shirish_sss
Forum Senior
Topics: 32
Posts: 134
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WHICH OF THE FOLLOWING INTERVENTIONS HAS SHOWN IMPROVED PATIENT CONDITION AND REDUCED MORTALITY IN PATIENTS WITH SEVERE SEPSIS IN INTENSIVE CARE UNIT....?
1) GIVING PROPHYLACTIC ANTIBIOTICS FOR MULTI-DRUG RESISTANT STAPHYLOCOCCI
2) XIGRIS
3) AGGRESSIVE MANAGEMENT OF DIC ASSOCIATED WITH SEPSIS
4) GIVING PARENTERAL NUTRITION
5) REDUCING THE STAY IN ICU AS MINIMUM AS POSSIBLE
6) GIVING PROPHYLACTIC ANTIBIOTICS TO PREVENT PSEUDOMONAS INFECTION
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| smitha
Forum Elite
Topics: 53
Posts: 236
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well, shirish......wat's the 2nd option u gave.......cud u plz mention that again?????? "XIGRIS"????, if that's the option, then i guess, iam lagging behind in not knowing it..................... :roll:
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| smitha
Forum Elite
Topics: 53
Posts: 236
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OK shirish........... i guess,if u tell me wat's "XIGRIS", i think u'd be giving me the answer away......... :lol: , coz THAT'S THE ANSWER for this q...........2.XIGRIS..........which is supposed to be reducing the mortality in ICU pt.s as well, as improving the pt.'s condition.......... 
DETAILS ON XIGRIS:
Fortunately, through research, there is a growing understanding of the pathophysiology of sepsis as a systemic inflammatory condition complicated by coagulation and fibrinolytic involvement. This has led to the development of agents that control the endogenous modulators of homeostasis, such as activated protein C and antithrombin III. The US Food and Drug Administration has approved a recombinant form of human activated protein C, drotrecogin alfa [/B[B]](activated) (Xigris), the first of this new category of medications for the treatment of patients with severe sepsis.
Physiologically, activated protein C is known to have 3 mechanisms for inhibiting sepsis.
First, it inhibits Factors Va and VIIIa, which result in an antithrombotic effect.
It inhibits plasminogen activator inhibitor-1. Activated protein C also limits the production of thrombin activatable fibrinolysis inhibitor (TAFI).
In vitro data suggest that activated protein C may block leukocyte adhesion to selectins, subsequently inhibiting human tumor necrosis factor production by monocytes.
Some researchers showed that activated protein C did limit the production of tumor necrosis factor-alpha and interleukin-1 and interferes with the interaction between lipopolysaccharides and CD14. It has been theorized that activated protein C may also reduce the thrombin-induced inflammatory responses of the microvascular endothelium. It is believed to decrease cytokine production and inhibit leukocyte attachment to the endothelium.
Drotrecogin alfa (activated) is a recombinant form of the serine protease with the same amino acid sequence as human plasma-derived activated protein C. It has the same sites of glycosylation as human plasma-derived activated protein C.
Researchers believe that because of these similarities, drotrecogin alfa (activated) functions in the same manner as activated protein C. However, this has not been clearly defined.
Patient Selection:
Adult patients with recent onset of severe sepsis or septic shock who are at high risk for death should be considered candidates for drotrecogin alfa (activated). They must have a known or suspected infection characterized by a temperature of at least 38°C (100.4°F) or less than or equal to 36°C (96.8°F), tachycardia, tachypnea of at least 20 breaths/minute and/or respiratory failure, a white cell count greater than or equal to 12,000/mm3 or less than or equal to 4000/mm3, or a differential count showing more than 10% immature neutrophils.
CONTRAINDICATIONS:Use of drotrecogin alfa (activated) may be contraindicated in patients with severe sepsis who are at increased risk of bleeding;
those who have a platelet count less than 30,000 x 106/L, even if the platelet count is increased after transfusions;
prothrombin time-international normalized ratio greater than 3.0;
recent gastrointestinal bleeding (within 6 weeks);
thrombolytic therapy (within 3 days);
oral anticoagulants or glycoprotein IIb/IIIa inhibitors (within 7 days); aspirin therapy greater than 650 mg per day or other platelet inhibitors (within 7 days);
ischemic stroke (within 3 months);
intracranial arteriovenous malformation or aneurysm;
known bleeding diathesis;
or chronic severe hepatic disease.
If clinically important bleeding occurs during drotrecogin alfa (activated) therapy administration, the infusion should be stopped immediately. Reinstitution of therapy may be considered once adequate hemostasis has been achieved. The medication should be administered at a dose of 24 mcg/kg/hour for 96 hours.
Drotrecogin alfa (activated) should be discontinued 2 hours prior to undergoing an invasive surgical procedure or procedures with an inherent risk of bleeding.
Once adequate hemostasis has been achieved, initiation of drotrecogin alfa (activated) may be reconsidered 12 hours after major invasive procedures or surgery or restarted immediately after uncomplicated less invasive procedures.The PROWESS/The Protein C Worldwide Evaluation of Severe Sepsis study demonstrated that treatment with drotrecogin alfa (activated) does significantly reduce the risk of death in patients with sepsis and acute organ dysfunction (severe sepsis).
Sepsis is a systemic response to infection that often manifests as multiple organ dysfunction and leads to death. The traditional goals of care have focused on the eradication of the underlying infection with antibiotic therapy and clinical management/support of the organ dysfunction. New advances in pharmacologic therapy have provided a new class of medication, which has demonstrated improved survival for these patients. Research is ongoing to determine the optimum use of medications, such as drotrecogin alfa (activated), to achieve the best outcomes for patients with severe sepsis.
This is about XIGRIS or DROTRECOGIN ALFA(ACTIVATED)...............
Thanx again shirish for posting this q, which lead to this post of mine................
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| shirish_sss
Forum Senior
Topics: 32
Posts: 134
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gr88888888888888888888888888888888888888888888888888888888888
answer smitha.....................
XIGRIS OR DOTRECOGEN-ALFA, WHATEVER NAME THE INTENSIVISTS CALL IT BY, IS THE ANSWER.
XIGRIS IS THE WORLD FAMOUS BRAND OF THIS DRUG MANUFACTURED BY ELLI-LILLY, I GUESS, CORRECT ME IF I M WRONG.
IN A NUMBER OF CLINICAL TRIALS CONDUCTED WORLDWIDE , XIGRIS HAS SHOWN TO IMROVE SURVIVAL IN PATIENTS OF SEVERE SEPSIS.
PATIENTS OF SEVERE SEPSIS ARE ALREADY AT A SIGNIFICANTLY HIGHER RISK OF MORTALITY , XIGRIS HAS BEEN A BOON FOR SUCH PATIENTS, PARTICULARLY IF THE PATIENT IS YOUNG.
THNX SMITHA FOR THE GR88888888 EXPLANATION.
THE FORUM REALLY NEEDS TO KNOW BOUT THIS.
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