Management of patients with severe melioidosis in intensive care

T Eoin West, Allen Cheng

Research output: Chapter in Book/Report/Conference proceedingChapterResearchpeer-review

Abstract

Melioidosis frequently presents as severe sepsis or septic shock. Appropriate managementtherefore dictates familiarity with standard sepsis therapies and approaches to intensive care. These treatments include early and aggressive haemodynamic management using intravenous fluids, vasopressors, and inotropes in a goal-directed fashion to maximise oxygen delivery to peripheral tissues. In the critically ill patient, oxygen consumption can be reduced with antipyretics, sedation, and mechanical ventilation. The role of glycaemic control and adjunctive treatments such as corticosteroids, activated protein C and granulocyte colony stimulating factor (G-CSF) are controversial. G-CSF has been formally studied in melioidosis patients, but the level of evidence for adjunctive treatments is insufficient. Mechanical ventilation for respiratory failure or acute lung injury may be required, necessitating an understanding of basic ventilator therapies. Treatment of acute renal injury and use of appropriate prophylactic therapies is also essential. Most, if not all,may be key factors in the reduction of the high mortality rate from melioidosis in developingcountries.
Original languageEnglish
Title of host publicationMelioidosis
Subtitle of host publicationA Century of Observation and Research
EditorsNatkunan Ketheesan
PublisherElsevier
ChapterSection VI.3
Pages209-219
Number of pages11
ISBN (Electronic)9780444534798
Publication statusPublished - 2012

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Melioidosis
Critical Care
Granulocyte Colony-Stimulating Factor
Artificial Respiration
Therapeutics
Sepsis
Antipyretics
Acute Lung Injury
Mechanical Ventilators
Septic Shock
Protein C
Acute Kidney Injury
Critical Illness
Oxygen Consumption
Respiratory Insufficiency
Adrenal Cortex Hormones
Hemodynamics
Oxygen
Mortality

Cite this

West, T. E., & Cheng, A. (2012). Management of patients with severe melioidosis in intensive care. In N. Ketheesan (Ed.), Melioidosis: A Century of Observation and Research (pp. 209-219). Elsevier.
West, T Eoin ; Cheng, Allen. / Management of patients with severe melioidosis in intensive care. Melioidosis: A Century of Observation and Research. editor / Natkunan Ketheesan. Elsevier, 2012. pp. 209-219
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West, TE & Cheng, A 2012, Management of patients with severe melioidosis in intensive care. in N Ketheesan (ed.), Melioidosis: A Century of Observation and Research. Elsevier, pp. 209-219.

Management of patients with severe melioidosis in intensive care. / West, T Eoin; Cheng, Allen.

Melioidosis: A Century of Observation and Research. ed. / Natkunan Ketheesan. Elsevier, 2012. p. 209-219.

Research output: Chapter in Book/Report/Conference proceedingChapterResearchpeer-review

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AB - Melioidosis frequently presents as severe sepsis or septic shock. Appropriate managementtherefore dictates familiarity with standard sepsis therapies and approaches to intensive care. These treatments include early and aggressive haemodynamic management using intravenous fluids, vasopressors, and inotropes in a goal-directed fashion to maximise oxygen delivery to peripheral tissues. In the critically ill patient, oxygen consumption can be reduced with antipyretics, sedation, and mechanical ventilation. The role of glycaemic control and adjunctive treatments such as corticosteroids, activated protein C and granulocyte colony stimulating factor (G-CSF) are controversial. G-CSF has been formally studied in melioidosis patients, but the level of evidence for adjunctive treatments is insufficient. Mechanical ventilation for respiratory failure or acute lung injury may be required, necessitating an understanding of basic ventilator therapies. Treatment of acute renal injury and use of appropriate prophylactic therapies is also essential. Most, if not all,may be key factors in the reduction of the high mortality rate from melioidosis in developingcountries.

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West TE, Cheng A. Management of patients with severe melioidosis in intensive care. In Ketheesan N, editor, Melioidosis: A Century of Observation and Research. Elsevier. 2012. p. 209-219