Genesis of Antibiotic Resistance (AR) LXXVIII: Turbulence Modeling of Hemodynamics in Simplified Severe Sepsis Protocol-2 (SSSP-2)-NCT01663701(ERP-EGDT): Correlation of time (& fluid bolus) dependent pressure drop in boundary layer separation with adverse pressure gradient (APG) in tandem with exacerbated in-hospital mortality (ihm).

The objective is to identify the underlying hemodynamic alteration in usual care group registered with 5 patients @ 100% ihm; vs the sepsis protocol cohort registered with 11 patients @ 90.05% ihmwith a median hospital stay of 5 days; GCS 3-8(SAPS3≥56, (Ref: Fig 3) NCT01663701(PMID: 28973227). Cause for Concern: The pivotal clinical indices such as, i. antibiogram, ii.drug resistance index(DRI), iii.resistance map(RM), iv.antibiotic resistance footprint (ARF), v.AR stewardship data, and vi. Global Antimicrobial Resistance and Use Surveillance System (GLASS) data, for the entire patients' cohorts before and after admitting to ED as a part of baseline characteristics, not presented. Rationale: Based on the aforesaid factor, it is inferred that patients in any given ERP-EGDT, are: i. pre-disposed to unknown level of infectious diseases burden with AR clinical persister(s)(ARClPrs); ii. activation of leucocytes, platelets, and erythrocytes forming LPE aggregates; iii. unknown extent of laceration in the precapillary arterioles, and post-capillary venules, and iv. deposition of LPE aggregates on the pre-capillary/post-capillary vessels, w/o intravascular (loss of glycocalyx), in the cerebral/coronary/pulmonary/hepatic pre-capillary arterioles, Fig 3.1 to 3.3; Fig 3.4, Derived rheological factors based on the data from Table 2: elements of sepsis resuscitation p1238; Fig 3: Risk of In-hospital Mortality, p1239; predicted to be PI <1.05%, SpO2 ≦95%, PaO2 of 55 mmHg, SaO2 <90%, SvO2 <90%, StO2 below normal, DO2 I below normal range, FiO2 <0.21(21%), PaCO2 < 38 - 42 mmHg and PaO2 /FiO2 <200mmHg. Derivation inclusive of CC, MCC (major complication or comorbidity), DDx:Pulmonary Edema, hypoxemia, tachypnea, and respiratory failure. GCS 3-8: Coma Grade IV- unconscious, deep sleep, vestibular ocular reflex(VOR) negative, craniocaudally loss of brainstem reflexes, no reaction to pain, flabby tone, pupil dilated & fixed). Geometry: Blood flow network and mother-daughters branching several generation of arterioles (or venules) with specific mean blood flow velocity (Vn ), arbitrary generation (g) where rn = vessel radius of generation(n), r1 and v1 = radius, Fig 3.4 (p90 ISBN13-978-0128024089). Hypothesis & Governing Equation: eq: 3.2; eq 3.3; eq 3.4; Poiseuille eq (to determine and analyze the cause & effect relationship of flow pressure drop in a long cylindrical pipe/pre-capillary vessels): DP=8mLQ /p R4 where DP = pressure difference between the two ends, m = dynamic viscosity, L=length of pipe, Q = volumetric flow rate, p = the dynamic viscosity, R = pipe radius (https://hyperphysics.phy-astr.gsu.edu/hbase/ppois.html). Prospect: Simulation efforts are in progress to determine the sequence of fluid flow within the time scale of <0hrÛEDÜ120hrs>, pseudo-plastic fluidÜdilatantÜBingham plasticÜ Hershel-BuckleyÜ ThixotropicÜ Rheopectic)and its role in physiological (capillary) shunt augmented ihm.