Shock - A reappraisal: The holistic approach

Bonanno, Fabrizio Giuseppe

doi:10.4103/0974-2700.96487

Cited by 11 publications

(13 citation statements)

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“…There is a second basic error: it focuses on the amount of blood loss and other parameters taken singularly instead of the individual systemic response to hemorrhage, which is the core by definition of the derangement, we call “shock.”[ 2 ]…”

Section: P Ast and C Urrent C mentioning

confidence: 99%

The need for a physiological classification of hemorrhagic shock

Bonanno¹

2020

J Emerg Trauma Shock

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Classifications mean to conceptualize in a cluster and rapidly summarize the assessment and management of a clinical scenario. In the specific case of a hemorrhagic shock (HS), a classification should serve the purpose of allowing a rapid clinical assessment of the shock level and the earliest or right timing of source control, possibly also on whether to apply damage control surgery (DCS) strategy or not. ATLS ® classification of HS is not sensitive and specific enough to help decision-making in reference to the timing of management, based only on the amount of blood loss that may be or may not rightly estimated, for example, blood loss on the floor in penetrating injuries before theatre. Moreover, it focuses also on other parameters, which are taken singularly, instead of the individual generalized physiological response to hemorrhage, which is the core by definition of the derangement we call “shock.” It is unhelpful, difficult, and impractical to apply as well. A new classification, which may well be called as the “physiological HS classification” or “therapeutic HS classification,” was proposed since 2010, following the new developments on microcirculation and an already going-on sensible praxis among some trauma surgeons. It bases on some physiological considerations such as the significance of fluid-blood resistant hypotension, body natural hemostatic mechanisms, the right definition of shock, and the relevance that hemorrhage-triggered ischemia-reperfusion toxemia and systemic inflammatory response have in critical illness scenarios as secondary insults from ischemia, which is what we mean to prevented with DCS. The key factor remains the persistence of hypotension, following fluid challenge.

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Section: P Ast and C Urrent C mentioning

confidence: 99%

The need for a physiological classification of hemorrhagic shock

Bonanno¹

2020

J Emerg Trauma Shock

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“…Circulatory shock is defined as mismatch among oxygen delivery and tissue consumption which leads to end-organ damage, multisystem organ failure, and potentially death [ 1 , 2 ]. Patients with circulatory shock commonly present with hypotension.…”

Section: Introductionmentioning

confidence: 99%

Temporal trends in the utilization of vasopressors in intensive care units: an epidemiologic study

Cheungpasitporn

Harrison

Carrera

et al. 2016

BMC Pharmacol Toxicol

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BackgroundThe choice of vasopressor use in the intensive care unit (ICU) depends primarily on provider preference. This study aims to describe the rate of vasopressor utilization and the trends of each vasoactive agent usage in the ICU over the span of 7 years in a tertiary referral center.MethodsAll adult ICU admissions, including medical, cardiac, and surgical ICUs from January 1st, 2007 through December 31st, 2013 were included in this study. Vasopressor use was defined as the continuous intravenous administration of epinephrine, norepinephrine, phenylephrine, dopamine, or vasopressin within a given ICU day. The vasopressor utilization index (VUI) was defined as the proportion of ICU days on each vasoactive agent divided by the total ICU days with vasopressor usage.ResultsDuring the study period, 72,005 ICU admissions and 272,271 ICU days were screened. Vasopressors were used in 19,575 ICU admissions (27 %) and 59,811 ICU days (22 %). Vasopressin was used in 24,496 (41 %), epinephrine in 23,229 (39 %), norepinephrine in 20,648 (34 %), dopamine in 9449 (16 %), and phenylephrine in 7508 (13 %) ICU days. The VUInorepinephrine increased from 0.24 in 2007 to 0.46 in 2013 and VUIphenylephrine decreased from 0.20 in 2007 to 0.08 in 2013 (p < 0.001 both). For epinephrine, dopamine, and vasopressin VUI did not change over the course of study.ConclusionVasopressors were used in about one fourth of ICU admissions and about one-fifth of ICU days. Although vasopressin is the most commonly used vasopressor, the use of norepinephrine found to have an increasing trajectory.Electronic supplementary materialThe online version of this article (doi:10.1186/s40360-016-0063-z) contains supplementary material, which is available to authorized users.

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“…[5]). Les mécanismes responsables de la formation accrue de lactate et la physiopathologie des chocs ont été largement documentés dans la littérature [6][7][8][9]. D'autre part, l'absence d'hyperlactatémie, parfois observée dans le choc septique [10], n'est classiquement pas observée dans le choc causé par une déshydratation sévère ou une hémorragie importante [11].…”

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