Shock

OBJECTIVE: To evaluate the efficacy and safety of using angiotensin II (Ang2) as primary vasopressor for vasodilatory hypotension. METHODS: This was a prospective observational study of critically ill adults admitted to an academic Intensive Care Unit (ICU) with vasodilatory hypotension. We treated 40 patients with Ang2 as primary vasopressor and compared them to 80 matched controls who received conventional vasopressors (norepinephrine, vasopressin, metaraminol, epinephrine, or combinations)...

BACKGROUND: Systemic inflammation act as a contributor to neurologic deficits after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). Extracellular cold-inducible RNA-binding protein (CIRP) has been demonstrated to be responsible in part for the inflammation through binding to Toll-like receptor 4 (TLR4) after cerebral ischemia. The short peptide C23 derived from CIRP has a high affinity for TLR4, we hypothesize that C23 reduces systemic inflammation after CA/CPR by blocking the binding of CIRP to TLR4...

OBJECTIVE: Based on the functions of immunoregulation and signal transduction, septic peripheral blood sequencing and bioinformatics technology were used to screen potential core targets. METHODS: Peripheral blood of twenty-three patients with sepsis and ten normal volunteers underwent RNA-seq processing within 24 hours after admission to the hospital. Data quality control and differential gene screening were performed based on R language (P < 0.01; log2FC ≥ 2)...

Sepsis-induced cardiomyopathy (SIC) is one of the most common complications of infection-induced sepsis. An imbalance in inflammatory mediators is the main factor leading to SIC. N6-methyladenosine (m6A) is closely related to the occurrence and development of sepsis. m6A reader YTH Domain Containing 1 (YTHDC1) is an m6A N6-methyladenosine recognition protein. However, the role of YTHDC1 in SIC remains unclear. Herein, we demonstrated that YTHDC1-shRNA inhibits inflammation, reduces inflammatory mediators, and improves cardiac function in a lipopolysaccharide (LPS)-induced SIC mouse model...

Acute respiratory distress syndrome (ARDS) is characterized by uncontrolled inflammation, which manifests as leukocyte infiltration and lung injury. However, the molecules that initiate this infiltration remain incompletely understood. We evaluated the effect of the nuclear alarmin interleukin (IL)-33 on lung damage and the immune response in lipopolysaccharide (LPS)-induced lung injury. We established a lipopolysaccharide (LPS)-induced lung injury mouse model. We used genetically engineered mice to investigate the relationship among the IL-33/ST2 axis, NKT cells, and ARDS...

BACKGROUND: Infantile pneumonia is a respiratory infection disease, seriously threatening the life of neonatal patients. Circular RNA (circRNA) dysregulation is reported to be involved in pneumonia pathogenesis. Circ_0012535 was previously displayed to be upregulated in blood samples of patients with community-acquired pneumonia. However, circ_0012535's role in this disorder remains unclear. We thus aim to unveil the functions of circ_0012535 in infantile pneumonia. METHODS: Fetal lung fibroblasts (WI38) treated with lipopolysaccharide (LPS) were used as pneumonia cell models...

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PURPOSE: To evaluate the effect of combined hydrocortisone, vitamin C, and thiamine (triple therapy) on the mortality of patients with septic shock. METHODS: This multicenter, open-label, two-arm parallel-group, randomized controlled trial was conducted in four intensive care units (ICUs) in Qatar. Adult patients diagnosed with septic shock requiring norepinephrine at a rate of ≥0.1 mcg/kg/min for ≥6 h were randomized to a triple therapy group or a control group...

OBJECTIVE: To identify and describe characteristics of patients with sepsis who could be treated with minimally invasive sepsis (MIS) approach without ICU admission, and to develop a prediction model to select candidates for MIS approach. METHODS: A secondary analysis of the electronic database of patients with sepsis at Mayo Clinic, Rochester, MN. Candidates for the MIS approach were adults with septic shock and < 48 hours of ICU stay, who did not require advanced respiratory support and were alive at hospital discharge...

OBJECTIVES: Systemic ischemia-reperfusion triggered by cardiac arrest (CA) and resuscitation often causes post-resuscitation multiple organ injuries. Mesenchymal stem cells (MSCs) have been proven to be a promising treatment for regional renal and intestinal ischemia reperfusion injuries. This study aimed to investigate the effects of MSCs on renal and intestinal injuries following cardiopulmonary resuscitation (CPR) in a porcine CA model. METHODS: Twenty-two male pigs were randomly assigned to the sham (n = 6), CA/CPR (n = 8), and CA/CPR + MSC (n = 8) groups...

BACKGROUND: Immunosuppression caused by immune cell apoptosis and an imbalance of T help 2 cells (Th2) and T help 1 cells (Th1), is associated with poor outcomes in septic patients. Esmolol was reported to improve survival by modulating immune responses in septic shock. Whether Esmolol could alleviate sepsis-induced immunosuppression and the optimal dose are unclear. METHODS: Four hours after cecal ligation and puncture (CLP), Wistar rats were randomized into CLP, CLP + E-5 (Esmolol:5 mg...

INTRODUCTION: Cell-free DNA (CFDNA) has emerged as a prognostic biomarker in patients with sepsis. Circulating CFDNA is hypothesized to be associated with histones in the form of nucleosomes. In vitro, DNA activates coagulation and inhibits fibrinolysis, whereas histones activate platelets and are cytotoxic to endothelial cells. Previous studies have targeted CFDNA or histones in animal models of sepsis using DNase I or heparins, respectively, which has reduced inflammatory and thrombosis markers, thereby improving survival...

A solution of high concentration albumin has been used for temporal volume expansion when timely resuscitation was unavailable following hemorrhagic shock. However, during prolonged hemorrhagic shock, cell edema and interstitial dehydration can occur and impede the volume expansion effect of albumin. Polyethylene glycol-20 K (PEG) can establish an osmotic gradient from swollen cells to capillary lumens and thus facilitate capillary fluid shift and volume expansion. We hypothesized that, with similar osmolality, 7...

INTRODUCTION: Sepsis is a dysregulated host response to infection that can lead to life-threatening organ dysfunction. Clinical and animal studies consistently demonstrate that female subjects are less susceptible to the adverse effects of sepsis, demonstrating the importance of understanding how sex influences sepsis outcomes. The signal transducer and activator of transcription 3 (STAT3) pathway is a major signaling pathway that facilitates inflammation during sepsis. STAT3 is abundantly expressed in white adipose tissue, however little is known about the contribution of white adipose tissue STAT3 activation during sepsis...

BACKGROUND: Hemorrhagic shock-induced acute lung injury (ALI) is commonly associated with the post-hemorrhagic shock mesenteric lymph (PHSML) return. Whether excessive autophagy is involved in PHSML-mediated ALI remains unclear. The relationship between estrogen treatment and PHSML or autophagy needs to verify. The current study will clarify the role of estrogen in reducing PHSML-mediated ALI through inhibition of autophagy. METHODS: Firstly, a hemorrhagic shock model in conscious rats was employed to observe the effects of 17β-estradiol (E2) on intestinal blood flow, pulmonary function, intestinal and pulmonary morphology, and expression of autophagy marker proteins...

BACKGROUND: Mortality in cardiogenic shock (CS) is up to 40%, and although risk scores have been proposed to stratify and assess mortality in CS, they have been shown to have inconsistent performance. The purpose was to compare CS prognostic scores and describe their performance in a real-world Latin American country. METHODS: We included 872 patients with CS. SCAI, CARDSHOCK, IABP-Shock II, CSS, ALC, GWTG-HF, and ADHERE scores were calculated. Decision curve analyses were performed to evaluate the net benefit of the different scoring systems...

BACKGROUND: Cecal ligation and perforation (CLP) is currently considered the gold standard model of sepsis, however, there are some deficiencies, such as low clinical relevance, inconsistency in severity grading, and an unknown proportion of CLP animals meeting the requirements of Sepsis-3. METHODS: Adult rats were randomly divided into three groups: modified CLP (M-CLP) group, CLP group, and sham group. The vital organ function of rats was evaluated 24 hours postoperatively by blood pressure, behavioral testing, histopathology, and blood test...

BACKGROUND: Sepsis-associated encephalopathy (SAE) is a dysfunction of the central nervous system experienced during sepsis with variable clinical and pathophysiologic features. We sought to identify distinct SAE phenotypes in relation to clinical outcomes. METHODS: The Medical Information Mart for Intensive Care IV (MIMIC-IV) database and the eICU database were employed to conduct a retrospective cohort study. Adult sepsis patients were included and SAE was defined as having a Glasgow Coma Scale (GCS) score ˂15, or delirium...

Pulmonary epithelial barrier injury contributes to acute lung injury, accelerating exudate formation, and resulting alveolar edema. Heme oxygenase-1 (HO-1) plays an important role in ameliorating the pathological symptoms of acute lung injury (ALI). Using an ALI mouse model induced by lipopolysaccharide (LPS) inhalation, the present study explored the potential molecular regulatory effect of hemin (a potent HO-1 inducer) against ALI epithelial damage. LPS challenge triggered dysfunction of the alveolar epithelial barrier, impaired tight junctions and disrupted alveoli fluid clearance, while these pathological changes were effectively reversed by hemin treatment...

While fluid resuscitation is fundamental in the treatment of sepsis-induced tissue hypo-perfusion, a sustained positive fluid balance is associated with excess mortality. Hyaluronan, an endogenous glycosaminoglycan with high affinity to water, has not been tested previously as adjuvant to fluid resuscitation in sepsis.In a prospective, parallel-grouped, blinded model of porcine peritonitis-sepsis, we randomized animals to intervention with adjuvant hyaluronan (add-on to standard therapy) (n = 8) or 0.9% saline (n = 8)...