rolbin SH , Levinson G , Shnider DM , et al Dopamine treatment of spinal hypotension decreases uterine blood fl ow in the pregnant
ewe Anesthesiology 1979 ; 51 : 37 – 40
158 Shoemaker WC , Appel PL , Kram HB , et al Prospective trial of supranormal values of survivors as therapeutic goals in high - risk
surgical patients Chest 1988 ; 94 : 1176 – 1186
159 Shoemaker WC , Appel PL , Kram HB Role of oxygen debt in the development of organ failure sepsis, and death in high - risk surgical
patients Chest 1992 ; 102 : 208 – 215
160 Tuchschmidt J , Fried J , Astiz M , et al Elevation of cardiac output
and oxygen delivery improves outcome in septic shock Chest 1992 ;
102 : 216 – 220
161 Boyd O , Grounds RM , Bennett ED A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high - risk surgical patients JAMA 1993 ; 270 :
2699 – 2707
162 Yu M , Levy MM , Smith P , et al Effect of maximizing oxygen delivery
on morbidity and mortality rates in critically ill patients: a prospec-tive, randomized, controlled study Crit Care Med 1993 ; 21 :
830 – 838
163 Bishop MH , Shoemaker WC , Appel PL , et al Prospective, random-ized trial of survivor values of cardiac index, oxygen delivery, and
oxygen consumption as resuscitation endpoints in severe trauma J
Trauma 1995 ; 38 : 780 – 787
164 Hayes MA , Timmins AC , Yau EH , et al Elevation of systemic oxygen
delivery in the treatment of critically ill patients N Engl J Med 1994 ;
330 : 1717 – 1722
165 Gattinoni L , Brazzi L , Pelosi P , et al A trial of goal - oriented
hemo-dynamic therapy in critically ill patients N Engl J Med 1995 ; 333 :
1025 – 1032
166 Hinds C , Watson D Manipulating hemodynamic and oxygen
trans-port in critically ill patients N Engl J Med 1995 ; 333 : 1074 – 1075
167 Fiddian - Green RG , Haglund U , Gutierrez G , et al Goals for the
resuscitation of shock Crit Care Med 1993 ; 21 : S25 – S31
128 Lindeborg DM , Pearl RG Recent advances in critical care medicine:
inotropic therapy in the critically ill patient Int Anesthesiol Clin
1993 ; 31 : 49 – 71
129 Ghosh S , Latimer RD , Gray BM , et al Endotoxin - induced organ
injury Crit Care Med 1993 ; 21 : S19
130 Roberts JM , Laros RK Hemorrhagic and endotoxic shock: a
patho-physiologic approach to diagnosis and management Am J Obstet
Gynecol 1971 ; 110 : 1041 – 1049
131 Hawkins DF Management and treatment of obstetric bacteremia
shock J Clin Pathol 1980 ; 33 : 895 – 896
132 Packman MI , Rackow EC Optimum left heart fi lling pressure
during fl uid resuscitation of patients with hypovolemic and septic
shock Crit Care Med 1983 ; 11 : 165 – 169
133 Rackow EC , Falk JL , Fein IA , et al Fluid resuscitation in circulatory
shock: a comparison of the cardiorespiratory effects of albumin,
hetastarch, and saline solutions in patients with hypovolemic and
septic shock Crit Care Med 1983 ; 11 : 839 – 850
134 Kaufman BS , Rackow EC , Falk JL The relationship between oxygen
delivery and consumption during fl uid resuscitation of hypovolemic
and septic shock Chest 1984 ; 85 : 336 – 340
135 Weil MN , Nishijima H Cardiac output in bacterial shock Am J Med
1978 ; 64 : 920 – 922
136 Shippy CR , Appel PL , Shoemaker WC Reliability of clinical
moni-toring to assess blood volume in critically ill patients Crit Care Med
1984 ; 12 : 107 – 112
137 Shoemaker WC , Kram HB , Appel PL , et al The effi cacy of central
venous and pulmonary artery catheters and therapy based upon
them in reducing mortality and morbidity Arch Surg 1990 ; 125 :
1332 – 1337
138 Swan HJ , Ganz W , Forrester J , et al Catheterization of the heart in
man with use of a fl ow - directed balloon - tipped catheter N Engl J
Med 1970 ; 283 : 447 – 451
139 Cotton DB , Gonik B , Dorman K , et al Cardiovascular alterations in
severe pregnancy - induced hypertension: relationship of central
venous pressure to pulmonary capillary wedge pressure Am J Obstet
Gynecol 1985 ; 151 : 762 – 764
140 Rackow EC , Kaufman BS , Falk JL , et al Hemodynamic response
to fl uid repletion in patients with septic shock: evidence for
early depression of cardiac performance Circ Shock 1987 ; 22 :
11 – 22
141 Lewis BS , Gotsman MS Current concepts of left ventricular
relax-ation and compliance Am Heart J 1980 ; 99 : 101 – 112
142 Haupt MT , Rackow EC Colloid osmotic pressure and fl uid
resusci-tation with hetastarch, albumin, and saline solutions Crit Care Med
1982 ; 10 : 159 – 162
143 Shoemaker WC , Appel PL , Kram HB Oxygen transport
measure-ments to evaluate tissue perfusion and titrate therapy: dobutamine
and dopamine effects Crit Care Med 1991 ; 19 : 672 – 688
144 Wagner BKJ , d ’ Amelio LF Pharmacologic and clinical
consider-ations in selecting crystalloid, colloidal, and oxygen - carrying
resus-citation fl uids, part 2 Clin Pharm 1993 ; 12 : 415 – 428
145 Finfer S , Bellomo R , Boyce N , et al A comparison of albumin and
saline for fl uid resuscitation in the intensive care unit N Engl J Med
2004 ; 350 : 2247 – 2256
146 Rao PS , Cavanagh D Endotoxic shock in the primate: some effects
of dopamine administration Am J Obstet Gynecol 1982 ; 144 :
61 – 66
147 Goldberg LI Dopamine: clinical uses of an endogenous
catechol-amine N Engl J Med 1974 ; 291 : 707 – 710
Trang 5189 Gibbs RS , Blanco JD , Hrilica VS Quantitative bacteriology of amni-otic fl uid from women with clinical intraamniamni-otic infection at term
J Infect Dis 1982 ; 145 : 1 – 8
190 MacArthur RD , Miller M , Albertson T , et al Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience
from the MONARCS trial Clin Infect Dis 2004 ; 38 : 284
191 Garau J , Xercavins M , Rodriguez - Carballeira M , et al Emergence and dissemination of quinolone - resistant Escherichia coli in
the community Antimicrob Agents Chemother 1999 ; 43 :
2736 – 2741
192 Gupta K , Sahm DF , Mayfi eld D , et al Antimicrobial resistance among uropathogens that cause community - acquired urinary tract
infections in women: a nationwide analysis Clin Infect Dis 2001 ; 33 :
89 – 94
193 Thornsberry C , Sahm DF , Kelly LJ , et al Regional trends in antimi-crobial resistance among clinical isolates of Streptococcus pneu-moniae , Haemophilus infl uenzae , and Moraxella catarrhalis in the
United States: results from the TRUST Surveillance Program, 1999 –
2000 Clin Infect Dis 2002 ; 34 : S4 – S16
194 Karlowsky JA , Thornsberry C , Jones ME , et al Factors associated
with relative rates of antimicrobial resistance among Streptococcus
pneumoniae in the United States: results from the TRUST
Surveillance Program (1998 – 2002) Clin Infect Dis 2003 ; 36 :
963 – 970
195 Doern GV , Brown SD Antimicrobial susceptibility among commu-nity - acquired respiratory tract pathogens in the USA: data from
PROTEKT US 2000 – 01 J Infect 2004 ; 48 : 56 – 65
196 Frazee BW , Lynn J , Charlebois ED , et al High prevalence of
meth-icillin - resistant Staphylococcus aureus in emergency department skin and soft tissue infections Ann Emerg Med 2005 ; 45 : 311 – 320
197 Lewis JS 2nd , Jorgensen JH Inducible clindamycin resistance in staphylococci Should clinicians and microbiologists be concerned?
Clin Infect Dis 2005 ; 40 : 280 – 285
198 Fagon JY , Chastre J , Vuagnat A , et al Nosocomial pneumonia and
mortality among patients in intensive care units JAMA 1996 ; 275 :
866 – 869
199 Urschel JD Necrotizing soft tissue infections Postgrad Med J 1999 ;
75 : 645
200 Gallup DG , Meguiar RV Coping with necrotizing fasciitis Contemp
Ob/Gyn 2004 ; 49 : 38
201 Collins CG Suppurative pelvic thrombophlebitis A study of 202 cases in which the disease was treated by ligation of the vena cava
and ovarian vein Am J Obstet Gynecol 1970 ; 108 : 681 – 687
202 Mei CT , Feeley TW Coagulopathies and the intensive care setting
Int Anesthesiol Clin 1993 ; 31 : 97 – 117
203 Marshall JC Infl ammation, coagulopathy, and the pathogenesis of multiple organ dysfunction syndrome Crit Care Med 2001 ;
29 (Suppl): S99 – S106
204 Vincent JL New therapeutic implications of anticoagulation media-tor replacement in sepsis and acute respiramedia-tory distress syndrome
Crit Care Med 2000 ; 28 : S83 – S85
205 Miller TR , Anderson RJ , Linas SL , et al Urinary diagnostic indices
in acute renal failure Ann Intern Med 1978 ; 89 : 47 – 50
206 Hardaway RM Prediction of survival or death of patients in a state
of severe shock Surg Gynecol Obstet 1981 ; 152 : 200 – 206
207 Ronco C , Bellomo R , Homel P , et al Effects of different doses in continuous veno - venous haemofi ltration on outcomes of acute renal failure: a prospective randomised trial Lancet 2000 ; 356 :
26 – 30
168 Tuchschmidt J , Oblitas D , Fried JC Oxygen consumption in sepsis
and septic shock Crit Care Med 1991 ; 19 : 664 – 671
169 Rackow EC , Astiz ME , Weil MH Cellular oxygen metabolism
during sepsis and shock: the relationship of oxygen consumption to
oxygen delivery JAMA 1988 ; 259 : 1989 – 1993
170 Dantzker D Oxygen delivery and utilization in sepsis Crit Care Clin
1989 ; 5 : 81 – 98
171 Gutierrez G , Lund N , Bryan - Brown CW Cellular oxygen utilization
during multiple organ failure Crit Care Clin 1989 ; 5 : 271 – 287
172 Shoemaker WC , Appel PL , Bland R , et al Clinical trial of an
algo-rithm for outcome prediction in acute circulatory failure Crit Care
Med 1983 ; 11 : 165
173 Pinsky MR , Vincent JL Let us use the PAC correctly and only when
we need it Crit Care Med 2005 ; 33 : 1119 – 1122
174 Vincent JL Hemodynamic support in septic shock Guidelines for
the management of severe sepsis and septic shock International
Sepsis Forum Intens Care Med 2001 ; 27 : S80 – S92
175 Catanzarite V , Willms D , Wong D , et al Acute respiratory distress
syndrome in pregnancy and the puerperium: causes, courses, and
outcomes Obstet Gynecol 2001 ; 97 : 760
176 Perry KG Jr , Martin RW , Blake PG , et al Maternal outcome
associ-ated with adult respiratory distress syndrome Am J Obstet Gynecol
1996 ; 174 : 391
177 Weg JG , Anzueto A , Balk RA , et al The relation of pneumothorax
and other air leaks to mortality in the acute respiratory distress
syndrome N Engl J Med 1998 ; 338 : 341
178 Ware LB , Matthay MA The acute respiratory distress syndrome N
Engl J Med 2000 ; 342 : 1334 – 1349
179 Ware LB , Matthay MA Alveolar fl uid clearance is impaired in the
majority of patients with acute lung injury and the acute respiratory
distress syndrome Am J Respir Crit Care Med 2001 ; 163 : 1376 – 1383
180 Bersten A , Sibbald WJ Acute lung injury in septic shock Crit Care
Clin 1989 ; 5 : 49 – 79
181 Ashbaugh DG , Maier RV Idiopathic pulmonary fi brosis in adult
respiratory distress syndrome: diagnosis and treatment Arch Surg
1985 ; 120 : 530 – 535
182 Meduri GU , Belenchia JM , Estes RJ , et al Fibroproliferative phase
of ARDS: clinical fi ndings and effects of corticosteroids Chest 1991 ;
100 : 943 – 952
183 Tomlinson MW , Caruthers TJ , Whitty JE , et al Does delivery
improve maternal condition in the respiratory - compromised
gravida? Obstet Gynecol 1998 ; 91 : 108
184 Jenkins TM , Troiano NH , Graves CR , et al Mechanical ventilation
in an obstetric population: characteristics and delivery rates Am J
Obstet Gynecol 2003 ; 188 : 439
185 Petrucci N , Lacovelli W Ventilation with lower tidal volumes versus
traditional tidal volumes in adults for acute lung injury and acute
respiratory distress syndrome Cochrane Database Syst Rev 2004 ; 2 :
CD003844
186 Acute Respiratory Distress Syndrome Network Ventilation with
lower tidal volumes as compared with traditional tidal volumes for
acute lung injury and the acute respiratory distress syndrome N Engl
J Med 2000 ; 342 : 1301 – 1308
187 Houck PM , Bratzler DW , Nsa W , et al Timing of antibiotic
admin-istration and outcomes for Medicare patients hospitalized with
community - acquired pneumonia Arch Intern Med 2004 ; 164 :
637 – 644
188 Duff P , Gibbs RS , Blanco JD , et al Endometrial culture techniques
in puerperal patients Obstet Gynecol 1983 ; 61 : 217 – 222
Trang 6patients with clinical signs of systemic sepsis N Engl J Med 1987 ;
317 : 659
228 Weigelt JA , Norcross JF , Borman KR , et al Early steroid therapy for
respiratory failure Arch Surg 1985 ; 120 ( 5 ): 536 – 540
229 Hooper RG , Kearl RA Established ARDS treated with a sustained
course of adrenocortical steroids Chest 1990 ; 97 : 138 – 143
230 Cunningham DS , Evan EE The effects of betamethasone on
mater-nal cellular resistance to infection Am J Obstet Gynecol 1991 ; 165 :
610
231 Crowley PA Antenatal corticosteroid therapy: a meta - analysis
of the randomized trials, 1972 to 1994 Am J Obstet Gynecol 1995 ;
173 : 322
232 Oettinger WK , Walter GO , Jensen UM , et al Endogenous prosta-glandin F2 alpha in the hyperdynamic state of severe sepsis in man
Br J Surg 1983 ; 70 : 237 – 239
233 Vada P Elevated plasma phospholipase A2 levels: correlation with the hemodynamic and pulmonary changes in gram - negative septic
shock J Lab Clin Med 1984 ; 104 : 873
234 Cefalo RC , Lewis PE , O ’ Brien WF , et al The role of prostaglandins
in endotoxemia: comparisons in response in the nonpregnant,
maternal, and fetal model Am J Obstet Gynecol 1980 ; 137 : 53 – 57
235 Rao PS , Cavanagh D , Gaston LW Endotoxic shock in the primate:
effects of aspirin and dipyridamole administration Am J Obstet
Gynecol 1981 ; 140 : 914 – 922
236 O ’ Brien WF , Cefalo RC , Lewis PE , et al The role of prostaglandins
in endotoxemia and comparisons in response in the nonpregnant, maternal, and fetal models II Alterations in prostaglandin physiol-ogy in the nonpregnant, pregnant, and fetal experimental animal
Am J Obstet Gynecol 1981 ; 139 : 535 – 539
237 Makabali GL , Mandal AK , Morris JA An assessment of the partici-patory role of prostaglandins and serotonin in the pathophysiology
of endotoxic shock Am J Obstet Gynecol 1983 ; 145 : 439 – 445
238 Lachman E , Pitsoe SB , Gaffi n SL Antilipopolysaccharide immuno-therapy in management of septic shock of obstetric and gynaecologic
origin Lancet 1984 ; 1 : 981 – 983
239 Greenman RL , Schein RMH , Martin MA , et al A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin
in the treatment of gram - negative sepsis JAMA 1991 ; 266 :
1097 – 1102
240 Wenzel RP Monoclonal antibodies and the treatment of gram
negative bacteremia and shock N Engl J Med 1991 ; 324 : 486
241 Ziegler EJ , Fisher CJ Jr , Sprung CL , et al Treatment of gram - negative bacteremia and septic shock with HA - 1A human monoclonal
anti-body against endotoxin N Engl J Med 1991 ; 324 : 429 – 436
242 Warren HS , Danner RL , Munford RS Anti - endotoxin monoclonal
antibodies N Engl J Med 1992 ; 326 : 1153
243 Natanson C , Hoffman WD , Suffredini AF , et al Selected treatment strategies for shock based on proposed mechanisms of pathogenesis
Ann Intern Med 1994 ; 120 : 771 – 783
244 Goldie AS , Fearon KCH , Ross JA , et al Natural cytokine antagonists and endogenous antiendotoxin core antibodies in sepsis syndrome
JAMA 1995 ; 274 : 172 – 177
245 Warren BL , Eid A , Singer P , et al KyberSept Trial Study Group Caring for the critically ill patients High - dose antithrombin III in severe sepsis: a randomized controlled trial JAMA 2001 ; 286 :
1869 – 1878
246 Bernard GR , Vincent JL , Laterre PF , et al Effi cacy and safety of
recombinant human activated protein C for severe sepsis N Engl J
Med 2001 ; 344 : 699 – 709
208 Schrier RW , Wang W Acute renal failure and sepsis N Engl J Med
2004 ; 351 : 159 – 169
209 Wojnar MM , Hawkins WG , Lang CH Nutritional support of the
septic patient Crit Care Clin 1995 ; 11 : 717 – 733
210 Mainous MR , Deitch EA Nutrition and infection Surg Clin North
Am 1994 ; 74 : 659 – 676
211 Deitch EA , Winterton J , Li M , et al The gut as a portal of entry for
bacteremia: role of protein malnutrition Ann Surg 1987 ; 195 :
681 – 692
212 Ziegler TR , Smith RJ , O ’ Dwyer ST , et al Increased intestinal
perme-ability associated with infection in burn patients Arch Surg 1988 ;
123 : 1313 – 1319
213 Riddington DW , Venkatesh B , Boivin CM , et al Intestinal
perme-ability, gastric intramucosal pH, and systemic endotoxemia in
patients undergoing cardiopulmonary bypass JAMA 1996 ; 275 :
1007 – 1012
214 Gys T , Hubens A , Neels H , et al Prognostic value of gastric
intra-mural pH in surgical intensive care patients Crit Care Med 1988 ; 16 :
1222 – 1224
215 Doglio GR , Pusajo JF , Egurrola MA , et al Gastric mucosal pH as a
prognostic index of mortality in critically ill patients Crit Care Med
1991 ; 19 : 1037 – 1040
216 Sauve JS , Cook DJ Gastrointestinal hemorrhage and ischemia:
pre-vention and treatment Int Anesthesiol Clin 1993 ; 31 : 169 – 183
217 Craven DE , Kunches LM , Kilinshy V , et al Risk factors for
pneumo-nia and fatality in patients receiving continuous mechanical
ventila-tion Am Rev Respir Dis 1986 ; 133 : 792 – 796
218 Bresalier RS , Grendell JH , Cello JP , et al Sucralfate suspension
versus titrated antacid for the prevention of acute stress - related
gas-trointestinal hemorrhage in critically ill patients Am J Med 1987 ; 83 :
110
219 Cannon LA , Heiselman D , Gardner W , et al Prophylaxis of upper
gastrointestinal tract bleeding in mechanically ventilated patients A
randomized study comparing the effi cacy of sucralfate, cimetidine,
and antacids Arch Intern Med 1987 ; 147 : 2101 – 2106
220 Driks MR , Craven DE , Celli BR , et al Nosocomial pneumonia in
intubated patients given sucralfate as compared with antacids or
histamine type 2 blockers N Engl J Med 1987 ; 317 : 1376 – 1382
221 Tryba M Risk of acute stress bleeding and nosocomial pneumonia
in ventilated intensive care unit patients: sucralfate versus antacids
Am J Med 1987 ; 83 : 117 – 124
222 Cook DJ , Reeve BK , Guyatt GH , et al Stress ulcer prophylaxis in
critically ill patients: resolving discordant meta - analyses JAMA
1996 ; 275 : 308 – 314
223 Briggs GG , Freeman RK , Yaffe SJ , eds Sucralfate: gastrointestinal
agent In: A Reference Guide to Fetal and Neonatal Risk: Drugs in
Pregnancy and Lactation , 4th edn Baltimore : Williams and Wilkins ,
1995 : 792
224 Van den Berghe G , Wouters P , Weckers F , et al Intensive insulin
therapy in critically ill patients N Engl J Med 2001 ; 345 :
1359 – 1367
225 Sprung CL , Caralis PV , Marcial EH , et al The effects of high - dose
corticosteroids in patients with septic shock N Engl J Med 1984 ; 311 :
1137 – 1143
226 Bone RC , Fisher CJ Jr , Clemmer TP , et al A controlled clinical trial
of high - dose methylprednisolone in the treatment of severe sepsis
and septic shock N Engl J Med 1987 ; 317 : 653 – 658
227 Veterans Administration Systemic Sepsis Cooperative Study
Group Effect of high - dose glucocorticoid therapy on mortality in
Trang 7247 Warren HS , Suffredini AF , Eichacker PQ , et al Risks and benefi ts of
activated protein C treatment for severe sepsis N Engl J Med 2002 ;
347 : 1027 – 1030
248 Abraham E , Laterre PF , Garg R , et al Drotrecogin alfa (activated)
for adults with severe sepsis and a low risk of death N Engl J Med
2005 ; 353 : 1332 – 1341
249 Johnston JA , Pulgar S , Ball DE , et al The impact of timely
drotre-cogin alfa (activated) administration on hospital mortality and
resource use Crit Care Med 2003 ; 31 : A73
250 Verceles A , Schwarcz R , Birnbaum P , et al Factors infl uencing
sur-vival in patients receiving activated protein C Crit Care Med 2003 ;
31 : A126
251 Vincent JL , Levy MM , Macias WL , et al Early intervention with
drotrecogin alfa (activated) improves survival benefi t Crit Care Med
2003 ; 31 : A123
252 Wheeler A , Steingrub J , Linde - Zwirble W , et al Prompt administra-tion of drotrecogin alfa (activated) is associated with improved
sur-vival Crit Care Med 2003 ; 31 : A120
Trang 8Critical Care Obstetrics, 5th edition Edited by M Belfort, G Saade,
M Foley, J Phelan and G Dildy © 2010 Blackwell Publishing Ltd
Raymond O Powrie
Department of Medicine, Obstetrics and Gynecology, Warren Alpert School of Medicine at Brown University, RI, USA
Introduction
Anaphylaxis is a serious potentially life - threatening allergic
reac-tion that is rapid in onset and requires prompt treatment The
pathophysiology, precipitants, and management of anaphylaxis
are similar in pregnant and non - pregnant patients so this
chapter will largely focus on the general management of this
condition but will highlight pregnancy specifi c concerns when
appropriate
Defi nitions
“ Anaphylaxis ” is a term that is often imprecisely used It was
coined in 1902 from the Greek words ana (meaning backwards)
and phylax (meaning guard) to describe the phenomenon where
an agent that was administered for its protective effect had instead
the opposite effect and instead caused harm Strictly speaking,
anaphylaxis refers to IgE - mediated immediate ( “ type 1 ” )
hyper-sensitivity reactions to proteins (see Table 42.1 ) [1 – 3] However,
in clinical practice, such reactions are often diffi cult to distinguish
from other types of severe allergic reactions that are not mediated
by IgE Such non - IgE - mediated reactions are correctly termed
“ anaphylactoid reactions ” Although true anaphylaxis is more
likely to cause hypotension and cardiac arrest than anaphylactoid
reactions, the initial management of the two conditions is
identi-cal and the two terms will therefore be used interchangeably in
this chapter
Epidemiology
Anaphylactoid reactions are responsible for 1% of emergency
room visits and perhaps 1000 deaths per year in the US Between
0.05 and 2% of individuals will have an anaphylactoid reaction over the course of their lifetime Anaphylactoid reactions are more likely to occur in hospitalized patients, with estimates of the frequency of anaphylaxis in hospital varying from 1 in 2700 to 1
in 5100 admissions [4,5] The incidence of anaphylaxis in preg-nant women is not known but there is no reason to believe that the incidence should be lower in this population, given both (i) the frequent need for both hospitalization and medications in this population and (ii) our present understanding of the immuno-logic changes in pregnancy
Precipitants
Table 42.2 reviews the most commonly identifi ed precipitants of anphylactoid reactions in adults Despite this extensive list, in
up to 60% of cases, the precipitating agent cannot be identifi ed [6,7] Some anaphylactic responses are only seen if the exposure
is followed by physical exertion or exercise Such a response
is called “ food - dependent, exercise - induced anaphylaxis ” (FDEIAn)
There are over 50 case reports that detail anaphylaxis occurring
in obstetric patients in relation to their antenatal/intrapartum care and some of these causes are also listed in Table 42.2
Risk f actors for a naphylaxis/anaphylactoid
r eactions
The following are some of the known risk factors for anaphylac-toid reactions
Gender
Women are more likely to have anaphylactoid responses in general and particularly to NSAIDs, latex and neuromuscular blockers It is theorized that this relates to gender differences
in antigen exposures, with women being more likely to have had prior exposures to antigens in cosmetics and skin - care products
Trang 9Table 42.1 Gell and Coombs classifi cation of allergic reactions [30]
Type Clinical manifestations Mechanism
I Anaphylactic, immediate - type hypersensitivity True anaphylaxis as described in this chapter Exposure to antigen causes release of histamine, leukotrienes and
prostaglandins from mast cells or basophils Usually an IgE - dependent reaction
II Antibody - dependent cytotoxicity Hemolytic anemia, Interstitial nephritis Antigens or haptens that are closely associated with a cell bind to
an antibody, which leads to cell death or tissue injury
damage to vessels and tissue
IV Cell - mediated or delayed hypersensitivity Contact dermatitis Tissue injury mediated by T cells which have been sensitized to
antigens
V Idiopathic Maculopapular rash, Stevens – Johnson syndrome Not known
Type of e xposure
Parenteral exposure to antigens is much more likely to cause
anaphylactoid reactions than is oral ingestion Parenteral
expo-sures may be less likely to present with hives and fl ushing and
therefore anaphylaxis may be mistaken for other causes of
hypo-tension [8] Inhalational exposures can rarely lead to anaphylaxis
and when this does occur, peanuts or latex are the most likely
precipitants Exposures to larger volumes of antigen are also more
like to put a patient at risk than are smaller ones Lastly,
concomi-tant exposures to other antigens to which the patient may have
an allergy also seem to put patients at increased risk
History of p rior e xposures
Consistent exposure is less likely to cause anaphylactoid responses
than intermittent ones
History of p revious a naphylactoid r esponse
Anaphylactoid responses are more likely to occur in patients who
have had anaphylaxis in the past However, anaphylaxis does not
predictably recur in every patient upon repeat exposure [9] If it
has been years since previous exposure to the precipitating
antigen, IgE levels may have declined over time and the immune
response may have become muted
History of a topy
Patients with atopy are at increased likelihood of anaphylactoid
reactions to most agents except for medications Atopic and
asth-matic individuals are also more likely to die when they do have
anaphylaxis [10]
Pathophysiology
True anaphylaxis is caused by the release of infl ammatory
media-tors from the degranulation of mast cells and basophiles This
degranulation occurs in response to the cross - linking of mast
cells bound to IgE with a precipitating antigen The mediators
initially released include histamine, prostaglandins, leukotrienes, and platelet activating factor Later, cytokines, interleukin 3 and
4 and tumor necrosis factor may be released The anaphylactic response can also be associated with stimulation of complement C3a, C4a and C5a Alternations in arachidonic acid metabolism may also contribute to the anaphylactic syndrome in some cases These mediators induce pruritus, vasodilation and increased vascular permeability They can also cause respiratory muscle contraction, autonomic nervous system stimulation, platelet aggregation, recruitment of infl ammatory cells and increased gas-trointestinal motility All of these responses contribute to the variable clinical presentation of anaphylaxis
Clinical p resentation
Symptoms generally develop within 5 – 60 minutes of exposure to the inciting antigen Parenteral administration leads to a more rapid response Oral ingestion will take longer In rare circum-stances, onset may be delayed up to several hours [11] The mani-festations of anaphylaxis vary widely and are reviewed in Table 42.3 Fatalities from anaphylaxis generally occur due to cardio-vascular collapse, and asphyxia from upper airway obstruction from edema or intractable bronchospasm
Timing and l ength of r eaction
Most cases of anaphylaxis have a single severe response that resolves with treatment over a few hours Some patients have a protracted syndrome that lasts for 24 – 48 hours Between 1 and 20% of cases of anaphylactoid responses will have an acute phase followed by a period of recovery and then a recurrence between 1 and 8 hours after the initial presentation Reports of a second wave
of symptoms occurring up to 72 hours after the initial exposure exist but are rare [12 – 14] The pathophysiology underlying such biphasic responses remains unclear Biphasic reactions appear to
Trang 10Table 42.2 Some precipitants of anaphylactoid reactions in adults [27,31 – 39]
Class of agent Specifi c agents Comments
Medications
True anaphylaxis to drugs requires previous
exposure, but anaphylactoid responses
can occur the fi rst time a medication is
administered
Antibiotics, especially β - lactams (penicillins and less commonly cephalosporins) Aspirin and other NSAIDs, particularly in patients with nasal polyps/chronic sinusitis and asthma
Neuromuscular blockers Narcotics
Antineoplastic compounds Insulin [40]
ACE inhibitors [41]
4 – 10% of people who have received penicillins have penicillin - specifi c Ig
E antibodies although very few of these patients will manifest anaphylaxis Anaphylaxis from penicillins is said to occur in 0.04 – 0.2%
of exposures, with death from anaphylaxis occurring in only 0.001% of all exposures Most of these patients will have had prior exposure to penicillins but no documented allergy to it Concerningly, one - third of patients who die of penicillin anaphylaxis do have a documented history of prior reactions to penicillin [42]
Although 20% of patients with PCN allergies will have laboratory or skin testing evidence of a cross - reaction to cephalosporins, only 1% will actually have a clinical reaction to cephalosporins For this reason, it is now recommended that cephalosporins be withheld from patients with PCN allergies only if their response to PCN included hypotension or respiratory diffi culty
Anaphylactoid responses to non - β - lactam antibiotics are uncommon NSAIDs can produce anaphylactoid responses by a variety of mechanisms, some of which are specifi c to a single drug, while others can occur with several different NSAIDs [43,44] Selective COX - 2 inhibitors are less likely to cause anaphylactoid reactions than NSAIDs
members of the order Hymenoptera [45]
(yellowjackets, wasps, imported fi re ants and harvester ants)
Foods [23,46 – 48] Seafood, fi sh, peanuts, tree nuts, vegetables
such as carrots and celery, wheat and grain
Although most commonly seen in children, food allergies can begin at any age in life
Food allergies are more likely to have bad outcomes in patients with asthma
Anaphylactoid reactions to seafood are not related to iodine content but rather to tropomyosin proteins
Celery and carrot anaphylaxis is more common in patients with allergies
to pollens
Wheat and grain are particularly likely to be associated with “ food dependent, exercise - induced anaphylaxis ” (FDEIAn)
Sulfi ting agents Sulfi tes (or sulfi ting agents) are a group of
simple chemicals that include sulfur dioxide and sulfi te salts Some of these agents are approved by the US FDA for use as food preservatives and to prevent food discoloration
Sulfi tes are most commonly found now in the following foods: dried soup mixes, vegetable juices, baked goods, canned or dried fi sh, dried fruit, relishes, shredded coconut, shrimp, lobster, scallops, olives, pickles, sauerkraut, dried noodle meals, molasses, gravies, potatoes, lemon and lime juice, jams and jellies, grape juice, wine, beer, maraschino cherries, dehydrated vegetables and fruit
In 1986 the US FDA prohibited the use of sulfi tes on fruits and vegetables meant to be eaten raw They also required companies to list on product labels sulfi ting agents that occur at concentrations of
10 ppm or higher, and any sulfi ting agents that had a technical or functional effect in the food regardless of the amount present
Immunotherapy injections Antigen exposures given by allergists to
downregulate systemic response in patients with allergies