Variations exist in United Kingdom and Ireland services for critically ill children needing interhospital transport. Future studies should assess the impact of these variations on long-term patient outcomes taking into account treatment provided prior to transport.
Summary
The location of care for many brain‐injured patients has changed since 2012 following the development of major trauma centres. Advances in management of ischaemic stroke have led to the urgent transfer of many more patients. The basis of care has remained largely unchanged, however, with emphasis on maintaining adequate cerebral perfusion as the key to preventing secondary injury. Organisational aspects and training for transfers are highlighted, and we have included an expanded section on paediatric transfers. We have also provided a table with suggested blood pressure parameters for the common types of brain injury but acknowledge that there is little evidence for many of our recommendations. These guidelines remain a mix of evidence‐based and consensus‐based statements. We have received assistance from many organisations representing clinicians who care for these patients, and we believe our views represent the best of current thinking and opinion. We encourage departments to review their own practice using our suggestions for audit and quality improvement.
Background and aims: Vascular leak accompanies systemic inflammation (SIRS) causing hypotension and multiple organ failure. Aims: We hypothesised that EphA2/ephrin-A1 signalling may be the link between cytokines released during inflammation and the vascular leak due to increased endothelial permeability in SIRS. We tested the effect of blocking EphA2/ephrin-A1 signalling in a mouse model of intestinal ischemia reperfusion injury (gut IR), which displays characteristics of SIRS. Methods: C57BL/6J mice were administered EphA4-Fc (blocks EphA2-ephrinA1 receptor ligand interaction) 0.5 mg intraperitoneally (i.p.) [n=6] or Fc-control 0.5 mg i.p. [n=6]. Mice were anaesthetised 16 hours later and a CMA20 (100KDa, Global Scientific) microdialysis catheter, inserted in the subcutaneous skin of the back and perfused with electrolyte solution. Mice were subject to 30 minutes of superior mesenteric artery occlusion followed by reperfusion. Sham mice underwent laparotomy only. Total protein was measured in the microdialysate every 30 minutes as a marker of vascular leak. Local ethics approval was obtained.Results: Gut IR induced systemic inflammation caused significant vascular leak measured by dialysate protein accumulation. Significantly, blockade of EphA2-ephrinA1 signalling with EphA4-Fc abolished vascular leak during reperfusion (P<0.05), compared with Fc-control treatment. Furthermore, histopathological injury scores of IR intestines were significantly reduced in EphA4-Fc treated mice. Conclusions: We have proof-of-concept data that EphA2-ephrinA1 signalling mediates vascular leak in systemic inflammation and have identified a novel therapeutic strategy.
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