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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The benefits of platelet thresholds for transfusion remain unclear. This study assessed the effect of two transfusion thresholds on the survival outcomes of patients with sepsis and thrombocytopenia. ⋯ In patients with sepsis and thrombocytopenia, platelet transfusion at a higher threshold was associated with a greater reduction in the 28- and 90-day mortalities than that at a lower threshold.
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Randomized Controlled Trial
Autoresuscitation of Poloxamer 188 in Pigs with Traumatic Severe Hemorrhage.
Poloxamer 188 (P188) is a copolymer surfactant with plasma membrane stabilizing action. This study investigated the effects of P188 on blood volume and coagulation in pigs after traumatic hemorrhage and hypotensive resuscitation. ⋯ Following traumatic hemorrhage and hypotensive resuscitation, P188 improved circulation volume and base deficit, but induced slower clotting initiation in pigs. Thus, P188 may have limited benefit as an initial small volume resuscitation adjunct following hemorrhage.
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Skeletal muscles play important roles in innate immunity. However, in vitro, their sensitivity to LPS is low. In other tissues, LPS sensing is facilitated by the presence of plasma, LPS binding protein (LBP), or soluble CD14 (sCD14). ⋯ LBP supplementation did not augment secretion; however, 1% plasma from CD14-/- mice suppressed cytokine/chemokine secretion from EDL muscle. In conclusion, intact slow and fast mouse muscles have similar cytokine/chemokine responses to LPS but depend on the presence of low levels of plasma constituents. Though sCD14 plays some role in EDL muscle, neither sCD14 nor LBP can fully account for the strong effects of plasma on LPS sensitivity.
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Severe hemorrhage (Hem) has been shown to be causal for the development of extra-pulmonary/indirect acute respiratory distress syndrome (iARDS) and is associated with severe endothelial cell (EC) injury. EC growth factors, Angiopoietin (Ang)-1 and -2, maintain vascular homeostasis via tightly regulated competitive interaction with the tyrosine kinase receptor, Tie2, expressed on ECs. ⋯ Together, these data imply that shock-induced increased expression of Tie1 can contribute to EC activation by inhibiting Ang:Tie2 interaction, culminating in EC dysfunction and the development of iARDS.
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Multicenter Study
Heparin Binding Protein for The Early Diagnosis and Prognosis Of Sepsis In The Emergency Department: The Prompt Multicenter Study.
The validation of new biomarkers for the diagnosis and risk stratification of patients with sepsis at an early point is essential for successful treatment. Recent publications prompted us to investigate of heparin binding protein (HBP) for the emergency department (ED) admissions. ⋯ Admission HBP can be used as a tool for the early diagnosis of sepsis and for the risk of early death in the ED.