The Experts below are selected from a list of 198 Experts worldwide ranked by ideXlab platform
Frederick A Moore - One of the best experts on this subject based on the ideXlab platform.
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postinjury abdominal compartment syndrome from recognition to prevention
The Lancet, 2014Co-Authors: Zsolt J Balogh, Ernest E Moore, William Lumsdaine, Frederick A MooreAbstract:Summary Postinjury abdominal compartment syndrome (ACS) is an example of a deadly clinical occurrence that was eliminated by strategic research and focused preventions. In the 1990s, the syndrome emerged with the widespread use of damage control surgery and aggressive crystalloid-based resuscitation. Patients who previously exsanguinated on the operating table made it to intensive care units, but then developed highly lethal hyperacute respiratory, renal, and cardiac failure due to increased abdominal pressure. Among many factors, delayed haemorrhage control and preload driven excessive use of crystalloid resuscitation were identified as modifiable predictors. The surrogate effect of preventive strategies, including the challenge of the 40-year-old standard of large volume crystalloid resuscitation for Traumatic Shock, greatly reduced cases of ACS. The discoveries were rapidly translated to civilian and military trauma surgical practices and fundamentally changed the way trauma patients are resuscitated today with substantially improved outcomes.
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early cytokine production risk stratifies trauma patients for multiple organ failure
Journal of The American College of Surgeons, 2009Co-Authors: Kenneth M Jastrow, Frederick A Moore, Bruce A Mckinley, Rosemary A Kozar, Ernest A Gonzalez, Mary F Mcguire, James W Suliburk, Sriram Iyengar, Deborah A Motschall, David W MercerAbstract:Background Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic Shock, early ( Study Design In a prospective observational pilot study of > 1 year at an urban Level I trauma center, serial (every 4 hours) serum cytokine levels were determined during a 24-hour period using multiplex suspension immunoassay in patients with major torso trauma (excluding severe brain injury) who met criteria for standardized Shock resuscitation. Temporal cytokine expression was assessed during Shock resuscitation in severe trauma patients to predict risk for MOF. MOF was assessed with the Denver score. Results Of 48 study patients (mean age 39 ± 3 years, 67% men, 88% blunt mechanism, mean Injury Severity Score 25 ± 2), MOF developed in 11 (23%). MOF patients had a considerably higher mortality (64% versus 3%) and fewer ICU-free days (3.5 ± 2 versus 17.8 ± 1.3 days) compared with non-MOF patients. Traditional predictors of MOF, including age (45 ± 7 versus 38 ± 3 years; p=0.21), Injury Severity Score (26 ± 3 versus 25 ± 2; p=0.67), admission hemoglobin (11.4 ± 0.9 versus 12.1 ± 0.5 g/dL; p=0.22), international normalized ratio (1.6 ± 0.2 versus 1.4 ± 0.06; p=0.17), and base deficit (9.0 ± 2 versus 7.1 ± 0.8; p=0.19), were not significantly different between MOF and non-MOF patients. Statistical analysis identified six candidate predictors of MOF: inducible protein 10, macrophage inflammatory protein-1β, interleukin-10, interleukin-6, interleukin-1Ra, and eotaxin. Conclusions These data provide insight into cytokine expression during Traumatic Shock that can enable earlier identification of patients at risk for development of MOF.
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is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients
American Journal of Surgery, 2008Co-Authors: Frederick A Moore, Teresa Nelson, Bruce A Mckinley, Ernest E Moore, Avery B Nathens, Peter Rhee, Juan Carlos Puyana, Gregory J Beilman, Stephen M CohnAbstract:BACKGROUND: Damage control resuscitation (DCR) with early plasma in combat casualties requiring massive transfusion (MT) decreases early deaths from bleeding. METHODS: To ascertain the potential role of early plasma DCR in civilian MT, we queried a prospective Traumatic Shock database of 383 civilians. RESULTS: Ninety-three (24%) of the Traumatic Shock civilians received a MT, of which 26 (28%) died early, predominantly from bleeding within 6 hours. Comparatively, this early MT death cohort arrived in more severe Shock and were coagulopathic (mean INR 2.4). In the critical period of MT (ie, the first 3 hours), these patients received 20 U of packed red blood cells (PRBCs) but only 4 U of fresh frozen plasma (FFP). They remained severely acidotic and their coagulopathy worsened as they exsanquinated. CONCLUSION: Civilians who arrived in Traumatic Shock, required a MT, and died early had worsening coagulopathy, which was not treated. DCR with FFP may have a role in civilian trauma.
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tissue oxygen saturation predicts the development of organ dysfunction during Traumatic Shock resuscitation
Journal of Trauma-injury Infection and Critical Care, 2007Co-Authors: Stephen M Cohn, Frederick A Moore, Ernest E Moore, Avery B Nathens, Peter Rhee, Juan Carlos Puyana, Gregory J Beilman, Janet Mccarthy, Rachelle B Jonas, Joe JohnstonAbstract:Background:Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of Shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in Shock.Methods:The
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preload optimization using starling curve generation during Shock resuscitation can it be done
Shock, 2004Co-Authors: Alan B Marr, Frederick A Moore, Christine S Cocanour, Rosemary A Kozar, Matthew R Sailors, Alicia Valdivia, John H Selby, Bruce A MckinleyAbstract:Preload-directed resuscitation is the standard of care in U.S. trauma centers. As part of our standardized protocol for Traumatic Shock resuscitation, patients who do not respond to initial interventions of hemoglobin replacement and fluid volume loading have optimal preload determined using a standardized algorithm to generate a "Starling curve." We retrospectively analyzed data from 147 consecutive resuscitation protocol patients during the 24 months ending August 2002. Fifty (34%) of these patients required preload optimization, of which the optimization algorithm was completed in 36 (72%). The average age of those who required preload optimization was 44 +/- 3 years vs. 34 +/- 1 years for patients who did not. Execution of the algorithm caused PCWP to increase from 18 +/- 1 mmHg to a maximum of 25 +/- 2 mmHg and CI to increase from 3.2 +/- 0.1 L/min m(-2) to 4.5 +/- 0.4 L/min m(-2). Algorithm logic determined PCWP = 24 +/- 2 to be optimal preload at the maximum CI = 4.8 +/- 0.4, and as the volume loading threshold for the remaining time of the resuscitation process. Starling curve preload optimization was begun 6.5 +/- 0.8 h after start of the resuscitation protocol and required 36 +/- 5 min and 4 +/- 0.4 fluid boluses (1.6 +/- 0.2 L). Comparison of early response of those patients who required preload optimization and those who did not indicated hemodynamic compromise apparent in the 1st 4 h of standardized resuscitation. We conclude that preload optimization using sequential fluid bolus and PCWP-CI measurement to generate a Starling curve is feasible during ICU Shock resuscitation, but that there is the disadvantage that increasing and maintaining high PCWP may contribute to problematic tissue edema.
Nathan J White - One of the best experts on this subject based on the ideXlab platform.
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effects of a combination hemoglobin based oxygen carrier hypertonic saline solution on oxygen transport in the treatment of Traumatic Shock
Resuscitation, 2011Co-Authors: Benjamin Leong, Penny S Reynolds, Mohamad H Tiba, William H Holbert, Gerard T Draucker, Juliana Medina, R W Barbee, Nathan J WhiteAbstract:Abstract Background Logistics complicate fluid resuscitation of Traumatic Shock on the battlefield. Traumatic Shock can result in oxygen debt (O 2 D) accumulation that is fatal. However, the ability of fluid strategies to repay O 2 D are not commonly reported. This pilot study examined various resuscitation fluids, including a combination of PEGylated bovine hemoglobin and hypertonic saline (AfterShock™) on their ability to repay O 2 D in Traumatic Shock. Methods 41 anesthetized swine underwent hemorrhage to an O 2 D of 80mL/kg. Animals received one of the following: 500mL whole blood, 500mL AfterShock™, 500mL hypertonic (7.2%) saline, 250mL hypertonic (7.2%) saline, 500mL Hetastarch (6%), or 500mL lactated Ringer's. Oxygen transport variables (O 2 D, oxygen consumption, oxygen delivery, central venous hemoglobin oxygen saturation, oxygen extraction ratios), lactate clearance, and survival were monitored for 3h after treatment. Data were analyzed using mixed-model ANOVA and comparisons were made to the performance of whole blood. Results Only animals receiving AfterShock™, 500mL hypertonic saline, and 500mL Hetastarch survived to 180min. While not statistically significant AfterShock™ demonstrated trends in improving the repayment of O 2 D and in improving oxygen transport variables despite having lower levels of global oxygen delivery compared to whole blood, Hetastarch and 500mL hypertonic saline groups. Conclusion Use of 500mL AfterShock™, 500mL of 7.2% saline or 500mL of Hetastarch resulted in improved short-term survival. While not statistically significant, AfterShock™ demonstrated trends in improving O 2 D. These findings may have implications for designing resuscitation fluids for combat casualty care.
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coagulopathy and Traumatic Shock characterizing hemostatic function during the critical period prior to fluid resuscitation
Resuscitation, 2010Co-Authors: Nathan J White, Erika J Martin, Donald F Brophy, Kevin R WardAbstract:Aims Identifying early changes in hemostatic clot function as a result of tissue injury and hypoperfusion may provide important information regarding the mechanisms of Traumatic coagulopathy. A combat-relevant swine model was used to investigate the development of coagulopathy during trauma by monitoring hemostatic function during increasing severity of Shock.
Bruce A Mckinley - One of the best experts on this subject based on the ideXlab platform.
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early cytokine production risk stratifies trauma patients for multiple organ failure
Journal of The American College of Surgeons, 2009Co-Authors: Kenneth M Jastrow, Frederick A Moore, Bruce A Mckinley, Rosemary A Kozar, Ernest A Gonzalez, Mary F Mcguire, James W Suliburk, Sriram Iyengar, Deborah A Motschall, David W MercerAbstract:Background Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic Shock, early ( Study Design In a prospective observational pilot study of > 1 year at an urban Level I trauma center, serial (every 4 hours) serum cytokine levels were determined during a 24-hour period using multiplex suspension immunoassay in patients with major torso trauma (excluding severe brain injury) who met criteria for standardized Shock resuscitation. Temporal cytokine expression was assessed during Shock resuscitation in severe trauma patients to predict risk for MOF. MOF was assessed with the Denver score. Results Of 48 study patients (mean age 39 ± 3 years, 67% men, 88% blunt mechanism, mean Injury Severity Score 25 ± 2), MOF developed in 11 (23%). MOF patients had a considerably higher mortality (64% versus 3%) and fewer ICU-free days (3.5 ± 2 versus 17.8 ± 1.3 days) compared with non-MOF patients. Traditional predictors of MOF, including age (45 ± 7 versus 38 ± 3 years; p=0.21), Injury Severity Score (26 ± 3 versus 25 ± 2; p=0.67), admission hemoglobin (11.4 ± 0.9 versus 12.1 ± 0.5 g/dL; p=0.22), international normalized ratio (1.6 ± 0.2 versus 1.4 ± 0.06; p=0.17), and base deficit (9.0 ± 2 versus 7.1 ± 0.8; p=0.19), were not significantly different between MOF and non-MOF patients. Statistical analysis identified six candidate predictors of MOF: inducible protein 10, macrophage inflammatory protein-1β, interleukin-10, interleukin-6, interleukin-1Ra, and eotaxin. Conclusions These data provide insight into cytokine expression during Traumatic Shock that can enable earlier identification of patients at risk for development of MOF.
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is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients
American Journal of Surgery, 2008Co-Authors: Frederick A Moore, Teresa Nelson, Bruce A Mckinley, Ernest E Moore, Avery B Nathens, Peter Rhee, Juan Carlos Puyana, Gregory J Beilman, Stephen M CohnAbstract:BACKGROUND: Damage control resuscitation (DCR) with early plasma in combat casualties requiring massive transfusion (MT) decreases early deaths from bleeding. METHODS: To ascertain the potential role of early plasma DCR in civilian MT, we queried a prospective Traumatic Shock database of 383 civilians. RESULTS: Ninety-three (24%) of the Traumatic Shock civilians received a MT, of which 26 (28%) died early, predominantly from bleeding within 6 hours. Comparatively, this early MT death cohort arrived in more severe Shock and were coagulopathic (mean INR 2.4). In the critical period of MT (ie, the first 3 hours), these patients received 20 U of packed red blood cells (PRBCs) but only 4 U of fresh frozen plasma (FFP). They remained severely acidotic and their coagulopathy worsened as they exsanquinated. CONCLUSION: Civilians who arrived in Traumatic Shock, required a MT, and died early had worsening coagulopathy, which was not treated. DCR with FFP may have a role in civilian trauma.
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preload optimization using starling curve generation during Shock resuscitation can it be done
Shock, 2004Co-Authors: Alan B Marr, Frederick A Moore, Christine S Cocanour, Rosemary A Kozar, Matthew R Sailors, Alicia Valdivia, John H Selby, Bruce A MckinleyAbstract:Preload-directed resuscitation is the standard of care in U.S. trauma centers. As part of our standardized protocol for Traumatic Shock resuscitation, patients who do not respond to initial interventions of hemoglobin replacement and fluid volume loading have optimal preload determined using a standardized algorithm to generate a "Starling curve." We retrospectively analyzed data from 147 consecutive resuscitation protocol patients during the 24 months ending August 2002. Fifty (34%) of these patients required preload optimization, of which the optimization algorithm was completed in 36 (72%). The average age of those who required preload optimization was 44 +/- 3 years vs. 34 +/- 1 years for patients who did not. Execution of the algorithm caused PCWP to increase from 18 +/- 1 mmHg to a maximum of 25 +/- 2 mmHg and CI to increase from 3.2 +/- 0.1 L/min m(-2) to 4.5 +/- 0.4 L/min m(-2). Algorithm logic determined PCWP = 24 +/- 2 to be optimal preload at the maximum CI = 4.8 +/- 0.4, and as the volume loading threshold for the remaining time of the resuscitation process. Starling curve preload optimization was begun 6.5 +/- 0.8 h after start of the resuscitation protocol and required 36 +/- 5 min and 4 +/- 0.4 fluid boluses (1.6 +/- 0.2 L). Comparison of early response of those patients who required preload optimization and those who did not indicated hemodynamic compromise apparent in the 1st 4 h of standardized resuscitation. We conclude that preload optimization using sequential fluid bolus and PCWP-CI measurement to generate a Starling curve is feasible during ICU Shock resuscitation, but that there is the disadvantage that increasing and maintaining high PCWP may contribute to problematic tissue edema.
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secondary abdominal compartment syndrome is an elusive early complication of Traumatic Shock resuscitation
American Journal of Surgery, 2002Co-Authors: Zsolt J Balogh, John B Holcomb, Bruce A Mckinley, Christine S Cocanour, Rosemary A Kozar, Drue N Ware, Frederick A MooreAbstract:Abstract Background The term secondary abdominal compartment syndrome (ACS) has been applied to describe trauma patients who develop ACS but do not have abdominal injuries. The purpose of this study was to describe major trauma victims who developed secondary ACS during standardized Shock resuscitation. Methods Our prospective database for standardized Shock resuscitation was reviewed to obtain before and after abdominal decompression Shock related data for secondary ACS patients. Focused chart review was done to confirm time-related outcomes. Results Over the 30 months period ending May 2001, 11 (9%) of 128 standardized Shock resuscitation patients developed secondary ACS. All presented in severe Shock (systolic blood pressure 85 ± 5 mm Hg, base deficit 8.6 ± 1.6 mEq/L), with severe injuries (injury severity score 28 ± 3) and required aggressive Shock resuscitation (26 ± 2 units of blood, 38 ± 3 L crystalloid within 24 hours). All cases of secondary ACS were recognized and decompressed within 24 hours of hospital admission. After decompression, the bladder pressure and the systemic vascular resistance decreased, while the mean arterial pressure, cardiac index, and static lung compliance increased. The mortality rate was 54%. Those who died failed to respond to decompression with increased cardiac index and did not maintain decreased bladder pressure. Conclusions: Secondary ACS is an early but, if appropriately monitored, recognizable complication in patients with major nonabdominal trauma who require aggressive resuscitation.
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tissue hemoglobin o2 saturation during resuscitation of Traumatic Shock monitored using near infrared spectrometry
Journal of Trauma-injury Infection and Critical Care, 2000Co-Authors: Bruce A Mckinley, Christine S Cocanour, Robert G Marvin, Frederick A MooreAbstract:Background: Near infrared (NIR) spectrometry offers a noninvasive monitor of tissue hemoglobin O 2 saturation and has been developed to report a quantitative clinical variable, Sto 2 [= HbO 2 /(HbO 2 + Hb)]. In this study, a prototype NIR oximeter was used to investigate the hypothesis that changes in systemic O 2 delivery index (Do 2 I) would be reflected by changes in Sto 2 in skeletal muscle, subcutaneous tissue, or both, as reperfusion occurs during Shock resuscitation. Sto 2 was also compared with other indices of severity of Shock or adequacy of resuscitation, including arterial base deficit, lactate, gastric mucosal Pco 2 (Pgco 2 ), and mixed venous hemoglobin O 2 saturation (Svo 2 ). Methods: Skeletal muscle and subcutaneous tissue Sto 2 were monitored simultaneously in eight severely injured trauma patients (88% blunt mechanism; age, 42 ± 6 years; Injury Severity Score, 27 ± 3) during standardized Shock resuscitation in the intensive care unit with the primary goal of Do 2 I ≥ 600 mL O 2 /min/m 2 for 24 hours, and for an additional 12 hours during transition from resuscitation to standard intensive care unit care. Results: Skeletal muscle Sto 2 increased significantly from 15 ± 2% (mean ± SEM) at the start of resuscitation to 49 ± 14% at 24 hours, and to ∼55% from 25 to 36 hours. Subcutaneous tissue Sto 2 ∼ 82% and was significantly greater than skeletal muscle Sto 2 throughout. Do 2 I increased significantly from 372 ± 54 to 718 ± 47 mL O 2 /min/m 2 during resuscitation. Over 36 hours, mean Do 2 I and skeletal muscle Sto 2 were highly correlated (r = 0.95). Neither Do 2 I-Pgco 2 nor Do 2 I-Svo 2 were significantly correlated; neither Svo 2 nor subcutaneous tissue Sto 2 changed significantly. Conclusion: Hemoglobin O 2 saturation was monitored non-invasively and simultaneously in skeletal muscle and subcutaneous tissues as Sto 2 (%) by using a prototype NIR oximeter. Skeletal muscle Sto 2 tracked systemic O 2 delivery during and after resuscitation. As a rapidly deployable, noninvasive monitor of peripheral tissue oxygenation and O 2 delivery, skeletal muscle Sto 2 obtained using NIR spectrometry would be useful to guide resuscitation in the intensive care unit, to monitor resuscitation status in the operating room, and, potentially, in combination with indicators such as base deficit and lactate, to detect Shock during initial assessment of the severe trauma patient in the emergency department.
Stephen M Cohn - One of the best experts on this subject based on the ideXlab platform.
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is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients
American Journal of Surgery, 2008Co-Authors: Frederick A Moore, Teresa Nelson, Bruce A Mckinley, Ernest E Moore, Avery B Nathens, Peter Rhee, Juan Carlos Puyana, Gregory J Beilman, Stephen M CohnAbstract:BACKGROUND: Damage control resuscitation (DCR) with early plasma in combat casualties requiring massive transfusion (MT) decreases early deaths from bleeding. METHODS: To ascertain the potential role of early plasma DCR in civilian MT, we queried a prospective Traumatic Shock database of 383 civilians. RESULTS: Ninety-three (24%) of the Traumatic Shock civilians received a MT, of which 26 (28%) died early, predominantly from bleeding within 6 hours. Comparatively, this early MT death cohort arrived in more severe Shock and were coagulopathic (mean INR 2.4). In the critical period of MT (ie, the first 3 hours), these patients received 20 U of packed red blood cells (PRBCs) but only 4 U of fresh frozen plasma (FFP). They remained severely acidotic and their coagulopathy worsened as they exsanquinated. CONCLUSION: Civilians who arrived in Traumatic Shock, required a MT, and died early had worsening coagulopathy, which was not treated. DCR with FFP may have a role in civilian trauma.
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tissue oxygen saturation predicts the development of organ dysfunction during Traumatic Shock resuscitation
Journal of Trauma-injury Infection and Critical Care, 2007Co-Authors: Stephen M Cohn, Frederick A Moore, Ernest E Moore, Avery B Nathens, Peter Rhee, Juan Carlos Puyana, Gregory J Beilman, Janet Mccarthy, Rachelle B Jonas, Joe JohnstonAbstract:Background:Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of Shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in Shock.Methods:The
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can near infrared spectroscopy identify the severity of Shock in trauma patients
Journal of Trauma-injury Infection and Critical Care, 2005Co-Authors: Bruce A Crookes, Stephen M Cohn, Scott Bloch, Jose Amortegui, Ronald J Manning, Matthew S Proctor, Ali Hallal, Lorne H Blackbourne, Robert Benjamin, Dror SofferAbstract:Background: Our recent experimental study showed that peripheral muscle tissue oxygen saturation (StO 2 ), determined noninvasively by near-infrared spectroscopy (NIRS), was more reliable than systemic hemodynamics or invasive oxygenation variables as an index of Traumatic Shock. The purpose of this study was to establish the normal range of thenar muscle StO 2 in humans and the relationship between Shock state and StO 2 in trauma patients. Methods: This was a prospective, nonrandomized, observational, descriptive study in normal human volunteers (n = 707) and patients admitted to the resuscitation area of our Level I trauma center (n = 150). To establish a normal StO 2 range, an NIRS probe was applied to the thenar eminence of volunteers (normals). Subsequently, in a group of trauma patients, an NIRS probe was applied to the thenar eminence and data were collected and stored for offline analysis. StO 2 monitoring was performed continuously and noninvasively, and values were recorded at 2-minute intervals. Five moribund trauma patients were excluded. Members of our trauma faculty, blinded to StO 2 values, classified each patient into one of four groups (no Shock, mild Shock, moderate Shock, and severe Shock) using conventional physiologic parameters. Results: Mean ± SD thenar StO 2 values for each group were as follows: normals, 87 ± 6% (n = 707); no Shock, 83 ± 10% (n = 85); mild Shock, 83 ± 10% (n = 19); moderate Shock, 80 ± 12% (n = 14); and severe Shock, 45 ± 26% (n = 14). The thenar StO 2 values clearly discriminated the normals or no Shock patients and the patients with severe Shock (p < 0.05). Conclusion: Decreased thenar muscle tissue oxygen saturation reflects the presence of severe hypoperfusion and near-infrared spectroscopy may be a novel method for rapidly and noninvasively assessing chances in tissue dysoxia.
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noninvasive muscle oxygenation to guide fluid resuscitation after Traumatic Shock
Surgery, 2004Co-Authors: Bruce A Crookes, Stephen M Cohn, Elizabeth A Burton, Jacob Nelson, Kenneth G ProctorAbstract:Abstract Background Three different protocols tested the hypothesis that hind limb muscle tissue O2 saturation (StO2), measured noninvasively with near-infrared spectroscopy (NIRS), is as reliable as invasive systemic oxygenation indices to guide fluid resuscitation. Methods In series 1, swine (n = 30) were hemorrhaged, then received either no fluid, a fixed volume of colloid (15 mL/kg), or shed blood plus lactated Ringer's (LR) titrated to MAP >60 mm Hg. In series 2, swine (n = 16) received a penetrating femur injury, a 47% to 55% hemorrhage to determine a median lethal dose (LD50) then shed blood plus LR titrated to MAP >60 mm Hg. In series 3, swine (n = 5) received the femur injury plus LD50 hemorrhage, and were resuscitated with LR titrated to StO2 >50%. Results In series 1, StO2 tracked mixed venous O2 saturation (SvO2), but discriminated between 3 survivor groups better than SvO2, arterial lactate, or arterial base excess. In series 2, StO2 tracked SvO2 but discriminated between 2 survivor groups better than SvO2, arterial lactate, or arterial base excess. In series 3, animals survived to extubation when resuscitated to an StO2 target. Conclusions Noninvasive muscle StO2 determined by NIRS was more reliable than invasive oxygenation variables as an index of Shock. Because muscle StO2 can be easily monitored in emergency situations, it may represent an improved method to gauge the severity of Shock or the adequacy of fluid resuscitation after trauma.
Anand Kumar - One of the best experts on this subject based on the ideXlab platform.
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the history and evolution of circulatory Shock
Critical Care Clinics, 2009Co-Authors: Rizwan A Manji, Kenneth E Wood, Anand KumarAbstract:This article reviews the development of early ideas regarding the origins and pathogenesis of Shock. The early history of Shock is related primarily to Traumatic Shock. More recent history centers on differentiation of clinical syndromes and individual characteristics. Definitions, classification systems, pathogenic theories, and treatments have evolved. Progress has been aided by constant development of improved assessment technologies. Today, Shock is not a single syndrome and the definition of Shock no longer is descriptive in nature. The most accepted current definition involves an oxygen supply/demand imbalance that can have various causes—hypovolemia, cardiac dysfunction, vascular failure, or obstructive processes.
