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 time course of nitric oxide (NO) production in posttrauma critical illness was monitored, and its relationship to posttrauma "sepsis/SIRS" and physiologic patterns was described. Eighty multiple trauma patients were studied (514 samples) during their course in the intensive care unit (Injury Severity Score 27.6; 36% deaths). Plasma NO was estimated from NO3 + NO2 by the Griess test and compared with that of 10 healthy controls (HC). ⋯ In conclusion, the severity of posttrauma critical illness was classified by PSSC and quantified by the L2PDEATH index. These reflect progressively increased NO levels and suggest worsening sepsis status. The reduced total peripheral resistance (TPR)-to-flow relationship (vascular tone) in deaths characteristic of the more severe septic PSSC states appeared related to the increased plasma NO.
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The role of tyrosine phosphorylation in endotoxin-induced phagocytic and tumor necrosis factor secretory responses was studied in rat alveolar macrophages and lung-recruited neutrophils. Exploration of sexual dimorphism in some aspects of these functions was also a specific aim. Male and female rats were injected intratracheally with endotoxin or saline. ⋯ Conditioned medium of alveolar macrophages of endotoxin-injected rats upregulates phagocytosis by blood neutrophils of naive rats and this upregulating activity is tyrosine phosphorylation dependent. The substrates for tyrosine phosphorylation are different in alveolar macrophages and lung neutrophils, as are their sensitivities to AG126. Significant gender differences exist in the modulation of phagocytosis by inhibition of tyrosine phosphorylation and in tumor necrosis factor secretion by endotoxin-stimulated alveolar macrophages.
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Eight patients with severe sepsis, four with septic shock, and eight without sepsis were studied to investigate whether skeletal muscle influences the whole body O2 consumption (VO2)-O2 delivery relationship and hemodynamics. A forearm VO2-O2 delivery dependency was observed only in nonseptic patients, in whom no whole body VO2-O2 delivery dependency appeared. ⋯ Neither a relationship between forearm VO2 and whole body VO2 nor between FAR and SVR was found in any groups of patients. Septic shock was associated with low FAR that was not affected by the FBF decrease, indicating that in this condition, hemodynamics could be influenced by skeletal muscle resistance.