Surgery
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Shock index as the ratio of heart rate to systolic blood pressure is a simple triage tool that correlates well with various outcomes in trauma patients. Concern has been raised regarding the accuracy of shock index in older patients. We sought to investigate the effects of age on the accuracy of shock index. ⋯ As expected, prehospital shock index alone has diminishing accuracy for patients older than 60 years of age and should be interpreted cautiously by trauma triage personnel. Shock index alone in patients younger than 60, and its increase during transit in patients older than 60, can be used as a valuable tool for the prehospital triage of trauma patients when determining the need for transport to a trauma center, preparation of resources, or activation of the trauma team.
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Traumatic brain injury (TBI) and hemorrhagic shock (HS) are major causes of trauma-related deaths and are especially lethal as a combined insult. Previously, we showed that early administration of fresh frozen plasma (FFP) decreased the size of the brain lesion and associated swelling in a swine model of combined TBI+HS. We have also shown separately that addition of valproic acid (VPA) to the resuscitation protocol attenuates inflammatory markers in the brain as well as the degree of TBI. The current study was performed to determine whether a combined FFP+VPA treatment strategy would exert a synergistic effect. ⋯ In a large animal model of TBI+HS, early treatment with a combination of FFP and VPA decreases the size of brain lesion and the associated swelling.
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Cerebral metabolic derangement and excitotoxicity play critical roles in the evolution of traumatic brain injury (TBI). We have shown previously that treatment with large doses of valproic acid (VPA) decreases the size of brain lesion. The goal of this experiment was to determine whether this effect was owing to metabolic modulation. ⋯ VPA treatment attenuates perturbation of post-traumatic cerebral metabolism by mitigating mitochondrial dysfunction, and decreases glutamate-mediated excitotoxic damage. These properties could explain its effectiveness in decreasing lesion size and post-traumatic cerebral edema.
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We have demonstrated previously that suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, improves survival in a lipopolysaccharide-induced lethal model of endotoxemia. The goal of this study was to investigate the impact of SAHA on survival in a more clinically relevant model of cecal ligation and puncture (CLP)-induced septic shock and to elucidate changes in cytokine responses and organ injury. ⋯ SAHA treatment improves survival, decreases "cytokine storm," and prevents distant organ damage in a lethal septic model.