The journal of trauma and acute care surgery
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To study the incidence and outcome of pulmonary edema in patients admitted with near hanging. ⋯ Pulmonary edema can be due to neurogenic, cardiogenic, postobstructive causes or an interplay of the three. Takotsubo cardiomyopathy/myocardial stunning related pulmonary edema seems more common than the others. Pulmonary edema occurred irrespective of level of consciousness or electrocardiographic changes and was not associated with mortality. Victims of near hanging with pulmonary edema can be effectively treated with supportive therapy.
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J Trauma Acute Care Surg · Jan 2012
Recombinant factor VIIa is effective at reversing coagulopathy in a lactic acidosis model.
The interplay of coagulopathy, acidosis, and hypothermia contributes to the death of the most seriously injured trauma patients. Because of in vitro testing and retrospective series, current recommendations advise correcting acidosis before administering recombinant factor VII (rFVIIa). ⋯ rFVIIa is effective at reversing the coagulopathy from lactic acidosis in a large animal model. Recommendations against its use in acidotic patients may not be valid.
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J Trauma Acute Care Surg · Jan 2012
Hypothermia reduces resuscitation fluid volumes required to maintain blood pressure in a rat hemorrhagic shock model.
To examine the hypothesis that resuscitative hypothermia would (1) reduce fluid requirements and reactive oxygen species production during a period of resuscitation and (2) improve survival after hemorrhagic shock (HS) in rats. ⋯ In a rat HS model, hypothermia during resuscitation from HS reduces resuscitation fluid volume required to maintain blood pressure and restores Vitamin E to the baseline level, and appears to have no adverse impact on long survival after HS.
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J Trauma Acute Care Surg · Jan 2012
Disruption of Nrf2 exacerbated the damage after spinal cord injury in mice.
Nuclear factor erythroid 2-related factor 2 (Nrf2) is a key transcriptional factor for antioxidant response element-regulated genes. After spinal cord injury (SCI), the Nrf2-antioxidant response element pathway is activated in the spinal cord. However, the function of Nrf2 after SCI has not yet been studied. ⋯ Genetic ablation of Nrf2 exacerbated the neurologic deficit and inflammation after SCI in mice. These findings raise the possibility that Nrf2 could be relevant in improving outcome after SCI.
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J Trauma Acute Care Surg · Jan 2012
Enoxaparin and fondaparinux attenuates endothelial damage in endotoxemic rats.
Prophylactic use of anticoagulants for septic patients in intensive care unit is a standard therapy for the prevention of venous thrombosis. Moreover, recent studies have demonstrated the anti-inflammatory effects of anticoagulants such as Factor Xa inhibitors and heparins. However, there have been no studies to examine the effects of fondaparinux and enoxaparin when applied in a sepsis model. Therefore, we examined the anti-inflammatory effects and bleeding events when these agents are applied in a lipopolysaccharide challenge model. ⋯ Fondaparinux and enoxaparin reduce organ dysfunction by decreasing endothelial damage. However, bleeding was more prominent in the fondaparinux group compared with the enoxaparin group at an equipotent dose for anti-Xa activity. Because the setting of this experiment is different from the clinical use, further study is required for the comparison of both pharmaceuticals.