Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Retraction Of Publication
The future of therapeutic myocardial angiogenesis: retraction.
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Multicenter Study Comparative Study Clinical Trial
Central venous oxygen saturation under non-protocolized resuscitation is not related to survival in severe sepsis or septic shock.
Protocolized hemodynamic resuscitation in severe sepsis or septic shock is not universally applied in all emergency departments and general hospital wards around the world. It is unknown whether ScvO2 levels are associated with the clinical outcome of severe sepsis or septic shock under nonprotocolized resuscitation. In this prospective study, we enrolled 124 noncirrhotic patients who were admitted to intensive care units for severe sepsis or septic shock. ⋯ In conclusion, our results showed that mean arterial pressure and central venous pressure were still the most important hemodynamic variables in initial hemodynamic resuscitation. Low postresuscitation ScvO2 was not associated with a worse outcome. It is possible that ScvO2 less than 70% might not necessarily be associated with tissue hypoxia, and critical ScvO2 levels require to be determined by further studies.
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Multicenter Study Clinical Trial
Renal resistive index better predicts the occurrence of acute kidney injury than cystatin C.
The objective of this study was to determine the predictive value of the renal resistive index (RI) and cystatin C values in serum (SCys) and urine (UCys) in the development of acute kidney injury (AKI) in critically ill patients with severe sepsis or polytrauma. This was a prospective, double-center, descriptive study. There were 58 patients with severe sepsis (n= 28) or polytrauma (n = 30). ⋯ In the subgroup of patients with AKI stage 2 or 3 on D1, RI remained the only parameter associated with persistent AKI on D3 (P = 0.016). In multivariate analysis comparing the predictive value of RI, SCys, and UCys, RI was the only parameter predictive of AKI stage 2 or 3 on D3. Renal resistive index seems to be a promising tool to assess the risk of AKI.
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It is not clear why some patients with aspiration advance to acute lung injury or acute respiratory distress syndrome, whereas others do not. The Western diet is high in advanced glycation end-products (AGEs), which have been found to be proinflammatory. We hypothesize that dietary AGEs exaggerate the pulmonary inflammatory response following gastric aspiration. ⋯ In conclusion, a diet high in AGEs exacerbates acute lung injury following gastric aspiration as evidenced by increases in neutrophil infiltration, airway albumin leakage, and decreased pulmonary compliance. This is the first evidence implicating exacerbation of acute inflammatory lung injury by dietary AGEs. Targeting AGEs in the circulatory system may offer a therapeutic strategy for limiting lung injury following gastric aspiration.
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Forty percent of trauma deaths are due to hemorrhage, with 33% to 56% occurring in the prehospital environment. This study proposes a new index (NI) based on the ratio of serum lactate concentration (LC) to peripheral perfusion (PP) as an indicator of hemorrhage-induced mortality during the prehospital stage. Thirty-six anesthetized rats were randomized into three groups according to volume of controlled blood loss. ⋯ The correlation coefficients with mortality for NI, SI, PP, SBP, MAP, PPR, DBP, TEMP, LC, RR, and HR were -0.818, -0.759, 0.726, 0.721, 0.694, 0.662, 0.597, 0.544, -0.487, 0.420, and -0.296, respectively, with the same order as the AUC. NI was shown to be an optimal independent mortality predictor on multivariable logistic regression analysis. In conclusion, the newly proposed hemorrhage-induced mortality index, based on blood lactate/PP ratio, was a better marker for predicting mortality in rats undergoing acute hemorrhage in comparison to the other parameters evaluated in this study.