Advances in Surgical Critical Care

Velmahos, George C.; Alam, Hasan B.

doi:10.1067/j.cpsurg.2008.03.003

Cited by 5 publications

(2 citation statements)

References 216 publications

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“…Treatments of shock have evolved over the last 50 years, but the changes over the last decade have been especially dramatic136, 137, 138. Based upon contemporary data, early goal directed fluid resuscitation should be considered the standard of care for septic shock, along with additional supportive measures as advocated by the Surviving Sepsis Guidelines89.…”

Section: Discussionmentioning

confidence: 99%

Advances in resuscitation strategies

Alam

2011

International Journal of Surgery

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Shock, regardless of etiology is characterized by decreased delivery of oxygen and nutrients to the tissues and our interventions are directed towards reversing the cellular ischemia and preventing its consequences. The treatment strategies that are most effective in achieving this goal obviously depend upon the different types of shock (hemorrhagic, septic, neurogenic and cardiogenic). This brief review focuses on the two leading etiologies of shock in the surgical patients: bleeding and sepsis, and addresses a number of new developments that have profoundly altered the treatment paradigms. The emphasis here is on new research that has dramatically altered our treatment strategies rather than the basic pathophysiology of shock.

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Section: Discussionmentioning

confidence: 99%

Advances in resuscitation strategies

Alam

2011

International Journal of Surgery

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“…Our therapeutic interventions are directed toward reversing the cellular ischemia and preventing its consequences [33,34]. Reperfusion injury starts with the simple reoxygenation of tissues after ischemic insult [35].…”

Section: Introductionmentioning

confidence: 99%

A Review of metabolic staging in severely injured patients

Aller

Arias

Alonso-Poza³

et al. 2010

Scand J Trauma Resusc Emerg Med

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An interpretation of the metabolic response to injury in patients with severe accidental or surgical trauma is made. In the last century, various authors attributed a meaning to the post-traumatic inflammatory response by using teleological arguments. Their interpretations of this response, not only facilitates integrating the knowledge, but also the flow from the bench to the bedside, which is the main objective of modern translational research. The goal of the current review is to correlate the metabolic changes with the three phenotypes -ischemia-reperfusion, leukocytic and angiogenic- that the patients express during the evolution of the systemic inflammatory response. The sequence in the expression of multiple metabolic systems that becomes progressively more elaborate and complex in severe injured patients urges for more detailed knowledge in order to establish the most adequate metabolic support according to the evolutive phase. Thus, clinicians must employ different treatment strategies based on the different metabolic phases when caring for this challenging patient population. Perhaps, the best therapeutic option would be to favor early hypometabolism during the ischemia-reperfusion phase, to boost the antienzymatic metabolism and to reduce hypermetabolism during the leukocytic phase through the early administration of enteral nutrition and the modulation of the acute phase response. Lastly, the early epithelial regeneration of the injured organs and tissues by means of an oxidative metabolism would reduce the fibrotic sequelae in these severely injured patients.

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Krieg und Flüssigkeitsmanagement

Exadaktylos

Alam

2009

Unfallchirurg

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In the coming years, our approach to the bleeding patient will have to change radically. The inevitable knowledge from the wars in Iraq and Afghanistan permits the prediction that conventional crystalloids will sooner or later disappear from volume replacement therapy. The dogma that fluids must always be given will be abandoned, to be replaced by the practice of careful and goal-directed resuscitation. In the near future, we would rely on designer fluids and sophisticated pharmacological agents to deliver personalized resuscitation based upon the specific needs of the individual patient.

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Advances in Surgical Critical Care

Cited by 5 publications

References 216 publications

Advances in resuscitation strategies

Advances in resuscitation strategies

A Review of metabolic staging in severely injured patients

Krieg und Flüssigkeitsmanagement

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