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Bergman ZR, Kiberenge RK, Bianco R, Beilman G, Brophy CM, Hocking KM, Alvis BD, Wise ES. The Effect of Fluid Pre-loading on Vital Signs and Hemodynamic Parameters in a Porcine Model of Lipopolysaccharide-Induced Endotoxemia. Cureus 2023; 15:e43103. [PMID: 37692606 PMCID: PMC10483090 DOI: 10.7759/cureus.43103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Animal models of distributive hypotension and resuscitation allow the assessment of hemodynamic monitoring modalities and resuscitation strategies. The fluid-first paradigm for resuscitation is currently being challenged with clinical trials. In this investigation, venous return and perfusion are assessed, and full hemodynamics are characterized, in a porcine model of endotoxemic hypotension with and without fluid pre-loading. Methods Two groups of six pigs had the induction of standardized endotoxemic hypotension ("critical hypotension"). Group 1 underwent four 10 cc/kg crystalloid boluses, and Group 2 was not fluid pre-resuscitated. Both groups underwent progressive norepinephrine (NE) up-titration to 0.25 mcg/kg/minute over 30 minutes. Vital signs, central parameters, and laboratory values were obtained at baseline, "critical hypotension," after each bolus and during NE administration. Results Endotoxemia decreased the systemic vascular resistance (SVR) in Group 1 (1031±106 dyn/s/cm-5 versus 738±258 dyn/s/cm-5; P=0.03) and Group 2 (1121±196 dyn/s/cm-5 versus 759±342 dyn/s/cm-5; P=0.003). In Group 1, the four fluid boluses decreased heart rate (HR), pulmonary capillary wedge pressure (PCWP), and central venous pressure (CVP) (P<0.05). No changes were observed in blood pressure, cardiac output (CO), or lactate. NE up-titration increased HR in Group 1 and decreased CVP in both groups. Higher final CVP (11 {3} versus 4 {4} mmHg; P=0.01) and PCWP (5 {1} versus 2 {2} mmHg; P=0.005) values were observed in Group 1 relative to Group 2, reflecting increased venous return. Conclusions Porcine endotoxemic hypotension and resuscitation were robustly characterized. In this model, fluid loading improved venous return with NE, though perfusion (CO) was preserved by increased NE-induced chronotropy.
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Affiliation(s)
- Zachary R Bergman
- Surgery, University of Minnesota School of Medicine, Minneapolis, USA
| | | | - Richard Bianco
- Surgery, University of Minnesota School of Medicine, Minneapolis, USA
| | - Gregory Beilman
- Surgery, University of Minnesota School of Medicine, Minneapolis, USA
| | | | - Kyle M Hocking
- Surgery and Biomedical Engineering, Vanderbilt University Medical Center, Nashville, USA
| | - Bret D Alvis
- Anesthesiology and Biomedical Engineering, Vanderbilt University Medical Center, Nashville, USA
| | - Eric S Wise
- Surgery, University of Minnesota School of Medicine, Minneapolis, USA
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Central Venous Waveform Analysis and Cardiac Output in a Porcine Model of Endotoxemic Hypotension and Resuscitation. J Am Coll Surg 2023; 236:294-304. [PMID: 36648257 DOI: 10.1097/xcs.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cardiac output (CO) is a valuable proxy for perfusion, and governs volume responsiveness during resuscitation from distributive shock. The underappreciated venous system has nuanced physiology that confers valuable hemodynamic information. In this investigation, deconvolution of the central venous waveform by the fast Fourier transformation (FFT) algorithm is performed to assess its ability to constitute a CO surrogate in a porcine model of endotoxemia-induced distributive hypotension and resuscitation. STUDY DESIGN Ten pigs were anesthetized, catheterized, and intubated. A lipopolysaccharides infusion protocol was used to precipitate low systemic vascular resistance hypotension. Four crystalloid boluses (10 cc/kg) were then given in succession, after which heart rate, mean arterial pressure, thermodilution-derived CO, central venous pressure (CVP), and the central venous waveform were collected, the last undergoing fast Fourier transformation analysis. The amplitude of the fundamental frequency of the central venous waveform's cardiac wave (f0-CVP) was obtained. Heart rate, mean arterial pressure, CVP, f0-CVP, and CO were plotted over the course of the boluses to determine whether f0-CVP tracked with CO better than the vital signs, or than CVP itself. RESULTS Distributive hypotension to a 25% mean arterial pressure decrement was achieved, with decreased systemic vascular resistance (mean 918 ± 227 [SD] dyne/s/cm-5 vs 685 ± 180 dyne/s/cm-5; p = 0.038). Full hemodynamic parameters characterizing this model were reported. Slopes of linear regression lines of heart rate, mean arterial pressure, CVP, f0-CVP, and CO were -2.8, 1.7, 1.8, 0.40, and 0.35, respectively, demonstrating that f0-CVP values closely track with CO over the 4-bolus range. CONCLUSIONS Fast Fourier transformation analysis of the central venous waveform may allow real-time assessment of CO during resuscitation from distributive hypotension, possibly offering a venous-based approach to clinical estimation of volume responsiveness.
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Zhang B, Guo S, Fu Z, Wu N, Liu Z. Association between fluid balance and mortality for heart failure and sepsis: a propensity score-matching analysis. BMC Anesthesiol 2022; 22:324. [PMID: 36273128 PMCID: PMC9587660 DOI: 10.1186/s12871-022-01865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fluid resuscitation is necessary to correct the sepsis-induced hypoperfusion, which is contradictory to the treatment of heart failure. This study explored the association between fluid balance (FB) of the first 24 h after ICU admission and mortality in critically ill patients with heart failure and sepsis. METHODS Data were extracted from the Medical Information Mart for Intensive Care database. The locally weighted scatterplot smoothing (Lowess) method was used to demonstrate the relationship between FB and in-hospital mortality. Groups were divided into high FB (≥ 55.85 ml/kg) and low FB (< 55.85 ml/kg) according to the cut-off value of FB using Receiver operating characteristic analysis and Youden index method. The primary outcome was in-hospital mortality. Subgroup analyses, multivariable logistic regression analyses, and Kaplan-Meier curves were used to detect the association and survival difference between groups. Inverse probability treatment weighting (IPTW) and propensity score matching (PSM) were performed to minimize the bias of confounding factors and facilitate the comparability between groups. RESULTS A total of 936 patients were included. The Lowess curve showed an approximate positive linear relationship for FB and in-hospital mortality. In the multivariable logistic regression adjusted model, high FB showed strong associations with in-hospital mortality (OR 2.53, 95% CI 1.60-3.99, p < 0.001) as compared to the low FB group. In IPTW and PSM models, high FB consistently showed higher in-hospital mortality (IPTW model: OR 1.94, 95% CI 1.52-2.49, p < 0.001; PSM model: OR 2.93, 95% CI 1.75-4.90, p < 0.001) and 30-day mortality (IPTW model: OR 1.65, 95% CI 1.29-2.10, p < 0.001; PSM model: OR 2.50, 95% CI 1.51-4.15, p < 0.001), compared with the low FB group. CONCLUSION For critically ill patients with heart failure and sepsis, high FB within the first 24 h after ICU admission could serve as an independent risk factor for in-hospital mortality and 30-day mortality. The avoidance of fluid overload exerts important effects on reducing mortality in such patients.
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Affiliation(s)
- Bufan Zhang
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
- Department of Cardiovascular Surgery & Intensive Care Unit, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, People's Republic of China
| | - Shaohua Guo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Zean Fu
- Department of Cardiovascular Surgery & Intensive Care Unit, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, People's Republic of China
| | - Naishi Wu
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
| | - Zhigang Liu
- Department of Cardiovascular Surgery & Intensive Care Unit, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, People's Republic of China.
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Abstract
Endotoxaemia is an inflammatory condition which happens due to the presence of outer cell wall layer of Gram-negative bacteria in blood circulation, containing lipopolysaccharide commonly known as endotoxin. This condition causes high mortality in affected animals and sheep are highly susceptible in this regard. Several researchers have emphasised the therapeutic regimens of endotoxaemia and its sequels in sheep. Furthermore, sheep are among the most commonly used animal species in experimental studies on endotoxaemia, and for the past five decades, ovine models have been employed to evaluate different aspects of endotoxaemia. Currently, there are several studies on experimentally induced endotoxaemia in sheep, and information regarding novel therapeutic protocols in this species contributes to better understanding and treating the condition. This review aims to specifically introduce various treatment methods of endotoxaemia in sheep.
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Affiliation(s)
- A. Chalmeh
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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5
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Dyer WB, Tung JP, Li Bassi G, Wildi K, Jung JS, Colombo SM, Rozencwajg S, Simonova G, Chiaretti S, Temple FT, Ainola C, Shuker T, Palmieri C, Shander A, Suen JY, Irving DO, Fraser JF. An Ovine Model of Hemorrhagic Shock and Resuscitation, to Assess Recovery of Tissue Oxygen Delivery and Oxygen Debt, and Inform Patient Blood Management. Shock 2021; 56:1080-1091. [PMID: 34014886 DOI: 10.1097/shk.0000000000001805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aggressive fluid or blood component transfusion for severe hemorrhagic shock may restore macrocirculatory parameters, but not always improve microcirculatory perfusion and tissue oxygen delivery. We established an ovine model of hemorrhagic shock to systematically assess tissue oxygen delivery and repayment of oxygen debt; appropriate outcomes to guide Patient Blood Management. METHODS Female Dorset-cross sheep were anesthetized, intubated, and subjected to comprehensive macrohemodynamic, regional tissue oxygen saturation (StO2), sublingual capillary imaging, and arterial lactate monitoring confirmed by invasive organ-specific microvascular perfusion, oxygen pressure, and lactate/pyruvate levels in brain, kidney, liver, and skeletal muscle. Shock was induced by stepwise withdrawal of venous blood until MAP was 30 mm Hg, mixed venous oxygen saturation (SvO2) < 60%, and arterial lactate >4 mM. Resuscitation with PlasmaLyte® was dosed to achieve MAP > 65 mm Hg. RESULTS Hemorrhage impacted primary outcomes between baseline and development of shock: MAP 89 ± 5 to 31 ± 5 mm Hg (P < 0.01), SvO2 70 ± 7 to 23 ± 8% (P < 0.05), cerebral regional tissue StO2 77 ± 11 to 65 ± 9% (P < 0.01), peripheral muscle StO2 66 ± 8 to 16 ± 9% (P < 0.01), arterial lactate 1.5 ± 1.0 to 5.1 ± 0.8 mM (P < 0.01), and base excess 1.1 ± 2.2 to -3.6 ± 1.7 mM (P < 0.05). Invasive organ-specific monitoring confirmed reduced tissue oxygen delivery; oxygen tension decreased and lactate increased in all tissues, but moderately in brain. Blood volume replacement with PlasmaLyte® improved primary outcome measures toward baseline, confirmed by organ-specific measures, despite hemoglobin reduced from baseline 10.8 ± 1.2 to 5.9 ± 1.1 g/dL post-resuscitation (P < 0.01). CONCLUSION Non-invasive measures of tissue oxygen delivery and oxygen debt repayment are suitable outcomes to inform Patient Blood Management of hemorrhagic shock, translatable for pre-clinical assessment of novel resuscitation strategies.
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Affiliation(s)
- Wayne B Dyer
- Australian Red Cross Lifeblood, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - John-Paul Tung
- Australian Red Cross Lifeblood, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Cardiovascular Research Institute, Basel, Switzerland
| | - Jae-Seung Jung
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sebastiano Maria Colombo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Pathophysiology and Transplantation, Universita degli Studi di Milano, Milano, Italy
| | - Sacha Rozencwajg
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Sorbonne Université, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Medical ICU, Pitié-Salpêtrière University Hospital, Paris, France
| | - Gabriela Simonova
- Australian Red Cross Lifeblood, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Fergal T Temple
- Australian Red Cross Lifeblood, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Tristan Shuker
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Chiara Palmieri
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - Aryeh Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood
- TeamHealth, Englewood Health, Englewood
- UF College of Medicine, University of Florida, Gainesville
- Department of Anesthesiology, Medicine and Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York
- Department of Anesthesiology and Critical Care, Rutgers University, Newark
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - David O Irving
- Australian Red Cross Lifeblood, Sydney, Australia
- Faculty of Health, University of Technology, Sydney, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Tiba MH, McCracken BM, Dickson RP, Nemzek JA, Colmenero CI, Leander DC, Flott TL, Daniels RC, Konopka KE, VanEpps JS, Stringer KA, Ward KR. A comprehensive assessment of multi-system responses to a renal inoculation of uropathogenic E. coli in swine. PLoS One 2020; 15:e0243577. [PMID: 33306742 PMCID: PMC7732124 DOI: 10.1371/journal.pone.0243577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The systemic responses to infection and its progression to sepsis remains poorly understood. Progress in the field has been stifled by the shortcomings of experimental models which include poor replication of the human condition. To address these challenges, we developed and piloted a novel large animal model of severe infection that is capable of generating multi-system clinically relevant data. METHODS Male swine (n = 5) were anesthetized, mechanically ventilated, and surgically instrumented for continuous hemodynamic monitoring and serial blood sampling. Animals were inoculated with uropathogenic E. coli by direct injection into the renal parenchyma and were maintained until a priori endpoints were met. The natural history of the infection was studied. Animals were not resuscitated. Multi-system data were collected hourly to 6 hours; all animals were euthanized at predetermined physiologic endpoints. RESULTS Core body temperature progressively increased from mean (SD) 37.9(0.8)°C at baseline to 43.0(1.2)°C at experiment termination (p = 0.006). Mean arterial pressure did not begin to decline until 6h post inoculation, dropping from 86(9) mmHg at baseline to 28(5) mmHg (p = 0.005) at termination. Blood glucose progressively declined but lactate levels did not elevate until the last hours of the experiment. There were also temporal changes in whole blood concentrations of a number of metabolites including increases in the catecholamine precursors, tyrosine (p = 0.005) and phenylalanine (p = 0.005). Lung, liver, and kidney function parameters worsened as infection progressed and at study termination there was histopathological evidence of injury in these end-organs. CONCLUSION We demonstrate a versatile, multi-system, longitudinal, swine model of infection that could be used to further our understanding of the mechanisms that underlie infection-induced multi-organ dysfunction and failure, optimize resuscitation protocols and test therapeutic interventions. Such a model could improve translation of findings from the bench to the bedside, circumventing a significant obstacle in sepsis research.
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Affiliation(s)
- Mohamad Hakam Tiba
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Brendan M. McCracken
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Robert P. Dickson
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jean A. Nemzek
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
- Unit of Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Carmen I. Colmenero
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Danielle C. Leander
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Thomas L. Flott
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rodney C. Daniels
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kristine E. Konopka
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - J. Scott VanEpps
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kathleen A. Stringer
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kevin R. Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
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7
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Naylor D, Sharma A, Li Z, Monteith G, Sullivan T, Canovas A, Mallard BA, Baes C, Karrow NA. Short communication: Characterizing ovine serum stress biomarkers during endotoxemia. J Dairy Sci 2020; 103:5501-5508. [PMID: 32307170 DOI: 10.3168/jds.2019-17718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
Breeding stress-resilient livestock is a potential strategy to help mitigate the negative effect of environmental and pathogenic stressors. The hypothalamic-pituitary-adrenal axis and immune system are activated during stress events and release mediators into the circulation that help restore physiological homeostasis. The purpose of this study was to assess a comprehensive set of circulatory mediators released in response to an acute immune stress challenge to identify candidate biomarkers that can be used for the selection of stress-resilient animals. Fifteen female lambs were stress challenged with an intravenous bolus of lipopolysaccharide (LPS; 400 ng/kg), and blood was collected from the jugular vein at 0, 2, 4, and 6 h after LPS challenge to identify and monitor candidate stress biomarkers; temperature was also recorded over time. Biomarker responses were evaluated with a repeated-measures model to compare time points with baseline values. As expected, all sheep had a monophasic febrile response to LPS challenge, and cortisol increased and returned to baseline by 6 h. The cytokines tumor necrosis factor-α, IL-6, IFN-γ (proinflammatory), and IL-10 (anti-inflammatory) increased, but only tumor necrosis factor-α returned to baseline during the monitoring period. The cytokines IL-1α, IL-1β, IL-17α (proinflammatory), and IL-4 (anti-inflammatory) did not respond to LPS challenge. All chemokines (CCL2, CCL3, CCL4, CXCL10, and IL-8) responded to LPS challenge; however, only CCL2, CCL3, CCL4, and CXCL10 increased over time, and only CCL3, CCL4, and CXCL10 returned to baseline during the monitoring period. MicroRNA (miR-145, miR-233, and miR-1246) also increased and remained elevated during the study. In summary, the LPS challenge induced a strong stress response in Rideau-Dorset sheep that could be monitored with a distinct profile of circulatory biomarkers.
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Affiliation(s)
- D Naylor
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - A Sharma
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Z Li
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - G Monteith
- Department of Clinical Studies, Ontario Veterinary College, Guelph, ON, N1G 2W1, Canada
| | - T Sullivan
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - A Canovas
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - B A Mallard
- Department of Pathobiology, Ontario Veterinary College, Guelph, ON, N1G 2W1, Canada
| | - C Baes
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada; Institute of Genetics, Vetsuisse Faculty, University of Bern, Bern, 3001, Switzerland
| | - N A Karrow
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada.
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8
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Marik PE, Byrne L, van Haren F. Fluid resuscitation in sepsis: the great 30 mL per kg hoax. J Thorac Dis 2020; 12:S37-S47. [PMID: 32148924 DOI: 10.21037/jtd.2019.12.84] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Large volume fluid resuscitation is currently viewed as the cornerstone of the treatment of septic shock. The surviving sepsis campaign (SSC) guidelines provide a strong recommendation to rapidly administer a minimum of 30 mL/kg crystalloid solution intravenously in all patients with septic shock and those with elevated blood lactate levels. However, there is no credible evidence to support this recommendation. In fact, recent findings from experimental, observational and randomized clinical trials demonstrate improved outcomes with a more restrictive approach to fluid resuscitation. Accumulating evidence suggests that aggressive fluid resuscitation is harmful. Paradoxically, excess fluid administration may worsen shock. In this review, we critically evaluate the scientific evidence for a weight-based fluid resuscitation approach. Furthermore, the potential mechanisms and consequences of harm associated with fluid resuscitation are discussed. Finally, we recommend an individualized, conservative and physiologic guided approach to fluid resuscitation.
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Affiliation(s)
- Paul E Marik
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Liam Byrne
- Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia.,Australian National University Medical School, Canberra Hospital, Garran, ACT, Australia
| | - Frank van Haren
- Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia.,Australian National University Medical School, Canberra Hospital, Garran, ACT, Australia
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9
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Obonyo NG, Byrne L, Tung JP, Simonova G, Diab SD, Dunster KR, Passmore MR, Boon AC, See Hoe L, Engkilde-Pedersen S, Esguerra-Lallen A, Fauzi MH, Pimenta LP, Millar JE, Fanning JP, Van Haren F, Anstey CM, Cullen L, Suen J, Shekar K, Maitland K, Fraser JF. Pre-clinical study protocol: Blood transfusion in endotoxaemic shock. MethodsX 2019; 6:1124-1132. [PMID: 31193460 PMCID: PMC6529713 DOI: 10.1016/j.mex.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/04/2019] [Indexed: 12/29/2022] Open
Abstract
The Surviving Sepsis Campaign (SCC) and the American College of Critical Care Medicine (ACCM) guidelines recommend blood transfusion in sepsis when the haemoglobin concentration drops below 7.0 g/dL and 10.0 g/dL respectively, while the World Health Organisation (WHO) guideline recommends transfusion in septic shock 'if intravenous (IV) fluids do not maintain adequate circulation', as a supportive measure of last resort. Volume expansion using crystalloid and colloid fluid boluses for haemodynamic resuscitation in severe illness/sepsis, has been associated with adverse outcomes in recent literature. However, the volume expansion effect(s) following blood transfusion for haemodynamic circulatory support, in severe illness remain unclear with most previous studies having focused on evaluating effects of either different RBC storage durations (short versus long duration) or haemoglobin thresholds (low versus high threshold) pre-transfusion. •We describe the protocol for a pre-clinical randomised controlled trial designed to examine haemodynamic effect(s) of early volume expansion using packed RBCs (PRBCs) transfusion (before any crystalloids or colloids) in a validated ovine-model of hyperdynamic endotoxaemic shock.•Additional exploration of mechanisms underlying any physiological, haemodynamic, haematological, immunologic and tissue specific-effects of blood transfusion will be undertaken including comparison of effects of short (≤5 days) versus long (≥30 days) storage duration of PRBCs prior to transfusion.
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Affiliation(s)
- Nchafatso G. Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- IDeAL/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Liam Byrne
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- The Canberra Hospital Intensive Care, Garran, ACT, Australia
- Australia National University, Canberra, ACT, Australia
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane City, QLD Australia
| | - Gabriela Simonova
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Sara D. Diab
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Kimble R. Dunster
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane City, QLD Australia
| | - Margaret R. Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Ai-Ching Boon
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Louise See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Sanne Engkilde-Pedersen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane City, QLD Australia
| | - Arlanna Esguerra-Lallen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
| | - Mohd H. Fauzi
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
| | - Leticia P. Pimenta
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Jonathan E. Millar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Jonathon P. Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Frank Van Haren
- The Canberra Hospital Intensive Care, Garran, ACT, Australia
- Australia National University, Canberra, ACT, Australia
- The University of Canberra, Bruce, ACT, Australia
| | - Chris M. Anstey
- Sunshine Coast University Hospital Intensive Care, Birtinya, Qld, Australia
| | - Louise Cullen
- University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Kiran Shekar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
- Adult Intensive Care, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Kathryn Maitland
- IDeAL/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Paediatrics, Faculty of Medicine, Imperial College London, United Kingdom
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane City, QLD Australia
- Adult Intensive Care, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
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10
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Oller L, Dyer WB, Santamaría L, Largo C, Javidroozi M, Shander A. The effect of a novel intravenous fluid (Oxsealife®) on recovery from haemorrhagic shock in pigs. Anaesthesia 2019; 74:765-777. [DOI: 10.1111/anae.14627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
| | - W. B. Dyer
- Australian Red Cross Blood Service and Faculty of Medicine and Health University of Sydney Sydney NSW Australia
| | - L. Santamaría
- Department of Anatomy, Histology, and Neuroscience School of Medicine Autonomous University of Madrid Madrid Spain
| | - C. Largo
- Department of Experimental Surgery IdiPAZ Hospital La Paz Madrid Spain
| | - M. Javidroozi
- TeamHealth Research Institute TeamHealth Englewood NJ USA
| | - A. Shander
- Departments of Anesthesiology Critical Care and Hyperbaric Medicine Englewood Hospital and Medical Center Englewood NJ USA
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11
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Passmore MR, Obonyo NG, Byrne L, Boon AC, Diab SD, Dunster KR, Fung YL, Spanevello MM, Fauzi MH, Pedersen SE, Simonova G, Anstey CM, Shekar K, Tung JP, Maitland K, Fraser JF. Fluid resuscitation with 0.9% saline alters haemostasis in an ovine model of endotoxemic shock. Thromb Res 2019; 176:39-45. [PMID: 30776686 DOI: 10.1016/j.thromres.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/22/2019] [Accepted: 02/11/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Fluid resuscitation is a cornerstone of severe sepsis management, however there are many uncertainties surrounding the type and volume of fluid that is administered. The entire spectrum of coagulopathies can be seen in sepsis, from asymptomatic aberrations to fulminant disseminated intravascular coagulation (DIC). The aim of this study was to determine if fluid resuscitation with saline contributes to the haemostatic derangements in an ovine model of endotoxemic shock. MATERIALS AND METHODS Twenty-one adult female sheep were randomly divided into no endotoxemia (n = 5) or endotoxemia groups (n = 16) with an escalating dose of lipopolysaccharide (LPS) up to 4 μg/kg/h administered to achieve a mean arterial pressure below 60 mmHg. Endotoxemia sheep received either no bolus fluid resuscitation (n = 8) or a 0.9% saline bolus (40 mL/kg over 60 min) (n = 8). No endotoxemia, saline only animals (n = 5) underwent fluid resuscitation with a 0.9% bolus of saline as detailed above. Hemodynamic support with vasopressors was initiated if needed, to maintain a mean arterial pressure (MAP) of 60-65 mm Hg in all the groups. RESULTS Rotational thromboelastometry (ROTEM®) and conventional coagulation biomarker tests demonstrated sepsis induced derangements to secondary haemostasis. This effect was exacerbated by saline fluid resuscitation, with low pH (p = 0.036), delayed clot initiation and formation together with deficiencies in naturally occurring anti-coagulants antithrombin (p = 0.027) and Protein C (p = 0.001). CONCLUSIONS Endotoxemia impairs secondary haemostasis and induces changes in the intrinsic, extrinsic and anti-coagulant pathways. These changes to haemostasis are exacerbated following resuscitation with 0.9% saline, a commonly used crystalloid in clinical settings.
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Affiliation(s)
- Margaret R Passmore
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | - Nchafatso G Obonyo
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; KEMRI-Wellcome Trust Research Programme, Kenya.
| | - Liam Byrne
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; Intensive Care Unit, The Canberra Hospital, Canberra, Australia.
| | - Ai-Ching Boon
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | - Sara D Diab
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia.
| | - Kimble R Dunster
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia.
| | - Yoke L Fung
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Australia.
| | - Michelle M Spanevello
- University of Queensland, Brisbane, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Mohd H Fauzi
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia.
| | - Sanne E Pedersen
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia.
| | - Gabriela Simonova
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Research and Development, Australian Red Cross Blood Service, Brisbane, Australia.
| | - Chris M Anstey
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; Sunshine Coast University Hospital Intensive Care, Birtinya, Australia.
| | - Kiran Shekar
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia.
| | - John-Paul Tung
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; Research and Development, Australian Red Cross Blood Service, Brisbane, Australia.
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kenya; Wellcome Trust Centre for Clinical Tropical Medicine and Department of Paediatrics, Faculty of Medicine, Imperial College, London, UK.
| | - John F Fraser
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
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12
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Part III: Minimum Quality Threshold in Preclinical Sepsis Studies (MQTiPSS) for Fluid Resuscitation and Antimicrobial Therapy Endpoints. Shock 2019; 51:33-43. [DOI: 10.1097/shk.0000000000001209] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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13
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Passmore MR, Byrne L, Obonyo NG, See Hoe LE, Boon AC, Diab SD, Dunster KR, Bisht K, Tung JP, Fauzi MH, Narula M, Pedersen SE, Esguerra-Lallen A, Simonova G, Sultana A, Anstey CM, Shekar K, Maitland K, Suen JY, Fraser JF. Inflammation and lung injury in an ovine model of fluid resuscitated endotoxemic shock. Respir Res 2018; 19:231. [PMID: 30466423 PMCID: PMC6249903 DOI: 10.1186/s12931-018-0935-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Sepsis is a multi-system syndrome that remains the leading cause of mortality and critical illness worldwide, with hemodynamic support being one of the cornerstones of the acute management of sepsis. We used an ovine model of endotoxemic shock to determine if 0.9% saline resuscitation contributes to lung inflammation and injury in acute respiratory distress syndrome, which is a common complication of sepsis, and investigated the potential role of matrix metalloproteinases in this process. Methods Endotoxemic shock was induced in sheep by administration of an escalating dose of lipopolysaccharide, after which they subsequently received either no fluid bolus resuscitation or a 0.9% saline bolus. Lung tissue, bronchoalveolar fluid (BAL) and plasma were analysed by real-time PCR, ELISA, flow cytometry and immunohistochemical staining to assess inflammatory cells, cytokines, hyaluronan and matrix metalloproteinases. Results Endotoxemia was associated with decreased serum albumin and total protein levels, with activated neutrophils, while the glycocalyx glycosaminoglycan hyaluronan was significantly increased in BAL. Quantitative real-time PCR studies showed higher expression of IL-6 and IL-8 with saline resuscitation but no difference in matrix metalloproteinase expression. BAL and tissue homogenate levels of IL-6, IL-8 and IL-1β were elevated. Conclusions This data shows that the inflammatory response is enhanced when a host with endotoxemia is resuscitated with saline, with a comparatively higher release of inflammatory cytokines and endothelial/glycocalyx damage, but no change in matrix metalloproteinase levels.
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Affiliation(s)
- Margaret R Passmore
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia. .,University of Queensland, Brisbane, Australia.
| | - Liam Byrne
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,Australian National University, Canberra, Australia
| | - Nchafatso G Obonyo
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Louise E See Hoe
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Ai-Ching Boon
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Sara D Diab
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - Kimble R Dunster
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Kavita Bisht
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - John-Paul Tung
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Mohd H Fauzi
- Department of Emergency Medicine, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Monica Narula
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Sanne E Pedersen
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - Arlanna Esguerra-Lallen
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - Gabriela Simonova
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Annette Sultana
- Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Chris M Anstey
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,Sunshine Coast University Hospital Intensive Care, Birtinya, Australia
| | - Kiran Shekar
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Wellcome Trust Centre for Clinical Tropical Medicine and Department of Paediatrics, Faculty of Medicine, Imperial College, London, UK
| | - Jacky Y Suen
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
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14
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Byrne L, Obonyo NG, Diab SD, Dunster KR, Passmore MR, Boon AC, Hoe LS, Pedersen S, Fauzi MH, Pimenta LP, Van Haren F, Anstey CM, Cullen L, Tung JP, Shekar K, Maitland K, Fraser JF. Unintended Consequences: Fluid Resuscitation Worsens Shock in an Ovine Model of Endotoxemia. Am J Respir Crit Care Med 2018; 198:1043-1054. [DOI: 10.1164/rccm.201801-0064oc] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Liam Byrne
- Critical Care Research Group and
- Intensive Care, Canberra Hospital, Garran, Australia
- Australia National University, Canberra, Australia
| | | | | | - Kimble R. Dunster
- Critical Care Research Group and
- Queensland University of Technology, Brisbane City, Australia
| | | | - Ai-Ching Boon
- Critical Care Research Group and
- University of Queensland, Brisbane, Australia
| | - Louise See Hoe
- Critical Care Research Group and
- University of Queensland, Brisbane, Australia
| | | | - Mohd Hashairi Fauzi
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
| | | | - Frank Van Haren
- Intensive Care, Canberra Hospital, Garran, Australia
- Australia National University, Canberra, Australia
- University of Canberra, Bruce, Australia
| | | | - Louise Cullen
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women’s Hospital, Herston, Australia
| | - John-Paul Tung
- Critical Care Research Group and
- Australian Red Cross Blood Service, Brisbane, Australia; and
| | - Kiran Shekar
- Critical Care Research Group and
- Adult Intensive Care, The Prince Charles Hospital, Brisbane, Australia
| | - Kathryn Maitland
- Department of Paediatrics, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - John F. Fraser
- Critical Care Research Group and
- Adult Intensive Care, The Prince Charles Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
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15
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Obonyo NG, Schlapbach LJ, Fraser JF. Sepsis: Changing Definitions, Unchanging Treatment. Front Pediatr 2018; 6:425. [PMID: 30729101 PMCID: PMC6351458 DOI: 10.3389/fped.2018.00425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
The recently revised Sepsis-3 definitions were based on criteria that were derived and validated in adult patient databases from high income countries. Both sepsis and septic shock continue to account for a substantial proportion of mortality globally, especially amongst children in low-and-middle income country settings. It is therefore urgent to develop and validate standardized criteria for sepsis that can be applied to pediatric populations in different settings, including in- and outside intensive care, both in high- and low/middle- income countries. This will be a pre-requisite to evaluate the impact of sepsis treatment strategies to improve clinical outcomes.
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Affiliation(s)
- Nchafatso Gikenyi Obonyo
- IDeAL/KEMRI-Wellcome Trust Research Programme, CGMRC, Kilifi, Kenya.,Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.,Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
| | - Luregn Jan Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia.,Department of Pediatrics, Inselspital Universitätsspital Bern, Bern, Switzerland.,Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - John Francis Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
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16
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What's New in SHOCK, January 2018? Shock 2017; 49:1-3. [PMID: 29251662 DOI: 10.1097/shk.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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