Abstract:
OBJECTIVE:Cardiac surgery, especially when employing cardiopulmonary bypass and deep hypothermic circulatory arrest, is associated with systemic inflammatory responses that significantly affect morbidity and mortality. Intestinal perfusion abnormalities have been implicated in such responses, but the mechanisms linking local injury and systemic inflammation remain unclear. Intestinal mast cells are specialized immune cells that secrete various preformed effectors in response to cellular stress. We hypothesized that mast cells are activated in a microenvironment shaped by intestinal ischemia/reperfusion, and investigated local and systemic consequences. DESIGN:Rat model of deep hypothermic circulatory arrest. SETTING:University research laboratory. SUBJECTS:Twelve- to 14-week-old male Sprague-Dawley rats. INTERVENTIONS:Rats were anesthetized and cooled to 16°C to 18°C on cardiopulmonary bypass before instituting deep hypothermic circulatory arrest for 45 minutes. Specimens were harvested following rewarming and 2 hours of recovery. MEASUREMENTS AND MAIN RESULTS:Significant intestinal barrier disruption was found, together with macro- and microscopic evidence of ischemia/reperfusion injury in ileum and colon, but not in the lungs or kidneys. Immunofluorescence and toluidine blue staining revealed increased numbers of mast cells and their activation in the gut. In animals pretreated with the mast cell stabilizer, cromolyn sodium, mast cell degranulation was blocked, and intestinal morphology and barrier function were preserved following deep hypothermic circulatory arrest. Furthermore, cromolyn sodium treatment was associated with reduced intestinal neutrophil influx and blunted systemic release of proinflammatory cytokines. CONCLUSION:Our data provide primary evidence that intestinal ischemia/reperfusion is a leading pathophysiologic process in a rat model of deep hypothermic circulatory arrest, and that intestinal injury, and local and systemic inflammatory responses are critically dependent on mast cell activation. This identifies intestinal mast cells as central players in deep hypothermic circulatory arrest-associated responses, and opens novel therapeutic possibilities for patients undergoing this procedure.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Karhausen J,Qing M,Gibson A,Moeser AJ,Griefingholt H,Hale LP,Abraham SN,Mackensen GBdoi
10.1097/CCM.0b013e31827cac7asubject
Has Abstractpub_date
2013-09-01 00:00:00pages
e200-10issue
9eissn
0090-3493issn
1530-0293journal_volume
41pub_type
杂志文章abstract:OBJECTIVE:In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious pr...
journal_title:Critical care medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.1097/01.CCM.0000050454.01978.3B
更新日期:2003-04-01 00:00:00
abstract::Patient awareness of intermittent positive-pressure ventilation (IPPV) treatment in the ICU was studied in 304 patients. These ICU patients were divided into three groups: those treated for internal medical diseases (IMD; n = 129), patients admitted after major surgical procedures (MSP; n = 126), and patients treated ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198901000-00006
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVES:To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge. DESIGN:Mixed-method design with a qualitative study embedded in a single-center randomized study. SETTING:Twelve-bed medical-surgical IC...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000001632
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVES:To perform a complete immunological characterization of compensatory anti-inflammatory response syndrome in patients with sepsis and to explore the relationship between these changes and clinical outcomes of 28-day mortality and secondary infections. DESIGN:Prospective single-center study conducted between ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000100
更新日期:2014-04-01 00:00:00
abstract::Recent strides in computational biology and high-throughput technologies have generated considerable interest in understanding complex biological systems. The application of these technologies to critical illness and injury offers the potential to define adaptive and maladaptive programs of gene expression induced by ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/ccm.0b013e318186a720
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:Delayed surfactant treatment (>2 hrs after birth) is less effective than early treatment in conventionally ventilated preterm infants with respiratory distress syndrome. The objective of this study was to evaluate if this time-dependent efficacy of surfactant treatment is also present during open lung ventila...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000243794.09377.96
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVES:Targeted temperature management has been shown to improve survival with good neurological outcome in patients after out-of-hospital cardiac arrest. The optimal approach to inducing and maintaining targeted temperature management, however, remains uncertain. The objective of this study was to evaluate these p...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000000551
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVES:Despite having dysregulated iron metabolism, critically ill patients may receive exogenous iron for the treatment of anemia. Iron is associated with increased tissue apoptosis and may facilitate bacterial growth. We hypothesized that exogenous iron administration given after the onset of sepsis would lead to...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000124878.02614.4c
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVES:To characterize the rates of accidental removal of endotracheal tubes, nasogastric tubes, central venous catheters, and arterial catheters. To assess the efficacy of corrective measures aimed at reducing the accidental removal of these devices. DESIGN:Prospective, observational, and interventional study. S...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200001000-00010
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broa...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181eb3ccd
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:To examine the hypothesis that heat stress applied after the administration of bacterial endotoxin is protective. DESIGN:Prospective, randomized, laboratory study. SETTING:University research laboratory. SUBJECTS:One hundred eleven adult male Sprague-Dawley rats (weight range 250 to 400 g). INTERVENTIONS:...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199710000-00025
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:This study evaluates the ability of perflubron to inhibit pulmonary neutrophil accumulation during partial liquid ventilation (PLV) in the setting of acute lung injury. DESIGN:Randomized, controlled, nonblinded study. SETTING:Research laboratory at a university. SUBJECTS:Male, Sprague-Dawley rats (n = 120,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199810000-00028
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVE:To review published studies of the influence of platelet factor 4 (PF4) and other cationic proteins on the generation of activated protein C (APC) by the thrombomodulin-protein C system. DATA SOURCE:Using the PubMed citation index, literature published from 1973 to 2003 regarding cationic proteins, PF4, and ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000126359.92825.e9
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVES:To determine the incidence and epidemiologic characteristics of cardiac arrests among tracheal intubations in PICUs. DESIGN:Retrospective cohort study of prospectively collected data. SETTING:Twenty-five diverse PICUs. PATIENTS:Critically ill children requiring tracheal intubation in PICUs. INTERVENTIONS...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001741
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVES:To test the hypothesis that after cecal ligation and puncture in the rat, there is increased expression of the tumor necrosis factor (TNF)/interleukin-1-dependent, acute-phase reactant alpha 1-acid glycoprotein in the liver, and that this change correlates temporally with increased abundance of TNF-alpha in ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199612000-00004
更新日期:1996-12-01 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 examine the pulmonary and cardiac function of children who survived an episode of acute hypoxemic respiratory failure. DESIGN:Descriptive cohort analysis. SETTING:Pediatric clinical research center of a university hospital. PATIENTS:Utilizing the criteria of PaO2 < 75 torr (< 10 kPa) with an FIO2 of > 0...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199601000-00024
更新日期:1996-01-01 00:00:00
abstract::Subcutaneous, transcutaneous, and conjunctival oxygen tensions (PscO2, PtcO2, and PcjO2, respectively) were measured in anesthetized dogs subjected sequentially to normoxia, hyperoxia, and hypoxia. Intravascular pressure, hemodynamic and oxygen transport variables were measured simultaneously. PtcO2 and PcjO2 closely ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198812000-00011
更新日期:1988-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the physiology and pharmacokinetics of a novel hemoglobin-based oxygen carrier of bovine origin. DESIGN:Randomized, single-blind, placebo-controlled, dose-escalation study. SETTING:The Upjohn Research Clinics (Kalamazoo, MI). SUBJECTS:Normal healthy adult men between the ages of 18 and 45 yrs. ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199605000-00006
更新日期:1996-05-01 00:00:00
abstract:OBJECTIVE:To investigate the relationship between behavioral alterations and changes in monoaminergic systems provoked by ischemia-reperfusion liver injury in rats. DESIGN:Prospective, randomized, controlled animal study. SETTING:University animal laboratory. SUBJECTS:Male Wistar rats. INTERVENTIONS:Acute liver fai...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199804000-00021
更新日期:1998-04-01 00:00:00
abstract::Quality of life was examined in 717 individuals 1 yr after their admission to a multidisciplinary ICU. Of these, 87% were able to live at home 6 months after their admission. Of patients 65 yr and older, 90% had been living independently before admission compared to 80% 1 yr afterward. Of those younger than 65 yr, mos...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198708000-00006
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVE:To compare the ability of two methods--Acute Physiology and Chronic Health Evaluation (APACHE II) and Mortality Prediction Model (MPM)--to predict hospital outcome for a large group of intensive care patients from Britain and Ireland. DESIGN:Prospective, multicenter, cohort study. SETTING:Twenty-six general...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-199409000-00007
更新日期:1994-09-01 00:00:00
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....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000964
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:To develop definitions of infection that can be used in clinical trials in patients with sepsis. CONTEXT:Infection is a key component of the definition of sepsis, yet there is currently no agreement on the definitions that should be used to identify specific infections in patients with sepsis. Agreeing on a ...
journal_title:Critical care medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.1097/01.ccm.0000168253.91200.83
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVES:Measurement of blood lactate concentration in the early management of sepsis is an important step in severity assessment. High blood lactate levels in the early phase of sepsis have classically been thought to be related to tissue hypoxia, but other factors could intervene. We hypothesized that the activatio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001308
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:To study the epidemiology, style of management, and outcome of intensive care patients with acute renal failure requiring replacement therapy in Australia. DESIGN:Prospective epidemiologic study. SETTING:Australian adult intensive care units providing acute renal replacement therapy. PATIENTS:Adult intensi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200110000-00010
更新日期:2001-10-01 00:00:00
abstract:OBJECTIVES:There has long-been controversy about the possible superiority of norepinephrine compared to dopamine in the treatment of shock. The objective was to evaluate the effects of norepinephrine and dopamine on outcome and adverse events in patients with septic shock. DATA SOURCES:A systematic search of the MEDLI...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0b013e31823778ee
更新日期:2012-03-01 00:00:00
abstract::PEEP is the most important therapeutic intervention in the management of acute respiratory failure. Transitory PEEP disconnection to perform clinically relevant maneuvers is often necessary, but its effect upon PaO2 and physiological shunt in patients requiring high-level PEEP is not clear from the literature. Nine ad...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197902000-00003
更新日期:1979-02-01 00:00:00
abstract:OBJECTIVE:In rodent models, enhanced formation of nitric oxide and formation of peroxynitrite have been implicated in the pathogenesis of various forms of shock. Here we examined the effect of mercaptoethylguanidine (MEG), an inducible nitric oxide synthase inhibitor and peroxynitrite scavenger, in a severe hemorrhagic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199907000-00027
更新日期:1999-07-01 00:00:00
abstract::Hemodynamic effects of controlled mechanical ventilation (CMV), intermittent mandatory ventilation (IMV), and intermittent mandatory ventilation with 5 cm H20 PEEP (IMV 5 peep) were studied in 20 patients after aortocoronary bypass surgery. Significant increases in cardiac index (CI) and stroke volume index (SI) (p le...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198207000-00001
更新日期:1982-07-01 00:00:00