Molly Deane, Samuel M Galvagno, Benjamin Moran, Deborah M Stein, Thomas M Scalea, James V O'Connor
BACKGROUND: Damage control laparotomy has increased survival for critically injured patient with penetrating abdominal trauma. There has been a slower adoption of a damage control strategy for thoracic trauma despite the considerable mortality associated with emergent thoracotomy for patients in profound shock. We postulated admission physiology, not blood pressure or shock index, would identify patients who would benefit from thoracic damage control. STUDY DESIGN: Retrospective trauma registry review from 2002 to 2017 at a busy, urban trauma center...
November 5, 2019: Shock
Binghu Li, Hongliang Zhao, Jie Zhang, Qingguang Yan, Tao Li, Liangming Liu
The aim of this study was to assess the efficacy and safety of various resuscitation fluids in septic shock by adopting a network meta-analysis (NMA). Randomized controlled trials (RCTs) comparing resuscitation fluids in septic shock were carried out by retrieving electronic databases. NMAs of 28-day mortality, 90-day mortality, incidence of acute kidney injury (AKI), and the need for renal replacement therapy (RRT) were conducted using the STATA 15.0 software. Probability-based ranking and surface under cumulative ranking (SUCRA) were performed to identify the optimal resuscitation fluid...
November 5, 2019: Shock
Hong Liu, Si-Qiang Zheng, Zhi-Hua Zeng, Zhi-Gang Liu, Xiao-Cheng Liu, Yong-Feng Shao
PURPOSE: Little is known regarding precise estimates of the association between perfusate oxygenation (PpO2) and acute lung injury (ALI) following tetralogy of Fallot repair. The objective is to investigate PpO2 and the risk of ALI following tetralogy of Fallot repair in pediatric patients. METHODS: We conducted a nested case-control study within a prospective Chinese TedaICH cohort including 134 ALI patients aged 1 month to 18 years undergoing complete repair of tetralogy of Fallot, and each was matched to 2 controls...
November 5, 2019: Shock
Max Lenz, Dominik F Draxler, Chao Zhang, Mona Kassem, Stefan P Kastl, Alexander Niessner, Kurt Huber, Johann Wojta, Gottfried Heinz, Walter S Speidl, Konstantin A Krychtiuk
BACKGROUND: Toll-like receptors (TLRs) play an important role in inflammatory processes in critically ill patients by binding to pathogen-associated molecular patterns and danger-associated molecular patterns (DAMPs). Whether neutrophil or monocyte TLR expression patterns are associated with outcome in critical illness is unknown. OBJECTIVES: To answer this question, we conducted a prospective, observational study including 215 consecutive patients admitted to a medical ICU at a tertiary care center...
November 4, 2019: Shock
Matthew K McIntyre, Charlotte J Winkler, Belinda I Gómez, Jean-Paul Lapierre, Joshua S Little, Michael A Dubick, Susannah Nicholson, David M Burmeister
INTRODUCTION: While recent reports underscore the significance of the gut microbiome (GM) in health and disease, its importance in burn outcomes remains unclear. Moreover, aggressive intravenous (IV) fluid resuscitation of patients may alter intestinal flora. Herein, we describe GM changes following a large burn in swine randomized to different volumes of IV Lactated Ringers' (LR). METHODS: Anesthetized Yorkshire swine sustained 40% Total body surface area full-thickness burns and were randomized to different volumes of IV LR: none (n = 3), 15 mL/kg/day (Low; n = 6), or 80 mL/kg/day (High; n = 6)...
October 16, 2019: Shock
Shunsuke Otani, Takehiko Oami, Benyam P Yoseph, Nathan J Klingensmith, Ching-Wen Chen, Zhe Liang, Craig Coopersmith
Sepsis induces both intestinal hyperpermeability and epithelial apoptosis. While each has been implicated in mediating sepsis mortality, the relationship between these two processes is unclear. We hypothesized that preventing intestinal apoptosis would prevent gut barrier dysfunction. To test this hypothesis, transgenic mice that overexpress the anti-apoptotic protein Bcl-2 in the gut epithelium (Fabpl-Bcl-2 mice) and wild type (WT) mice were subjected to sham laparotomy or cecal ligation and puncture and orally gavaged with fluorescein isothiocyanate conjugated-dextran (FD-4) five hours before sacrifice...
October 15, 2019: Shock
Zhuoqun Fang, Gaofeng Wu, Dongliang Zhang, Kejia Wang, Xudong Deng, Mengdong Liu, Juntao Han, Dahai Hu, Xuekang Yang
Genistein (Gen) exhibits strong anti-oxidative/anti-nitrative activity and cardioprotective effects in several models; however, its role in burn-induced myocardial injury is unknown. This study investigated the protective effect of Gen on burn-induced myocardial injury and aimed to elucidate the mechanism of protection. Mice were injected with Gen, intraperitoneally, at different dose immediately after burn injury. The expression levels of Notch-1 intracellular domain (NICD1) and hairy and enhancer of split (Hes-1) were determined by immunoblotting...
October 15, 2019: Shock
Golnar Eftekhari, Amir Shojaei, Mohammad R Raoufy, Hossein Azizi, Saeed Semnanian, Alireza Mani
OBJECTIVE: Sepsis is a leading cause of mortality and morbidity in infants. Although the measures of autonomic dysfunction (e.g. reduced heart rate variability) predict mortality in sepsis, the mechanism of sepsis-induced autonomic dysfunction has remained elusive. The nucleus of the solitary tract hjh(NTS) is a vital structure for the integrated autonomic response to physiological challenges. In the present study we hypothesized that sepsis alters the excitability of NTS neurons in a rat model of neonatal sepsis (14-day old rats)...
October 15, 2019: Shock
Cornelia Knaak, Friederike S Schuster, Claudia Spies, Gerald Vorderwülbecke, Peter Nyvlt, Thomas Schenk, Felix Balzer, Paul La Rosée, Gritta Janka, Frank M Brunkhorst, Didier Keh, Gunnar Lachmann
BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH), an uncontrolled overactivation of the immune system, is well characterized in pediatric patients, yet, much less is known about this life-threatening condition in adult patients. As HLH is often complicated by organ failure, patients will require admission to the intensive care unit for organ support therapy. However, recognition of HLH patients in the ICU is challenged by the clinical overlap with sepsis. Here, we analyze HLH patients to better understand its clinical presentation, diagnosis and treatment...
October 15, 2019: Shock
Christian Tapking, Daniel Popp, David N Herndon, Ludwik K Branski, Gabriel Hundeshagen, Andrew M Armenta, Martin Busch, Patrick Most, Michael P Kinsky
Patients that experience severe burn injuries face a massive inflammatory response resulting in hemodynamic and cardiovascular complications. Even after immediate and appropriate resuscitation, removal of burn eschar and covering of open areas, burn patients remain at high risk for serious morbidity and mortality. As a result of the massive fluid shifts following the initial injury, along with large volume fluid resuscitation, the cardiovascular system is critically affected. Further, increased inflammation, catecholamine surge and hypermetabolic syndrome impacts cardiac dysfunction, which worsens outcomes of burn patients...
October 15, 2019: Shock
Marc Jeschke, Edward R Sherwood
No abstract text is available yet for this article.
October 15, 2019: Shock
Christian Scheer, Sven-Olaf Kuhn, Marcus Vollmer, Klaus Hahnenkamp, Sebastian Rehberg
No abstract text is available yet for this article.
October 7, 2019: Shock
Holger A Lindner, Thomas Kirschning, Anna-Meagan Fairley, Mariella E Oster, Christel Weiß, Verena Schneider-Lindner
No abstract text is available yet for this article.
October 7, 2019: Shock
Suwei Li, Xianyao Wan, Krzysztof Laudanski
No abstract text is available yet for this article.
September 17, 2019: Shock
Xiaoyang Zhou, Zhaojun Xu
No abstract text is available yet for this article.
September 17, 2019: Shock
Thomas Lafon, Alexandra Appert, Mathilde Hadj, Vincent Bigrat, Vincent Legarcon, Paul Claveries, Marine Goudelin, Bruno Evrard, Ana Catalina Hernandez Padilla, Arthur Baisse, Philippe Vignon
STUDY OBJECTIVE: We evaluated the early haemodynamic profile of patients presenting with acute circulatory failure to the Emergency Department using focused echocardiography performed by emergency physicians after a dedicated training program. METHODS: Patients presenting to the Emergency Department with an acute circulatory failure of any origin were successively examined by a recently trained emergency physician and by an expert in critical care echocardiography...
September 17, 2019: Shock
Subramaniam Krishnan, Charmagne Beckett, Benjamin Espinosa, Danielle V Clark
No abstract text is available yet for this article.
September 17, 2019: Shock
Thomas Clavier, Emmanuel Besnier, Julie Maucotel, Arnaud Arabo, Laurence Desrues, Mohamad El Amki, Nicolas Perzo, Vincent Richard, Fabienne Tamion, Pierrick Gandolfo, Martine Dubois, Hélène Castel, Vincent Compère
INTRODUCTION: Urotensin II (UII) is a potent vasoactive peptide activating the G protein-coupled receptor UT, and is involved in systemic inflammation and cardiovascular functions. The aim of our work was to study the impact of the UT antagonist urantide on survival, systemic inflammation and cardiac function during endotoxic shock. METHODS: C57Bl/6 mice were intraperitoneally injected with lipopolysaccharide (LPS) and then randomized to be injected either by urantide or NaCl 0...
September 17, 2019: Shock
Diana Pang, Yijen L Wu, Alicia M Alcamo, Jessica Cummings, Valentina Di Caro, Thomas Walko, Victor Hsue, Robert S B Clark, Ashok Panigrahy, Patrick M Kochanek, Rajesh K Aneja
Sepsis-induced brain injury is associated with an acute deterioration of mental status resulting in cognitive impairment and acquisition of new functional limitations in sepsis survivors. However, the exact nature of brain injury in this setting is often subtle and remains to be fully characterized both in pre-clinical studies and at the bedside. Given the translation potential for the use of magnetic resonance imaging (MRI)1 to define sepsis-induced brain injury, we sought to determine and correlate the cellular changes with neuroradiographic presentations in a classic murine model of sepsis induced by cecal ligation and puncture (CLP)2...
September 10, 2019: Shock
Eizo Watanabe, Osamu Nishida, Yasuyuki Kakihana, Motoi Odani, Tatsuaki Okamura, Tomohiro Harada, Shigeto Oda
BACKGROUND: Sepsis often induces an immunosuppressive state, which is associated with high mortality rates. Immunostimulation may be beneficial for sepsis. We investigated the pharmacokinetics, pharmacodynamics, and safety of nivolumab, a human programmed death-1 immune checkpoint inhibitor approved for the treatment of several cancers. METHODS: In this multicenter, open-label phase 1/2 study, a single 480 or 960 mg nivolumab dose was intravenously infused into Japanese patients with immunosuppressive sepsis...
September 6, 2019: Shock
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