Physiopathologie du choc hémorragique

Copotoiu, Ruxandra; Cinca, Ecaterina; Collange, Olivier; Lévy, François; Mertès, P. M.

doi:10.1016/j.tracli.2016.07.004

Cited by 9 publications

(4 citation statements)

References 64 publications

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“…The adaptive mechanisms allowing the adaptation of the organism are neurological, renal, and hormonal. These can lead to the three phases of THS: compensated, decompensated and exceeded (29).…”

Section: Pathophysiologymentioning

confidence: 99%

Therapeutic Potential of Mesenchymal Stromal Cell-Derived Extracellular Vesicles in the Prevention of Organ Injuries Induced by Traumatic Hemorrhagic Shock

et al. 2021

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Severe trauma is the principal cause of death among young people worldwide. Hemorrhagic shock is the leading cause of death after severe trauma. Traumatic hemorrhagic shock (THS) is a complex phenomenon associating an absolute hypovolemia secondary to a sudden and significant extravascular blood loss, tissue injury, and, eventually, hypoxemia. These phenomena are responsible of secondary injuries such as coagulopathy, endotheliopathy, microcirculation failure, inflammation, and immune activation. Collectively, these dysfunctions lead to secondary organ failures and multi-organ failure (MOF). The development of MOF after severe trauma is one of the leading causes of morbidity and mortality, where immunological dysfunction plays a central role. Damage-associated molecular patterns induce an early and exaggerated activation of innate immunity and a suppression of adaptive immunity. Severe complications are associated with a prolonged and dysregulated immune–inflammatory state. The current challenge in the management of THS patients is preventing organ injury, which currently has no etiological treatment available. Modulating the immune response is a potential therapeutic strategy for preventing the complications of THS. Mesenchymal stromal cells (MSCs) are multipotent cells found in a large number of adult tissues and used in clinical practice as therapeutic agents for immunomodulation and tissue repair. There is growing evidence that their efficiency is mainly attributed to the secretion of a wide range of bioactive molecules and extracellular vesicles (EVs). Indeed, different experimental studies revealed that MSC-derived EVs (MSC-EVs) could modulate local and systemic deleterious immune response. Therefore, these new cell-free therapeutic products, easily stored and available immediately, represent a tremendous opportunity in the emergency context of shock. In this review, the pathophysiological environment of THS and, in particular, the crosstalk between the immune system and organ function are described. The potential therapeutic benefits of MSCs or their EVs in treating THS are discussed based on the current knowledge. Understanding the key mechanisms of immune deregulation leading to organ damage is a crucial element in order to optimize the preparation of EVs and potentiate their therapeutic effect.

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Section: Pathophysiologymentioning

confidence: 99%

Therapeutic Potential of Mesenchymal Stromal Cell-Derived Extracellular Vesicles in the Prevention of Organ Injuries Induced by Traumatic Hemorrhagic Shock

et al. 2021

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“…Previous studies have shown that rapid blood volume withdrawal during HH could lead to reductions in venous return, HR, cardiac output, fall in blood pressure 9 , 25 as well as biphasic RSNA response 26 . The activation of arterial baroreceptors mediates renal sympathoexcitation prior to vagal cardiopulmonary afferents-induced renal sympathoinhibition.…”

Section: Discussionmentioning

confidence: 99%

Involvement of median preoptic nucleus and medullary noradrenergic neurons in cardiovascular and sympathetic responses of hemorrhagic rats

Naves

Marques

Mourão

et al. 2018

Sci Rep

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The infusion of hypertonic saline solution (HSS) is known to be beneficial to the treatment of hypovolemic hemorrhage (HH). The central mechanism of HSS-induced cardiovascular and autonomic recovery of animals subjected to HH remains unclear. Hence, the present study evaluated the involvement of median preoptic nucleus (MnPO) and medullary noradrenergic neurons (A1 and A2) in HSS-induced cardiovascular and sympathetic responses in hemorrhagic rats. The wistar rats were subjected to specific lesion of noradrenergic neurons through the nanoinjections of anti-DβH-saporin into caudal ventrolateral medulla (A1 neurons) and nucleus of the solitary tract (A2 neurons). After recovery, mean arterial pressure (MAP) and renal sympathetic nervous activity were recorded. The HH was performed through blood withdrawal until a MAP of 60 mmHg was attained. In sham rats, HSS infusion (3M NaCl) reestablished MAP without change in HH-induced sympathoinhibition. The muscimol (agonist of GABAA receptor) was nanoinjected in MnPO during HH and MnPO inhibition abolished the recovery of MAP and HSS-induced sympathoinhibition. Simultaneous lesions of A1 and A2 abolished MAP restoration and sympathoinhibition after HSS infusion. These results suggest that the recovery of MAP and HSS-induced sympathoinhibition in hemorrhaged rats depend on intact neural projections from A1 and A2 to MnPO.

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“…Large-scale bleeding in pregnant women may happen before, during, or after giving birth. Intense bleeding during childbirth seems to be the leading cause of maternal death and disability across the globe [13].…”

Section: Health Issues Related To Pregnancy and Childbirthmentioning

confidence: 99%

Management of Severe Perioperative Bleeding

Elkady¹,

Khalil

Elrahman

2023

Benha Journal of Applied Sciences

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Perioperative bleeding continues to be a serious problem during and after surgery, leading to increased mortality and morbidity. Non-vascular sources of haemostatic perioperative bleeding often result from a bleeding problem that has gone undiscovered, from the specifics of the surgery itself, or acquired coagulation abnormalities due to haemorrhage, hemodilution, or the administration of haemostatic factors. Allogeneic blood product delivery, pharmacologic medicines, and the growing use of pure or recombinant haemostatic factors are all considered conventional treatment techniques in the management of bleeding patients. Trauma and sophisticated surgical operations, such as heart surgery and liver transplantation, cause a cascade of haemostatic alterations in the perioperative period. Tranexamic acid, desmopressin, fibrinogen, and prothrombin complex concentrates are some of the newer methods used for both the prevention and treatment of perioperative bleeding. More in-depth evaluation of targeted treatment for haemostasis is now possible because to point-of-care testing using thromboelastography, rotational thromboelastometry, and platelet function tests. Better management, less use of allogeneic blood products, and fewer transfusion-related complications may be achieved by multimodal, and strategic approaches. The goal of this effort is to alleviate the difficulty of controlling bleeding in surgical patients. Research priorities include, but are not limited to, preventing hypotension, sustaining appropriate tissue perfusion and oxygenation, and preventing bleeding.

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Physiopathologie du choc hémorragique

Cited by 9 publications

References 64 publications

Therapeutic Potential of Mesenchymal Stromal Cell-Derived Extracellular Vesicles in the Prevention of Organ Injuries Induced by Traumatic Hemorrhagic Shock

Therapeutic Potential of Mesenchymal Stromal Cell-Derived Extracellular Vesicles in the Prevention of Organ Injuries Induced by Traumatic Hemorrhagic Shock

Involvement of median preoptic nucleus and medullary noradrenergic neurons in cardiovascular and sympathetic responses of hemorrhagic rats

Management of Severe Perioperative Bleeding

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