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
-
Remote ischemic perconditioning (RIPer) and local ischemic postconditioning (IPost) are promising methods to decrease ischemia-reperfusion injury. We tested whether these two methods were effective in reducing infarct size through activation of endoplasmic reticulum (ER) stress response, a potential survival pathway. Rats exposed to myocardial ischemia-reperfusion were allocated to one of six groups: control, no intervention at myocardial reperfusion; IPost, three cycles of 10-s coronary artery occlusion followed by 10-s reperfusion applied at the onset of myocardial reperfusion; RIPer, 10-min limb ischemia followed by 10-min reperfusion initiated during coronary artery occlusion; control + 4-PBA, injection of ER stress inhibitor 4-phenylbutyrate (4-PBA) 1 h before coronary occlusion; IPost + 4-PBA; and RIPer + 4-PBA. ⋯ Furthermore, 4-PBA abolished cardioprotection induced by IPost (infarct size 53.75 ± 3.49 vs. 33.32 ± 3.65%, P < 0.05) but not by RIPer (28.80 ± 10.45% vs. 21.86 ± 3.98%, not statistically significant). GRP78 and cleaved activating transcription factor 6 levels were no longer increased in IPost group after 4-PBA. These findings point to a role for ER stress response in cardioprotection against reperfusion injury in IPost but not RIPer, suggesting differences in cardioprotective mechanisms between local and remote conditioning.
-
Early fluid administration is fundamental for the initial treatment of severe sepsis and septic shock patients. A large portion of suspected severe sepsis and septic shock patients can be quickly resuscitated with therapeutic tests until surrogate cardiac output markers, such as heart rate and urinary output, are normalized. ⋯ When clinical stabilization is not achieved with initial fluid resuscitation, more careful, complete, and accurate monitoring should be started for both reversing tissue hypoxia and preventing fluid overload. This challenge requires appropriate knowledge of the physiological foundations governing the different monitoring method advantages and their respective limitations, therefore allowing the election of the best therapeutic measures for each different scenario.
-
To determine whether early coagulopathy affects the mortality associated with severe civilian pediatric trauma, trauma patients younger than 18 years admitted to a pediatric intensive care unit from 2001 to 2010 were evaluated. Patients with burns, primary asphyxiation, preexisting bleeding diathesis, lack of coagulation studies, or transferred from other hospitals more than 24 h after injury were excluded. Age, sex, race, mechanism of injury, initial systolic blood pressure, Glasgow Coma Scale score, Injury Severity Score, prothrombin time, partial thromboplastin time, platelet count, and international normalized ratio were recorded. ⋯ In contrast, the combination of TBI and early coagulopathy was associated with a fourfold increase in mortality in this patient population. Early coagulopathy is an independent predictor of mortality in civilian pediatric patients with severe trauma. The increase in mortality was particularly significant in patients with TBI either isolated or combined with other injuries, suggesting that a rapid correction of this coagulopathy could substantially decrease the mortality after TBI in pediatric trauma patients.
-
Sepsis is the main cause of acute kidney injury (AKI) among individuals hospitalized in intensive care units. Acute kidney injury is an independent risk factor for mortality, and its occurrence increases the complexity and cost of treatment. However, the pathophysiological mechanisms of AKI remain unclear. ⋯ Dialysis is the main treatment for AKI. Although there is no clear benefit of any specific dialysis modality, these patients are initially instructed to use continuous dialysis methods, especially for the most severe cases with multiple organ system dysfunctions and for those who display signs of hemodynamic instability. Recent studies demonstrate that patients should receive a dialysis dose of at least 25 mL · kg · h.