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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Multicenter Study Clinical Trial
Cirrhotic Patients Admitted to the ICU with Septic Shock: Factors Predicting Short and Long-Term Outcome.
Cirrhotic patients with septic shock have a poor prognosis in ICU compared to general population of critically ill patients. Little is known about long-term outcome in these patients. We performed a retrospective analysis of a prospective cohort of cirrhotic patients with septic shock. ⋯ The results emphasize the poor prognosis of cirrhotic patients with septic shock admitted to the ICU. The need for organ supports appears to be a better predictor of short-term outcome than the underlying hepatic disease. Renal replacement therapy is associated with both short and long-term outcomes.
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Clinical Trial Observational Study
Plasma Renin Concentration is Associated with Hemodynamic Deficiency and Adverse Renal Outcome in Septic Shock.
In septic shock, both systemic vasodilatation and glomerular arteriole dilatation are responsible for the drop in glomerular filtration observed in early acute kidney injury. Angiotensin II has been shown to act on both mechanisms. Our objective was to evaluate the impact of renin angiotensin system activation, on hemodynamic deficiency and renal outcome in patient with septic shock and to assess whether urinary sodium could be a reliable test for high plasma renin concentration screening. ⋯ Plasma renin concentration is associated with adverse renal outcome, probably through shock severity and insufficient glomerular efferent arterioles vasoconstriction. An association was observed between low natriuresis and high plasma renin concentration.
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Editorial
Perfluorocarbon Gas Transport: an Overview of Medical History With Yet Unrealized Potentials.
Perfluorocarbon (PFCs) compounds have been a hereto fore under realized pharmaceutical class of intravenous emulsions and respiratory adjuvants researched extensively since the late 1970. This review represents an introduction for a series of more detailed lectures/manuscripts that were part of a combined United States collaborative Federal agency meeting in early February, 2017 at Ft Detrick, MD, focused upon potential technologies in development to fulfill a perceived need: "When blood transfusion is not available." As such, PFCs represent a distinctly different class of pharmaceutical artificial oxygen (and other gas) transporters than are hemoglobin-based oxygen carriers (HBOCs). ⋯ The PFCs should be viewed as pharmaceuticals possessing unique gas solubility and diffusion characteristics such that they may relieve ischemia of tissues with low/flow-no flow states therefore they can enhance tissue salvage while other definitive treatments are being sought. PFCs as short-term enhanced tissue oxygen (and other gas enhancements) delivery vehicles should have varied and potentially game-changing medical potentials.
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Perftoran, which has been rebranded as Vidaphor for marketing in North America, is an emulsion of perfluorocarbons in a surfactant and electrolyte mixture. It was developed in Russia as an oxygen-carrying intravenous plasma additive for hemorrhagic anemia and ischemic conditions from various etiologies. It was approved for clinical use in Russia in 1996 and used by the Russian Armed Forces and in civilian medical care. ⋯ It has been safely administered to more patients than any oxygen carrier currently under development. A newly formed United States Corporation (FluorO2 Therapeutics, Inc.) intends to manufacture the product in the United States under GMP standards and make it available for clinical use in Mexico and Latin America and pursue research to support eventual approval in the United States for human and veterinary use. This article will briefly review key information about this product and provide references for the interested reader.
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Clinical Trial Observational Study
Delta Neutrophil Index for the Prediction of the Development of Sepsis-Induced Acute Kidney Injury in the Emergency Department.
The early prediction of acute kidney injury (AKI) in sepsis and provision of timely treatment may improve outcomes. We investigated the efficacy of the delta neutrophil index (DNI)-which reflects the fraction of immature granulocytes-in predicting sepsis-induced AKI and 30-day mortality in cases of severe sepsis or septic shock. ⋯ Higher DNI values are independent predictors of severe AKI development and 30-day mortality in sepsis. Physicians can use the DNI to quickly determine the severity of sepsis and initial treatment strategies without additional costs and effort.