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Fluid resuscitation tolerance responsive

Eng-Kean Yeong, Ciaran P O'Boyle, Hui-Fu Huang, Hao-Chih Tai, Yen-Chun Hsu, Shu-Yang Chuang, Yu-Feng Wu, Che-Wei Chang, Tom J Liu, Hong-Shiee Lai
OBJECTIVE: To investigate the outcomes of a local healthcare system in managing a burn mass casualty incident (BMCI). METHODS: Thirty-three victims admitted to the National Taiwan University Hospital within 96h of the explosion were included in the study. Data were recorded on: patient demographics, Baux score, laboratory data, management response, treatment strategies, and outcomes. Case notes from June 27, 2015 to November 2015 were reviewed with a focus on fluid resuscitation, ventilation support, nutrition, infection control, sepsis treatment, and wound closure plan...
May 9, 2018: Burns: Journal of the International Society for Burn Injuries
Will Jaffee, Spencer Hodgins, William T McGee
Severe sepsis and septic shock remain among the deadliest diseases managed in the intensive care unit. Fluid resuscitation has been a mainstay of early treatment, but the deleterious effects of excessive fluid administration leading to tissue edema are becoming clearer. A positive fluid balance at 72 hours is associated with significantly increased mortality, yet ongoing fluid administration beyond a durable increase in cardiac output is common. We review the pathophysiologic and clinical data showing the negative effects of edema on pulmonary, renal, central nervous, hepatic, and cardiovascular systems...
January 1, 2017: Journal of Intensive Care Medicine
Erik C Brockman, Travis C Jackson, C Edward Dixon, Hülya Bayɪr, Robert S B Clark, Vincent Vagni, Keri Feldman, Catherine Byrd, Li Ma, Carleton Hsia, Patrick M Kochanek
Resuscitation with polynitroxylated pegylated hemoglobin (PNPH), a pegylated bovine hemoglobin decorated with nitroxides, eliminated the need for fluid administration, reduced intracranial pressure (ICP) and brain edema, and produced neuroprotection in vitro and in vivo versus Lactated Ringer's solution (LR) in experimental traumatic brain injury (TBI) plus hemorrhagic shock (HS). We hypothesized that resuscitation with PNPH would improve acute physiology versus whole blood after TBI+HS and would be safe and effective across a wide dosage range...
April 1, 2017: Journal of Neurotrauma
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Koji Morishita, Raul Coimbra, Simone Langness, Brian P Eliceiri, Todd W Costantini
CD103(+) dendritic cells (DCs) continuously migrate from the intestine to the mesenteric lymph nodes (MLNs) and maintain tolerance by driving the development of regulatory T cells (Treg) in the gut. The relative expression of Treg and T-helper 17 (Th17) cells determines the balance between tolerance and immunity in the gut. We hypothesized that trauma/hemorrhagic shock (T/HS) would decrease the CD103(+) DC population in the mesenteric lymph and alter the Treg-to-Th17 ratio in the MLN. We further hypothesized that vagus nerve stimulation (VNS) would promote tolerance to inflammation by increasing the Treg-to-Th17 ratio in the MLN after injury...
August 1, 2015: American Journal of Physiology. Gastrointestinal and Liver Physiology
Michael R Rowland, Neli P Ragina, Joy Sarkar, Catherine F T Uyehara, Anthony J Senagore
BACKGROUND: Hemorrhagic shock leads to a complex cascade of metabolic and hormonal processes that may result in hypoperfusion, end organ damage, and death even when blood pressure is restored. Studies have shown that morbidity and mortality could be attributable to a diminished availability of endothelial-derived nitric oxide (eNO). It is unclear whether adequate levels of citrulline (CIT) and arginine (ARG)--the precursors of eNO synthesis--are available to sustain the eNO needed to maintain adequate perfusion in severe shock...
October 2014: Surgery
Bertrand Prunet, Nicolas Prat, David Couret, Pierre-Yves Cordier, Sophie De Bourmont, Dominique Lambert, Yves Asencio, Eric Meaudre, Pierre Michelet
BACKGROUND: This study compared three different fluid resuscitation strategies in terms of respiratory tolerance and hemodynamic efficacy in a pig model of blunt chest trauma with lung contusion and controlled hemorrhagic shock. We hypothesized that the choice of fluid resuscitation strategy (type and amount of fluids) may impact differently contused lungs in terms of extravascular lung water (EVLW) 20 h after trauma. METHODS: Anesthetized female pigs (n = 5/group) received five bolt shots to the right thoracic cage and allowed to hemorrhage for 30 min, with 25 to 30 mL/kg of blood loss...
February 2014: Shock
Erik S Shank, Robert L Sheridan, Colleen M Ryan, Timothy J Keaney, J A Jeevendra Martyn
Because of ineffectiveness and tolerance to benzodiazepines and opioids developing with time, drugs acting via other receptor systems (eg, α-2 agonists) have been advocated in burn patients to improve sedation and analgesia. This study in severely burned pediatric subjects examined the hemodynamic consequences of dexmedetomidine (Dex) administration. Eight intubated patients with ≥20 to 79% TBSA burns were studied between 7 and 35 days after injury. After baseline measurements of mean arterial blood pressure and heart rhythm were taken, each patient received a 1...
May 2013: Journal of Burn Care & Research: Official Publication of the American Burn Association
Yongqing Li, Hasan B Alam
Shock, regardless of etiology, is characterized by decreased tissue perfusion resulting in cell death, organ dysfunction, and poor survival. Current therapies largely focus on restoring tissue perfusion through resuscitation but have failed to address the specific cellular dysfunction caused by shock. Acetylation is rapidly emerging as a key mechanism that regulates the expression of numerous genes (epigenetic modulation through activation of nuclear histone proteins), as well as functions of multiple cytoplasmic proteins involved in key cellular functions such as cell survival, repair/healing, signaling, and proliferation...
2012: Advances in Experimental Medicine and Biology
Christopher S Davis, Joslyn M Albright, Stewart R Carter, Luis Ramirez, Hajwa Kim, Richard L Gamelli, Elizabeth J Kovacs
This prospective study aims to address mortality in the context of the early pulmonary immune response to burn and inhalation injury. The authors collected bronchoalveolar lavage fluid from 60 burn patients within 14 hours of their injury when smoke inhalation was suspected. Clinical and laboratory parameters and immune mediator profiles were compared with patient outcomes. Patients who succumbed to their injuries were older (P = .005), had a larger % TBSA burn (P < .001), and required greater 24-hour resuscitative fluids (P = ...
January 2012: Journal of Burn Care & Research: Official Publication of the American Burn Association
Laurent Bodson, Koceïla Bouferrache, Antoine Vieillard-Baron
PURPOSE OF REVIEW: To re-emphasize the epidemiology, pathophysiology, diagnosis, and treatment of cardiac tamponade. RECENT FINDINGS: Cardiac tamponade is a cause of obstructive shock. Incidence of cardiac tamponade is poorly documented. In cardiac tamponade, the pericardial pressure may reach 15-20  mmHg, leading to an equalization of pressures into the cardiac chambers and to a huge decrease in the systemic venous return. The right atrial transmural pressure becomes negligible...
October 2011: Current Opinion in Critical Care
Annie M Whitaker, Jesse Sulzer, Edith Walker, Keisa Mathis, Patricia E Molina
BACKGROUND: Trauma/hemorrhage (TxHem) is associated with an immediate pro-inflammatory response that, if exaggerated or prolonged, is thought to contribute to the subsequent immunosuppression that characterizes the period after injury. Previously we have demonstrated that chemical sympathectomy (SNSx) accentuates this immediate pro-inflammatory response to TxHem. These findings suggest that the noradrenergic system plays a critical role in limiting the magnitude of the inflammatory response during TxHem and preserving the integrity of the host defense response to a subsequent infectious challenge during the period after TxHem...
2010: Neuroimmunomodulation
Stathis Poulakidas, Areta Kowal-Vern
BACKGROUND: Component separation technique has been used successfully in ventral hernia repair occurring after damage control surgery. Abdominal compartment syndrome, seen in severely injured burn patients, frequently requires decompressive laparotomy. The patient is at risk during this time not only for burn injury complications but also for those from an open abdomen. METHODS: This report presents the successful application of the component separation technique for early closure of decompressive laparotomies in patients with >75% total body surface area burn, which included the abdominal wall...
December 2009: Journal of Trauma
Elke Rudloff, Rebecca Kirby
Traumatic shock can result from one or more of the following: hypovolemia, increased capillary permeability and vasodilatation, impaired myocardial contractility or dysfunction, blood loss, and cardiovascular obstruction. Animals with traumatic injuries are less tolerant of sudden increases in hydrostatic pressure, which can exacerbate fluid leakage into damaged tissues and disrupt blood clots. Pain amplifies the shock response, and analgesic therapy is always recommended in the trauma patient. Therapy must be individualized and monitored closely...
May 2008: Veterinary Clinics of North America. Small Animal Practice
John C Chatham, Laszlo G Nöt, Norbert Fülöp, Richard B Marchase
An early and rapid response to severe injury or trauma is the development of hyperglycemia, which has long been thought to be an essential survival response by providing fuel for vital organ systems and facilitating mobilization of interstitial fluid reserves by increasing osmolarity. However, glucose can also be metabolized via the hexosamine biosynthesis pathway (HBP), leading to the synthesis of uridine diphosphate N-acetyl-glucosamine(UDP-GlcNAc). UDP-GlcNAc is a substrate for the addition, via an O-linkage, of a single N-acetylglucosamine to serine or threonine residues of nuclear and cytoplasmic proteins (O-glycosylation, O-GlcNAc)...
April 2008: Shock
Qaisar A Shah, Alexandros Georgiadis, M Fareed K Suri, Gustavo Rodriguez, Adnan I Qureshi
OBJECTIVE: To report experience with intra-arterial (IA) calcium channel blocker (nicardipine) in patients with acute ischemic stroke with and without reteplase, mechanical thrombectomy (snare), and primary angioplasty to achieve maximal recanalization. Selective delivery of calcium channel blocker may improve perfusion and possibly provide neuroprotection in cerebral ischemia. METHODS: We performed a retrospective study to determine the angiographic and clinical outcomes among patients treated with IA nicardipine administered as 2...
2007: Neurocritical Care
Yngvar Gundersen, Per Vaagenes, Ingjerd Thrane, Sigrun H Sterri, Per Kristian Opstad
Polytrauma and resuscitative efforts induce extensive alterations in the host's internal environment and cellular responses that may be a serious threat to these patients. Administration of exogenous thiols has been recommended to modulate the post-traumatic inflammatory responses. In this study, we have investigated the effect of N-acetylcysteine (NAC) on the early markers of leukocyte activation and subsequent endotoxin hyporesponsiveness. Twenty-eight pigs were exposed to a standardized gunshot injury. First aid treatment and initial life saving surgery was started without delay...
March 2005: Resuscitation
Jean-Louis Vincent, Herwig Gerlach
OBJECTIVE: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for fluid resuscitation in severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. DESIGN: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee...
November 2004: Critical Care Medicine
Matthias Majetschak, Stephen M Cohn, Udo Obertacke, Kenneth G Proctor
BACKGROUND: Recent studies suggest that extracellular ubiquitin could have a physiologic role in immunodepression in sepsis and trauma. The therapeutic potential of exogenous ubiquitin after trauma has not been examined. To fill this gap, we designed a series of experiments in a clinically relevant trauma model. METHODS: Forty minutes after femur fractures and hemorrhage, swine received 1.3 mg of ubiquitin per kilogram or bovine serum albumin intravenously followed by fluid resuscitation to maintain systemic hemodynamics...
May 2004: Journal of Trauma
H K Sillett, J T Whicher, L K Trejdosiewicz
This study was designed to determine whether dextran, gelatin or hydroxyethyl starch-based colloidal resuscitation fluids (CRF) are inhibitory to T lymphocyte activation and mitogenesis in vitro. Isolated peripheral blood lymphocytes from normal donors were activated with mitogen (PHA) and cultured in up to 50% v:v CRF. Dual-label flow cytometry for CD69 and CD25 were used to assess early and full T cell activation responses, respectively, and thymidine incorporation was used to assess mitogenesis. T cell activation and mitogenic responses were not inhibited in the presence of CRF, implying that any systemic immunodepression associated with CRF infusion is not directly related to CRF-mediated impairment of T cell activation...
August 1998: British Journal of Anaesthesia
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