Volume replacement in trauma patients within the first 24 h and its impact on the interpretation of biochemical data

Gebhard, Florian; Riepl, C.; Liener, U. C.; Kinzl, L.; Brückner, U. B.

doi:10.1007/s004230000152

Cited by 11 publications

(5 citation statements)

References 19 publications

(24 reference statements)

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“…The observed rapid complement dysfunction was paralleled by instant serum increases of C3a, C5a and SC5b-9, all of which were already enhanced at the scene. Since any volume reconstitution therapy has a significant impact on the interpretation of biochemical data (23), all values of the complement activation products were adjusted to the serum protein levels to prevent misinterpretation by dilution effects, except for the CH-50 values to avoid assay interferences. However, it cannot be excluded, that the application of blood products (fresh frozen plasma, red blood cells) or massive transfusions of saline or hydroxyethyl starch have some influence on the complement status of patients.…”

Section: Discussionmentioning

confidence: 99%

Early Complementopathy After Multiple Injuries in Humans

Burk

Martin

Flierl

et al. 2012

Shock

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After severe tissue injury, innate immunity mounts a robust systemic inflammatory response. However, little is known about the immediate impact of multiple trauma on early complement function in humans. In the present study we hypothesized that multiple trauma results in immediate activation, consumption and dysfunction of the complement cascade and that the resulting severe “complementopathy” may be associated with morbidity and mortality. Therefore a prospective multicenter study with 25 healthy volunteers and 40 polytrauma patients (mean injury severity score [ISS] = 30.3 ± 2.9) was performed. After polytrauma serum was collected as early as possible at the scene, upon admission to the emergency room and 4, 12, 24, 120 and 240 hours post trauma and analysed for the complement profile. Complement hemolytic activity (CH-50) was massively reduced within the first 24 h after injury, recovered only 5 days after trauma and discriminated between lethal and non-lethal 28-day outcome. Serum levels of the complement activation products C3a and C5a were significantly elevated throughout the entire observation period and correlated with the severity of traumatic brain injury and survival. The soluble terminal complement complex SC5b-9 and mannose-binding lectin (MBL) showed a biphasic response after trauma. Key fluid phase inhibitors of complement, such as C4b-binding protein (C4BP) and factor I, were significantly diminished early after trauma. The present data indicate an almost synchronically rapid activation and dysfunction of complement suggesting a trauma-induced “complementopathy” early after injury. These events may participate to the impairment of the innate immune response observed after severe trauma.

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Section: Discussionmentioning

confidence: 99%

Early Complementopathy After Multiple Injuries in Humans

Burk

Martin

Flierl

et al. 2012

Shock

Self Cite

143

150

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“…Systemic, pulmonary, intestinal, and hepatic (ultrasound flow probes on the portal vein and the hepatic artery) hemodynamics and gas exchange (arterial, portal, hepatic, and mixed venous blood gas analyses and oximetry), intrathoracic blood volume, extravascular lung water (thermal-green dye double indicator dilution technique), ileal mucosal-arterial PCO 2 gap (fiberoptic sensor placed via an ileostomy), mixed expiratory NO and arterial nitrate ϩ nitrite concentrations (chemoluminescence analyzer), endogenous glucose production rate (steady-state approach after gas chromatography-mass spectrometry assessment of plasma isotope enrichment during infusion of 6,6-2 H 2 -glucose), blood glucose, lactate, pyruvate, bilirubin, creatinine, 8-isoprostane, and alanine and aspartate aminotransferase activities were determined as described previously (19,20). The results for alanine and aspartate aminotransferase activities, bilirubin, creatinine, 8-isoprostane, and total nitrate/nitrite concentrations are normalized per gram of plasma protein to correct for dilutional effects of intravenous fluids (21). Whole blood reduced and oxidized glutathione (GSH, GSSG, reported per gram of hemoglobin) concentrations and GSH/ GSSG ratios were determined with a commercially available kit (Calbiochem GSH/GSSG Ratio Assay Kit, EMD Biosciences, San Diego, CA).…”

Section: Methodsmentioning

confidence: 99%

Ethyl pyruvate improves systemic and hepatosplanchnic hemodynamics and prevents lipid peroxidation in a porcine model of resuscitated hyperdynamic endotoxemia*

Hauser

Kick

Asfar

et al. 2005

Critical Care Medicine

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“…The measured isoprostane and GSH concentrations were normalized per g total plasma protein content to correct for any dilutional effects of intravenous (i.v.) fluids (19).…”

Section: Measurements and Calculationsmentioning

confidence: 99%

TIN???Mesoporphyrin for Inhibition of Heme Oxygenase During Long-Term Hyperdynamic Porcine Endotoxemia

Nalos¹,

Vassilev²,

Pittner³

et al. 2003

Shock

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Heme oxygenase (HO) has both deleterious and protective effects in various shock models. Most of these data have been derived from experiments with hypodynamic shock states associated with depressed cardiac output. Therefore we studied the role of HO during long-term porcine hyperdynamic endotoxemia characterized by a sustained increase in cardiac output resulting from colloid resuscitation to maintain mean arterial pressure > 60 mmHg. Systemic, pulmonary, and hepatosplanchnic hemodynamic and metabolic effects of the HO-inhibitor tin-mesoporphyrin (SnMP) were assessed in anesthetized and mechanically ventilated animals. After 12 h of continuous intravenous lipopolysaccharide (LPS), animals received either vehicle (n = 6) or SnMP (n = 8; 6 micromol kg(-1) i.v. over 30 min at 12 and 18 h of LPS). Measurements were performed before LPS, before SnMP infusion, and at 24 h of LPS. SnMP did not influence systemic hemodynamics but significantly increased mean pulmonary artery pressure. Although liver blood flow was not affected, SnMP markedly impaired liver lactate clearance. HO inhibition was associated with increased plasma nitrate levels likely the result of increased NO production. Our results suggest a protective role of HO activation during hyperdynamic porcine endotoxemia possibly as a result of an interaction with the LPS-induced increase in NO formation.

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Volume replacement in trauma patients within the first 24 h and its impact on the interpretation of biochemical data

Abstract: PPC proved a suitable parameter to estimate dilution effects and to adjust plasma concentrations of prostanoids. We recommend that consideration be given to possible dilution effects during the first 24 h when interpreting biochemical data in trauma patients.

Cited by 11 publications

References 19 publications

Early Complementopathy After Multiple Injuries in Humans

Early Complementopathy After Multiple Injuries in Humans

Ethyl pyruvate improves systemic and hepatosplanchnic hemodynamics and prevents lipid peroxidation in a porcine model of resuscitated hyperdynamic endotoxemia*

TIN???Mesoporphyrin for Inhibition of Heme Oxygenase During Long-Term Hyperdynamic Porcine Endotoxemia

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