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septic shock fluids trauma

Elisa Estenssoro, Arnaldo Dubin
Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance...
2016: Medicina
Alexander Levitov, Heidi L Frankel, Michael Blaivas, Andrew W Kirkpatrick, Erik Su, David Evans, Douglas T Summerfield, Anthony Slonim, Raoul Breitkreutz, Susanna Price, Matthew McLaughlin, Paul E Marik, Mahmoud Elbarbary
OBJECTIVE: To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites. METHODS: Grading of Recommendations, Assessment, Development and Evaluation system was used to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and to determine the "strength" of recommendations as either strong (strength class 1) or conditional/weak (strength class 2), thus generating six "grades" of recommendations (1A-1B-1C-2A-2B-2C)...
June 2016: Critical Care Medicine
Liangming Liu, Huiling Wu, JiaTao Zang, Guangming Yang, Yu Zhu, Yue Wu, Xiangyun Chen, Dan Lan, Tao Li
OBJECTIVES: Sepsis and septic shock are the common complications in ICUs. Vital organ function disorder contributes a critical role in high mortality after severe sepsis or septic shock, in which endoplasmic reticulum stress plays an important role. Whether anti-endoplasmic reticulum stress with 4-phenylbutyric acid is beneficial to sepsis and the underlying mechanisms are not known. DESIGN: Laboratory investigation. SETTING: State Key Laboratory of Trauma, Burns and Combined Injury...
August 2016: Critical Care Medicine
Ronald Chang, John B Holcomb
Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial treatment of sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one that restores intravascular volume while minimizing edema; unfortunately, edema and edema-related complications are common consequences of current resuscitation strategies. Crystalloids are recommended as first-line therapy, but the type of crystalloid is not specified...
July 2016: Shock
Derek S Wheeler
The so-called "golden hour" of trauma resuscitation has been applied to a number of disease conditions in the intensive care unit (ICU) setting. For example, the "golden hour" as applied to the treatment of critically children and adults with severe sepsis and septic shock is based upon early recognition, early administration of antibiotics, and early reversal of the shock state. However, several clinical studies published over the last decade have called into question this time-honored approach and suggest that overly aggressive fluid resuscitation may cause more harm than good...
2015: Critical Care: the Official Journal of the Critical Care Forum
Jason Chertoff, Michael Chisum, Bryan Garcia, Jorge Lascano
Over the last two decades, there have been vast improvements in sepsis-related outcomes, largely resulting from the widespread adoption of aggressive fluid resuscitation and infection control. With increased understanding of the pathophysiology of sepsis, novel diagnostics and resuscitative interventions are being discovered. In recent years, few diagnostic tests like lactate have engendered more attention and research in the sepsis arena. Studies highlighting lactate's prognostic potential for mortality and other outcomes are ubiquitous and largely focus on the early stage of sepsis management, defined as the initial 6 h and widely referred to as the "golden hours...
2015: Journal of Intensive Care
Daniel A Lichtenstein
This review article describes two protocols adapted from lung ultrasound: the bedside lung ultrasound in emergency (BLUE)-protocol for the immediate diagnosis of acute respiratory failure and the fluid administration limited by lung sonography (FALLS)-protocol for the management of acute circulatory failure. These applications require the mastery of 10 signs indicating normal lung surface (bat sign, lung sliding, A-lines), pleural effusions (quad and sinusoid sign), lung consolidations (fractal and tissue-like sign), interstitial syndrome (lung rockets), and pneumothorax (stratosphere sign and the lung point)...
June 2015: Chest
E Divarci, B Karapinar, M Yalaz, O Ergun, A Celik
PURPOSE: Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high mortality rates in children (40-60%). However, literature lacks comprehensive series in childhood. In this study, we aimed to determine the incidences of IAH and ACS, to identify high risk disorders for the development of IAH/ACS and to decrease ACS-associated mortality by early diagnosis and timely intervention. METHODS: A prospective study was performed between December 2009 and October 2010 in our institution...
March 2016: Journal of Pediatric Surgery
Kees H Polderman, Joseph Varon
Administering intravenous fluids to support the circulation in critically ill patients has been a mainstay of emergency medicine and critical care for decades, especially (but not exclusively) in patients with distributive or hypovolemic shock. However, in recent years, this automatic use of large fluid volumes is beginning to be questioned. Analysis from several large trials in severe sepsis and/or acute respiratory distress syndrome have shown independent links between volumes of fluid administered and outcome; conservative fluid strategies have also been associated with lower mortality in trauma patients...
March 2015: American Journal of Emergency Medicine
Basil Enicker, Thandinkosi E Madiba
BACKGROUND: Assaults with a machete cause compound skull fractures which present as a neurosurgical emergency. We aimed to profile cranial injuries caused by a machete over a 10 year period in a single neurosurgical unit. MATERIALS AND METHODS: Retrospective data analysis of cranial injuries following assault with a machete, admitted to the neurosurgery ward, from January 2003 to December 2012 was performed. Medical records were analyzed for demographics, clinical presentation, CT scan findings, surgical treatment and Glasgow Outcome Scale (GOS) at discharge...
September 2014: Injury
Kaweesak Chittawatanarat, Boonsong Patjanasoontorn, Suthat Rungruanghiranya
OBJECTIVE: Pragmatic surveys for shock management by Thai physicians are unavailable. The objective of this study is to identify the shock management patterns on both; the incidence of septic shock and hemorrhagic shock here in Thailand. MATERIAL AND METHOD: Two thousand questionnaires were sent to physicians who are called on to care for patients in shock across Thailand. The questionnaire is composed of 58 items regarding all aspects of the management of septic and hemorrhagic shock...
January 2014: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Emre Divarcı, Orkan Ergün, Bülent Karapınar, Mehmet Yalaz, Ahmet Celik
BACKGROUND: Increased intra-abdominal pressure (IAP) can result in multiorgan failure. Trauma, mechanical bowel obstruction (MBO), abdominal wall defects (AWD) and fluid resuscitation in septic shock are conditions associated with a high risk of increased IAP in children. It may be possible to treat these conditions more effectively using intravesical pressure measurement. METHODS: This prospective study was performed between December 2009 and October 2010. Intravesical pressure (IVP) measurement was used to determine IAP...
November 2013: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Jose Paul Perales Villarroel, Yuxia Guan, Evan Werlin, Mary A Selak, Lance B Becker, Carrie A Sims
BACKGROUND: Trauma and hypovolemic shock are associated with mitochondrial dysfunction and septic complications. We hypothesize that hypovolemic shock and resuscitation results in peripheral blood mononuclear cell (PBMC) mitochondrial dysfunction that is linked to immunosuppression. METHODS: With the use of a decompensated shock model, Long-Evans rats were bled to a mean arterial pressure of 40 mm Hg until the blood pressure could no longer be maintained without fluid infusion...
July 2013: Journal of Trauma and Acute Care Surgery
Patrick M Kochanek, Rachel P Berger, Ericka L Fink, Alicia K Au, Hülya Bayır, Michael J Bell, C Edward Dixon, Robert S B Clark
The use of biomarkers of brain injury in pediatric neurocritical care has been explored for at least 15 years. Two general lines of research on biomarkers in pediatric brain injury have been pursued: (1) studies of "bio-mediators" in cerebrospinal fluid (CSF) of children after traumatic brain injury (TBI) to explore the components of the secondary injury cascades in an attempt to identify potential therapeutic targets and (2) studies of the release of structural proteins into the CSF, serum, or urine in order to diagnose, monitor, and/or prognosticate in patients with TBI or other pediatric neurocritical care conditions...
2013: Frontiers in Neurology
Kusum Menon, James D McNally, Karen Choong, Roxanne E Ward, Margaret L Lawson, Tim Ramsay, Hector R Wong
OBJECTIVE: Limited evidence exists on the use of corticosteroids in pediatric shock. We sought to determine physicians' practices and beliefs with regard to the management of pediatric shock. DESIGN: Cross-sectional, Internet-based survey. SETTING: Canada. SUBJECTS: Physicians identified as practicing pediatric intensive care in any of 15 academic centers. MEASUREMENTS AND MAIN RESULTS: Seventy of 97 physicians (72...
June 2013: Pediatric Critical Care Medicine
Tomasz Targowski
Severe infections of the respiratory system are the most important causes of hospital mortality and often unfold as severe sepsis or septic shock. Systemic inflammatory response syndrome (SIRS) with infection evidence (known as sepsis) and septic shock (severe sepsis with hemodynamic instability relentless on fluid resuscitation) are major healthcare problems, affecting millions of individuals around the world and killing about one-third affected every year. Similarly to myocardial infarction or severe trauma rapid onset and appropriateness of medical management in the first hours of sepsis are key point for clinical outcome...
November 2012: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Annie-Claire Nadeau-Fredette, Josée Bouchard
Critically ill adult patients at risk for or with acute kidney injury (AKI) require careful attention to their hemodynamic status because hypotension and hypovolemia may contribute to or worsen kidney injury. Increasing evidence suggests that isotonic crystalloids should be used instead of colloids for initial expansion of intravascular volume in patients at risk for AKI or with AKI, such as those with sepsis, septic shock, or trauma. The timing and amount of volume to be administered to prevent AKI and other organ damage is still debated, but an aggressive fluid repletion in the early setting is probably beneficial...
January 2013: Advances in Chronic Kidney Disease
R Jacobs, P M Honore, N Hosseinpour, K Nieboer, H D Spapen
Acute cardiac arrest during pregnancy is a rare but devastating event. Major causes are haemorrhagic, septic or anaphylactic shock, trauma, pulmonary or amniotic fluid embolism, and congenital or acquired cardiac disease. We present a case of massive intrathoracic migration of viscera through a left diaphragmatic hernia in a pregnant multipara, causing acute obstructive shock and cardiac arrest. Complications of intrathoracic herniation occur when the intruding viscera cause left lung and cardiac compression or mediastinal "tamponade" with decreased venous return...
May 2012: Acta Clinica Belgica
Michael A Puskarich, Nathan I Shapiro, Stephen Trzeciak, Jeffrey A Kline, Alan E Jones
Elevated levels of plasma mitochondrial DNA (mtDNA) have been reported in trauma patients and may contribute to the systemic immune response. We sought to determine the plasma levels of mtDNA in emergency department (ED) patients with and without sepsis and evaluate their association with severity of illness. This was a prospective observational study of patients presenting to one of three large, urban, tertiary care EDs. Patients were enrolled into one of three cohorts: (i) sepsis defined as suspected infection and two or more systemic inflammatory response criteria without hypotension, (ii) septic shock defined as sepsis plus hypotension despite an adequate fluid challenge, and (iii) control defined as noninfected ED patients without systemic inflammatory response/hypotension...
October 2012: Shock
Miklos Lipcsey, Nicholas Cz Woinarski, Rinaldo Bellomo
Near infrared spectroscopy of the thenar eminence (NIRSth) is a noninvasive bedside method for assessing tissue oxygenation. The NIRS probe emits light with several wavelengths in the 700- to 850-nm interval and measures the reflected light mainly from a predefined depth. Complex physical models then allow the measurement of the relative concentrations of oxy and deoxyhemoglobin, and thus tissue saturation (StO2), as well as an approximation of the tissue hemoglobin, given as tissue hemoglobin index.Here we review of current knowledge of the application of NIRSth in anesthesia and intensive care...
2012: Annals of Intensive Care
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