Abstract:
OBJECTIVE:To define the impact of prehospital hypotension on the dynamic, systemic acute inflammatory response to blunt trauma. DESIGN:Retrospective study. SETTINGS:Tertiary care institution. PATIENTS:Twenty-two hypotensive blunt trauma patients matched with 28 normotensive blunt trauma patients. INTERVENTION:None. MEASUREMENTS AND MAIN RESULTS:From a cohort of 472 blunt trauma survivors studied following institutional review board approval, two stringently matched subcohorts were derived. Twenty-two patients who sustained prehospital hypotension following blunt trauma (15 males and 7 females; age, 45 ± 3.8; Injury Severity Score, 20.7 ± 1.8) were matched with 28 normotensive trauma patients (20 males and 8 females; age, 46.1 ± 2.5; Injury Severity Score, 20.8 ± 1.3). Serial blood samples (three samples within the first 24 hr and then from days 1 to 7 postinjury) were assessed for 24 inflammatory mediators using Luminex, and No2-/No3- was measured using the nitrate reductase/Griess assay. Two-way analysis of variance was used to compare groups. Dynamic Bayesian Network inference was used to infer causal relationships based on probabilistic measures. Statistically significant differences were observed in ICU length of stay, total length of stay, days on mechanical ventilator, and Marshall Multiple Organ Dysfunction score between hypotensive and normotensive patients. Shock markers (shock index, pH, lactate, and base deficit) were significantly altered in hypotensive patients. Plasma levels of chemokines (monocyte chemotactic protein-1/CCL2, inducible protein-10/CXCL10, macrophage inflammatory protein-1α/CCL3, and interleukin-8/CCL8) and cytokines (interleukin-6, interleukin-10, interleukin-17, granulocyte-macrophage colony-stimulating factor, interleukin-1β, and interleukin-7) as well as soluble interleukin-2 receptor-α were significantly elevated over the first 7 days postinjury in the hypotensive versus normotensive patients. Dynamic Bayesian Network suggested that the chemokines monocyte chemotactic protein-1/CCL2 and monokine induced by gamma interferon/CXCL9 in the hypotensive and normotensive patients, respectively, affect plasma interleukin-6 levels differentially in the initial 24 hours postinjury. CONCLUSIONS:Studies in stringently matched patient cohorts suggest that an episode of prehospital hypotension post trauma leads to early, dynamic reprogramming of systemic inflammation (including differential upstream regulation of interleukin-6), which is associated with worse outcomes.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Almahmoud K,Namas RA,Zaaqoq AM,Abdul-Malak O,Namas R,Zamora R,Sperry J,Billiar TR,Vodovotz Ydoi
10.1097/CCM.0000000000000964subject
Has Abstractpub_date
2015-07-01 00:00:00pages
1395-404issue
7eissn
0090-3493issn
1530-0293journal_volume
43pub_type
杂志文章abstract:OBJECTIVES:Carbon monoxide poisoning affects 50,000 per year in the United States alone. Mortality is approximately 3%, and up to 40% of survivors suffer from permanent neurocognitive and affective deficits. Hyperbaric oxygen therapy has shown benefit on reducing the long-term neurologic sequelae of carbon monoxide poi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003135
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVE:Emergency preservation and resuscitation (EPR) comprise a novel approach for resuscitation of exsanguination cardiac arrest victims. EPR uses a cold aortic flush to induce deep hypothermic preservation, followed by resuscitation with cardiopulmonary bypass. Development of a rat EPR model would enable study of...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000253398.61666.0D
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that PaCO2 levels generated during permissive hypercapnia may enhance arterial oxygenation, when ventilation is maintained. DESIGN:Prospective study. SETTING:Research laboratory in a hospital. SUBJECTS:One group of eight mongrel dogs (four male; four female). INTERVENTIONS:The dogs ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199811000-00030
更新日期:1998-11-01 00:00:00
abstract:OBJECTIVES:The mortality outcome of mechanical ventilation, a key intervention in the critically ill, has been variously reported to be determined by intensive care patient volume. We determined the volume-(mortality)-outcome relationship of mechanically ventilated patients whose records were contributed to the Austral...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318236f2af
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:This study tested the hypothesis that interruption of the renin-angiotensin system with either an angiotensin-converting enzyme inhibitor or a mineralocorticoid receptor antagonist will decrease the prevalence of atrial fibrillation after cardiac surgery. DESIGN:Randomized double-blind placebo-controlled stu...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0b013e31825b8be2
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVE:To perform an analysis of the quality of life of survivors after ICU discharge. DESIGN:Prospective study. SETTING:Medical-surgical ICU of a Spanish reference hospital. PATIENTS:Patients (n = 606) admitted in a 6-month period. METHOD:A questionnaire regarding quality of life issues was completed at the tim...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199209000-00012
更新日期:1992-09-01 00:00:00
abstract:OBJECTIVES:We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004709
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:To compare intraosseous with central venous blood samples for biochemical analyses and hemoglobin levels during cardiopulmonary resuscitation (CPR) and during cardiopulmonary resuscitation with infusion of sodium bicarbonate, epinephrine, and saline boluses through the intraosseous site. DESIGN:Prospective, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199906000-00039
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVES:Milrinone is a phosphodiesterase F-III inhibitor with positive inotropic and vasodilating activities. We investigated the hemodynamic response and pharmacokinetics of intravenous milrinone in patients with acute heart failure. DESIGN:Double-blind studies: a prospective, multicenter, double-blind, dose-findi...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/00003246-199609000-00010
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVES:To determine the reliability of volitional and nonvolitional limb muscle strength assessment in critically ill patients and to provide guidelines for the implementation of limb muscle strength assessment this population. DATA SOURCES:The following computerized bibliographic databases were searched with MeSH...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0000000000000030
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVES:To determine the incidence of enteral feed intolerance, identify factors associated with enteral feed intolerance, and assess the relationship between enteral feed intolerance and key nutritional and clinical outcomes in critically ill patients. DESIGN:Analysis of International Nutrition Survey database col...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004712
更新日期:2021-01-01 00:00:00
abstract::Intermittent Mandatory Ventilation (IMV) provides an alternative method of support to assisted and controlled mechanical ventilation in neonates with acute respiratory failure. Specific advantages include the use of only the level of mechanical support which is required on an individual basis. Because intrapleural pre...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197701000-00004
更新日期:1977-01-01 00:00:00
abstract:OBJECTIVES:Preliminary studies have suggested that low doses of corticosteroids might rapidly improve hemodynamics in late septic shock treated with catecholamines. We examined the effect of hydrocortisone on shock reversal, hemodynamics, and survival in this particular setting. DESIGN:Prospective, randomized, double-...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-199804000-00010
更新日期:1998-04-01 00:00:00
abstract::Patients (n = 158) who had been respirator-treated and who could remember the treatment were retrospectively (after greater than 2 months) interviewed about their experiences. Of all patients, 47% had felt anxiety and/or fear during the treatment. These feelings were intimately related to the experience of agony/panic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198910000-00021
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:To determine whether the supplementation of parenteral nutrition with ω-3 fatty acids confers treatment benefits to critically ill adult patients. DATA SOURCE:We performed computerized searches for relevant articles from 1996 to June 2011 on MEDLINE, EMBASE, and the Cochrane register of controlled trials and...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0b013e3182657578
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVES:To create a novel tool to predict favorable neurologic outcomes during ICU stay among children with critical illness. DESIGN:Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with favorable neurologic outcomes. A mixed effects logistic regressio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002753
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients. DESIGN:Retrospective analysis of all subarachnoid hemorrhage admissions. SETTINGS:Neurocritical care unit. PATIENTS:All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014. INTERVENTIO...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002497
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVES:To quantitate duplex Doppler measurements of splanchnic perfusion to determine if these measurements are reproducible in euvolemic humans and if such measurements are sensitive to mild degrees of systemic hypovolemia. DESIGN:Prospective, nonrandomized, controlled trial. SETTING:Clinical research center. P...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199503000-00013
更新日期:1995-03-01 00:00:00
abstract:OBJECTIVE:Unplanned readmission of hospitalized patients to an intensive care unit (ICU) is associated with a worse outcome, but our ability to identify who is likely to deteriorate after ICU dismissal is limited. The objective of this study is to develop and validate a numerical index, named the Stability and Workload...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0B013E318164E3B0
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:Insulin reduces morbidity and mortality among critically ill patients, but the molecular mechanisms of its effect remain unknown. Insulin is a well-known inhibitor of glycogen synthase kinase-3, which may play an important role in systemic inflammation and shock. Here we investigate the role of blood glucose ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000215457.83953.E3
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:Increased cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) patterns were shown to characterize the physiologic status of surviving high-risk surgical patients, and indicate increased metabolic needs; relatively normal DO2 and VO2 values were found to characterize the sequential pattern of n...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199105000-00014
更新日期:1991-05-01 00:00:00
abstract:OBJECTIVES:Secretoneurin is associated with cardiomyocyte Ca handling and improves risk prediction in patients with acute myocardial dysfunction. Whether secretoneurin improves risk assessment on top of established cardiac biomarkers and European System for Cardiac Operative Risk Evaluation II in patients undergoing ca...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003670
更新日期:2019-05-01 00:00:00
abstract::Oral amiodarone's slow absorption handicaps rapid treatment of life-threatening arrhythmias. We used iv amiodarone to treat ten patients with hemodynamically significant atrial arrhythmias and life-threatening ventricular arrhythmias refractory to all conventional medical treatment. Arrhythmias were controlled in nine...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198509000-00012
更新日期:1985-09-01 00:00:00
abstract:OBJECTIVE:Levosimendan is a novel inodilator that improves cardiac contractility by sensitizing troponin C to calcium. This drug has proved to be effective in treating advanced congestive heart failure but has not been evaluated in septic settings. The purpose of the present study was to study the effects of this drug ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200111000-00022
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the relationship of patient care variables to survival and functional outcome in the pediatric population with traumatic brain injury. DESIGN:Retrospective chart review. SETTING:A 16-bed pediatric critical care unit in an academic community children's hospital. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200207000-00038
更新日期:2002-07-01 00:00:00
abstract::The right atrial pressure (Pra) was compared to the pulmonary capillary wedge pressure (Pcw) in 54 patients. In patients with heart disease, the correlation of Pra with Pcw was poor. However, in patients without clinical heart disease, Pra approximated Pcw, in both absolute number and change. This finding was independ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197805000-00010
更新日期:1978-05-01 00:00:00
abstract:OBJECTIVE:To describe the symptom experiences of family members of patients at high risk for dying in the intensive care unit and to assess risk factors associated with higher symptom burden. DESIGN:Prospective, cross-sectional study. SETTING:Three intensive care units at a large academic medical center. PARTICIPANT...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e3181cf6d94
更新日期:2010-04-01 00:00:00
abstract:OBJECTIVE:To investigate relationships between acute adrenergic stress, plasma catecholamine concentrations, and beta 2-adrenergic receptors. DESIGN:Prospective, descriptive study. SETTING:Emergency medical service at a university hospital. PATIENTS:Twenty-seven patients with out-of-hospital cardiac arrest (n = 11),...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199704000-00015
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:Subarachnoid hemorrhage results in significant long-lasting neurologic sequelae. Here, we investigated whether human albumin improves long-term outcomes in experimental subarachnoid hemorrhage and whether neurovascular remodeling is involved in the protection of albumin. DESIGN:Laboratory investigation. SET...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001193
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVE:Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its effi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000065270.53951.9E
更新日期:2003-05-01 00:00:00