Shock

BACKGROUND: Cardiac output (CO) assessment is essential for management of patients with circulatory failure. Among the different techniques used for their assessment, pulsed-wave Doppler cardiac output (PWD-CO) has proven to be an accurate and useful tool. Despite this, assessment of PWD-CO could have some technical difficulties, especially in the measurement of left ventricular outflow tract diameter (LVOTd). The use of a parameter such as minute distance (MD) which avoids LVOTd in the PWD-CO formula could be a simple and useful way to assess the cardiac output in critically ill patients...

The molecular mechanism for nobiletin's protective effect against heatstroke-induced acute lung injury (HS-ALI) remains largely unknown. Previous research has demonstrated that ferroptosis is an important pathogenic event in HS-ALI. Nobiletin is a natural polymethoxylated flavonoid. Herein, we investigated the potential contribution of nobiletin to HS-ALI by inhibiting ferroptosis. Heat stress was used to induce HS-ALI in mice, and MLE-12 cells were stimulated by heat stress in vitro. Nobiletin was administrated by gavage for 2 hours before HS induction...

PURPOSE: Intensive care unit-acquired weakness (ICUAW) is a severe neuromuscular complication that frequently occurs in patients with sepsis. The precise molecular pathophysiology of mitochondrial calcium uptake 1 (MICU1) and mitochondrial calcium uniporter (MCU) in ICUAW has not been fully elucidated. Here, we speculate that ICUAW is associated with MICU1:MCU protein ratio-mediated mitochondrial calcium ([Ca2+]m) uptake dysfunction. METHODS: Cecal ligation and perforation (CLP) was performed on C57BL/6 J mice to induce sepsis...

BACKGROUND: Trauma-induced hypocalcemia is common and associated with adverse outcomes, but the mechanisms remain unclear. Thus, we aimed to characterize the metabolomic and proteomic differences between normo- and hypocalcemic trauma patients to illuminate biochemical pathways that may underlie a distinct pathology linked with this clinical phenomenon. METHODS: Plasma was obtained on arrival from injured patients at a Level 1 Trauma Center. Samples obtained after transfusion were excluded...

Sepsis-induced acute liver injury is a life-threatening condition involving inflammation, oxidative stress, and endothelial dysfunction. In the present study, the preventive effects of resveratrol (RV) alone and resveratrol-loaded silver nanoparticles (AgNPs+RV) against sepsis-induced damage were investigated and compared in a rat model of polymicrobial sepsis induced by cecal ligation and puncture (CLP). Rats were divided into four groups: Sham, CLP, RV, and AgNPs+RV. Pro-inflammatory cytokines (tumor necrosis factor-alpha [TNF-α], interleukin-1 beta [IL-1β], interleukin-6 [IL-6]), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) activation, presepsin, procalcitonin, 8-hydroxy-2'-deoxyguanosine (8-OHDG), vascular endothelial growth factor (VEGF), and Sirtuin-1 (SIRT-1) levels were assessed to determine the treatments' effects...

The pathophysiology of pediatric sepsis is characterized by increased innate immune activation earlier in life. Interleukin-1 is a pro-inflammatory cytokine implicated in the pathophysiology of sepsis and ferritin is a stable surrogate biomarker for elevated IL-1 levels. Data in adult sepsis has shown that use of anakinra, an anti-IL-1 receptor antagonist led to improved clinical outcomes in patients with features of macrophage activation and hyperferritinemia. However, data in pediatric sepsis is lack. Our narrative review sought to highlight the current understanding of using IL-1 inhibitors in pediatric sepsis...

BACKGROUND: Ischemia-reperfusion after cardiac arrest activates peptidyl arginine deiminase and citrullinates histone H3 (CitH3), which leads to the formation of neutrophil extracellular traps (NETs). This study attempted to determine the alterations in NET components in post-cardiac arrest patients as well as analyze the association of NETs with 28-day all-cause mortality. METHODS: In this study, 95 patients with return of spontaneous circulation (ROSC) after cardiac arrest were included...

BACKGROUND: Vasopressor plays a crucial role in septic shock. However, the time for vasopressor initiation remains controversial. We conducted a systematic review and meta-analysis to explore its initiation timing for septic shock patients. METHODS: PubMed, Cochrane Library, Embase, and Web of Sciences were searched from inception to July 12nd, 2023 for relevant studies. Primary outcome was short-term mortality. Meta-analysis was performed using Stata 15.0.ResultsTwenty-three studies were assessed, including 2 RCTs and 21 cohort studies...

BACKGROUND: Tranexamic acid (TXA) reduces mortality in trauma patients. Intramuscular (i.m.) administration could be advantageous in low-resource and military settings. Achieving the same serum concentration as i.v. administration is important to achieve equal mortality reduction. Therefore, we aimed to investigate whether dividing an i.m. dose of TXA between two injection sites, and whether an increase in dose, would lead to serum concentrations comparable to those achieved by i.v. administration...

BACKGROUND: While central venous oxygen saturation (ScvO2) has been used as an endpoint for the treatment of circulatory shock, its role in guiding the evaluation and treatment of patients with severe hypoxemia remains to be assessed. The aim of this study was to assess the incidence of low ScvO2 in a cohort of hypoxemic patients and the association of this finding with differences in clinical management and patient outcomes. METHODS: Retrospective review of data from adult ICU patients with hypoxemia who required invasive mechanical ventilation for over 24 hours and had at least one ScvO2 measured within 6 hours of a PaO2/FiO2 ratio < 200...

BACKGROUND: The aim of this study was to investigate the relationship between dynamic arterial elastance (EaDyn) and the pulsatile and steady components of arterial load in an endotoxin shock model using a two-element Windkessel model and to describe the behavior of EaDyn in this model. METHODS: Ten female Yorkshire pigs were administered lipopolysaccharide intravenously to induce endotoxin shock, while three female pigs served as the control group. Measurements of EaDyn (ratio between pulse pressure variation (PPV) and stroke volume variation (SVV)), effective arterial elastance, arterial compliance (Cart), and systemic vascular resistance were taken every 30 minutes in the endotoxin group until shock was induced...

OBJECTIVE: Neurological complications after myocardial ischemia/reperfusion (IR) injury remain high and seriously burden patients and their families. Dexmedetomidine (Dex), an α2 agonist, is endowed with analgesic-sedative and anti-inflammatory effects. Therefore, our study aims to explore the mechanism and effect of Dex on brain damage following myocardial IR injury. METHODS: C57BL/6 mice were randomly divided into Sham, IR, and IR + Dex groups, and myocardial IR models were established...

BACKGROUND: Tissue trauma and hemorrhage result in pronounced activation of the innate immune system. Given known crosstalk between inflammation and coagulation, soluble inflammatory mediators could be associated with venous thromboembolisms (VTE) after major trauma. OBJECTIVES: Identify plasma inflammatory mediators that are independent predictors of VTE risk in trauma patients. METHODS: We performed a secondary analysis of the Pragmatic Randomized Optimal Platelets and Plasma Ratios (PROPPR) study...

Normal shear stress is essential for the normal structure and functions of the microcirculation. Hemorrhagic shock leads to reduced shear stress due to reduced tissue perfusion. Although essential for the urgent restoration of cardiac output and systemic blood pressure, large volume resuscitation with currently available solutions causes hemodilution, further reducing endothelial shear stress. In this narrative review, we consider how the use of currently available resuscitation solutions results in persistent reduction in endothelial shear stress, despite successfully increasing cardiac output and systemic blood pressure...

BACKGROUND: We aimed to evaluate the ability of inferior vena cava (IVC) distensibility using the transhepatic approach to predict fluid responsiveness in mechanically ventilated patients with septic shock after emergency laparotomy. METHODS: This prospective observational study included mechanically ventilated paralyzed adult who had septic shock following emergency laparotomy. The IVC dimensions were measured through the transhepatic and subxiphoid approaches...

INTRODUCTION: The optimal target of mean arterial pressure (MAP) during CRRT is unknown. METHOD: We retrospectively collected the hourly MAP data in AKI patients requiring CRRT who admitted to the intensive care unit in the University of Tokyo hospital during 2011-2019. Patients who died within 48 hours of CRRT start and whose average value of hourly MAPs during the first 48 hours was <65 mmHg were excluded. When the average value of MAP was≤75 mmHg or > 75 mmHg, patients were allocated to the low or high target group...

Sepsis-induced acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is characterized by widespread pulmonary inflammation and immune response, in which pro-inflammatory polarization of alveolar macrophages (AMs) plays an important role. Mitochondria are the key intracellular signaling platforms regulating immune cell responses. Moreover, accumulating evidence suggests that the mitochondrial dynamics of macrophages are imbalanced in sepsis and severe ALI/ARDS. However, the functional significance of mitochondrial dynamics of AMs in septic ALI/ARDS remains largely unknown, and whether it regulates the polarized phenotype of AMs is also unclear...

Gut barrier dysfunction caused by intestinal ischemia/reperfusion (I/R) injury is associated with substantial death and morbidity. In this research, the role of microRNAs (miRNAs) in regulating intestinal I/R injury was investigated. We used miRNA sequencing to analyze clinical ischemic and normal intestinal samples. Through bioinformatics analysis based on sequencing results, we found that upregulated miRNAs inhibited epithelial barrier function and cell proliferation, with miR-379-5p being the most significantly upregulated in the ischemic intestine...

INTRODUCTION: Acute kidney injury (AKI) is a prevalent medical disorder characterized by a sudden decline in kidney function, often because of ischemia-reperfusion events. It is associated with significant chronic complications, and currently available therapies are limited to supportive measures. Extracellular cold-inducible RNA-binding protein (eCIRP) has been identified as a mediator that potentiates inflammation following ischemia-reperfusion injury. However, it has been discovered that miRNA 130b-3p acts as an endogenous inhibitor of eCIRP...

BACKGROUND: Serum calcium levels disorder have been reported to be associated with poor prognosis in different diseases. Studies on the association between serum calcium and outcomes of septic patients remained limited. The aim of this study is to investigate the association between serum calcium and 28-day mortality in septic patients. METHOD: Patients diagnosed with sepsis in the Medical Information Mart for Intensive Care III database were included. Patients were divided into five groups according to the quintiles of serum calcium levels, and their baseline characteristics were compared...