The Experts below are selected from a list of 1035 Experts worldwide ranked by ideXlab platform
Keith G. Lurie - One of the best experts on this subject based on the ideXlab platform.
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Fluidless Resuscitation with Permissive Hypotension via Impedance Threshold Device Therapy Compared with Normal Saline Resuscitation in a Porcine Model of Severe Hemorrhage
Journal of Trauma and Acute Care Surgery, 2013Co-Authors: Anja Metzger, Jennifer Rees, Nicolas Segal, Scott Mcknite, Timothy R Matsuura, Victor A. Convertino, Robert T. Gerhardt, Keith G. LurieAbstract:BACKGROUNDOne approach to improve outcomes after trauma and hemorrhage is to follow the principles of Permissive Hypotension by avoiding intravascular overpressure and thereby preventing dislodgement of platelet plugs early in the clotting process. We hypothesized that augmentation of negative intra
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"Fluidless" resuscitation with Permissive Hypotension via impedance threshold device therapy compared with normal saline resuscitation in a porcine model of severe hemorrhage.
The journal of trauma and acute care surgery, 2013Co-Authors: Anja Metzger, Jennifer Rees, Nicolas Segal, Scott Mcknite, Victor A. Convertino, Robert T. Gerhardt, Timothy Matsuura, Keith G. LurieAbstract:One approach to improve outcomes after trauma and hemorrhage is to follow the principles of Permissive Hypotension by avoiding intravascular overpressure and thereby preventing dislodgement of platelet plugs early in the clotting process. We hypothesized that augmentation of negative intrathoracic pressure (nITP) by treatment with an impedance threshold device would improve hemodynamics without compromising Permissive Hypotension or causing hemodilution, whereas aggressive fluid resuscitation with normal saline (NS) would result in hemodilution and SBPs that are too high for Permissive Hypotension and capable of clot dislodgement. Thirty-four spontaneously breathing anesthetized female pigs (30.6 ± 0.5 kg) were subjected to a fixed 55% hemorrhage over 30 minutes; block randomized to nITP, no treatment, or intravenous bolus of 1-L NS; and evaluated over 30 minutes. Results are reported as mean ± SEM. Average systolic blood pressures (SBPs) (mm Hg) 30 minutes after the study interventions were as follows: nITP, 82.1 ± 2.9; no treatment, 69.4 ± 4.0; NS 89.3 ± 5.2. Maximum SBPs during the initial 15 minutes of treatment were as follows: nITP, 88.0 ± 4.3; no treatment, 70.8 ± 4.3; and NS, 131 ± 7.6. After 30 minutes, mean pulse pressure (mm Hg) was significantly higher in the nITP group (nITP, 32.3 ± 2.2) versus the no-treatment group (21.5 ± 1.5 controls) (p < 0.05), and the mean hematocrit was 25.2 ± 0.8 in the nITP group versus 19 ± 0.6 in the NS group (p < 0.001). In this porcine model of hemorrhagic shock, nITP therapy significantly improved SBP and pulse pressure for 30 minutes without overcompensation compared with controls with no treatment. By contrast, aggressive fluid resuscitation with NS but not nITP resulted in a significant rise in SBP to more than 100 mm Hg within minutes of initiating therapy that could cause a further reduction in hematocrit and clot dislodgment.
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Abstract 142: Augmentation of Negative Intrathoracic Pressure Improves Hemodynamics Without Popping the Clot: A Randomized Study Comparing an Impedance Threshold Device vs Saline to Treat Severe Hemorrhage Through Permissive Hypotension in a Spontane
Circulation, 2011Co-Authors: Anja Metzger, Jennifer Rees, Nicolas Segal, Scott Mcknite, Timothy R Matsuura, Victor A. Convertino, Keith G. LurieAbstract:Objective: An evolving concept in the field of trauma care is the prehospital management of shock associated with uncontrolled hemorrhage. Traditional prehospital care includes early and aggressive intervention focusing on fluid resuscitation. In recent years, however, early aggressive fluid replacement has become the subject of controversy as studies have demonstrated increased blood loss and mortality associated with this therapy. In contrast to aggressive fluid resuscitation, the technique of Permissive Hypotension has demonstrated increased long-term survival in both animal and human studies. Permissive Hypotension minimizes hemodilution, intra-operative blood loss, and prehospital blood loss by preventing popping of the clot. We hypothesized that that augmentation of negative intrathoracic pressure (nITP) by spontaneously breathing through an impedance threshold device (ITD) would improve hemodynamics and provide Permissive Hypotension with less hemodilution and risk of popping the clot in a porcine model of severe hemorrhagic shock. Methods: Twenty-seven spontaneously breathing female pigs (30.6 ± 0.5 kg), anesthetized with propofol, were subjected to a 55% bleed and randomized equally in a prospective, blinded manner to either nITP, no treatment, or iv bolus of 1 L of saline (NaCl) and evaluated acutely for 30 minutes. Results: Results are reported as mean ± SEM and shown in Table 1. Conclusion: In this porcine model of hemorrhagic shock, the nITP treatment significantly improved systolic blood pressure (SBP) and pulse pressure (PP) for 30 minutes in an equivalent manner to the 1L NaCl treatment without exceeding SBPs associated with popping the clot and hemodilution.
Hemanshu Prabhakar - One of the best experts on this subject based on the ideXlab platform.
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Permissive Hypotension in traumatic brain injury with blunt aortic injury how low can we go
Journal of Anaesthesiology Clinical Pharmacology, 2014Co-Authors: Santvana Kohli, Naveen Yadav, Gyaninder Pal Singh, Hemanshu PrabhakarAbstract:With an ever-increasing incidence of high impact collisions, polytrauma is becoming increasingly common. Patients with traumatic brain injury (TBI) may require urgent surgical intervention along with maintenance of an adequate mean arterial pressure (MAP) to maintain cerebral perfusion. On the other hand, patients who sustain blunt aortic injuries (BAI) have a high mortality rate, many of them succumbing to their injury at the site of trauma. Surgery has been the mainstay of the management strategy for the remaining survivors. However, in recent years, the paradigm has shifted from early operative management to conservative treatment with aggressive blood pressure and heart rate control, serial imaging, and close clinical monitoring. When TBI and BAI coexist in a patient, it becomes crucial to maintain the MAP within a narrow range to prevent secondary insult to the brain as well as to prevent aortic rupture. We present the management of a case of TBI with traumatic aortic pseudoaneurysm, which required stringent monitoring and maintenance of hemodynamics during decompressive craniectomy.
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Permissive Hypotension in traumatic brain injury with blunt aortic injury: How low can we go?
Journal of anaesthesiology clinical pharmacology, 2014Co-Authors: Santvana Kohli, Naveen Yadav, Gyaninder Pal Singh, Hemanshu PrabhakarAbstract:With an ever-increasing incidence of high impact collisions, polytrauma is becoming increasingly common. Patients with traumatic brain injury (TBI) may require urgent surgical intervention along with maintenance of an adequate mean arterial pressure (MAP) to maintain cerebral perfusion. On the other hand, patients who sustain blunt aortic injuries (BAI) have a high mortality rate, many of them succumbing to their injury at the site of trauma. Surgery has been the mainstay of the management strategy for the remaining survivors. However, in recent years, the paradigm has shifted from early operative management to conservative treatment with aggressive blood pressure and heart rate control, serial imaging, and close clinical monitoring. When TBI and BAI coexist in a patient, it becomes crucial to maintain the MAP within a narrow range to prevent secondary insult to the brain as well as to prevent aortic rupture. We present the management of a case of TBI with traumatic aortic pseudoaneurysm, which required stringent monitoring and maintenance of hemodynamics during decompressive craniectomy.
Bryan A. Cotton - One of the best experts on this subject based on the ideXlab platform.
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resuscitation for hypovolemic shock
Surgical Clinics of North America, 2017Co-Authors: Kyle J Kalkwarf, Bryan A. CottonAbstract:: Hemorrhage is the leading cause of preventable deaths in trauma patients. After presenting a brief history of hemorrhagic shock resuscitation, this article discusses damage control resuscitation and its adjuncts. Massively bleeding patients in hypovolemic shock should be treated with damage control resuscitation principles including limited crystalloid, whole blood or balance blood component transfusion to Permissive Hypotension, preventing hypothermia, and stopping bleeding as quickly as possible.
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Balanced Resuscitation in Trauma Management.
The Surgical clinics of North America, 2017Co-Authors: Paul M. Cantle, Bryan A. CottonAbstract:Over the past decade substantial knowledge has been gained in understanding both the coagulopathy of trauma and the complications associated with aggressive crystalloid-based resuscitation. Balanced resuscitation, which includes Permissive Hypotension, limiting crystalloid use, and the transfusion of blood products in ratios similar to whole blood, has changed the previous standard of care. Prompt initiation of massive transfusion and the protocolled use of 1:1:1 product ratios have improved the morbidity and mortality of patients with trauma in hemorrhagic shock. Balanced resuscitation minimizes the impact of trauma-induced coagulopathy, limits blood product waste, and reduces the complications that occur with aggressive crystalloid resuscitation.
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Prediction of Massive Transfusion in Trauma
Critical care clinics, 2017Co-Authors: Paul M. Cantle, Bryan A. CottonAbstract:Hemorrhage is the leading cause of preventable death in trauma. Damage control resuscitation relies on Permissive Hypotension, minimizing crystalloid use, and early implementation of massive transfusion protocols with established blood component ratios. These protocols improve the survival of the severely injured patient. Trauma physicians must quickly and accurately predict when a massive transfusion protocol should be activated. Several validated transfusion scores have been developed for this purpose. Many of these scores are useful for resuscitation research. One option, the ABC score, is an accurate, validated, and clinically useful score that is simple to calculate and rapidly obtained.
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Massive Transfusion Protocols for Patients With Substantial Hemorrhage
Transfusion medicine reviews, 2011Co-Authors: Pampee P. Young, Bryan A. Cotton, Lawrence T. GoodnoughAbstract:Transfusion medicine for the resuscitation of patients with massive hemorrhage has recently advanced from reactive, supportive treatment with crystalloid and red blood cell therapy to use of standardized massive transfusion protocols (MTPs). Through MTPs, medical facilities are able to standardize the most effective posthemorrhage treatments and execute them rapidly while reducing potential waste of blood products. Damage control resuscitation is an example of an MTP, where patients are (1) allowed more Permissive Hypotension, (2) spared large volumes of crystalloid/colloid therapy (through low volume resuscitation), and (3) transfused with blood products preemptively using a balanced ratio of plasma and platelets to red blood cells. This focused approach improves the timely availability of blood components during resuscitation. However, the use of MTPs remains controversial. This review describes published experiences with MTPs and illustrates the potential value of several MTPs currently utilized by academic transfusion services.
Jan Bakker - One of the best experts on this subject based on the ideXlab platform.
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re thinking resuscitation leaving blood pressure cosmetics behind and moving forward to Permissive Hypotension and a tissue perfusion based approach
Critical Care, 2013Co-Authors: Martin W Dunser, Jukka Takala, Andreas Brunauer, Jan BakkerAbstract:Definitions of shock and resuscitation endpoints traditionally focus on blood pressures and cardiac output. This carries a high risk of overemphasizing systemic hemodynamics at the cost of tissue perfusion. In line with novel shock definitions and evidence of the lack of a correlation between macro- and microcirculation in shock, we recommend that macrocirculatory resuscitation endpoints, particularly arterial and central venous pressure as well as cardiac output, be reconsidered. In this viewpoint article, we propose a three-step approach of resuscitation endpoints in shock of all origins. This approach targets only a minimum individual and context-sensitive mean arterial blood pressure (for example, 45 to 50 mm Hg) to preserve heart and brain perfusion. Further resuscitation is exclusively guided by endpoints of tissue perfusion irrespectively of the presence of arterial Hypotension ('Permissive Hypotension'). Finally, optimization of individual tissue (for example, renal) perfusion is targeted. Prospective clinical studies are necessary to confirm the postulated benefits of targeting these resuscitation endpoints.
Anja Metzger - One of the best experts on this subject based on the ideXlab platform.
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Fluidless Resuscitation with Permissive Hypotension via Impedance Threshold Device Therapy Compared with Normal Saline Resuscitation in a Porcine Model of Severe Hemorrhage
Journal of Trauma and Acute Care Surgery, 2013Co-Authors: Anja Metzger, Jennifer Rees, Nicolas Segal, Scott Mcknite, Timothy R Matsuura, Victor A. Convertino, Robert T. Gerhardt, Keith G. LurieAbstract:BACKGROUNDOne approach to improve outcomes after trauma and hemorrhage is to follow the principles of Permissive Hypotension by avoiding intravascular overpressure and thereby preventing dislodgement of platelet plugs early in the clotting process. We hypothesized that augmentation of negative intra
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"Fluidless" resuscitation with Permissive Hypotension via impedance threshold device therapy compared with normal saline resuscitation in a porcine model of severe hemorrhage.
The journal of trauma and acute care surgery, 2013Co-Authors: Anja Metzger, Jennifer Rees, Nicolas Segal, Scott Mcknite, Victor A. Convertino, Robert T. Gerhardt, Timothy Matsuura, Keith G. LurieAbstract:One approach to improve outcomes after trauma and hemorrhage is to follow the principles of Permissive Hypotension by avoiding intravascular overpressure and thereby preventing dislodgement of platelet plugs early in the clotting process. We hypothesized that augmentation of negative intrathoracic pressure (nITP) by treatment with an impedance threshold device would improve hemodynamics without compromising Permissive Hypotension or causing hemodilution, whereas aggressive fluid resuscitation with normal saline (NS) would result in hemodilution and SBPs that are too high for Permissive Hypotension and capable of clot dislodgement. Thirty-four spontaneously breathing anesthetized female pigs (30.6 ± 0.5 kg) were subjected to a fixed 55% hemorrhage over 30 minutes; block randomized to nITP, no treatment, or intravenous bolus of 1-L NS; and evaluated over 30 minutes. Results are reported as mean ± SEM. Average systolic blood pressures (SBPs) (mm Hg) 30 minutes after the study interventions were as follows: nITP, 82.1 ± 2.9; no treatment, 69.4 ± 4.0; NS 89.3 ± 5.2. Maximum SBPs during the initial 15 minutes of treatment were as follows: nITP, 88.0 ± 4.3; no treatment, 70.8 ± 4.3; and NS, 131 ± 7.6. After 30 minutes, mean pulse pressure (mm Hg) was significantly higher in the nITP group (nITP, 32.3 ± 2.2) versus the no-treatment group (21.5 ± 1.5 controls) (p < 0.05), and the mean hematocrit was 25.2 ± 0.8 in the nITP group versus 19 ± 0.6 in the NS group (p < 0.001). In this porcine model of hemorrhagic shock, nITP therapy significantly improved SBP and pulse pressure for 30 minutes without overcompensation compared with controls with no treatment. By contrast, aggressive fluid resuscitation with NS but not nITP resulted in a significant rise in SBP to more than 100 mm Hg within minutes of initiating therapy that could cause a further reduction in hematocrit and clot dislodgment.
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Abstract 142: Augmentation of Negative Intrathoracic Pressure Improves Hemodynamics Without Popping the Clot: A Randomized Study Comparing an Impedance Threshold Device vs Saline to Treat Severe Hemorrhage Through Permissive Hypotension in a Spontane
Circulation, 2011Co-Authors: Anja Metzger, Jennifer Rees, Nicolas Segal, Scott Mcknite, Timothy R Matsuura, Victor A. Convertino, Keith G. LurieAbstract:Objective: An evolving concept in the field of trauma care is the prehospital management of shock associated with uncontrolled hemorrhage. Traditional prehospital care includes early and aggressive intervention focusing on fluid resuscitation. In recent years, however, early aggressive fluid replacement has become the subject of controversy as studies have demonstrated increased blood loss and mortality associated with this therapy. In contrast to aggressive fluid resuscitation, the technique of Permissive Hypotension has demonstrated increased long-term survival in both animal and human studies. Permissive Hypotension minimizes hemodilution, intra-operative blood loss, and prehospital blood loss by preventing popping of the clot. We hypothesized that that augmentation of negative intrathoracic pressure (nITP) by spontaneously breathing through an impedance threshold device (ITD) would improve hemodynamics and provide Permissive Hypotension with less hemodilution and risk of popping the clot in a porcine model of severe hemorrhagic shock. Methods: Twenty-seven spontaneously breathing female pigs (30.6 ± 0.5 kg), anesthetized with propofol, were subjected to a 55% bleed and randomized equally in a prospective, blinded manner to either nITP, no treatment, or iv bolus of 1 L of saline (NaCl) and evaluated acutely for 30 minutes. Results: Results are reported as mean ± SEM and shown in Table 1. Conclusion: In this porcine model of hemorrhagic shock, the nITP treatment significantly improved systolic blood pressure (SBP) and pulse pressure (PP) for 30 minutes in an equivalent manner to the 1L NaCl treatment without exceeding SBPs associated with popping the clot and hemodilution.