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
-
The aim of the study was to evaluate the effects of bolus infusion of hypertonic hydroxyethyl starches (HHESs) and continuous infusion of hypertonic saline (HTS) in the early resuscitation in crush syndrome. ⋯ Bolus infusion of HHES combined with normal saline could be an effective therapy for crush syndrome in the early resuscitation period. However, continuous HTS injection was not seemed to be a suitable choice particularly in the absence of monitoring equipment for serum irons or blood gases (institutional protocol no. ZN5R20110016).
-
Early fluid administration is fundamental for the initial treatment of severe sepsis and septic shock patients. A large portion of suspected severe sepsis and septic shock patients can be quickly resuscitated with therapeutic tests until surrogate cardiac output markers, such as heart rate and urinary output, are normalized. ⋯ When clinical stabilization is not achieved with initial fluid resuscitation, more careful, complete, and accurate monitoring should be started for both reversing tissue hypoxia and preventing fluid overload. This challenge requires appropriate knowledge of the physiological foundations governing the different monitoring method advantages and their respective limitations, therefore allowing the election of the best therapeutic measures for each different scenario.
-
The objective of this study was to investigate the association of endothelial-related markers with organ dysfunction and in-hospital mortality to validate our earlier findings in a multicenter study. We hypothesize that (i) endothelial biomarkers will be associated with organ dysfunction and mortality in sepsis and that (ii) soluble fms-like tyrosine kinase 1 (sFlt-1) holds promise as a novel prognostic marker in sepsis. ⋯ This multicenter validation study confirms that markers of endothelial activation are associated with sepsis severity, organ dysfunction, and mortality in sepsis. This supports the hypothesis that the endothelium plays a central role in the pathophysiology of sepsis and may serve as a more accurate prediction tool and a target for therapies aimed at ameliorating endothelial cell dysfunction. In addition, sFLT-1 holds promise as a novel sepsis severity biomarker.