Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Simple prognostic marker search remains relevant for patients with acute abdomen. Previously it was shown that the levels of aromatic amino acid metabolites (phenyl carboxylic acids - PhCAs) are significantly increased in septic and other critically ill patients [http://ccforum.com/content/18/S2/P60]. ⋯ : The total serum level of 4PhCAs and APACHE II Score have comparable predictive power for patients with acute abdomen. Thus, aromatic amino acid metabolites (PhCAs) can be attributed to the promising prognostic indicators for integrated patient severity assessment. Supported by Russian Science Foundation Grant №15-15-00110.
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The mortality rate of acute respiratory distress syndrome (ARDS) remains unacceptably high despite that lung protective ventilatory strategies have been widely used. Pharmacological therapy is required to further reduce ARDS mortality. Mechanical ventilation is associated with oxidative stress and lung fibrosis, which may contribute to increased mortality and poor quality of life in ARDS. We hypothesized that the cytokine, midkine (MK), that can be upregulated during oxidative stress, facilitates the development of ARDS- associated lung fibrosis. ⋯ MK may serves as a biomarker for ARDS, as well as acting as an effector activating MK- Notch2-ACE signaling pathway, contributing to lung remodeling. The MK appears to be a potential therapeutic target in the context of ARDS associated lung fibrosis.
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During systemic inflammatory conditions, such as sepsis, the immune system is uniquely challenged. Studies indicate that excessive complement activation is associated with impaired neutrophil function although the mechanism is marginally characterised. As a balanced cytosolic pH regulation is essential for cellular function, the effect of complement activation on neutrophil pH and resulting functional changes was investigated. ⋯ These results suggest that excessive complement activation via C5a leads to a NHE-1-mediated shift of pHi and subsequent neutrophil functions during septic shock. Therefore, targeted inhibition of the C5a-C5aR interaction may balance the pHi homeostasis of neutrophils regulating crucial cellular functions during sepsis.
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Hospital mortality of severe sepsis and septic shock is about 55% in Germany. An improved compliance with the resuscitation bundle of the Surviving Sepsis Campaign significantly reduced hospital mortality. However, the long-term effect upon 90-day mortality remains unclear. ⋯ A continuous training program for the ICU staff focusing on the resuscitation bundle significantly reduced 90-day mortality in anesthesiological and medical ICU patients with severe sepsis and septic shock.
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Haemostatic resuscitation is postulated to support clotting function by replacing pro-coagulant factors in a physiological ratio. The aim of this study was to determine whether haemostatic resuscitation maintains adequate thrombin generation potential during massive transfusion. ⋯ Conventional haemostatic resuscitation fails to support the thrombin generation required for fibrinogen conversion; targeted supra-physiological concentrates may be superior for earlier haemostasis.