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Zhu Y, Deng H, She H, Zhou Y, Wu Y, Zhang J, Liu L, Tao L. Protective Effect of Moderate Hypotonic Fluid on Organ Dysfunction via Alleviating Lethal Triad Following Seawater Immersion With Hemorrhagic Shock in Rats. Front Physiol 2022; 13:827838. [PMID: 35185622 PMCID: PMC8854799 DOI: 10.3389/fphys.2022.827838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/06/2022] [Indexed: 01/06/2023] Open
Abstract
Previous studies found that seawater immersion combined with hemorrhagic shock (SIHS) induced serious organ function disorder, and lethal triad was a critical sign. There were no effective treatments of SIHS. Fluid resuscitation was the initial measurement for early aid following hemorrhagic shock, while the proper fluid for SIHS is not clear. Effects of different osmotic pressures [lactated Ringer’s (LR) solution, 0.3% saline, 0.6% saline, and 0.9% normal saline] on the lethal triad, mitochondrial function, vital organ functions, and survival were observed following SIHS in rats. The results showed that SIHS led to an obvious lethal triad, which presented the decrease of the body temperature, acidosis, and coagulation functions disorder in rats. Fluid resuscitation with different osmotic pressures recovered the body temperature and corrected acidosis with different levels; effects of 0.6% normal saline were the best; especially for the coagulation function, 0.6% normal saline alleviated the lethal triad significantly. Further studies showed that SIHS resulted in the damage of the mitochondrial function of vital organs, the increase of the vascular permeability, and, at the same time, the organ function including cardiac, liver, and kidney was disordered. Conventional fluid such as LR or 0.9% normal saline could not improve the mitochondrial function and vascular leakage and alleviate the damage of the organ function. While moderate hypotonic fluid, the 0.6% normal saline, could lighten organ function damage via protecting mitochondrial function. The 0.6% normal saline increased the left ventricular fractional shortening and the left ventricular ejection fraction, and decreased the levels of aspartate transaminase, alanine transferase, blood urea nitrogen, and creatinine in the blood. The effects of fluids with different osmotic pressures on the mean arterial pressure (MAP) had a similar trend as above parameters. The survival results showed that the 0.6% normal saline group improved the survival rate and prolonged the survival time, the 72 h survival rate was 7/16, as compared with the LR group (3/16). The results indicate that appropriate hypotonic fluid is suitable after SIHS, which alleviates the lethal triad, protects the mitochondrial function and organ functions, and prolongs the survival time.
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Kuang L, Zhu Y, Wu Y, Peng X, Tian K, Liu L, Li T. Synergetic Effect of 4-Phenylbutyric Acid in Combination with Cyclosporine A on Cardiovascular Function in Sepsis Rats via Inhibition of Endoplasmic Reticulum Stress and Mitochondrial Permeability Transition Pore Opening. Front Pharmacol 2021; 12:770558. [PMID: 34916944 PMCID: PMC8670008 DOI: 10.3389/fphar.2021.770558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Sepsis/septic shock is a common complication in the intensive care unit, and the opening of the mitochondrial permeability transition pore (mPTP), as well as the endoplasmic reticulum stress (ERS), play important roles in this situation. Whether the combination of anti-ERS and anti-mPTP by 4-phenylbutyric acid (PBA) and Cyclosporine A (CsA) could benefit sepsis is unclear. Methods: The cecal ligation and puncture-induced septic shock models were replicated in rats, and lipopolysaccharide (LPS)-challenged primary vascular smooth muscle cells and H9C2 cardiomyocytes in vitro models were also used. The therapeutic effects of CsA, PBA, and combined administration on oxygen delivery, cardiac and vascular function, vital organ injury, and the underlying mechanisms were observed. Results: Septic shock significantly induced cardiovascular dysfunction, hypoperfusion, and organ injury and resulted in high mortality in rats. Conventional treatment including fluid resuscitation, vasoactive agents, and antibiotics slightly restored tissue perfusion and organ function in septic rats. Supplementation of CsA or PBA improved the tissue perfusion, organ function, and survival of septic shock rats. The combined application of PBA and CsA could significantly enhance the beneficial effects, compared with using PBA or CsA alone. Further study showed that PBA enhanced CsA-induced cardiovascular protection, which contributed to better therapeutic effects. Conclusion: Anti-ERS and anti-mPTP-opening by the combination of PBA and CsA was beneficial to septic shock. PBA enforced the CsA-associated cardiovascular protection and contributed to the synergetic effect.
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Affiliation(s)
- Lei Kuang
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yu Zhu
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yue Wu
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaoyong Peng
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Kunlun Tian
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liangming Liu
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Tao Li
- Department of Shock and Transfusion, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Yu JY, Peng JH, Hui L, Huang HQ, Tan MH, Jian G. Association between the effect of controlled fluid resuscitation on massive hemorrhage and expression of human neutrophil lipocalin. Exp Ther Med 2018; 16:3534-3538. [PMID: 30233706 PMCID: PMC6143906 DOI: 10.3892/etm.2018.6591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 07/25/2018] [Indexed: 11/07/2022] Open
Abstract
The present study was designed to investigate the association between the effect of controlled fluid resuscitation on massive hemorrhage and expression of human neutrophil lipocalin (HNL). A total of 112 patients confirmed with traumatic hemorrhage were enrolled as study subjects and were randomly divided into the control group (n=56) and observation group (n=56). The control group was treated with rapid fluid resuscitation, and the observation group was treated with controlled fluid resuscitation. The success rate of resuscitation, incidence rate of complications, and HNL levels were compared both before and after resuscitation at multiple time intervals. The success rate of resuscitation showed a significant improvement while the incidence rate of complications were decreased. The HNL levels in both groups revealed increase after resuscitation at 3–10 h, thereby, they showed decline following peak point. However, the peak reduction in the observation group appeared earlier, while the HNL levels at 24 and 72 h were significantly lower than those in the control group. The study concluded that the effect of controlled fluid resuscitation on massive hemorrhage was superior to that of rapid fluid resuscitation. Moreover, controlled fluid resuscitation was also able to decrease the level of HNL as well as inflammatory response.
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Affiliation(s)
- Jie-Yang Yu
- Intensive Care Unit, People's Hospital of Baise, Baise, Guangxi Zhuang Autonomous Region 533000, P.R. China
| | - Jia-Hua Peng
- Intensive Care Unit, People's Hospital of Baise, Baise, Guangxi Zhuang Autonomous Region 533000, P.R. China
| | - Li Hui
- Intensive Care Unit, People's Hospital of Baise, Baise, Guangxi Zhuang Autonomous Region 533000, P.R. China
| | - Hui-Quan Huang
- Intensive Care Unit, People's Hospital of Baise, Baise, Guangxi Zhuang Autonomous Region 533000, P.R. China
| | - Ming-Hua Tan
- Intensive Care Unit, People's Hospital of Baise, Baise, Guangxi Zhuang Autonomous Region 533000, P.R. China
| | - Guo Jian
- Intensive Care Unit, People's Hospital of Baise, Baise, Guangxi Zhuang Autonomous Region 533000, P.R. China
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Lou X, Lu G, Zhao M, Jin P. Preoperative fluid management in traumatic shock: A retrospective study for identifying optimal therapy of fluid resuscitation for aged patients. Medicine (Baltimore) 2018; 97:e9966. [PMID: 29465593 PMCID: PMC5841965 DOI: 10.1097/md.0000000000009966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Fluid resuscitation was used on aged patients with traumatic shock in their early postoperative recovery. The present study aimed to assess whether different fluid resuscitation strategies had an influence on aged patients with traumatic shock.A total of 219 patients with traumatic shock were recruited retrospectively. Lactated Ringer and hydroxyethyl starch solution were transfused for fluid resuscitation before definite hemorrhagic surgery. Subjects were divided into 3 groups: group A: 72 patients were given aggressive fluid infusion at 20 to 30 mL/min to restore normal mean arterial pressure (MAP) of 65 to 75 mm Hg. Group B: 72 patients were slowly given restrictive hypotensive fluid infusion at 4 to 5 mL/min to maintain MAP of 50 to 65 mm Hg. Group C: 75 patients were given personalized infusion to achieve MAP of 75 to 85 mm Hg. Preoperative infusion volume, preoperative MAP, optimal initial points for surgery, postoperative shock time and mortality rates at 6 and 24 hours after surgery were determined.No significant difference in clinical characteristics was found among the 3 groups. Amount of preoperative infusion was considerably lower in the restrictive group (P < .01, compared with group A). A significant difference in preoperative infusion volume was found between the personalized and other 2 groups (P < .01, compared with groups A and B). Patients in the personalized resuscitation group achieved a higher preoperative MAP (P < .01 compared with Group B; P < .05, compared with group A) and required less prepared time for surgery (P < .01 compared with groups A and B). In addition, a lower mortality rate at 6 and 24 hours after operation was observed in the subjects with personalized therapy (P < .05, compared with group B).Personalized management of fluid resuscitation in traumatized aged patients with appropriate volume and speed of fluid transfusion, suggesting increased survival rate and less prepared time for surgery.
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Affiliation(s)
| | - Guanzhen Lu
- Surgery Department, Huzhou Central Hospital, Huzhou, Zhejiang
| | - Mingming Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
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Chen ZH, Jin CD, Chen S, Chen XS, Wang ZE, Liu W, Lin JC. The application of early goal directed therapy in patients during burn shock stage. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2017; 7:27-33. [PMID: 28695055 PMCID: PMC5498846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
Early goal directed therapy (EGDT) provided at the earliest stages of burn shock, has significant benefits for ordinary burn patients, however, its effect on patients with more than 80% of total surface area burned (TBSA) still remains unclear. In this study, 34 extensively burned patients with (87.3±5.6)% of total surface area burned were collected from January 2008 to January 2014. All burn patients here had similar monitoring or treatment modalities. Of these 34 burn patients, 13 patients were treated with EGDT under pulse indicator continuous cardiac output (PICCO) monitoring, and 21 patients were treated with conventional fluid management. Information obtained in the course of treatment included mean arterial pressure (MAP), central venous oxygen saturation (ScvO2), oxygenation index (PaO2/FiO2), blood lactic acid and urine volume, infusion volume (mL·1% TBSA-1·Kg-1), complications of over-resuscitation (hydrothorax or pulmonary edema), case rate of burn sepsis and fatality. Our results demonstrated that there existed significant difference between the two groups in parameters below: 1. Higher ScvO2 (%) after EGDT (EGDT: 78.1±8.6, CG: 65.5±11.2; t=-3.446, P<0.05), 2. Higher PaO2/FiO2 after EGDT (EGDT: 381.4±56.6, CG: 328.9±48.6; t=2-875, P<0.05), 3. Lower mean infusion volume after EGDT (mL·1% TBSA-1·Kg-1) (EGDT: 3.29±0.26, CG: 3.71±0.31; t=5.292, P<0.05), 4. Lower complications of over-resuscitation after EGDT (EGDT: 2/13, CG: 15/21; P<0.05); However, no statistical significance existed in parameters below: 1. MAP (EGDT: 76.2±13.1, CG: 74.3±15.6; t=-0.36, P>0.05), 2. Urine volume (EGDT: 0.83±0.12, CG: 0.85±0.17; t=0.370, P>0.05), 3. Case of burn sepsis (EGDT: 13/13, CG: 20/21; P=1), 4. Case fatality (EGDT: 1/13, CG: 3/21; P=1). The finding results showed that patients with more than 80% of total surface area burned during burn shock phase could get better outcome from EGDT.
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Affiliation(s)
- Zhao-Hong Chen
- Department of Burns, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
- Fujian Burn Institute, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
| | - Chang-Dan Jin
- Department of Burns, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
- Fujian Burn Institute, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
| | - Shun Chen
- Department of Burns, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
- Fujian Burn Institute, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
| | - Xiao-Song Chen
- Department of Plastic Surgery, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
| | - Zi-En Wang
- Department of Burns, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
- Fujian Burn Institute, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
| | - Wei Liu
- Department of Burns, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
- Fujian Burn Institute, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
| | - Jian-Chang Lin
- Department of Burns, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
- Fujian Burn Institute, Fujian Medical University Union HospitalFuzhou 350001, Fujian, China
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4-Phenylbutyric Acid Reveals Good Beneficial Effects on Vital Organ Function via Anti-Endoplasmic Reticulum Stress in Septic Rats. Crit Care Med 2017; 44:e689-701. [PMID: 26958745 DOI: 10.1097/ccm.0000000000001662] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Sepsis and septic shock are the common complications in ICUs. Vital organ function disorder contributes a critical role in high mortality after severe sepsis or septic shock, in which endoplasmic reticulum stress plays an important role. Whether anti-endoplasmic reticulum stress with 4-phenylbutyric acid is beneficial to sepsis and the underlying mechanisms are not known. DESIGN Laboratory investigation. SETTING State Key Laboratory of Trauma, Burns and Combined Injury. SUBJECTS Sprague-Dawley rats. INTERVENTIONS Using cecal ligation and puncture-induced septic shock rats, lipopolysaccharide-treated vascular smooth muscle cells, and cardiomyocytes, effects of 4-phenylbutyric acid on vital organ function and the relationship with endoplasmic reticulum stress and endoplasmic reticulum stress-mediated inflammation, apoptosis, and oxidative stress were observed. MEASUREMENTS AND MAIN RESULTS Conventional treatment, including fluid resuscitation, vasopressin, and antibiotic, only slightly improved the hemodynamic variable, such as mean arterial blood pressure and cardiac output, and slightly improved the vital organ function and the animal survival of septic shock rats. Supplementation of 4-phenylbutyric acid (5 mg/kg; anti-endoplasmic reticulum stress), especially administered at early stage, significantly improved the hemodynamic variables, vital organ function, such as liver, renal, and intestinal barrier function, and animal survival in septic shock rats. 4-Phenylbutyric acid application inhibited the endoplasmic reticulum stress and endoplasmic reticulum stress-related proteins, such as CCAAT/enhancer-binding protein homologous protein in vital organs, such as heart and superior mesenteric artery after severe sepsis. Further studies showed that 4-phenylbutyric acid inhibited endoplasmic reticulum stress-mediated cytokine release, apoptosis, and oxidative stress via inhibition of nuclear factor-κB, caspase-3 and caspase-9, and increasing glutathione peroxidase and superoxide dismutase expression, respectively. CONCLUSIONS Anti-endoplasmic reticulum stress with 4-phenylbutyric acid is beneficial to septic shock. This beneficial effect of 4-phenylbutyric acid is closely related to the inhibition of endoplasmic reticulum stress-mediated oxidative stress, apoptosis, and cytokine release. This finding provides a potential therapeutic measure for clinical critical conditions, such as severe sepsis.
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Li T, Yang G, Zhu Y, Tzang FC, Lau SH, Kwok SY, Wong BL, Liu L. Beneficial effects of novel cross-linked hemoglobin YQ23 on hemorrhagic shock in rats and pigs. J Surg Res 2016; 210:213-222. [PMID: 28457331 DOI: 10.1016/j.jss.2016.11.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/21/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND To overcome the problems of previously reported hemoglobin-based oxygen carriers, we developed a stabilized nonpolymeric cross-linked tetrameric hemoglobin solution (YQ23). The aims of this study were to investigate the oxygen carrying and releasing properties of this novel hemoglobin-based oxygen carrier and to determine whether it has beneficial effects for hemorrhagic shock. METHODS Using a hemorrhagic shock model in Sprague-Dawley rats and mini-pigs, we tested the effects of infusing 0.1, 0.3, and 0.5 g/kg YQ23 on animal survival, tissue oxygen delivery (DO2) and consumption (VO2), hemodynamics parameters, and liver, renal, and cardiac function. RESULTS YQ23 infusion increased the survival rate of rats and pigs with severe hemorrhagic shock in a dose-dependent manner. Moreover, it improved the hemodynamic parameters, cardiac output, DO2 and VO2, and the mitochondrial respiratory function of vital organs. Among the three doses of YQ23, 0.5 gHb/kg YQ23 achieved a similar beneficial effect as whole blood. CONCLUSIONS This study indicated that the novel cross-linked tetrameric hemoglobin YQ23 has good oxygen carrying and releasing properties and exhibits beneficial effects on hemorrhagic shock in rats and pigs by improving the oxygen carrying and delivery function of blood, which maintains organ function.
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Affiliation(s)
- Tao Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Guangming Yang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Yu Zhu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P.R. China
| | | | | | - Sui-Yi Kwok
- New B Innovation Limited, Hong Kong, P.R. China
| | - Bing L Wong
- New B Innovation Limited, Hong Kong, P.R. China
| | - Liangming Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P.R. China.
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Gradually Increased Oxygen Administration Improved Oxygenation and Mitigated Oxidative Stress after Resuscitation from Severe Hemorrhagic Shock. Anesthesiology 2016; 123:1122-32. [PMID: 26352377 DOI: 10.1097/aln.0000000000000859] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The optimal oxygen administration strategy during resuscitation from hemorrhagic shock (HS) is still controversial. Improving oxygenation and mitigating oxidative stress simultaneously seem to be contradictory goals. To maximize oxygen delivery while minimizing oxidative damage, the authors proposed the notion of gradually increased oxygen administration (GIOA), which entails making the arterial blood hypoxemic early in resuscitation and subsequently gradually increasing to hyperoxic, and compared its effects with normoxic resuscitation, hyperoxic resuscitation, and hypoxemic resuscitation in severe HS. METHODS Rats were subjected to HS, and on resuscitation, the rats were randomly assigned to four groups (n = 8): the normoxic, the hyperoxic, the hypoxemic, and the GIOA groups. Rats were observed for an additional 1 h. Hemodynamics, acid-base status, oxygenation, and oxidative injury were observed and evaluated. RESULTS Central venous oxygen saturation promptly recovered only in the hyperoxic and the GIOA groups, and the liver tissue partial pressure of oxygen was highest in the GIOA group after resuscitation. Oxidative stress in GIOA group was significantly reduced compared with the hyperoxic group as indicated by the reduced malondialdehyde content, increased catalase activity, and the lower histologic injury scores in the liver. In addition, the tumor necrosis factor-α and interleukin-6 expressions in the liver were markedly decreased in the GIOA group than in the hyperoxic and normoxic groups as shown by the immunohistochemical staining. CONCLUSIONS GIOA improved systemic/tissue oxygenation and mitigated oxidative stress simultaneously after resuscitation from severe HS. GIOA may be a promising strategy to improve resuscitation from HS and deserves further investigation.
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Duan C, Li T, Liu L. Efficacy of limited fluid resuscitation in patients with hemorrhagic shock: a meta-analysis. Int J Clin Exp Med 2015; 8:11645-11656. [PMID: 26380001 PMCID: PMC4565384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/20/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUNDS The objective of this meta-analysis was to evaluate the efficacy of limited fluid resuscitation during active hemorrhage compared with regular fluid resuscitation and provide strong evidences for the improvement of fluid resuscitation strategies in uncontrolled hemorrhagic shock. METHODS Electronic searches were performed using PubMed, Medline, Embase and CNKI in accordance with pre-set guidelines. Clinical trials and observation studies were included or excluded according to the criteria. The endpoints examined were mortality, hemoglobin (Hb), platelets (PLT), hematocrit (Hct), prothrombin Time (PT), activated partial thromboplastin time (APTT), base excess (BE), blood lactic acid (BLA) and the main complications, such as multiple organ dysfunction syndrome (MODS) and acute Respiratory Distress Syndrome (ARDS). Risk ratios (RR), mean differences (MDs) and 95% confidence intervals (95% Cl) were calculated using fixed/random effect model. RESULTS The search indentified 11 studies including 1482 subjects. 725 hemorrhagic patients were treated with limited fluid resuscitation while 757 patients undertook regular fluid resuscitation during active hemorrhage. Limited fluid resuscitation had its advantage to reduce the mortality in hemorrhagic shock (RR = 0.67; 95% CI = 0.56-0.81; P < 0.0001) and easily controlled the blood routine index close to normal compared with regular fluid resuscitation (Hb: MD = 13.04; 95% CI = 2.69-23.38; P = 0.01. PLT: MD = 23.16; 95% CI = 6.41-39.91; P = 0.007. Hct: MD = 0.02; 95% CI = 0.02-0.03; P < 0.00001). LFR also had shorter PT and APTT compared with RFR (PT: MD = -2.81; 95% CI = -3.44--2.17; P < 0.00001 and APTT: MD = -5.14; 95% CI = -6.16--4.12; P < 0.00001). As for blood gas analysis, LFR reduced the decrease of BE (MD = 2.48; 95% CI = 1.11-3.85; P = 0.0004) and increase of BLA (MD = -0.65; 95% CI = -0.85--0.44; P < 0.00001). Besides, LFR may also reduce the occurrence of postoperative complications (MODS: RR= 0.37; 95% CI = 0.21-0.66; P = 0.0008. ARDS: RR = 0.35; 95% CI = 0.21-0.60; P < 0.0001). CONCLUSION The results provide convincing evidence that support the continued investigation and use of limited fluid resuscitation during active hemorrhage in the trauma setting.
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Affiliation(s)
- Chenyang Duan
- Department of Research Institute of Surgery, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University Chongqing 400042, P. R. China
| | - Tao Li
- Department of Research Institute of Surgery, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University Chongqing 400042, P. R. China
| | - Liangming Liu
- Department of Research Institute of Surgery, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University Chongqing 400042, P. R. China
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Hypotensive resuscitation in combination with arginine vasopressin may prolong the hypotensive resuscitation time in uncontrolled hemorrhagic shock rats. J Trauma Acute Care Surg 2015; 78:760-6. [PMID: 25742254 DOI: 10.1097/ta.0000000000000564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The optimal resuscitation strategy for traumatic hemorrhagic shock is not completely determined. The objective of the present study was to investigate whether hypotensive resuscitation in combination with arginine vasopressin (AVP) can prolong the hypotensive resuscitation time by minimizing blood loss and stabilizing hemodynamics for uncontrolled hemorrhagic shock. METHODS With an established rat model of uncontrolled hemorrhagic shock, we compared the beneficial effects of hypotensive resuscitation in combination with AVP to maintain blood pressure at 50 mm Hg for 3 hours to hypotensive resuscitation alone on animal survival, blood loss, and vital organ functions. RESULTS Hypotensive resuscitation in combination with AVP maintenance for 3 hours significantly reduced total blood loss and fluid requirement during hypotensive resuscitation period and significantly improved the survival of shock rats as compared with hypotensive resuscitation alone. Among the four concentrations of AVP, 5 × 10 U/mL had the best effect: it significantly improved hemodynamics and increased cardiac function, oxygen delivery, as well as hepatic blood flow and hepatic function in the shock rats. However, renal blood flow in the hypotensive resuscitation + AVP group was lower than that in the hypotensive resuscitation alone group. CONCLUSION Hypotensive resuscitation in combination with early application of AVP could prolong the tolerance time of hypotensive resuscitation and "buy" longer safe prehospital transport time by reducing blood loss and stabilizing hemodynamics. This strategy may be a promising strategy for the early management of trauma patients with active bleeding.
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Liu S, Li T, Yang G, Hu Y, Xiao X, Xu J, Zhang J, Liu L. Protein markers related to vascular responsiveness after hemorrhagic shock in rats. J Surg Res 2015; 196:149-58. [PMID: 25801977 DOI: 10.1016/j.jss.2015.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/27/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vascular hyporesponsiveness is an important pathophysiological feature of some critical conditions such as hemorrhagic shock. Many proteins and molecules are involved in the regulation of the pathologic process, however the mechanism has still remained unclear. Our study was intended to look for the related protein markers involved in the regulation of vascular reactivity after hemorrhagic shock. METHODS Differential in-gel electrophoresis and tandem mass spectrometry were applied to quantify the differences of protein expression in the superior mesenteric arteries from hemorrhagic shock and normal rats. RESULTS A total of 2317 differentially expressed protein spots in the superior mesenteric arteries of rats before and after hemorrhagic shock were found, and 146 protein spots were selected for tandem mass spectrometry identification. Thirty-seven differentially expressed proteins were obtained, including 3 uncharacterized proteins and 34 known proteins. Among them, heat shock protein beta-1 and calmodulin were the known proteins involved in the occurrence of vascular hyporesponsiveness. Bioinformatics analysis results showed that 18 proteins were related to vasoconstriction, 11 proteins may be involved in other vascular functions such as regulation of angiogenesis and endothelial cell proliferation. CONCLUSIONS The changes of vascular responsiveness after hemorrhagic shock in rats may be associated with the upregulation or downregulation of previously mentioned protein expressions. These findings may provide the basis for understanding and further study of the mechanism and treatment targets of vascular hyporeactivity after shock.
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Affiliation(s)
- Shangqing Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China; Experimental Teaching Centre of Human Anatomy, School of Basic Medical Sciences, North Sichuan Medical College, Nangchong, Sichuan, P. R. China
| | - Tao Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Guangming Yang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Yi Hu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Xudong Xiao
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Jin Xu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Jie Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Liangming Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China.
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Hwabejire JO, Nembhard CE, Oyetunji TA, Seyoum T, Abiodun MP, Siram SM, Cornwell EE, Greene WR. Age-related mortality in blunt traumatic hemorrhagic shock: the killers and the life savers. J Surg Res 2015; 213:199-206. [PMID: 28601315 DOI: 10.1016/j.jss.2015.04.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/16/2015] [Accepted: 04/15/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are sparse data on the association between age and mortality in hemorrhagic shock (HS). We examined this association in this study. MATERIALS AND METHODS The Glue Grant database was analyzed. Patients aged ≥16 y with blunt traumatic HS were stratified into eight age groups (16-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and ≥85 y) to identify the mortality inflection point. Subsequently, patients were restratified into young age (16-44 y), middle age (45-64 y), and elderly (≥65 y). Multivariate analysis was used to determine predictors of mortality by group. RESULTS A total of 1976 patients were included, with mortality of 16%. Mortality by initial age group is as follows: 16-24 (13.0%), 25-34 (11.9%), 35-44 (11.9%), 45-54 (15.6%), 55-64 (15.7%), 65-74 (20.3%), 75-84 (38.2%), and ≥85 y (51.6%), delineating 65 y as the mortality inflection point. Overall, 55% were young, 30% middle age, and 15% elderly. Predictors of mortality in the young include multiple-organ dysfunction score (MODS; odds ratio [OR]: 1.93, confidence interval [CI]: 1.62-2.30), emergency room lactate (OR: 1.14, CI: 1.02-1.27), injury severity score (OR: 1.06, CI: 1.03-1.09), and cardiac arrest (OR: 10.60, CI: 3.05-36.86). Predictors of mortality in the middle age include MODS (OR: 1.38, CI: 1.24-1.53), cardiac arrest (OR: 12.24, CI: 5.38-27.81), craniotomy (OR: 5.62, CI: 1.93-16.37), and thoracotomy (OR: 2.76, CI: 1.28-5.98). In the elderly, predictors of mortality were age (OR: 1.07, CI: 1.02-1.13), MODS (OR: 1.47, CI: 1.26-1.72), laparotomy (OR: 2.04, CI: 1.02-4.08), and cardiac arrest (OR: 11.61, CI: 4.35-30.98). Open fixation of nonfemoral fractures was protective against mortality in all age groups. CONCLUSIONS In blunt HS, mortality parallels increasing age, with the inflection point at 65 y. MODS and cardiac arrest uniformly predict mortality across all age groups. Craniotomy and thoracotomy are associated with mortality in the middle age, whereas laparotomy is associated with mortality in the elderly.
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Affiliation(s)
- John O Hwabejire
- Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia
| | - Christine E Nembhard
- Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Theodros Seyoum
- Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia
| | - Mayowa P Abiodun
- Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia
| | - Suryanarayana M Siram
- Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia
| | - Edward E Cornwell
- Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia
| | - Wendy R Greene
- Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia.
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