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Thomas Datzmann, Martin Wepler, Ulrich Wachter, Josef A Vogt, Oscar McCook, Tamara Merz, Enrico Calzia, Michael Gröger, Clair Hartmann, Pierre Asfar, Peter Radermacher, Nussbaum Benedikt Lukas
Hyperoxia (ventilation with FIO2 = 1.0) has vasoconstrictor properties, in particular in the coronary vascular bed, and, hence, may promote cardiac dysfunction. However, we previously showed that hyperoxia attenuated myocardial injury during resuscitation from hemorrhage in swine with coronary artery disease. Therefore, we tested the hypothesis whether hyperoxia would also mitigate myocardial injury and improve heart function in the absence of chronic cardiovascular co-morbidity.After 3 hours of hemorrhage (removal of 30% of the calculated blood volume and subsequent titration of mean arterial pressure to 40mmHg) 19 anesthetized, mechanically ventilated and instrumented pigs received FIO2 = 0...
November 6, 2018: Shock
Yonghui Yu, Longlong Yang, Shaofang Han, Yushou Wu, Lingying Liu, Yang Chang, Xiaoteng Wang, Jiake Chai
INTRODUCTION: Cell autophagy is an important material recycling process and is involved in regulating many vital activities under both physiological and pathological conditions. However, the mechanism of autophagy regulating burn-induced skeletal muscle wasting still needs to be elucidated. METHODS: The rat burn model with 30% total body surface area and L6 cell line were used in this study. An immunofluorescence assay was used to detect autophagic levels. miRNA array and real-time PCR were employed to measure miR-190b levels, and its influence on PHLPP1 protein translation was estimated using luciferase reporter assay...
November 6, 2018: Shock
Nikki Treskes, Wilhelmina Aria Christina Koekkoek, Arthur Raymond Hubert van Zanten
BACKGROUND: Stress-induced hyperglycemia is common among septic shock patients. Nutritional support influences glucose homeostasis but this effect has never been studied in septic shock. We aimed to determine the course of hyperglycemia and serum insulin levels in critically ill septic shock patients and to address the effects of caloric intake on glycemia, insulin levels, and exogenous insulin requirements. METHODS: A prospective observational study of 24 ventilated septic shock patients for 72 hours...
November 6, 2018: Shock
Maxime Nguyen, Damien Denimal, Auguste Dargent, Pierre-Grégoire Guinot, Laurence Duvillard, Jean-Pierre Quenot, Bélaïd Bouhemad
BACKGROUND: In septic shock, both systemic vasodilatation and glomerular arteriole dilatation are responsible for the drop in glomerular filtration observed in early acute kidney injury. Angiotensin II has been showed to act on both mechanisms. Our objective was to evaluate the impact of renin angiotensin system activation, on hemodynamic deficiency and renal outcome in patient with septic shock and to assess whether urinary sodium could be a reliable test for high plasma renin concentration screening...
November 6, 2018: Shock
Nikolaus Hofmann, Johannes Zipperle, Florian Brettner, Mohammad Jafarmadar, Mostafa Ashmwe, Claudia Keibl, Martin Ponschab, Ulrike Kipmann, Arian Bahrami, Heinz Redl, Soheyl Bahrami, Valentin Fuhrmann, Herbert Schöchl
BACKGROUND: Plasma-based resuscitation showed protective effects on the endothelial glycocalyx compared to crystalloid resuscitation. There is paucity of data regarding the effect of coagulation factor concentrates (CFC) on the glycocalyx in hemorrhagic shock (HS). We hypothesized that colloid-based resuscitation supplemented with CFCs offers a therapeutic value to treat endothelial damage following HS. METHODS: Eighty-four rats were subjected to pressure controlled (mean arterial pressure (MAP) 30-35 mmHg) and lab guided (targeted cutoff: lactate >2...
November 6, 2018: Shock
Thomas Baudry, Romain Hernu, Baptiste Valleix, Vincent Jahandiez, Etienne Faucher, Marie Simon, Martin Cour, Laurent Argaud
Cirrhotic patients with septic shock have a poor prognosis in ICU compared to general population of critically ill patients. Little is known about long-term outcome in these patients. We performed a retrospective analysis of a prospective cohort of cirrhotic patients with septic shock. The aim of this study was to describe both short and long-term outcomes and to evaluate factors predicting mortality. Data from 149 patients were analyzed (mean age: 60 ± 11 years, sex ratio: 2.4). Mortality rate in the ICU was 54% and at 1 year it was 73%...
November 1, 2018: Shock
Andrew A Udy, Mark Finnis, Daryl Jones, Anthony Delaney, Stephen Macdonald, Rinaldo Bellomo, Sandra Peake
INTRODUCTION: To describe the utilization of vasopressors (VP) in patients enrolled in the Australasian Resuscitation In Sepsis Evaluation (ARISE) trial, and to explore the association between time to VP and 90-day mortality. METHODS: The primary exposure variable was VP use after arrival in the emergency department (ED). Vasoactive agents considered as VP included: norepinephrine, epinephrine, metaraminol, or vasopressin. Time-to-event analysis, multivariable logistic regression, and propensity-matched treatment effects modeling were used to assess the association between time to VP and 90-day mortality...
October 30, 2018: Shock
Freja Stæhr Holm, Pradeesh Sivapalan, Niels Seersholm, Theis Skovsgaard Itenov, Per Hjort Christensen, Jens-Ulrik Stæhr Jensen
BACKGROUND: Gelsolin is an actin-scavenger controlling the tissue damage from actin in the blood. Gelsolin levels in circulation drops when tissue damage and corresponding actin release is pronounced due to catabolic conditions. The purpose of this study was to determine if low plasma gelsolin independently predicts a reduced chance of weaning from ventilator-demanding respiratory failure in critically ill patients within 28 days from admission. RESULTS: This cohort study included 746 critically ill patients with ventilator-demanding respiratory failure from the randomized clinical trial, "Procalcitonin And Survival Study"...
October 18, 2018: Shock
Natascha G Alves, Andrea N Trujillo, Jerome W Breslin, Sarah Y Yuan
Excessive microvascular permeability is a serious complication following hemorrhagic shock and resuscitation (HSR). S1P has been shown to ameliorate microvascular leakage in a model of combined alcohol intoxication and hemorrhagic shock and resuscitation (HSR). In the current study, we tested the hypothesis that S1P reduces HSR-induced microvascular leakage by preserving endothelial cell junctional structure and the endothelial glycocalyx through protection of mitochondrial function. We used an established in vivo rat model of conscious HSR and assessed microvascular leakage, endothelial glycocalyx integrity, and mitochondrial function by intravital microscopy...
October 18, 2018: Shock
Jeffrey W Shupp, Kathleen E Brummel-Ziedins, Mitchell J Cohen, Kalev Freeman, Rasha Hammamieh, Uma S Mudunuri, Thomas Orfeo, Lauren T Moffatt, Bernard H Brownstein, Kenneth G Mann, Marti Jett, Anthony E Pusateri
INTRODUCTION: Provisioning care for traumatically injured patients makes conducting research very proximal to injury difficult. These studies also inherently have regulatory barriers to overcome. Here we outline a protocol for acute-phase enrollment of traumatically injured patients into a prospective observational clinical trial with precise and comprehensive sample acquisition in support of a systems biology approach to a research study. METHODS: Experts in trauma, burn, blood coagulation, computational biology, and integrative systems biology developed a prospective study that would capture the natural history of coagulation pathology after traumatic injury...
October 18, 2018: Shock
T Tyler Patterson, Susannah Nicholson, David Wallace, Gregory W J Hawryluk, Ramesh Grandhi
Traumatic brain injury (TBI) contributes to nearly one in three injury-related deaths in the United States and accounts for a substantial public health burden and cost. The current literature reports that physiologic responses in the gastrointestinal system after TBI include, but are not limited to, epithelial barrier dysfunction, microbiota changes, and immunologic transformations. Recent evidence suggests gut alterations after TBI modify the homeostasis of the bidirectional gut-microbiota-brain axis, resulting in altered immune responses in the periphery and the brain...
October 17, 2018: Shock
Weiwei Chen, Li Ma, Ranran Li, Shunwei Huang, Rongli Xie, Ying Chen, Bing Zhao, Jian Fei, Hongping Qu, Hao Chen, Enqiang Mao, Er-Zhen Chen
OBJECTIVE: The aim of the study was to investigate the role of dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin (DC-SIGN) in intestinal epithelial cells (IECs) in regulating sepsis-induced acute intestinal injury and systemic inflammatory response. METHODS: To induce sepsis condition, Male C57BL/6 mice were exposed to cecal ligation and puncture (CLP) in vivo, whereas a normal human IECs line (FHs74Int) was stimulated with lipopolysaccharide (LPS) in vitro...
October 17, 2018: Shock
Jiefeng Xu, Qijiang Chen, Xiaohong Jin, Chunshuang Wu, Zilong Li, Guangju Zhou, Yongan Xu, Anyu Qian, Yulin Li, Mao Zhang
Rapid induction of hypothermia early after resuscitation can be an effective strategy against post-cardiac arrest syndrome (PCAS). Preliminary data suggested that continuous renal replacement therapy (CRRT) might be an efficient method to rapidly induce hypothermia. In this study, we investigated the efficacy of cooling induced by CRRT and its effects on the outcomes of PCAS in a porcine model.Thirty-two male domestic pigs weighing 36 ± 2 kg were randomized into 4 groups: sham control (n = 5), normothermia (n = 9), surface cooling (SC, n = 9), and CRRT (n = 9)...
October 17, 2018: Shock
Thibault Duburcq, Arthur Durand, Antoine Tournoys, Viviane Gnemmi, Caroline Bonner, Valery Gmyr, Thomas Hubert, François Pattou, Mercedes Jourdain
BACKGROUND: Antithrombin III physiological levels are decreased during septic shock, and supplementation therapy could therefore be beneficial. OBJECTIVE: We hypothesized that the use of recombinant human antithrombin could reduce Disseminated Intravascular Coagulation (DIC) occurrence. METHODS: We conducted a randomized open label controlled experimental study. Ten female "Large White" pigs were challenged with intravenous infusion of E...
October 15, 2018: Shock
Feng Kuai, Lei Wang, Jianhua Su, Yu Wang, Yi Han, Suming Zhou
FTY720 is a sphingosine 1 phosphate (S1P) receptor agonist approved for the treatment of multiple sclerosis (MS), which is a chronic inflammatory autoimmune disorder. Sepsis is a complex syndrome associated with progressive endotoxemic developments, which finally leads to damage of multiple organs, including the heart. In critical patients, cardiovascular dysfunction due to sepsis is a major cause of death. Previous studies have shown an association between S1P and cardioprotection in the situation of ischemia reperfusion and myocardial infarction...
October 8, 2018: Shock
Xavier Bobbia, Laurent Muller, Pierre-Géraud Claret, Laure Vigouroux, Antonia Perez-Martin, Jean Emmanuel de La Coussaye, Jean Yves Lefrant, Guillaume Louart, Claire Roger, Thibaut Markarian
BACKGROUND: The correlation between cardiac output (CO) evaluated by echocardiography and CO measured by thermodilution (COth) varies according to different studies. A new transthoracic echocardiography (TTE) tool allows automatic calculation of the subaortic velocity time index (VTIauto) and CO (COauto). The main objective was to evaluate the correlation between COth and COauto in an anesthetized, ventilated piglet hemorrhagic shock (HS) model. The secondary objectives were to evaluate the correlation between COth and CO evaluated by manual measurements of VTI, and the preload-dependency of VTIvaresp...
October 8, 2018: Shock
Thomas Breuer, Christian S Bruells, Klemens Horst, Christoph Thiele, Frank Hildebrand, Stephan Linnartz, Tom Siegberg, Nadine Frank, Ghislaine Gayan-Ramirez, Lukas Martin, Dirk H Ostareck, Gernot Marx, Tim-Philipp Simon
INTRODUCTION: Mechanical ventilation is known to activate oxidative stress and proteolytic pathways in the diaphragm. Trauma by inducing inflammation and activating proteolytic pathways may potentiate the effects of mechanical ventilation on the diaphragm. In a blunt chest trauma with concomitant injuries we tested the hypothesis that trauma via inflammation further activates the proteolytic pathways and worsens atrophy in the diaphragm. MATERIAL AND METHODS: Piglets were separated into 2 groups and underwent 72hrs of mechanical ventilation...
October 8, 2018: Shock
Mona Vogel, Hannes Christow, Isabel Manz, Michael Denkinger, Amanda Amoah, Desiree Schütz, Andreas Brown, Bettina Möhrle, Annika Schaffer, Miriam Kalbitz, Florian Gebhard, Benjamin Mayer, Markus Huber-Lang, Hartmut Geiger
Endogenously mobilized stem and progenitor cells (SPCs) or exogenously provided SPCs are thought to be beneficial for trauma therapy. However, still little is known about the synchronized dynamics of the number of SPCs in blood after severe injury and parameters like cytokine profiles that correlate with these numbers. We determined the number of hematopoietic stem cells, common myeloid progenitors, granulocyte-macrophage progenitors and mesenchymal stem/stromal cells in peripheral blood (PB) 0-3 h, 8 h, 24 h, 48 h and 120 h after polytrauma in individual patients (injury severity score ≥ 21)...
October 4, 2018: Shock
Lisa Wrba, J Josephine Ohmann, Philipp Eisele, Shinjini Chakraborty, Sonja Braumüller, Christian K Braun, Bettina Klohs, Anke Schultze, Heike von Baum, Annette Palmer, Markus Huber-Lang, Rebecca Halbgebauer
Dysfunction of the gut-blood barrier plays an important role in many diseases, such as inflammatory bowel disease, hemorrhagic shock (HS) or burn injury. However, little is known about gut barrier dysfunction after hemodynamically instable polytrauma (PT). Therefore, we aimed to evaluate the effects of PT and HS on remote intestinal damage and barrier dysfunction, especially regarding the role of Zonula occludens protein 1 (ZO-1) as an important tight junction protein.Male C57BL/6 mice were subjected to either PT (thorax trauma, closed head injury, soft tissue injury and distal femoral fracture), 60 min of pressure-controlled HS (30 ± 5 mmHg), or PT+HS, or sham procedures...
October 4, 2018: Shock
Jian Kang, Ping Gong, Xiao-Dong Zhang, Wen-Juan Wang, Chun-Sheng Li
OBJECTIVE: Early differential diagnosis of an infection in a trauma patient is likely to have a significant influence on the prognosis. In the present study, we evaluated the early differential value of plasma presepsin, procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) on infection in trauma patients. METHODS: Trauma patients were divided into noninfected (n = 89) and infected trauma groups (n = 68); healthy adult volunteers (n = 60) and patients having sterile surgery (n = 60) were enrolled as the controls...
October 4, 2018: Shock
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