phenylephrine-hydrochloride and Systemic-Inflammatory-Response-Syndrome

We showed previously that probiotics containing lactobacilli significantly improve the outcome of acute pancreatitis. "Synbiotic 2000", a new synbiotic composition with high colony forming unit (CFU) comprises four different types of pre- and probiotics. In this prospective, randomized, double-blind study we evaluated the role of "Synbiotic 2000" in the treatment of severe acute pancreatitis.. Patients with severe acute pancreatitis were randomized into two groups. Nasojejunal feeding was commenced within 24 hours after admission in both groups and continued for at least seven days. The first group of patients received four different lactobacilli preparations with 10(10) CFU, respectively, and prebiotics containing four bioactive fibres (inulin, beta-glucan, resistant starch and pectin) in addition. Patients in the second (control) group received only prebiotics.. 62 patients with severe acute pancreatitis completed the study. Altogether 8 patients died. We detected lower incidence of multiorgan failure (MOF), septic complications and mortality in the first group compared to the control, but the differences were statistically not significant. The total incidence of systemic inflammatory response syndrome (SIRS) and MOF were significantly different between the two groups (8 vs. 14; p < 0.05). Furthermore, the number patients recovering with complications were significantly less in the first group receiving modern synbiotic therapy compared to the control (p < 0.05). Finally, we found lower rate of late (over 48 hours) organ failure in the first versus the control group (3.0% vs. 17.2%).. Our results suggest that early nasojejunal feeding with synbiotic may prevent organ dysfunctions in the late phase of severe acute pancreatitis. In addition, our data also indicate that the infection of pancreatic necrosis may be associated with early phase organ failure.

Topics: Adult; Aged; Aged, 80 and over; beta-Glucans; Combined Modality Therapy; Double-Blind Method; Enteral Nutrition; Female; Humans; Inulin; Jejunum; Lactobacillus; Male; Middle Aged; Multiple Organ Failure; Nose; Pancreatitis, Acute Necrotizing; Pectins; Probiotics; Prospective Studies; Severity of Illness Index; Starch; Systemic Inflammatory Response Syndrome; Treatment Outcome

Patients in a surgical intensive care unit (ICU) have a high incidence of nosocomial infections which often lead to septic shock and death. Since specific antibiotic treatment is often difficult, it is recommended that routine nose/throat swabs be obtained in order to have a better idea of the causative agent when a systemic inflammatory response occurs in a given patient.. In 1435 patients in a cardiac surgical ICU, routine nose/throat swabs were taken thrice a week and tested for microorganisms and systemic inflammation. Blood cultures were also obtained. Antibiotic treatment was given to cover the microbes from the nose/throat swabs. Alternatively, an empirical antibiotic therapy was given to patients whose swabs had tested negative.. Of the 86 patients with systemic inflammation, 29 had blood cultures positive for microbes. Of these, 18 received a specific antibiotic therapy based on their positive nose/throat cultures prior to the return of the blood cultures from the laboratory. However, only 11 patients tested positive for the same microbes on routine swabs and blood cultures. While positive routine swabs are quite specific to sepsis when there is a systemic inflammatory response, routine swabs are not a suitable screening tool due to their low sensitivity.. Routine nose/throat swabs led to earlier specific antibiotic treatment in only 22 % of patients with clinical signs of systemic inflammation. In 36 % of cases, the organisms detected in the routine swabs and blood cultures were not identical. Hence, we believe that routine swabs are of limited value in instituting earlier, specific antibiotic therapy in septic patients.

Topics: Antibiotic Prophylaxis; Cardiac Surgical Procedures; Critical Care; Cross Infection; Humans; Nose; Pharynx; Sepsis; Survival Rate; Systemic Inflammatory Response Syndrome