China
Africa
Explore chapters and articles related to this topic
ICU Issues with Abdominal and Pelvic Trauma
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Allison J. Tompeck, Ara J. Feinstein
Not infrequently, patients with combined abdomino-pelvic trauma have ongoing resuscitation needs without evidence of ongoing bleeding or serious organ injury. Traumatic shock (TS), also known as vasoplegic syndrome (VS), describes a state of persistent hypotension, normal or increased cardiac output, and decreased systemic vascular resistance [8, 9]. A key component of this clinical diagnosis is the absence of alternative etiologies such as sepsis, uncontrolled hemorrhage, missed injuries, abdominal compartment syndrome, or hypovolemia. Risk factors shown to increase the incidence of TS include blood transfusion, pelvic or long bone fractures, burns over a significant body surface area, traumatic injuries with an elevated injury severity score (ISS), and conditions with significant systemic inflammation such as pancreatitis. The exact pathogenesis is unclear. It is likely due to the presence of overlapping mechanistic pathways affecting vascular reactivity, which clinically culminate in persistent failure of vascular homeostasis [8, 9]. The persistent hypotension of TS uniquely results in oliguria yet normal capillary refill and oxygen arterial saturation [8].
Transfusion practice in resuscitation and critical illness
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
The crystalloid school of thought is based on the concept that reduced extracellular water is the primary defect in shock states. Before the Second World War, Collier et al30 and Blalock31 advocated the administration of large volumes of saline and glucose in the treatment of traumatic shock. In the 1950s and 1960s, Moyer32 and Shires,33–36 amongst others, used large volumes of sodium-rich solutions. Crystalloid supporters recommend the use of adequate volumes of isotonic fluids (Ringer’s lactate or isotonic saline) to replace the deficit due to both intravascular and extracellular fluid losses in shock states. There are numerous experimental studies that support the presence of extracellular water losses in excess of the measured plasma volume losses and increased intracellular water resulting from leakage of fluid into the intracellular compartment during shock. However, other investigators have criticized the methods used to measure extracellular water in these studies, and have failed to reproduce the results of these studies.37
Hypercoagulable State in Trauma Patients
Published in Pia Glas-Greenwalt, Fibrinolysis in Disease Molecular and Hemovascular Aspects of Fibrinolysis, 2019
The majority of patients demonstrated suppressed plasminogen activator activity by the fibrin plate method.12,20 A marked short-term elevation in plasminogen activator inhibitor 1 (PAI-1) has been observed 6 to 12 h after trauma with only about 1/10 of the increase left at 24 h.21 Other authors22 have reported fairly normal PAI values after major traumatic shock. It seems that the stimulation of PAI-1 synthesis occurs in the early phase after trauma. Because of the rapid blood clearance, t-PA inhibition presents a rapidly changing pattern in response to trauma. This depression of fibrinolysis has to be interpreted as a lower capacity to challenge the hypercoagulable state usually present in these patients.
Bicarbonated Ringer’s solution improves L-arg-induced acute pancreatitis in rats via the NF-κB and Nrf2 pathways
Published in Scandinavian Journal of Gastroenterology, 2023
Bicarbonated Ringer’s solution is a new type of crystalloid solution compound preparation of multiple electrolytes, such as sodium, potassium, magnesium and calcium ions [6]. It is mainly used for the supplementation and correction of extracellular fluid when circulating blood flow and interstitial fluid decrease, the maintenance and supplementation of water and electrolyte balance in the human body, and the correction of metabolic acidosis. BRS also acts as a unique NaHCO3-based buffer system and is expected to exhibit a prompt alkalinizing effect through the direct production of HCO3− from NaHCO3 without any intervening metabolic process and reaction with bivalent cations [7]. The components and compositions of LRS and BRS are given in Table 1. A recent study suggested that sodium bicarbonated Ringer’s solution is effective in early resuscitation for patients with multiple severe injuries and traumatic shock by improving coagulation function and lactic acid metabolism, reducing the risk of related complications and improving clinical outcomes of patients [8].
Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients
Published in Current Medical Research and Opinion, 2020
For traumatic shock, delayed hemorrhage control and excessive use of crystalloids for preloading are recognized as modifiable predictors of highly lethal hyperacute organ failure (respiratory, renal, and cardiac) due to increased abdominal pressure26. Moving away from the decades-old approach of large-volume resuscitation with crystalloids, characterized by edema formation and weight gain, substantially reduced the rate of postinjury abdominal compartment syndrome and morbidity in this indication26,27. However, increased body weight is still common following major surgery, and in the acute phase of critical illness can persist for several days; it is typically ascribed to the inflammatory stress response in combination with liberal use of fluid therapy28,29. The extent to which the kidneys retain or excrete fluid in the pathophysiology of injury may be particularly relevant for this increase in body weight due to edema formation28.