Comparison of Clinical Outcomes with Initial Norepinephrine or Epinephrine for Hemodynamic Support After Return of Spontaneous Circulation
Conclusion:
These data suggest prospective study of initial vasopressors used for hemodynamic support after ROSC may be warranted. Rates of intra-emergency department refractory shock, rearrest, or death were higher among epinephrine treated patients compared to norepinephrine treated patients in this population. However, inability to control for potential confounding variables in retrospective studies limits the findings. These results are hypothesis generating and further study is warranted. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Mechanistic Studies of DNase I Activity: Impact of Heparin Variants and PAD4
Conclusion:
Heparin enhances DNA-mediated digestion of DNA–histone complexes in a size-dependent manner that is independent of its anticoagulant properties. Citrullination of histones by PAD4 renders DNA–histone complexes susceptible to DNase I digestion. Endogenous DNase I levels are persistently decreased in septic patients, which supports the potential utility of DNase I as a therapy for sepsis. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
The 28-Day Mortality Outcome of the Complete Hour-1 Sepsis Bundle in the Emergency Department
Conclusions:
The complete Hour-1 Sepsis Bundle treatment in the ED was not significantly associated with 28-day mortality and delayed septic shock.
Trial registration:
The trial was registered in the Thai Clinical Trial Registry, TCTR 20200526013. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Microvascular Dysfunction in Patients with Critical Covid-19, a Pilot Study
Conclusions:
This small-sized pilot study demonstrates that critical COVID-19 infection is associated with microvascular impairment and, in particular, a markedly reduced endothelial function. Our results also suggest that microvascular function may not be fully recovered 3 months after disease onset. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Inclusion of Albumin in the Initial Resuscitation of Adult Patients with Medical Sepsis or Septic Shock: a Propensity Score-Matched Analysis
Conclusions:
Using albumin during the initial 6 h of resuscitation was not associated with benefits in clinical outcomes of patients with medical sepsis. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Association of the Circulating Supar Levels with Inflammation, Fibrinolysis, and Outcome in Severe Burn Patients
This study aimed to investigate the early association between circulating suPAR levels and biomarkers of fibrinolysis, pro/anti-inflammatory, and prognosis.
Methods:
Sixty-four consecutive Chinese patients with severe burns and 26 healthy volunteers were enrolled in a prospective observational cohort. Clinical characteristics and laboratory data were collected prospectively. Blood samples were collected at 48 h post-burn, and suPAR and biomarkers of pro/anti-inflammatory and fibrinolysis were detected by enzyme-linked immunosorbent assays. Important indicators between non-survivors and survivors were compared. Lin...
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Survival and Outcomes After Cardiac Arrest With VA-ECMO Rescue Therapy
Background:
Extracorporeal membrane oxygenation (ECMO) use in patients with cardiac arrest is increasing. Utilization remains variable between centers using ECMO as a rescue therapy or early protocolized extracorporeal cardiopulmonary resuscitation.
Methods:
Single-center, retrospective evaluation of cardiac arrest with cardiopulmonary resuscitation and rescue ECMO support from 2011 through 2019. Study objectives included survival, non-neurologic, and neurologic outcomes; validation of the SAVE and modified SAVE (mSAVE) scores for survival and favorable neurologic outcome; and predictive factor identification in...
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients
Conclusion:
Perfusion index (PI), lactate, and lactate clearance provided comparable sensitivity and specificity for predicting outcomes among pediatric patients with shock Therefore, we suggest that the PI is an inexpensive, rapid, and non-invasive tool that can be used to predict illness severity and mortality in busy pediatric intensive care units and emergency departments. This tool may guide better patient triage and an earlier diagnosis of shock in this setting. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Fluid Responsiveness Predictability in Immediate Postoperative Pediatric Cardiac Surgery. Is the Old Slandered Central Venous Pressure Back Again?
Conclusions:
In a distinct population of mechanically ventilated, young, pediatric cardiac patients in the immediate postoperative period, SPV, USCOM preload parameters, as well as IVC-based parameters by bedside ultrasound failed to predict fluid responsiveness. Dynamic CVP change over several hours was the only parameter that yielded significant but modest fluid responsiveness predictability. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Prognosis and Risk Factors of Sepsis Patients in Chinese ICUs: A Retrospective Analysis of a Cohort Database
Conclusions:
Patients with hypotension but without hyperlactacidemia in the ICU also show a high 28-day mortality, and some clinical factors may affect their prognosis and must be treated carefully in the future. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Clinical Effect of Systemic Steroids in Patients with Cirrhosis and Septic Shock
Conclusion:
The use of systemic steroids was more prevalent in cirrhotic patients with higher vasopressor requirements. It was not associated with decreased mortality or increased ICU- and hospital-free days, or to adverse effects. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
The Weekend Effect in Septic Shock Patients Using the Nationwide Emergency Department Sample Database
Conclusion:
There was no statistically significant difference in overall mortality between septic shock patients admitted on the weekend or weekday. Our results are contradictory to previous studies showing an increased mortality with the weekend effect. The previous observations that have been made may not stand up with current treatment protocols. (Source: Shock)
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Repurposing of Clinically Approved Poly-(ADP-Ribose) Polymerase Inhibitors for the Therapy of Sepsis
Sepsis’ pathogenesis involves multiple mechanisms that lead to a dysregulation of the host's response. Significant efforts have been made in search of interventions that can reverse this situation and increase patient survival. Poly (ADP-polymerase) (PARP) is a constitutive nuclear and mitochondrial enzyme, which functions as a co-activator and co-repressor of gene transcription, thus regulating the production of inflammatory mediators. Several studies have already demonstrated an overactivation of PARP1 in various human pathophysiological conditions and that its inhibition has benefits in regulating intracellular proces...
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Review Articles Source Type: research
Therapeutically Targeting Microvascular Leakage in Experimental Hemorrhagic SHOCK: A Systematic Review and Meta-Analysis
Background:
Microvascular leakage is proposed as main contributor to disturbed microcirculatory perfusion following hemorrhagic shock and fluid resuscitation, leading to organ dysfunction and unfavorable outcome. Currently, no drugs are available to reduce or prevent microvascular leakage in clinical practice. We therefore aimed to provide an overview of therapeutic agents targeting microvascular leakage following experimental hemorrhagic shock and fluid resuscitation.
Methods:
PubMed, EMBASE.com, and Cochrane Library were searched in January 2021 for preclinical studies of hemorrhagic shock using any therapeuti...
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Review Articles Source Type: research
Effect of Combined Hydrocortisone, Ascorbic Acid and Thiamine for Patients with Sepsis and Septic Shock: A Systematic Review and Meta-Analysis
This study aims to assess the effect of HAT therapy on patients with sepsis and septic shock.
Methods:
We searched PubMed, Embase, and Cochrane Library for studies on HAT therapy published up to November 11, 2020. The primary outcome was the duration of vasopressor use. Secondary outcomes were change of Sequential Organ Failure Assessment (SOFA) score within 72 h; death within intensive care unit (ICU), hospital, and 28 or 30 days; length of stay in ICU and hospital; rate of procalcitonin (PCT) clearance and incidence of adverse events. We also used trial sequential analysis (TSA) to assess the reliability of th...
Source: Shock - November 26, 2021 Category: Emergency Medicine Tags: Review Articles Source Type: research
