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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Clinical Trial Observational Study
Plasma Adenylate Levels are Elevated in Cardiopulmonary Arrest Patients and May Predict Mortality.
Cerebral and cardiac dysfunction cause morbidity and mortality in postcardiac arrest syndrome (PCAS) patients. Predicting clinical outcome is necessary to provide the optimal level of life support for these patients. In this pilot study, we examined whether plasma ATP and adenylate levels have value in predicting clinical outcome in PCAS patients. ⋯ Plasma ATP levels correlated with lactate levels, Acute Physiology and Chronic Health Evaluation II scores, and the time it took to ROSC (time-to-ROSC). Plasma adenylate levels in patients who died after resuscitation were significantly higher than in survivors. Based on our results and receiver-operating characteristic curve analysis, we conclude that plasma adenylate levels may help predict outcome in PCAS patients.
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Multicenter Study Clinical Trial
Predictors of Successful Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation After Coronary Revascularization for Acute Myocardial Infarction Complicated by Cardiac Arrest: A Retrospective Multicenter Study.
While veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been utilized to resuscitate and stabilize hemodynamics in patients of acute myocardial infarction (AMI) complicated by cardiac arrest (CA), it is essential to predict the possibility of weaning from ECMO to determine further strategies, including use of ventricular assist device. We aimed to determine predictors of successful weaning from VA-ECMO in the early phase of ECMO treatment. ⋯ Successful weaning from VA-ECMO was predicted by post-PCI TIMI flow grade, MAP at 4 h, and serum lactate at 24 h after VA-ECMO initiation in patients of AMI complicated by CA. Furthermore, in patients who failed to wean from ECMO, LVEF did not recover within 48 h. In such patients, adjunctive use of other circulatory mechanical devices must be considered.
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The aim of this study was to investigate the correlation between plasma sphingosine-1-phosphate (S1P) and ceramide concentrations in sepsis, and the possible mechanisms for altered expression. ⋯ Integrated analysis of plasma S1P and ceramide predict septic mortality with high accuracy. The decreased platelet SphK1 expression and subsequent reduced SphKs activity might be responsible for the decreased plasma S1P levels during sepsis.
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Multicenter Study Clinical Trial
Prognostic Value of Tissue Oxygen Saturation Using a Vascular Occlusion Test in Patients in the Early Phase of Multiorgan Dysfunction Syndrome.
Multiple organ dysfunction syndrome (MODS) is a common disease pattern in intensive care units which is associated with an increased mortality. The aim of this study was to investigate whether a near-infrared spectroscopy (NIRS)-based noninvasive ischemia-reperfusion test (vascular occlusion test) using the parameter of tissue oxygen saturation (StO2) contains prognostic information for patients in the early phase of MODS. ⋯ Impaired values of the VOT-parameters OS and RS are associated with an increased 28-day mortality in patients in the early phase of MODS.
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Randomized Controlled Trial Observational Study
Long-Term Effects of Experimental Human Endotoxemia on Immune Cell Function: Similarities and Differences With Sepsis.
Sepsis is the cause of more than 5.3 million deaths per year, and novel immunotherapeutic strategies are highly warranted. Human models that mirror sepsis immunology are instrumental to this aim. The response to endotoxin in humans during the first 24 h captures many hallmarks of the inflammatory response observed in sepsis. ⋯ These changes differed with those observed in septic shock patients. Another long-term effect of experimental endotoxemia was elevated numbers of effector CD8 cells and an increased percentage of proliferating and cytokine expressing CD8 cells, and these phenomena were also present in sepsis patients. In conclusion, despite considerable differences, experimental endotoxemia captures several long-term aspects of sepsis immunology, specifically the behavior of CD8 T cells, which may eventually aid the development of new therapies for sepsis patients.