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Permissive hypotension

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https://www.readbyqxmd.com/read/27913815/-volume-therapy-in-the-severely-injured-patient-recommendations-and-current-guidelines
#1
Sigune Kaske, Marc Maegele
BACKGROUND: Volume therapy is a cornerstone of early resuscitation of severely injured trauma patients, but the optimal strategy remains under debate. A recent Cochrane review could not find evidence for or against early volume replacement or large versus small amounts of fluid. METHOD: Current recommendations and guidelines regarding volume therapy in severely injured patients are summarized based upon the updated European Trauma Guideline on the management of major bleeding and coagulopathy following trauma (fourth edition) and the S3-Guideline Polytrauma and combined with a selective review of the literature...
December 2, 2016: Der Unfallchirurg
https://www.readbyqxmd.com/read/27894500/prediction-of-massive-transfusion-in-trauma
#2
REVIEW
Paul M Cantle, Bryan A Cotton
Hemorrhage is the leading cause of preventable death in trauma. Damage control resuscitation relies on permissive hypotension, minimizing crystalloid use, and early implementation of massive transfusion protocols with established blood component ratios. These protocols improve the survival of the severely injured patient. Trauma physicians must quickly and accurately predict when a massive transfusion protocol should be activated. Several validated transfusion scores have been developed for this purpose. Many of these scores are useful for resuscitation research...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27894494/optimal-fluid-therapy-for-traumatic-hemorrhagic-shock
#3
REVIEW
Ronald Chang, John B Holcomb
The resuscitation of traumatic hemorrhagic shock has undergone a paradigm shift in the last 20 years with the advent of damage control resuscitation (DCR). Major principles of DCR include minimization of crystalloid, permissive hypotension, transfusion of a balanced ratio of blood products, and goal-directed correction of coagulopathy. In particular, plasma has replaced crystalloid as the primary means for volume expansion for traumatic hemorrhagic shock. Predicting which patient will require DCR by prompt and accurate activation of a massive transfusion protocol, however, remains a challenge...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27871539/liberal-or-restrictive-fluid-management-during-elective-surgery-a-systematic-review-and-meta-analysis
#4
REVIEW
Pim B B Schol, Ivon M Terink, Marcus D Lancé, Hubertina C J Scheepers
This article reviews if a restrictive fluid management policy reduces the complication rate if compared to liberal fluid management policy during elective surgery. The PubMed database was explored by 2 independent researchers. We used the following search terms: "Blood transfusion (MESH); transfusion need; fluid therapy (MESH); permissive hypotension; fluid management; resuscitation; restrictive fluid management; liberal fluid management; elective surgery; damage control resuscitation; surgical procedures, operative (MESH); wounds (MESH); injuries (MESH); surgery; trauma patients...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27801767/pontine-warning-syndrome-a-chameleon-of-ischemic-stroke
#5
Alejandro Enriquez-Marulanda, Pablo Amaya-Gonzalez, Jorge L Orozco
INTRODUCTION: Crescendo transient ischemic attacks or "Stroke Warning Syndromes" consist of stereotyped frequent short-lasting episodes of focal neurological deficits. This is explained by intermittent hypoperfusion of the vascular territory of terminal arteries with insufficient collateral flow, presenting a high risk for subsequent infarction. Pontine warning syndrome (PWS) is a subtype of this atypical presentation of stroke/transient ischemic attack and is considered a challenge for diagnosis...
November 2016: Neurologist
https://www.readbyqxmd.com/read/27787569/-cardiopulmonary-resuscitation-in-cardiac-arrest-following-trauma
#6
B A Leidel, K-G Kanz
For decades, survival rates of cardiac arrest following trauma were reported between 0 and 2 %. Since 2005, survival rates have increased with a wide range up to 39 % and good neurological recovery in every second person injured for unknown reasons. Especially in children, high survival rates with good neurologic outcomes are published. Resuscitation following traumatic cardiac arrest differs significantly from nontraumatic causes. Paramount is treatment of reversible causes, which include massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade...
October 27, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/27597733/propofol-dose-finding-to-reach-optimal-effect-for-semi-elective-intubation-in-neonates
#7
Anne Smits, Liesbeth Thewissen, Alexander Caicedo, Gunnar Naulaers, Karel Allegaert
OBJECTIVE: To define the effective dose for 50% of patients (ED50) of propofol for successful intubation and to determine the rate of successful extubation in those patients with planned intubation, surfactant administration, and immediate extubation (INSURE procedure). In addition, pharmacodynamic effects were assessed. STUDY DESIGN: Neonates (n = 50) treated with propofol for (semi-)elective endotracheal intubation were stratified in 8 strata by postmenstrual and postnatal age...
September 2, 2016: Journal of Pediatrics
https://www.readbyqxmd.com/read/27595109/hypotensive-resuscitation-among-trauma-patients
#8
REVIEW
Matthew M Carrick, Jan Leonard, Denetta S Slone, Charles W Mains, David Bar-Or
Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27566811/management-of-bleeding-in-vascular-surgery
#9
REVIEW
Y E Chee, S E Liu, M G Irwin
Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27531659/tactical-damage-control-resuscitation-in-austere-military-environments
#10
REVIEW
Yann Daniel, S Habas, L Malan, J Escarment, J-S David, S Peyrefitte
BACKGROUND: Despite the early uses of tourniquets and haemostatic dressings, blood loss still accounts for the vast majority of preventable deaths on the battlefield. Over the last few years, progress has been made in the management of such injuries, especially with the use of damage control resuscitation concepts. The early application of these procedures, on the field, may constitute the best opportunity to improve survival from combat injury during remote operations. DATA SOURCES: Currently available literature relating to trauma-induced coagulopathy treatment and far-forward transfusion was identified by searches of electronic databases...
December 2016: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/27434314/benefit-risk-assessment-of-paliperidone-oral-extended-release-tablet-versus-monthly-injectable-for-maintenance-treatment-of-schizophrenia
#11
Bennett Levitan, Michael Markowitz, Ibrahim Turkoz, Dong-Jing Fu, Srihari Gopal, Larry Alphs
The purpose of this study was to conduct a post-hoc benefit-risk assessment of paliperidone palmitate once-monthly (PP1M) injectable versus oral paliperidone extended-release (ER) in schizophrenia maintenance treatment. The Benefit-Risk Action Team framework was used to structure the analysis based on patient-level data from two similar, double-blind, placebo-controlled relapse studies. Efficacy outcomes were relapse, psychiatric hospitalization, Clinical Global Impression-Severity scale, Personal and Social Performance (PSP) scale, and Positive and Negative Syndrome Scale (PANSS)...
November 2016: International Clinical Psychopharmacology
https://www.readbyqxmd.com/read/27405065/c1-inhibitor-limits-organ-injury-and-prolongs-survival-in-swine-subjected-to-battlefield-simulated-injury
#12
James C Campbell, Yansong Li, Edwin van Amersfoort, Anurag Relan, Michael Dubick, Forest Sheppard, Anthony Pusateri, Debra Niemeyer, George C Tsokos, Jurandir J Dalle Lucca
Complement system activation is recognized as a deleterious component of the mammalian physiological response to traumatic injury with severe hemorrhage (TH). Female Yorkshire swine were subjected to a simulated austere prehospital battlefield scenario. Each animal underwent controlled hemorrhage of 22 mL/kg at 100 mL/min rate for approximately 10 min followed by soft tissue injury, femur fracture, and spleen injury. Subsequent blood loss was uncontrolled. Twenty-eight minutes postinjury the animals were randomized into treatment or no treatment with recombinant human C1 esterase inhibitor (C1INH) (500 IU/kg, n = 11) and into receiving or not permissive hypotensive resuscitation (n = 14) with infusion of 45 mL/kg lactated Ringer's solution (2× blood lost)...
September 2016: Shock
https://www.readbyqxmd.com/read/27332626/droxidopa-and-reduced-falls-in-a-trial-of-parkinson-disease-patients-with-neurogenic-orthostatic-hypotension
#13
Robert A Hauser, Stephane Heritier, Gerald J Rowse, L Arthur Hewitt, Stuart H Isaacson
OBJECTIVES: Droxidopa is a prodrug of norepinephrine indicated for the treatment of orthostatic dizziness, lightheadedness, or the "feeling that you are about to black out" in adult patients with symptomatic neurogenic orthostatic hypotension caused by primary autonomic failure including Parkinson disease (PD). The objective of this study was to compare fall rates in PD patients with symptomatic neurogenic orthostatic hypotension randomized to droxidopa or placebo. METHODS: Study NOH306 was a 10-week, phase 3, randomized, placebo-controlled, double-blind trial of droxidopa in PD patients with symptomatic neurogenic orthostatic hypotension that included assessments of falls as a key secondary end point...
September 2016: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/27300645/ocular-hypotensive-effect-of-ono-9054-an-ep3-fp-receptor-agonist-results-of-a-randomized-placebo-controlled-dose-escalation-study
#14
Alon Harris, Caroline L Ward, Cheryl L Rowe-Rendleman, Takafumi Ouchi, Andrew Wood, Akifumi Fujii, Janet B Serle
PURPOSE: To assess pharmacodynamic and safety profiles of ONO-9054 following single and multiple day dosing in subjects with ocular hypertension or open-angle glaucoma. MATERIALS AND METHODS: This was a phase I, single-center, randomized, double-masked, placebo-controlled dose-escalation study. Nine subjects were randomized to each of ONO-9054 3, 10, 20, 30 μg/mL and 12 to placebo. Subjects received a single drop to each eye at 07:00±30 minutes (single dose). Following a 4-day no-treatment period, subjects were dosed once daily for 14 consecutive days (multiple day dosing)...
June 13, 2016: Journal of Glaucoma
https://www.readbyqxmd.com/read/27176127/controlled-hypotension-versus-normotensive-resuscitation-strategy-for-people-with-ruptured-abdominal-aortic-aneurysm
#15
REVIEW
Daniel H Moreno, Daniel G Cacione, Jose C C Baptista-Silva
BACKGROUND: An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair...
May 13, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27100755/-blood-failure-time-to-view-blood-as-an-organ-how-oxygen-debt-contributes-to-blood-failure-and-its-implications-for-remote-damage-control-resuscitation
#16
Christopher K Bjerkvig, Geir Strandenes, Håkon S Eliassen, Philip C Spinella, Theodor K Fosse, Andrew P Cap, Kevin R Ward
Hemorrhagic shock is both a local and systemic disorder. In the context of systemic effects, blood loss may lead to levels of reduced oxygen delivery (DO2 ) sufficient to cause tissue ischemia. Similar to other physiologic debts such as sleep, it is not possible to incur a significant oxygen debt and suffer no consequences for lack of timely repayment. While the linkage between oxygen debt and traditional organ failure (renal, hepatic, lung, and circulation) has been long recognized, we should consider failure in two additional linked and very dynamic organ systems, the endothelium and blood...
April 2016: Transfusion
https://www.readbyqxmd.com/read/27048075/permissive-hypotension-in-trauma-permissive-hypotension-can-be-a-viable-strategy-in-the-prehospital-setting-when-used-appropriately
#17
Hawnwan Philip Moy, Abigail Cosgrove
No abstract text is available yet for this article.
March 2016: EMS World
https://www.readbyqxmd.com/read/26966058/study-protocol-for-a-single-blind-placebo-controlled-randomised-trial-of-tianjiu-effects-in-patients-with-intradialytic-hypotension
#18
Ming-Yen Tsai, Yu-Jen Su, Hwee-Yeong Ng, Shih-Yu Chen, Yu-Chuen Huang, Chien-Hsing Wu, Yung-Hsiang Chen
INTRODUCTION: Intradialytic hypotension (IDH) is the most frequent complication of haemodialysis (HD) and may contribute to cardiovascular events and high mortality. The aetiology of IDH is multifactorial; therefore, it remains a challenging problem in the management of patients with HD. Since the application of Tianjiu at specific points can influence haemodynamics, we hypothesise that Tianjiu therapy at the traditionally used meridian points will reduce the severity of hypotension in patients who undergo HD...
2016: BMJ Open
https://www.readbyqxmd.com/read/26957262/the-effect-of-permissive-hypotension-in-combined-traumatic-brain-injury-and-blunt-abdominal-trauma-an-experimental-study-in-swines
#19
T Vrettos, E Poimenidi, P Athanasopoulos, S Balasis, N Karagiorgos, T Siklis, G Gatzounis, F Fligkou
OBJECTIVE: Optimal hemodynamic resuscitation strategy of the trauma patient with uncontrolled hemorrhage and severe head injury in the pre-hospital setting remains a special challenge. Permissive hypotension prior to definite surgical haemostasis promotes coagulation, decreases blood loss and favors survival. However, hypotension is associated with poor outcome in severe head injury. The purpose of this experimental animal study was to assess the impact of permissive hypotension on survival, hemodynamic profile and brain oxygenation parameters before and/or after definite surgical haemostasis...
2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/26934280/bleeding-and-damage-control-surgery
#20
Roseny R Rodrigues, Maria José C Carmona, Jose Otavio C A Junior
PURPOSE OF REVIEW: Bleeding is still a major cause of death in trauma patients. Damage control surgery is a strategy that aims to control bleeding and avoid secondary contamination of the cavity. This article checks the principles and indications of damage control surgery, bleeding management, and the role of the anesthesiologist in trauma context. The efficient treatment of severe trauma and exsanguinated patients includes a surgical approach to the patient performed as quickly as possible...
April 2016: Current Opinion in Anaesthesiology
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