Traumatic and septic shock alias post-trauma critical illness

Hardaway, Robert M.

doi:10.1046/j.1365-2168.1998.00911.x

Cited by 28 publications

(28 citation statements)

References 67 publications

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“…The inclusion criteria were as follows: (1) The patients who were consistent with the diagnostic criteria of traumatic shock [4] : they were graded as mild, moderate and severe shocks according to their duration of hypotension (mild shock <30 min, severe shock > 60 min, and moderate shock in between). Also they were evaluated in terms of the organ dysfunction variables including respiration, cardiovascular system, blood, central nerve system, kidney, liver and gastrointestinal tract in accordance with the MODS diagnostic criteria [5] ; (2) The patients were all inpatients at age of 18-85 years old; (3) No previous history of diabetes; (4) No participation in any other clinical researches in recent 3 months.…”

Section: Selection Of Patientsmentioning

confidence: 99%

Clinical effects of intensive insulin therapy treating traumatic shock combined with multiple organ dysfunction syndrome

Liu

et al. 2011

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups: control group (n=56) treated with conventional therapy, and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells (WBC) counts, prothrombin time (PT), serum creatinine (SCr), alanine aminotransferase (ALT), serum albumin and PaO(2) were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced (P<0.05), but the level of serum albumin was significantly increased (P<0.05) at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 (P<0.01) after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased (P<0.01). The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

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Section: Selection Of Patientsmentioning

confidence: 99%

Clinical effects of intensive insulin therapy treating traumatic shock combined with multiple organ dysfunction syndrome

Liu

et al. 2011

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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“…The association rate (k a ), dissociation rate (k d ) and the apparent dissociation constant (K D ) of surfactin binding to lipid A were calculated to be 2.27ϫ10 4 M Ϫ1 s Ϫ1 , 2.46ϫ10 Ϫ3 s Ϫ1 and 1.09ϫ10 Ϫ7 M, respectively. Those parameters of polymyxin B binding to lipid A were calculated to be 7.86ϫ10 6 …”

Section: Direct Interaction Between Surfactin and Lipid Amentioning

confidence: 99%

“…NFkB is known to play a critical role in the development of inflammatory responses by upregulating the expression of cell adhesion molecules and many inflammatory cytokines, such as tumor necrosis factor-a (TNF-a ) and interleukins (IL). Systemic production of these proinflammatory mediators causes the sepsis syndrome, which is clinically characterized by hypotension, fever, and respiratory dysfunction, and may lead to multi-organ failure and death [6,7]. LPS can be recognized by monocytes, macrophages, neutrophils, and endothelial cells in mammals.…”

Section: Introductionmentioning

confidence: 99%

“…Because it triggers the sepsis syndrome [6,7], inflammation of the bowels including Crohn's disease [14,15], and periodontitis [16,17], LPS is considered to be one of the most common and potent pathogenic factors of blood vessels. Therefore, searching for molecules that can inhibit LPSinduced endothelial cell dysfunction should contribute to the discovery of new anti-inflammatory agents.…”

Section: Introductionmentioning

confidence: 99%

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Inhibition of Lipopolysaccharide Activity by a Bacterial Cyclic Lipopeptide Surfactin

et al. 2006

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Compounds that inactivate lipopolysaccharide (LPS) activity have the potential of being new antiinflammatory agents. Therefore, we searched among microbial secondary metabolites for compounds that inhibited LPS-stimulated adhesion between human umbilical vein endothelial cells (HUVEC) and HL-60 cells. By this screening, we found a cyclic lipopeptide surfactin from the culture broth of Bacillus sp. BML752-121F2 to be inhibitory. The addition of the surfactin prior to the LPS stimulation decreased HL-60 cell-HUVEC adhesion without showing any cytotoxicity. We confirmed that surfactin inhibited LPS-induced expression of ICAM-1 and VCAM-1 in HUVEC. It also inhibited the cellular adhesion induced by lipid A, the active component of LPS; but it did not inhibit TNF-a or IL-1b -induced cell adhesion. Then, surfactin was shown to suppress the interaction of lipid A with LPS-binding protein (LBP) that mediates the transport of LPS to its receptors. Finally, surface plasmon resonance (SPR) analysis revealed the surfactin to interact reversibly with lipid A. Thus, this Bacillus surfactin was shown to be an inhibitor of LPS-induced signal transduction, directly interacting with LPS.

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“…Survivors of severe hemorrhagic shock states after multiple trauma are prone to various complications during their subsequent hospital care [15,17,32]. As the course of these complications can be modified by timely intervention, early accurate identification of those with a life-threatening hemorrhagic condition is crucial [3,18].…”

Section: Introductionmentioning

confidence: 99%

Calculation of Different Triage Scores Based on the German Trauma Registry

et al. 2005

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European Journal of TraumaAb stract Background and Purpose: Exact, prehospital, on-scene grading is crucial in patients with life-threatening injuries. For blunt trauma, early patient grading continues to represent a challenge. In Europe, the ratio between heart rate and blood pressure (Shock Index [SI]) was frequently used in the 1980s, but was later discarded as irrelevant due to improved rescue times. The current study reevaluates the usefulness of this index based on the German Trauma Registry. Methods: Patients documented in the German Trauma Registry between 1993 and 2001 were investigated. The registry lists patients with multiple injuries. From these patients, inclusion criteria were multiple injuries with complete on-scene documentation. A subgroup analysis was performed for patients who have minor injuries (Injury Severity Score [ISS] < 16, no requirement of intensive care therapy) and patients who died in the emergency room (ER). The association between pathologic values of the SI and later complications (organ failure and death) was investigated. Also, associations between pathologic shock indices and the clinical diagnoses as made by the physician on scene and special injuries diagnosed after hospital admission were calculated. Results: 6,346 patients were included in the study and demonstrated the following demographic parameters: mean age 33.4 (16-81) years, male gender 76.4%; mean admission Glasgow Coma Scale (GCS) 9.8 (4-15) points, mean alert time 14.4 (6.3-73) min, mean rescue time 43.5 (22-91) min; mean prehospital crystalloids 954.9(200-4,300) and colloids 773 (150-3,100). A receiver operating characteristic (ROC) analysis regarding the association between a score and the likelihood of complications was calculated and provided the following results: Revised Trauma Score (RTS), 0.633; SI, 0.684; pulse rate, 0.579; blood pressure, 0.564; respiratory rate, 0.377. An odds ratio was calculated, describing the likelihood of organ failure in specific patient subgroups. The highest values were obtained for patients who died in the ER (6.3), patients in whom the cause of death was hemorrhagic shock (6.1), and patients who sustained predominantly abdominal (5.3) and pelvic injuries (4.5). Conclusion: The data of this study supports previous findings that the ratio between pulse and systolic blood pressure is sensitive in detecting shock states in patients with multiple injuries. In the current population, the value of the SI as a field screening tool was better in patients who died of shock and those who sustained abdominal or pelvic injuries when compared with those who had extremity fractures only. It was improvable by adding the presumed major clinical prehospital diagnosis. The score is easily accessible and may be used for estimation of the blood volume status on scene.

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Traumatic and septic shock alias post-trauma critical illness

Cited by 28 publications

References 67 publications

Clinical effects of intensive insulin therapy treating traumatic shock combined with multiple organ dysfunction syndrome

Clinical effects of intensive insulin therapy treating traumatic shock combined with multiple organ dysfunction syndrome

Inhibition of Lipopolysaccharide Activity by a Bacterial Cyclic Lipopeptide Surfactin

Calculation of Different Triage Scores Based on the German Trauma Registry

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