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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It is widely recognized that endothelial hyperpermeability (EH) plays a pivotal role in the pathophysiology of severe sepsis and septic shock. However, very few attention has been paid to EH when we apply infusion therapy on the patients with severe sepsis and septic shock. And such infusion therapy without the consideration on EH often results in the interstitial edema which is one of the main causes of derangement in microcirculation and dysoxia in sepsis. ⋯ Therefore, we applied CAH-CHDF when we gave infusion therapy on those patients regardless of their renal function. Blood pressure, urine volume, colloid osmotic pressure and tissue oxygen metabolism were maintained better with this strategy compared to the septic patients treated conventionally without countermeasures against EH with CAH-CHDF. Thus we conclude that CAH-CHDF might be very effective as countermeasures against EH and that it is useful when we apply infusion therapy on septic patients.
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Hemorrhagic shock (HS) causes tissue hypoxia, increased oxidative stress and hyper-inflammation. Therapeutic hypothermia may decrease mortality through reduced inflammation and hypometabolism, but may be associated with loss of plasma, potentially compromising circulation. Therefore, we investigated the effects of moderate therapeutic hypothermia on immune and barrier dysfunction (BD) in a long-term model of resuscitated HS. ⋯ Supported by the German Department of Defense (AZ E/U2AD/CF523/DF556).
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The study was designed to assess whether high dosages of norepinephrine are associated with increased death rate and to determine the dosage of norepinephrine associated with an intensive care unit (ICU) death rate greater than 90%. We conducted a retrospective, noninterventional, observational study in a single ICU (15 beds) of an academic hospital. From January 2009 to May 2013, data of all patients with a diagnosis of septic shock were extracted from our database. ⋯ The death rate reached 90% for the quantile of patients receiving more than 1 μg/kg per minute of norepinephrine. In our cohort, four independent factors associated with mortality were identified: age (odds ratio, 1.02 [95% confidence interval, 1.00-1.04]; P = 0.02), thrombocytopenia (odds ratio, 3.8 [95% confidence interval, 1.8-8.5]; P < 0.001), urine output less than 500 mL (odds ratio, 8.7 [95% confidence interval, 3.6-25]; P < 0.001), and dosage of norepinephrine greater than 1 μg/kg per minute (odds ratio, 9.7 [95% confidence interval, 4.5-23]; P < 0.001). However, because of the study's design, unmeasured confounding factors should be taken into account in our findings.
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Endogenous hydrogen sulfide (H2S) has been recently recognized as a molecule fundamentally involved in the regulation of mitochondrial bioenergetics. Therefore we aimed to compare maximum mitochondrial respiratory activity (JO2max) as well as the degree of coupling (L/E-ratio) in small homogenized liver and kidney tissue biopsies from wildtype (WT) and cystathionine γ-lyase (CSE)-KO mice who underwent an experimental thoracic trauma (TXT) or not (Sham). ⋯ We conclude that after a standardized thoracic trauma CSE deficiency only slightly influences mitochondrial respiration. The changes in the L/E-ratio probably result from compensatory mechanisms.
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Local drug application is used to avoid systemic side effects. We analysed whether locally applied Iloprost (PGI2-analogue) or Nitroglycerin (NO-donor) influence gastric mucosal perfusion (μflow) and oxygenation (μHbO2) during physiological and haemorrhagic conditions. ⋯ Strategischer Forschungsfonds.