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Lactate and hypotension

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https://www.readbyqxmd.com/read/29123903/early-evaluation-of-severity-in-patients-with-severe-sepsis-a-comparison-with-septic-shock-subgroup-analysis-of-the-japanese-association-for-acute-medicine-sepsis-registry-jaam-sr
#1
Takehiko Tarui, Yoshihiro Yamaguchi, Koichiro Suzuki, Ryosuke Tsuruta, Hiroto Ikeda, Hiroshi Ogura, Shigeki Kushimoto, Joji Kotani, Shin-Ichiro Shiraishi, Yasushi Suzuki, Kiyotsugu Takuma, Naoshi Takeyama, Seitaro Fujishima, Toshihiko Mayumi, Yasuo Miki, Norio Yamashita, Naoki Aikawa, Satoshi Gando
Aim: The purpose of this subgroup analysis of a Japanese multicenter registry, the Japanese Association for Acute Medicine Sepsis Registry Advanced (JAAM-SR-Advanced), was to identify early outcome indicators for severe sepsis that are useful and more objective than "septic shock." Methods: Among 624 patients with severe sepsis registered in JAAM-SR-Advanced, 554 with valid serum lactate data were retrospectively studied. Hypotension before and after fluid resuscitation and the highest lactate values over the initial 24 h were compared for their ability to predict in-hospital mortality...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29112081/predictors-prevalence-and-outcomes-of-early-crystalloid-responsiveness-among-initially-hypotensive-patients-with-sepsis-and-septic-shock
#2
Daniel E Leisman, Martin E Doerfler, Sandra M Schneider, Kevin D Masick, Jason A D'Amore, John K D'Angelo
OBJECTIVES: The prevalence of responsiveness to initial fluid challenge among hypotensive sepsis patients is unclear. To avoid fluid overload, and unnecessary treatment, it is important to differentiate these phenotypes. We aimed to 1) determine the proportion of hypotensive sepsis patients sustaining favorable hemodynamic response after initial fluid challenge, 2) determine demographic and clinical risk factors that predicted refractory hypotension, and 3) assess the association between timeliness of fluid resuscitation and refractoriness...
November 3, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29077159/inflammatory-factor-in-donor-liver-and-its-effect-on-recipient-myocardial-injury-after-liver-transplantation
#3
J-B Chen, G-Y Chen, S-D Wei, J-J Sun, G-B Liu, Z-T Xie, G-F Tang
OBJECTIVE: To study the inflammatory factors in donor livers and its effect on recipient myocardial injury after liver transplantation recipients. PATIENTS AND METHODS: Eighteen patients who underwent orthotopic liver transplantations between January 2014 and December 2015 in our hospital were selected. A portion of the hepatic venous blood of donor's livers was preserved in heparinized tubes after partial resection. The concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), and the activity of lactate dehydrogenase (LDH) in serum were measured...
October 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29040243/toxic-shock-syndrome-still-a-timely-diagnosis
#4
Kira L Gossack-Keenan, April J Kam
BACKGROUND: Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. After improved patient education and tampon labeling, the incidence of menstrual TSS has declined. CASE: A previously healthy 14-year-old girl presented to an urgent care center with a 2-day history of fever, erythematous maculopapular rash, vomiting, diarrhea, and malaise...
October 16, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29026888/korean-shock-society-septic-shock-registry-a-preliminary-report
#5
Tae Gun Shin, Sung Yeon Hwang, Gu Hyun Kang, Won Young Kim, Seung Mok Ryoo, Kyuseok Kim, You Hwan Jo, Sung Phil Chung, Young Seon Joo, Jin Ho Beom, Sung-Hyuk Choi, Young Hoon Yoon, Woon Yong Kwon, Tae Ho Lim, Kap Su Han, Han Sung Choi, Gil Joon Suh
OBJECTIVE: To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). METHODS: This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included...
September 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28915221/metformin-exerts-beneficial-effects-in-hemorrhagic-shock-in-an-ampk%C3%AE-1-independent-manner
#6
Paul Kim, Giovanna Piraino, Michael O'Connor, Paul W Hake, Vivian Wolfe, Patrick Lahni, Basilia Zingarelli
Despite therapeutic advances in hemorrhagic shock, mortality from multiple organ failure remains high. AMP-activated protein kinase (AMPK) is involved in cellular energy homeostasis. Two catalytic subunits, α1 and α2, have been identified, with α1 subunit largely expressed in major organs. Here, we hypothesized that genetic deficiency of AMPKα1 worsens hemorrhage-induced multiple organ failure. We also investigated whether treatment with metformin, a clinically used drug for metabolic homeostasis, affords beneficial effects...
September 14, 2017: Shock
https://www.readbyqxmd.com/read/28915214/non-hemodynamic-effects-of-catecholamines
#7
Clair Hartmann, Peter Radermacher, Martin Wepler, Benedikt Nußbaum
Circulatory shock is defined as an imbalance between tissue oxygen supply and demand, and mostly results from a loss of blood volume, cardiac pump failure, and/or reduction of vasomotor tone. The clinical hallmarks of circulatory shock are arterial hypotension and lactate acidosis. Since the degree and duration of hypotension are major determinants of outcome, vasopressor administration represents a cornerstone therapy to treat these patients. Current guidelines recommend the use of catecholamines as the drug of first choice...
October 2017: Shock
https://www.readbyqxmd.com/read/28899735/a-randomised-comparison-of-bolus-phenylephrine-and-ephedrine-for-the-management-of-spinal-hypotension-in-patients-with-severe-preeclampsia-and-fetal-compromise
#8
R A Dyer, A Emmanuel, S C Adams, C J Lombard, M J Arcache, A Vorster, C A Wong, N Higgins, A R Reed, M F James, Y Joolay, S Schulein, D van Dyk
BACKGROUND: Studies in healthy patients undergoing elective caesarean delivery show that, compared with phenylephrine, ephedrine used to treat spinal hypotension is associated with increased fetal acidosis. This has not been investigated prospectively in women with severe preeclampsia. METHODS: Patients with preeclampsia requiring caesarean delivery for a non-reassuring fetal heart tracing were randomised to receive either bolus ephedrine (7.5-15mg) or phenylephrine (50-100µg), to treat spinal hypotension...
August 11, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28837867/the-inhibition-of-inducible-nitric-oxide-synthase-and-oxidative-stress-by-agmatine-attenuates-vascular-dysfunction-in-rat-acute-endotoxemic-model
#9
Mohammed S El-Awady, Manar A Nader, Maha H Sharawy
Vascular dysfunction leading to hypotension is a major complication in patients with septic shock. Inducible nitric oxide synthase (iNOS) together with oxidative stress play an important role in development of vascular dysfunction in sepsis. Searching for an endogenous, safe and yet effective remedy was the chief goal for this study. The current study investigated the effect of agmatine (AGM), an endogenous metabolite of l-arginine, on sepsis-induced vascular dysfunction induced by lipopolysaccharides (LPS) in rats...
August 16, 2017: Environmental Toxicology and Pharmacology
https://www.readbyqxmd.com/read/28818851/inotropes-for-preterm-babies-during-the-transition-period-after-birth-friend-or-foe
#10
REVIEW
Heike Rabe, Hector Rojas-Anaya
During the transition to extrauterine life, preterm infants are at high risk of developing circulatory failure. Currently, hypotension is used as major diagnostic criteria for starting treatments such as fluid boluses, inotropes or steroids. Most of these treatment options have not been studied in large randomised controlled trials for efficacy and safety and are under discussions. A wide variety in their use is reported in the literature and clear evidence about which inotrope or other treatment should be preferred is lacking...
November 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28814248/pediatric-abdominal-trauma
#11
Tim Lynch
Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Non-operative management is employed in over 95% of patients. Penetrating injuries are less common but often require operative management. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries. Computed tomography (CT) is the gold standard in the identification of intra-abdominal injury...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28806492/evaluation-of-gastric-and-bladder-tonometry-as-indicators-of-tissue-perfusion-in-induced-hypotension-in-dogs
#12
Juan Morgaz, Lidia Espigares-Rodríguez, Pilar Muñoz-Rascón, Rocío Navarrete, Jose Andrés Fernández-Sarmiento, María Del Mar Granados Machuca
OBJECTIVE: To evaluate the use of gastric (PgCO2 ) and bladder (PbCO2 ) tonometry for assessing tissue hypoperfusion in dogs during sevoflurane-induced hypotension, and to compare these measurements with delivery of oxygen, arterial oxygen content, and plasma lactate concentration. DESIGN: Prospective experimental trial. SETTING: University veterinary teaching hospital. ANIMALS: Fourteen adult Beagle dogs. INTERVENTIONS: Anesthetic induction was performed by mask with sevoflurane and oxygen...
September 2017: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/28734854/pulse-pressure-variation-as-a-guide-for-volume-expansion-in-dogs-undergoing-orthopedic-surgery
#13
Denise T Fantoni, Keila K Ida, André M Gimenes, Matheus M Mantovani, Jacqueline R Castro, Geni C F Patrício, Aline M Ambrósio, Denise A Otsuki
OBJECTIVE: To investigate whether pulse pressure variation (PPV) can predict fluid responsiveness in healthy dogs during clinical surgery. STUDY DESIGN: Prospective clinical study. ANIMALS: Thirty-three isoflurane-anesthetized dogs with arterial hypotension during orthopedic surgery. METHODS: Fluid challenge with lactated Ringer's solution (15 mL kg(-1) in 15 minutes) was administered in mechanically ventilated dogs (tidal volume 10 mL kg(-1)) with hypotension [mean arterial pressure (MAP) < 65 mmHg]...
March 22, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28729904/impact-of-a-sepsis-bundle-in-wards-of-a-tertiary-hospital
#14
F Teles, W G Rodrigues, M G T C Alves, C F T Albuquerque, S M O Bastos, M F A Mota, E S Mota, F J L Silva
BACKGROUND: Sepsis is a prevalent disease worldwide and still exhibits high rates of mortality. In the last years, many interventions aiming a positive impact on sepsis evolution have been studied. One of the main is the use of managed care protocols (sepsis bundles), which consist in systematization of diagnosis and treatment, such as standardization of antibiotics, collection of specific tests (cultures, lactate), and fluid replacement. Some studies have shown a reduction in hospital costs and lower mortality with the use of these tools...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28729329/fluids-in-sepsis-and-septic-shock-fissh-protocol-for-a-pilot-randomised-controlled-trial
#15
Bram Rochwerg, Tina Millen, Peggy Austin, Michelle Zeller, Frédérick D'Aragon, Roman Jaeschke, Marie-Hélène Masse, Sangeeta Mehta, Francois Lamontagne, Maureen Meade, Gordon Guyatt, Deborah J Cook
INTRODUCTION: Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28719516/echocardiography-and-passive-leg-raising-in-the-postoperative-period-a-prospective-observational-study
#16
Yasser El Hadouti, Lucía Valencia, Angel Becerra, Aurelio Rodríguez-Pérez, Jean L Vincent
BACKGROUND: Signs of hypovolaemia are frequent in the postoperative period, but not all patients need or respond to fluid administration. An increase in cardiac output (CO) after passive leg raising (PLR) has been demonstrated to be useful as a volume response predictor in non-surgical, spontaneously breathing patients. OBJECTIVE: The objective of this study was to evaluate the accuracy of transthoracic echocardiography after PLR to predict fluid responsiveness in post-surgical patients...
July 15, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28709157/hypotensive-resuscitation-with-hypertonic-saline-dextran-improves-survival-in-a-rat-model-of-hemorrhagic-shock-at-high-altitude
#17
Jingxiang Zhao, Guoxing You, Bo Wang, Zhenwei Sun, Zhen Wang, Sha Xia, Lian Zhao, Hong Zhou
OBJECTIVE: To compare the efficacy of hypotensive resuscitation with hypertonic saline dextran 70 (HSD) and lactated Ringer (LR) solutions in a rat model of hemorrhagic shock at a simulated altitude of 4,000 m. METHODS: Anesthetized rats were bled to maintain their mean arterial pressure (MAP) at 45 mm Hg for 1 h. The distal quarter of the tail was then amputated to allow free blood loss; rats were simultaneously resuscitated with 4 mL kg HSD (HSD group, n = 10) or 4 mL kg LR (LR group, n = 10), followed by hypotensive resuscitation with LR to maintain MAP at 55 to 60 mm Hg for 1 h...
August 2017: Shock
https://www.readbyqxmd.com/read/28685464/hemoglobin-based-oxygen-carrier-hboc-development-in-trauma-previous-regulatory-challenges-lessons-learned-and-a-path-forward
#18
Peter E Keipert
Historically, hemoglobin-based oxygen carriers (HBOCs) were being developed as "blood substitutes," despite their transient circulatory half-life (~ 24 h) vs. transfused red blood cells (RBCs). More recently, HBOC commercial development focused on "oxygen therapeutic" indications to provide a temporary oxygenation bridge until medical or surgical interventions (including RBC transfusion, if required) can be initiated. This included the early trauma trials with HemAssist (®) (BAXTER), Hemopure (®) (BIOPURE) and PolyHeme (®) (NORTHFIELD) for resuscitating hypotensive shock...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28671163/predictors-of-mortality-of-severe-sepsis-among-adult-patients-in-the-medical-intensive-care-unit
#19
Aziz Kallikunnel Sayed Mohamed, Asmita Anilkumar Mehta, Ponneduthamkuzhy James
BACKGROUND: Sepsis is an important cause of mortality in the Intensive Care Units (ICUs) worldwide. Information regarding early predictive factors for mortality and morbidity is limited. AIMS AND OBJECTIVES: The primary objective of the study was to estimate the mortality of severe sepsis among adult patients admitted into the medical ICU. The secondary objective was to identify the predictors associated with mortality. MATERIALS AND METHODS: Adult patients admitted with severe sepsis in the medical ICU were studied...
July 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/28663637/evaluation-of-leg-wrapping-for-the-prevention-of-postspinal-hypotension-in-cesarean-section-under-spinal-anesthesia
#20
Aparna Abhijit Bagle, Adithya Vishnu, Anil Kumar, Amit Malik, Vinit Garg, Gayatri Khanvilkar
BACKGROUND: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. MATERIALS AND METHODS: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups...
April 2017: Anesthesia, Essays and Researches
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