Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes.
Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes.
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DOI：
10.6061/clinics/2016(10)02
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发表时间：
2016-10-01
期刊：
影响因子：
--
通讯作者：
Cheung BM
中科院分区：
文献类型：
--
作者：
Chou DW;Wu SL;Chung KM;Han SC;Cheung BM
脓毒性肺栓塞是一种罕见但危及生命的疾病。然而，关于需要重症监护的脓毒性肺栓塞患者的数据尚未得到很好的报道。本研究阐明了需要重症监护的患者中脓毒性肺栓塞的临床放射学谱、致病病原体和结局。对2005年1月至2013年12月期间需要入住重症监护室的20例脓毒性肺栓塞患者的电子病历进行了审查。85%的患者发生多器官功能障碍综合征，急性呼吸衰竭是最常见的器官衰竭（75%）。最常见的CT表现包括供血血管征（90%），无空洞（80%）或有空洞（65%）的外周结节和外周楔形阴影（75%）。最常见的原发感染源是肝脓肿（40%），其次是肺炎（25%）。两种最常见的致病病原体是肺炎克雷伯菌（50%）和金黄色葡萄球菌（35%）。与存活者相比，死亡者的血清肌酐、动脉二氧化碳分压、急性生理学和慢性健康评估II和序贯器官衰竭评估评分显著更高，他们更容易发生急性肾损伤、弥散性血管内凝血和肺水肿。住院死亡率为30%。肺炎是最常见的死亡原因，其次是肝脓肿。需要重症监护的脓毒性肺栓塞患者，特别是合并肺炎和肝脓肿的患者，死亡率较高。早期诊断、适当的抗生素治疗、手术干预和呼吸支持是必不可少的。
Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.
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DOI：
10.6061/clinics/2015(06)03
发表时间：
2015-06
期刊：
Clinics (Sao Paulo, Brazil)
影响因子：
--
作者：
Chou DW;Wu SL;Chung KM;Han SC
通讯作者：
Han SC
影响因子：
11.1
作者：
Lee, H. -C.;Chuang, Y. -C.;Ko, W. -C.
通讯作者：
Ko, W. -C.
影响因子：
28.2
作者：
Lee, Seung-Joon;Cha, Seung-Ick;Kim, Gun-Woo
通讯作者：
Kim, Gun-Woo
影响因子：
3.3
作者：
Sakuma, Masahito;Sugimura, Koichiro;Shirato, Kunio
通讯作者：
Shirato, Kunio
影响因子：
2.6
作者：
Jung, Jo Sung;Lee, Sang Mi;Lee, Jeong Won
通讯作者：
Lee, Jeong Won