J Trauma
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There are many complications involved in the immobilization of unconscious patients with potential cervical spine injuries. In February 2005, the Intensive Care Society (ICS), United Kingdom, produced consensus guidelines to evaluate spinal injuries in unconscious victims of blunt multiple injuries to address this important clinical problem. ⋯ A unit policy ensures that current recommendations are followed. Despite the ICS guidelines being published 4 years ago, over half of the individual intensive care units have no policy in place. A lack of adequate guidance for junior doctors can lead to steps in the process of clearance being omitted and potential injuries being missed. We recommend that the national organization do more to facilitate a wider dissemination of these guidelines.
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Pulse contour-derived cardiac output for continuous hemodynamic monitoring is becoming popular in critical care. However, the data regarding its reliability during acute hemodynamic instability are inconsistent. This study was conducted to determine whether pulse contour-derived cardiac output truly reflects rapid hemodynamic changes. ⋯ Pulse contour-derived hemodynamic parameters do not accurately reflect rapid hemodynamic changes, and the trend may be misleading in piglets. Physicians are advised to interpret pulse contour-derived hemodynamic parameters with caution or to use invasive monitoring to guide treatment strategy therapy.
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Supporting its therapeutic application in sepsis, p38 mitogen-activated protein kinase (MAPK) inhibition decreases cardiopulmonary injury and lethality with lipopolysaccharide challenge. However, only one preclinical study has reported the survival effects of a p38 inhibitor (SB203580, 100 mg/kg) during infection. We therefore tested SB203580 in mice (n = 763) challenged with intratracheal Escherichia coli and treated with antibiotics and fluids. ⋯ Thus, SB203580 had divergent effects on cardiac and lung function in E. coli challenged mice. Furthermore, high dose worsened survival and low dose did not improve it. Altogether, these findings suggest that clearly defining the risks and benefits of p38 MAPK inhibition is important before such treatment is applied in patients with or at risk of serious infection.
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Severe injury can cause intestinal permeability through decreased expression of tight junction proteins, resulting in systemic inflammation. Activation of the parasympathetic nervous system after shock through vagal nerve stimulation is known to have potent anti-inflammatory effects; however, its effects on modulating intestinal barrier function are not fully understood. We postulated that vagal nerve stimulation improves intestinal barrier integrity after severe burn through an efferent signaling pathway, and is associated with improved expression and localization of the intestinal tight junction protein occludin. ⋯ Vagal nerve stimulation performed before injury improves intestinal barrier integrity after severe burn through an efferent signaling pathway and is associated with improved tight junction protein expression.
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Tissue injury from mechanical trauma modulates innate immunity. The resultant systemic inflammatory response syndrome (SIRS) closely mimics clinical sepsis, and bacterial n-formyl peptides are septic mediators. Similar formyl peptides exist in mitochondria but little is known about their actions on human neutrophils (PMN). ⋯ Formylated mitochondrial proteins are potent immune activators. Acting through the FPR-1 receptor on professional phagocytes, MDP elicits [Ca]i release responses and Ca entry via G-protein-coupled pathways. MDP activates chemotaxis and respiratory burst. Our findings suggest a novel paradigm wherein one root cause of SIRS after trauma may be the release of mitochondrial fragments from mechanically damaged tissues. In this paradigm, mitochondrial debris "alarmins" alter host PMN phenotype, activating or suppressing immunity, predisposing to SIRS, sepsis or organ failure.