Macroscopic Postmortem Findings in 235 Surgical Intensive Care Patients with Sepsis
Although detailed analyses of the postmortem findings of various critically ill patient groups have been published, no such study has been performed in patients with sepsis. In this retrospective cohort study, we reviewed macroscopic postmortem examinations of surgical intensive care unit (ICU) pati...
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| Veröffentlicht in: | Anesthesia and analgesia 2009-06, Vol.108 (6), p.1841-1847 |
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| creator | Torgersen, Christian Moser, Patrizia Luckner, Günter Mayr, Viktoria Jochberger, Stefan Hasibeder, Walter R. Dünser, Martin W. |
| description | Although detailed analyses of the postmortem findings of various critically ill patient groups have been published, no such study has been performed in patients with sepsis. In this retrospective cohort study, we reviewed macroscopic postmortem examinations of surgical intensive care unit (ICU) patients who died from sepsis or septic shock.
Between 1997 and 2006, the ICU database and autopsy register were reviewed for patients who were admitted to the ICU because of sepsis/septic shock, or who developed sepsis/septic shock at a later stage during their ICU stay and subsequently died from of sepsis/septic shock. Clinical data and postmortem findings were documented in all patients.
Postmortem results of 235 patients (84.8%) were available for statistical analysis. The main causes of death as reported in the patient history were refractory multiple organ dysfunction syndrome (51.5%) and uncontrollable cardiovascular failure (35.3%). Pathologies were detected in the lungs (89.8%), kidneys/urinary tract (60%), gastrointestinal tract (54%), cardiovascular system (53.6%), liver (47.7%), spleen (33.2%), central nervous system (18.7%), and pancreas (8.5%). In 180 patients (76.6%), the autopsy revealed a continuous septic focus. The most common continuous foci were pneumonia (41.3%), tracheobronchitis (28.9%), peritonitis (23.4%), uterine/ovarial necrosis (9.8% of female patients), intraabdominal abscesses (9.1%), and pyelonephritis (6%). A continuous septic focus was observed in 63 of the 71 patients (88.7%) who were admitted to the ICU because of sepsis/septic shock and treated for longer than 7 days.
Relevant postmortem findings explaining death in surgical ICU patients who died because of sepsis/septic shock were a continuous septic focus in approximately 80% and cardiac pathologies in 50%. The most frequently affected organs were the lungs, abdomen, and urogenital tract. More diagnostic, therapeutic and scientific efforts should be launched to identify and control the infectious focus in patients with sepsis and septic shock. |
| doi_str_mv | 10.1213/ane.0b013e318195e11d |
| format | Article |
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Between 1997 and 2006, the ICU database and autopsy register were reviewed for patients who were admitted to the ICU because of sepsis/septic shock, or who developed sepsis/septic shock at a later stage during their ICU stay and subsequently died from of sepsis/septic shock. Clinical data and postmortem findings were documented in all patients.
Postmortem results of 235 patients (84.8%) were available for statistical analysis. The main causes of death as reported in the patient history were refractory multiple organ dysfunction syndrome (51.5%) and uncontrollable cardiovascular failure (35.3%). Pathologies were detected in the lungs (89.8%), kidneys/urinary tract (60%), gastrointestinal tract (54%), cardiovascular system (53.6%), liver (47.7%), spleen (33.2%), central nervous system (18.7%), and pancreas (8.5%). In 180 patients (76.6%), the autopsy revealed a continuous septic focus. The most common continuous foci were pneumonia (41.3%), tracheobronchitis (28.9%), peritonitis (23.4%), uterine/ovarial necrosis (9.8% of female patients), intraabdominal abscesses (9.1%), and pyelonephritis (6%). A continuous septic focus was observed in 63 of the 71 patients (88.7%) who were admitted to the ICU because of sepsis/septic shock and treated for longer than 7 days.
Relevant postmortem findings explaining death in surgical ICU patients who died because of sepsis/septic shock were a continuous septic focus in approximately 80% and cardiac pathologies in 50%. The most frequently affected organs were the lungs, abdomen, and urogenital tract. More diagnostic, therapeutic and scientific efforts should be launched to identify and control the infectious focus in patients with sepsis and septic shock.</description><identifier>ISSN: 0003-2999</identifier><identifier>EISSN: 1526-7598</identifier><identifier>DOI: 10.1213/ane.0b013e318195e11d</identifier><identifier>PMID: 19448210</identifier><identifier>CODEN: AACRAT</identifier><language>eng</language><publisher>Hagerstown, MD: International Anesthesia Research Society</publisher><subject>Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Autopsy ; Biological and medical sciences ; Central Nervous System - pathology ; Cohort Studies ; Critical Care ; Databases, Factual ; Female ; Humans ; Kidney - pathology ; Lung - pathology ; Male ; Medical sciences ; Middle Aged ; Myocardium - pathology ; Retrospective Studies ; Sepsis - pathology ; Sepsis - therapy ; Shock, Septic - pathology ; Urinary Tract - pathology</subject><ispartof>Anesthesia and analgesia, 2009-06, Vol.108 (6), p.1841-1847</ispartof><rights>International Anesthesia Research Society</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4260-bb9932388e50767e82379bf4a27451df9a501ebd5899a47e5f8edba1e57c91c23</citedby><cites>FETCH-LOGICAL-c4260-bb9932388e50767e82379bf4a27451df9a501ebd5899a47e5f8edba1e57c91c23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00000539-200906000-00020$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>314,780,784,4606,27922,27923,65231</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21551590$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19448210$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Torgersen, Christian</creatorcontrib><creatorcontrib>Moser, Patrizia</creatorcontrib><creatorcontrib>Luckner, Günter</creatorcontrib><creatorcontrib>Mayr, Viktoria</creatorcontrib><creatorcontrib>Jochberger, Stefan</creatorcontrib><creatorcontrib>Hasibeder, Walter R.</creatorcontrib><creatorcontrib>Dünser, Martin W.</creatorcontrib><title>Macroscopic Postmortem Findings in 235 Surgical Intensive Care Patients with Sepsis</title><title>Anesthesia and analgesia</title><addtitle>Anesth Analg</addtitle><description>Although detailed analyses of the postmortem findings of various critically ill patient groups have been published, no such study has been performed in patients with sepsis. In this retrospective cohort study, we reviewed macroscopic postmortem examinations of surgical intensive care unit (ICU) patients who died from sepsis or septic shock.
Between 1997 and 2006, the ICU database and autopsy register were reviewed for patients who were admitted to the ICU because of sepsis/septic shock, or who developed sepsis/septic shock at a later stage during their ICU stay and subsequently died from of sepsis/septic shock. Clinical data and postmortem findings were documented in all patients.
Postmortem results of 235 patients (84.8%) were available for statistical analysis. The main causes of death as reported in the patient history were refractory multiple organ dysfunction syndrome (51.5%) and uncontrollable cardiovascular failure (35.3%). Pathologies were detected in the lungs (89.8%), kidneys/urinary tract (60%), gastrointestinal tract (54%), cardiovascular system (53.6%), liver (47.7%), spleen (33.2%), central nervous system (18.7%), and pancreas (8.5%). In 180 patients (76.6%), the autopsy revealed a continuous septic focus. The most common continuous foci were pneumonia (41.3%), tracheobronchitis (28.9%), peritonitis (23.4%), uterine/ovarial necrosis (9.8% of female patients), intraabdominal abscesses (9.1%), and pyelonephritis (6%). A continuous septic focus was observed in 63 of the 71 patients (88.7%) who were admitted to the ICU because of sepsis/septic shock and treated for longer than 7 days.
Relevant postmortem findings explaining death in surgical ICU patients who died because of sepsis/septic shock were a continuous septic focus in approximately 80% and cardiac pathologies in 50%. The most frequently affected organs were the lungs, abdomen, and urogenital tract. More diagnostic, therapeutic and scientific efforts should be launched to identify and control the infectious focus in patients with sepsis and septic shock.</description><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Autopsy</subject><subject>Biological and medical sciences</subject><subject>Central Nervous System - pathology</subject><subject>Cohort Studies</subject><subject>Critical Care</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney - pathology</subject><subject>Lung - pathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>Retrospective Studies</subject><subject>Sepsis - pathology</subject><subject>Sepsis - therapy</subject><subject>Shock, Septic - pathology</subject><subject>Urinary Tract - pathology</subject><issn>0003-2999</issn><issn>1526-7598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkN2KFDEQRoMo7rj6BiK50bteq5JOd3Ipg6sLKy6MXod0unon2j9jknbw7c2wgwsGilBwvirqMPYa4QoFyvdupivoACVJ1GgUIfZP2AaVaKpWGf2UbQBAVsIYc8FepPSjtAi6ec4u0NS1FggbtvvifFySXw7B87sl5WmJmSZ-HeY-zPeJh5kLqfhujffBu5HfzJnmFH4T37pI_M7lQHNO_Bjynu_okEJ6yZ4Nbkz06vxfsu_XH79tP1e3Xz_dbD_cVr4WDVRdZ4wUUmtS0DYtaSFb0w21E22tsB-MU4DU9Uob4-qW1KCp7xySar1BL-Qle_cw9xCXXyulbKeQPI1jUbOsyTatqEFrU8D6ATydmiIN9hDD5OIfi2BPMm1J2P9lltib8_y1m6h_DJ3tFeDtGXCpuBmim31I_ziBSqEy8Lj_uIyZYvo5rkeKdk9uzHsLp6ekqQSAgaY0VSkB8i-VjI1L</recordid><startdate>20090601</startdate><enddate>20090601</enddate><creator>Torgersen, Christian</creator><creator>Moser, Patrizia</creator><creator>Luckner, Günter</creator><creator>Mayr, Viktoria</creator><creator>Jochberger, Stefan</creator><creator>Hasibeder, Walter R.</creator><creator>Dünser, Martin W.</creator><general>International Anesthesia Research Society</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090601</creationdate><title>Macroscopic Postmortem Findings in 235 Surgical Intensive Care Patients with Sepsis</title><author>Torgersen, Christian ; Moser, Patrizia ; Luckner, Günter ; Mayr, Viktoria ; Jochberger, Stefan ; Hasibeder, Walter R. ; Dünser, Martin W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4260-bb9932388e50767e82379bf4a27451df9a501ebd5899a47e5f8edba1e57c91c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Autopsy</topic><topic>Biological and medical sciences</topic><topic>Central Nervous System - pathology</topic><topic>Cohort Studies</topic><topic>Critical Care</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney - pathology</topic><topic>Lung - pathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardium - pathology</topic><topic>Retrospective Studies</topic><topic>Sepsis - pathology</topic><topic>Sepsis - therapy</topic><topic>Shock, Septic - pathology</topic><topic>Urinary Tract - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Torgersen, Christian</creatorcontrib><creatorcontrib>Moser, Patrizia</creatorcontrib><creatorcontrib>Luckner, Günter</creatorcontrib><creatorcontrib>Mayr, Viktoria</creatorcontrib><creatorcontrib>Jochberger, Stefan</creatorcontrib><creatorcontrib>Hasibeder, Walter R.</creatorcontrib><creatorcontrib>Dünser, Martin W.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesia and analgesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Torgersen, Christian</au><au>Moser, Patrizia</au><au>Luckner, Günter</au><au>Mayr, Viktoria</au><au>Jochberger, Stefan</au><au>Hasibeder, Walter R.</au><au>Dünser, Martin W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Macroscopic Postmortem Findings in 235 Surgical Intensive Care Patients with Sepsis</atitle><jtitle>Anesthesia and analgesia</jtitle><addtitle>Anesth Analg</addtitle><date>2009-06-01</date><risdate>2009</risdate><volume>108</volume><issue>6</issue><spage>1841</spage><epage>1847</epage><pages>1841-1847</pages><issn>0003-2999</issn><eissn>1526-7598</eissn><coden>AACRAT</coden><abstract>Although detailed analyses of the postmortem findings of various critically ill patient groups have been published, no such study has been performed in patients with sepsis. In this retrospective cohort study, we reviewed macroscopic postmortem examinations of surgical intensive care unit (ICU) patients who died from sepsis or septic shock.
Between 1997 and 2006, the ICU database and autopsy register were reviewed for patients who were admitted to the ICU because of sepsis/septic shock, or who developed sepsis/septic shock at a later stage during their ICU stay and subsequently died from of sepsis/septic shock. Clinical data and postmortem findings were documented in all patients.
Postmortem results of 235 patients (84.8%) were available for statistical analysis. The main causes of death as reported in the patient history were refractory multiple organ dysfunction syndrome (51.5%) and uncontrollable cardiovascular failure (35.3%). Pathologies were detected in the lungs (89.8%), kidneys/urinary tract (60%), gastrointestinal tract (54%), cardiovascular system (53.6%), liver (47.7%), spleen (33.2%), central nervous system (18.7%), and pancreas (8.5%). In 180 patients (76.6%), the autopsy revealed a continuous septic focus. The most common continuous foci were pneumonia (41.3%), tracheobronchitis (28.9%), peritonitis (23.4%), uterine/ovarial necrosis (9.8% of female patients), intraabdominal abscesses (9.1%), and pyelonephritis (6%). A continuous septic focus was observed in 63 of the 71 patients (88.7%) who were admitted to the ICU because of sepsis/septic shock and treated for longer than 7 days.
Relevant postmortem findings explaining death in surgical ICU patients who died because of sepsis/septic shock were a continuous septic focus in approximately 80% and cardiac pathologies in 50%. The most frequently affected organs were the lungs, abdomen, and urogenital tract. More diagnostic, therapeutic and scientific efforts should be launched to identify and control the infectious focus in patients with sepsis and septic shock.</abstract><cop>Hagerstown, MD</cop><pub>International Anesthesia Research Society</pub><pmid>19448210</pmid><doi>10.1213/ane.0b013e318195e11d</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Autopsy Biological and medical sciences Central Nervous System - pathology Cohort Studies Critical Care Databases, Factual Female Humans Kidney - pathology Lung - pathology Male Medical sciences Middle Aged Myocardium - pathology Retrospective Studies Sepsis - pathology Sepsis - therapy Shock, Septic - pathology Urinary Tract - pathology |
| title | Macroscopic Postmortem Findings in 235 Surgical Intensive Care Patients with Sepsis |
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