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ARDS coagulopathy

Melissa Kolarik, Eric Roberts
Emergency care, including the resuscitation of patients involved in traumatic events, has evolved over the years. A prior practice of utilizing large volumes of crystalloids has been found to contribute to complications such as coagulopathy, fluid overload, and adult respiratory distress syndrome (ARDS). In contrast, permissive hypotension is a method of fluid restriction that allows for low blood pressure and mean arterial pressure during the resuscitation period. When permissive hypotension occurs and fluids are restricted in trauma patients, the incidence of ARDS can be reduced significantly with improvement in patient outcomes...
January 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Hyoung Soo Kim, Sang Ook Ha, Sang Jin Han, Hyun-Sook Kim, Sun Hee Lee, Ki-Suck Jung, Sunghoon Park
The utility of extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) of noninfectious origin remains unclear. Data on patients with ARDS of noninfectious origin who underwent ECMO were reviewed retrospectively. We compared the pre-ECMO characteristics and hospital outcomes of patients with traumatic and nontraumatic ARDS. In total, 23 patients (trauma, n = 9; nontrauma, n = 14) were included in the study. The mean patient age was 42 years, there were three females, and the mean pre-ECMO Simplified Acute Physiologic Score (SAPS) II was 60...
November 28, 2016: Artificial Organs
Shamsa Shariatpanahi, Shahryar Pourfarzam, Mohammadhosein Gheini
Macrophage Activating Syndrome (MAS) is a life-threatening disease seen in autoimmune diseases including lupus erythematosus, rheumatoid arthritis, Still's disease, polyarteritis nodosa. It is characterized by fever, pancytopenia, liver failure, coagulopathy, and neurologic symptoms and high serum ferritin. A 27 yr. old female patient was admitted in shahid Mostafa Khomeini Hospital (Tehran-Iran) in May 2011 because of lower extremities edema and ascites and fever from 1.5 month ago. In physical examinations she had generalized lymphadenopathy, splenomegaly and pleural effusion...
2016: Iranian Journal of Pathology
Tomoharu Miyashita, Ali Karim Ahmed, Shinichi Nakanuma, Koichi Okamoto, Seisho Sakai, Jun Kinoshita, Isamu Makino, Keishi Nakamura, Hironori Hayashi, Katsunobu Oyama, Hidehiro Tajima, Hiroyuki Takamura, Itasu Ninomiya, Sachio Fushida, John W Harmon, Tetsuo Ohta
A number of studies have reported that acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are independent risk factors for organ dysfunction and mortality in patients with sepsis. Although ALI/ARDS might be an essential therapeutic target during the management of sepsis, severe sepsis should be treated effectively and as soon as identified. We have classified three phases, ranging from sepsis to organ dysfunction, characterizing the interaction between neutrophils and platelets. The first phase is neutrophil extracellular trap (NET) formation and intravasated platelet aggregation...
July 2016: In Vivo
Jiří Valenta, Zdeněk Stach, Pavel Michálek
A snake breeder, 47-years-old man, was bitten by the saw-scaled viper (Echis carinatus sochureki). After admission to Toxinology Centre, within 1.5 h, laboratory evaluation showed clotting times prolonged to non-measurable values, afibrinogenaemia, significantly elevated D-dimers, haemolysis and myoglobin elevation. Currently unavailable antivenom was urgently imported and administered within 10 hours. In 24 hours, oligoanuric acute kidney injury (AKI) and mild acute respiratory distress syndrome (ARDS) developed...
2016: Prague Medical Report
Sriram Pothapregada, Banupriya Kamalakannan, Mahalakshmy Thulasingam
OBJECTIVES: To study the clinical profile and outcome of the atypical manifestations of dengue fever in children. METHODS: All children (0-12 y of age) diagnosed and confirmed as dengue fever at a tertiary care hospital at Puducherry, between the 1st of August 2012 and January 31st 2015 were reviewed retrospectively from hospital case records as per the revised World Health Organization (WHO) guidelines 2011 for dengue fever. The diagnosis was confirmed by NS1 antigen-based ELISA test or dengue serology for IgM and IgG antibodies and the data was analyzed using SPSS 16...
June 2016: Indian Journal of Pediatrics
F R Farber, A Muehlenbachs, T E Robey
Babesiosis, an infection caused by the protozoan Babesia microti and transmitted by the Ixodes scapularis tick, is commonly described in the literature with an approximate incidence of 1000 cases per year (Herwaldt et al., 2012). Infections in North America occur most frequently during the spring and summer months in the Northeastern and Midwestern United States. Babesia can cause a wide spectrum of clinical manifestations ranging from a self-limited febrile illness or mild anemia to severe illness causing acute respiratory distress syndrome (ARDS), disseminated intravascular coagulopathy (DIC) and multisystem organ failure...
July 2015: Ticks and Tick-borne Diseases
Hui Jin, Li-Qun Tang, Zhi-Guo Pan, Na Peng, Qiang Wen, You-Qing Tang, Lei Su
BACKGROUND: This study reports a 10-year retrospective analysis of multiple trauma complicated by pulmonary contusion. The purpose of this study is to ascertain the risk factors for mortality due to trauma in patients with pulmonary contusion, the impact of various treatment options for prognosis, and the risk factors for concurrent Acute Respiratory Distress Syndrome (ARDS). METHODS: We retrospectively analyzed 252 trauma patients with lung contusion admitted to the General Hospital of Guangzhou Command from January 2000 to June 2011 by using the statistical processing system SPSS 17...
2014: Military Medical Research
Alexander D Cornet, A B Johan Groeneveld, Jorrit J Hofstra, Alexander P Vlaar, Pieter R Tuinman, Arthur van Lingen, Marcel Levi, Armand R J Girbes, Marcus J Schultz, Albertus Beishuizen
RATIONALE: Pulmonary coagulopathy may play a pathogenetic role in acute respiratory distress syndrome (ARDS), by contributing to alveolocapillary inflammation and increased permeability. Recombinant human activated protein C (rh-APC) may inhibit this process and thereby improve patient outcome. METHODS: A prospective randomized, saline-controlled, single-blinded clinical trial was performed in the intensive care units of two university hospitals, and patients with ARDS were included within 24 h after meeting inclusion criteria...
2014: PloS One
Sebastian Rehberg, Yusuke Yamamoto, Linda E Sousse, Collette Jonkam, Robert A Cox, Donald S Prough, Perenlei Enkhbaatar
BACKGROUND: Pulmonary coagulopathy has become an important therapeutic target in adult respiratory distress syndrome (ARDS). We hypothesized that combining intravenous recombinant human antithrombin (rhAT), nebulized heparin, and nebulized tissue plasminogen activator (TPA) more effectively improves pulmonary gas exchange compared with a single rhAT infusion, while maintaining the anti-inflammatory properties of rhAT in ARDS. Therefore, the present prospective, randomized experiment was conducted using an established ovine model...
January 2014: Journal of Trauma and Acute Care Surgery
Pantep Angchaisuksiri
Blood coagulation activation is frequently found in patients with malaria. Clinically apparent bleeding or disseminated intravascular coagulation (DIC) is associated with very severe disease and a high mortality. Protein C, protein S, and antithrombin levels were found to be low in P. falciparum, but were normal in P. vivax infection. Plasma levels of plasminogen activator inhibitor-1 were high in cases of P. falciparum infection whereas tissue plasminogen activator levels were low. Elevated plasma levels of von Willebrand factor (vWF) and vWF propeptide, thrombomodulin, endothelial microparticles have been reported in P...
January 2014: Thrombosis Research
Sarah C Christiaans, Brant M Wagener, Charles T Esmon, Jean Francois Pittet
The protein C system plays an active role in modulating severe systemic inflammatory processes such as sepsis, trauma, and acute respiratory distress syndrome (ARDS) via its anticoagulant and anti-inflammatory properties. Plasma levels of activated protein C (aPC) are lower than normal in acute inflammation in humans, except early after severe trauma when high plasma levels of aPC may play a mechanistic role in the development of posttraumatic coagulopathy. Thus, following positive results of preclinical studies, a clinical trial (PROWESS) with high continuous doses of recombinant human aPC given for 4 days demonstrated a survival benefit in patients with severe sepsis...
October 1, 2013: American Journal of Physiology. Lung Cellular and Molecular Physiology
Cattleya Thongrong, Pornthep Kasemsiri, James P Hofmann, Sergio D Bergese, Thomas J Papadimos, Vicente H Gracias, Michael D Adolph, Stanislaw P A Stawicki
Amniotic fluid embolism (AFE) is an unpredictable and as-of-yet unpreventable complication of maternity. With its low incidence it is unlikely that any given practitioner will be confronted with a case of AFE. However, this rare occurrence carries a high probability of serious sequelae including cardiac arrest, ARDS, coagulopathy with massive hemorrhage, encephalopathy, seizures, and both maternal and infant mortality. In this review the current state of medical knowledge about AFE is outlined including its incidence, risk factors, diagnosis, pathophysiology, and clinical manifestations...
January 2013: International Journal of Critical Illness and Injury Science
D W de Lange, M A Sikma, J Meulenbelt
CONTEXT: Although extracorporeal membrane oxygenation (ECMO) was used in many patients following its introduction in 1972, most hospitals had abandoned this experimental treatment for adult patients. Recently, improvements in the ECMO circuitry rendered it more biocompatible. The surprisingly low mortality in patients with severe acute respiratory distress syndrome who were treated with ECMO in the influenza A/H1N1 pandemic of 2009 resurrected interest in ECMO in many intensive care units around the world...
June 2013: Clinical Toxicology
A D Cornet, J J Hofstra, A P Vlaar, P R Tuinman, M Levi, A R Girbes, M J Schultz, A B Groeneveld, A Beishuizen
OBJECTIVE: Acute respiratory distress syndrome (ARDS) frequently complicates critical illness. We hypothesized that an infusion of recombinant human activated protein C (rh-APC), a natural anticoagulant, would attenuate pulmonary coagulopathy and injury. METHODS: In this sub study of a multicenter open-label randomized controlled trial of patients with ARDS, we compared an intravenous (i.v.) infusion of rh-APC (24 mcg kg(-1)  h(-1) for 96 h) with placebo. Patients with sepsis or septic shock were excluded...
May 2013: Journal of Thrombosis and Haemostasis: JTH
Kedareshwar P S Narvencar, Savio Rodrigues, Ramnath P Nevrekar, Lydia Dias, Amit Dias, Marina Vaz, E Gomes
BACKGROUND & OBJECTIVES: Scrub typhus is one of the differential diagnoses of haemorrhagic fevers especially if associated with jaundice and/or renal failure. Goa State in the western region of India has been witnessing increased incidence of such fevers, therefore, the present study was undertaken to identify whether scrub typhus is the aetiological agent. METHODS: Adult patients presenting with undiagnosed febrile illness between June 2009 to October 2010, were evaluated...
December 2012: Indian Journal of Medical Research
Young Joo Han, June Dong Park, Jae Wook Choi, Dong In Suh, Young Yull Koh
The coagulation cascade and inflammatory process are known to be associated with the pathophysiology of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). We retrospectively investigated laboratory values indicating coagulopathy obtained within 24 hr from diagnosis of ALI/ARDS in 79 children who received mechanical ventilation between 2008 and 2009 and their final outcomes. Prothrombin time (PT) (P = 0.001) and activated partial thromboplastin time PTT (APTT) (P = 0.001) were more prolonged in non-survivors than survivors (mean; 1...
December 2012: Journal of Korean Medical Science
R de Pablo, J Monserrat, A Prieto, M Alvarez-Mon
PURPOSE: Chemokines are a large superfamily of small proteins that function not only in leukocyte trafficking, but are also necessary for linkage between innate and adaptive immunity. Little is known about their role in septic shock. We hypothesized that serum levels of the most important chemokines are related to organ failure, disease severity and outcome. DESIGN: A prospective observational study was carried out. SETTING: Surgical-clinical Intensive Care Unit...
November 2013: Medicina Intensiva
G J Glas, K F Van Der Sluijs, M J Schultz, J-J H Hofstra, T Van Der Poll, M Levi
Enhanced intrapulmonary fibrin deposition as a result of abnormal broncho-alveolar fibrin turnover is a hallmark of acute respiratory distress syndrome (ARDS), pneumonia and ventilator-induced lung injury (VILI), and is important to the pathogenesis of these conditions. The mechanisms that contribute to alveolar coagulopathy are localized tissue factor-mediated thrombin generation, impaired activity of natural coagulation inhibitors and depression of bronchoalveolar urokinase plasminogen activator-mediated fibrinolysis, caused by the increase of plasminogen activator inhibitors...
January 2013: Journal of Thrombosis and Haemostasis: JTH
Rashna Dass Hazarika, Nayan Mani Deka, A B Khyriem, W V Lyngdoh, Himesh Barman, Sourabh Gohain Duwarah, Pankaj Jain, Dibakar Borthakur
OBJECTIVES: To report an outbreak of invasive meningococcal disease from Meghalaya, in the north east India, from January 2008 through June 2009. METHODS: Retrospective review of case sheets was done. One hundred ten patients with invasive meningococcal disease were included for the study. RESULTS: Of the total patients, 61.8 % were boys and 38.2 % were girls (boy to girl ratio = 1.62:1). The average age of presentation was 8.48 ± 5...
May 2013: Indian Journal of Pediatrics
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