Intravascular Volume Loss Research Articles

INITIAL MANAGEMENT OF HYPOVOLEMIC SHOCK IN CHILDREN – A SYSTEMATIC REVIEW OF THE LITERATURE

Introduction: Hypovolemic shock in children is a critical condition that occurs when there is a significant loss of intravascular volume, leading to decreased tissue perfusion and compromising organ function. It can be triggered by several factors, such as dehydration, hemorrhages and gastrointestinal conditions, which can lead to a rapid deterioration of the clinical condition. The patient presented with tachycardia, hypotension, weakness, and signs of hypoperfusion, requiring early evaluation and diagnosis. Initial treatment focuses on rapid rehydration and volume replacement, as well as specific measures to address the underlying cause. Thus, the present study aims to perform a systematic review of the literature on the initial management of hypovolemic shock in children. Methodology: This systematic literature review study was developed from the search of indexed articles, cross-sectional studies and retrospective case studies, in which 20 articles were found in the period from 2015 to 2024, consulted in the National Library of Medicine (PubMed MEDLINE) and Scientific Electronic Library Online (SciELO) databases. Of these 10, 3 articles were selected for the systematic review of the literature. Articles were included considering the type of shock, which is hypovolemic shock, the age group of children aged 0 to 10 years, and the publication date from 2015 to 2024. Results and discussion: It was observed that in most cases, there is a good response of the pediatric group to volume replacement with colloid fluids. However, if there is no response to fluids, which is assessed by improving vital signs, level of consciousness, and diuresis, it may be necessary to consider the use of vasoactive drugs. Conclusion: The initial management of hypovolemic shock in children is a critical intervention that can save lives. Early identification, appropriate support, and volume resuscitation are essential steps to restore perfusion and minimize complications. Continuous training of health teams in emergency protocols is critical to improving outcomes in children affected by this condition.

Screening and Phasewise Management of Burn Injuries.

Thermal, electrical, chemical, or electromagnetic radiationcan cause painful wounds or burns. Spilling hot liquids onto the skin can also cause these kinds of injuries. The two biggest factors contributing to burn injuries in the elderly are smoking and exposure to open flames, while scalding is the primary cause of burn damage in children. Newborns and the elderly make up the majority of burn casualties. In India, there are estimated to be 6-7 million burn cases per year. The high incidence is attributed to the population's illiteracy, poverty, and lack of awareness of safety. The problem is made much worse by the fact that basic and secondary healthcare levels do not provide systematic burn care.Coagulation necrosis is caused by denaturing proteins due to heat from burns. Platelets clump together, arteries narrow, and partly perfused tissue (called the stasis zone) may spread out around the wound. In the stasis zone, tissue is hyperemic and inflammatory. When the skin's natural barrier is breached, microorganisms can enter the body and cause poor temperature regulation, fluid loss, and invasion. Intravascular volume loss is typically worsened by injured or edematous tissues. Significant heat loss may occur from the wounded dermis' lack of thermoregulation, particularly in exposed wounds. The severity determines the different treatments.Serious burns require considerable care, while lesser burns just require cleaning and painkillers. Just-partially thickened burns must be cleansed with soap and water before being clothed. For full-thickness burns, surgery, including skin grafting, is frequently required. Extensive intravenous fluid doses are often required to treat serious burns resulting from tissue edema and capillary fluid leakage.

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects.

Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and end-organ damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes.

Spontaneous retroperitoneal hematoma in COVID-19 patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that has led to a global pandemic and unfortunately has caused a health crisis. Severe coronavirus disease 2019 (COVID-19) can manifest with bilateral pneumonia and hypoxemic respiratory failure but also can affect different organ systems. Spontaneous rectus sheath haematomas and retroperitoneal haematomas are recognized, rare, complications of anti-coagulation therapy, including LMWH. A prompt diagnosis is important to antagonize anticoagulation and prevent further bleeding. Massive bleeding into the retroperitoneum represents a problem not only because of the loss of intravascular volume, but also because the increase in abdominal pressure may compromise perfusion to different organs, such as the liver, gut, and kidneys. We present 3 cases of severe spontaneous soft tissue hematomas (SSTH) in patient with SARS-CoV-2 infection, who were taking low molecular weight heparin for prophylaxis of DIC and venous thromboembolism. First one is 56-yeard-old female patient with retroperitoneal and extraperitoneal haematoma presenting with dysuria and haematuria, the second one is 67-year-old male patient with iliopsoas haematoma and the third one is 51-year-old female patient with rectus sheath haematoma. All patients were treated conservatively. Clinicians should be attentive about bleeding complications as retroperitoneal haematomas in COVID-19 patients on anticoagulant therapy. There is no consensus on management of retroperitoneal haematomas. Each decision as conservative treatment, embolization or surgery should be made according to the clinical stability of the patient and by risk and benefit assessment.

S3304 A Retrospective Analysis of Orthostatic Hypotension and Risk Stratification in Patients Presenting With Acute Gastrointestinal Bleeds

Introduction: Gastrointestinal bleeding (GIB) is a common presentation occurring in 150 per 100,000 patients with a mortality rate of 2-15%. The timely assessment of patients and accurate risk stratification is of the utmost importance. Physicians have adopted several risk stratification tools to help assess risk and guide medical management. One parameter that is ill-defined in risk stratification of acute GIBs is orthostatic hypotension (OH). The presence of OH in GIB is widely utilized as a surrogate for intravascular volume depletion and hemodynamic instability as a marker of increased mortality. Through retrospective analysis we assessed the proposed link between OH and disposition, intervention, and mortality and its ability to risk stratify patients with GIB. Methods: We conducted an IRB-approved, retrospective study in all patients from a single tertiary referral center with an ICD-10 diagnosis for GIB and OH between the years of 2018-2020. Our cohort consisted of 77 patients in whom we assessed timing of endoscopic intervention, intensive care unit (ICU) admission, and mortality using chi-square analyses. Results: Upon review of the 77 patients selected with GIB and OH, 46 (59.7%) were ultimately admitted to the ICU. Of the 46 patients in the ICU, 34 (74%) required endoscopic intervention with 7 (15%) requiring emergent intervention, defined as occurring within 6 hours of evaluation by gastroenterology. Of the 77 patients, 8 (10.4%) required emergent intervention, 24 (31.2%) required intervention within 24 hours of evaluation, and 19 (24.7%) intervention beyond 24 hours. There were 26 (33.8%) that required no intervention prior to discharge. Overall, 75 (97.4%) were discharged, while 2 (2.6%) passed away. Based on our initial data with chi-square analyses, there were no statistically significant associations between OH, intervention, disposition, and mortality. Conclusion: Acute GI bleeding require swift evaluation and risk stratification. It is taught that 1000cc (20% of body volume) of blood loss can induce orthostasis. This argues that OH upon presentation may represent significant hemodynamic instability and increase overall mortality. There are other etiologies of OH that may need to be considered independent of intravascular volume loss. Our initial data suggest that OH alone in the setting of GIB is insufficient in assessment for disposition, intervention, and mortality. Future studies are warranted to better risk stratify patients presenting with acute GIBs and the association with OH.Table 1.: Crosstab analysis comparing the intervention group with ICU admission and discharge status. Following the crosstab analysis, a chi-square test was used to compare the intervention groups on the categorical variables. The P-value for the intervention groups compared to admission was P = .21 while the P-value for discharge status was P = .08. There were no statistically significant associations to report.

Comparison between plasma lactate and lactate clearance with the impact of acute phase complication in burn injury patient

Severe burn can cause rapid loss of intravascular volume with resultant a decrease in peripheral blood flow which reduces tissue oxygen transport and in turn, increases plasma lactate. Plasma lactate and lactate clearance are useful parameters to compare complicated and uncomplicated burn patients in the acute phase. The study aimed to evaluate the initial and 24-h plasma lactate levels as well as lactate clearance as useful parameters to assess acute phase complications of burn patients. This was a cross-sectional study involving 35 burn patients who admitted at Abdul Wahab Sjahranie District Hospital, Samarinda during the period of September 2018 to September 2019. The study was immediately begun after admission of the patients. Plasma lactate levels were measured at admission and24-h after the first measurement. The acute phase complication was assessed 72 h after burns from the laboratory parameter. Fisher’s exact test and t test using SPSS software version 24were applied for statistical analysis. The 24-h plasma lactate level (p= 0.001) and plasma lactate clearance (p = 0.002) were significantly correlated with the occurrence of acute phase complications of burns. However, the initial plasma lactate level was not significantly correlated (p = 0.609). In conclusion, there is a significantly correlation between 24-h plasma lactate level and plasma lactate clearance are with the occurrence of acute phase complications of burns.

Low-Intensity Intradialytic Exercise Attenuates the Relative Blood Volume Drop Due to Intravascular Volume Loss during Hemodiafiltration

Introduction: Patients in hemodiafiltration (HDF) eliminate volume overload by ultrafiltration. Vascular volume loss is among the main mechanisms contributing to adverse events such as intradialytic hypotension. Here, we hypothesize that the intradialytic exercise (IDEX) is an intervention that could improve the acute response of physiological mechanisms involved during vascular volume loss. To test this hypothesis, we evaluated the hemodynamic response to mild aerobic exercise during HDF. Methods: Nineteen end-stage renal disease (ESRD) patients (11 women: 40 ± 10.8 years old, and 8 men: 42 ± 21 years old) receiving HDF thrice a week, with 6 months of previous physical conditioning, participated in this study. Three HDF sessions were scheduled for each patient: 1 resting in supine position, 1 resting in sitting position, and 1 doing aerobic exercise. The first 2 sessions were taken as control. The ultrafiltration rate was set to 800 mL/h in each session. The hemodynamic response was monitored through the relative blood volume (RBV), and cardiovascular variables measured noninvasively by photoplethysmography. Adequacy variables such as Kt/V and percentage reduction of urate, urea, creatinine (Cr), and phosphate were also monitored. Findings: The decrease rate of the RBV was smaller in the session with IDEX compared to the sessions with no exercise. No differences were found neither in the cardiovascular variables nor in the adequacy variables among the 3 sessions. There were no hypotension events during the session with exercise, and 8 events during the sessions without exercise (p = 0.002). Discussion: Mild exercise during HDF decreased the RBV drop and was associated with less hypotension events. The lack of differences in the hemodynamic variables suggests an adequate acute response of cardiovascular compensation variables to intradialytic hypovolemia.

Unsupervised anomaly detection in peripheral venous pressure signals with hidden Markov models

This paper proposes an automatic anomaly detection and removal algorithm for peripheral venous pressure (PVP) signals, which can be used to predict intravascular volume loss in humans. PVP signal collection is a minimally invasive procedure that can be performed by using a standard peripheral intravenous (PIV) catheter and a commercial pressure-monitoring transducer. PVP signals are highly susceptible to motion and noise artifacts such as patient movements or unintended manipulation of PIV lines. Anomalies in PVP signals can corrupt useful information and seriously affect the integrity of PVP signal analysis. We propose to detect and remove such anomalies by exploiting the properties of PVP signals. Specifically, a dynamic linear model (DLM) with a Kalman filter is used to track and predict the time-domain evolution of PVP signals. The prediction residuals of the Kalman filter are then modeled with a hidden Markov model (HMM), with the normal and anomalous status of the signal modeled by using binary states of a hidden Markov chain. The HMM parameters along with the hidden states are iteratively estimated by using an unsupervised learning algorithm with a modified Baum–Welch method. The anomaly detection algorithm is applied to clinical data from a cohort of 24 pediatric patients with hypertrophic pyloric stenosis. Experimental results demonstrate that the proposed unsupervised anomaly detection algorithm can efficiently remove anomalies in PVP signals without the need of a training phase. The algorithm can also be applied to other time series signals, such as Electrocardiography (ECG) and Photoplethysmogram (PPG) signals.

Antioxidants Reduce Tissue Necrosis in The Zone of Stasis: Review of Burn Wound Conversion

Summary: Severe burns are devastating condition identified by loss of hemodynamic stability and intravascular volume. Adequate fluid replacement, nutritional support, and immediate wound grafting can reduce the risk of infection and mortality. Oxidative stress was shown to have significant role in the burn wound conversion, which happens when the zone of stasis can’t be salvaged and progresses to necrosis. Decreasing the level of oxidative stress early may be fundamental in reducing burn injury progression into deeper tissue. Several animal studies have demonstrated the advance of antioxidant supplementation for burns outcomes. Approach to this salvageable burn tissue is a breakthrough for new directions in burn management. Antioxidant supplementations was proven to prevent burn conversion on the ischemic zone. Administering antioxidant post-burn is linked with less progression of burn depth and inflammatory cytokine release, which alleviates burn-related morbidity and mortality and improves patient’s quality of life. To date, no clinical trials have been done to reproduce similar outcomes of this ROS-scavenging therapy as successfully observed in murine models. Antioxidant supplementation is a promising treatment avenue to halt burn wound conversion following severe burns.
 Keywords: Burn wound, wound conversion, burn management, antioxidant

Transient polycythemia during diabetic ketoacidosis triggered by dengue fever in a middle-aged woman

Either dengue fever or diabetic ketoacidosis can cause the high hemoglobin concentration due to intravascular volume loss. When both entities were found together as in our case, the hemoglobin concentration could access the strikingly high level until either of them could not contribute it. She was a Thai woman with 46 years of age presenting with fever, fatigue and severe sore throat for a few days. The physical examination showed she had mild dyspnea and oral thrush, the temperature was 36.4 degree Celsius, and her pulse rate was 102/min. Her blood tests showed: Hb 18.3 g%, WBC 9,850/mm3, atypical lymphocyte 10%, platelet 16,000/mm3, MCV 89.2 fl, Dengue NS1 antigen-positive, dengue IgG-positive, IgM-weakly positive, KOH preparation of curd from buccal mucosa-positive for budding yeasts and pseudo-hyphae, blood sugar 442 mg%, triglyceride 578 mg%, Na 122.8 mEq/L, K 6.28 mEq/L, Cl 90.6 mEq/L, CO2 9.2 mEq/L, blood ketone 53.6 mmol/L, lactate 4.5 mmol/L, pH 7.257, pCO2 27.4 mmHg, HCO3 11.9 mmo/L, BUN 22.9 mg%, creatinine 0.64 mg%, AST 375 U/L, ALT 224 U/L, alkaline phosphatase 151 U/L. She was diagnosed as having diabetes with diabetic ketoacidosis, dengue fever and polycythemia. She was immediately treated with intravenous fluid therapy to correct the metabolic acidosis, electrolyte imbalance and dehydration, insulin for hyperglycemia, clotrimazole for oral thrush and platelet transfusion. Her high hemoglobin level was dramatically lowered until became normal within one day of therapy whereas she also recovered from DKA although the platelet was progressively lowered every day. It suggested that transient polycythemia was solely contributed by DKA that was triggered by dengue fever hence DKA from dengue fever should be added in the list of unusual causes of transient polycythemia.

Comparison between two different cardiovascular models during a hemorrhagic shock scenario.

Hemorrhagic shock is a form of hypovolemic shock determined by rapid and large loss of intravascular blood volume and represents the first cause of death in the world, whether on the battlefield or in civilian traumatology. For this, the ability to prevent hemorrhagic shock remains one of the greatest challenges in the medical and engineering fields. The use of mathematical models of the cardiocirculatory system has improved the capacity, on one hand, to predict the risk of hemorrhagic shock and, on the other, to determine efficient treatment strategies. In this paper, a comparison between two mathematical models that simulate several hemorrhagic scenarios is presented. The models considered are the Guyton and the Zenker model. In the vast panorama of existing cardiovascular mathematical models, we decided to compare these two models because they seem to be at the extremes as regards the complexity and the detail of information that they analyze. The Guyton model is a complex and highly structured model that represents a milestone in the study of the cardiovascular system; the Zenker model is a more recent one, developed in 2007, that is relatively simple and easy to implement. The comparison between the two models offers new prospects for the improvement of mathematical models of the cardiovascular system that may prove more effective in the study of hemorrhagic shock.

Anti-interferon-α receptor 1 antibodies attenuate inflammation and organ injury following hemorrhagic shock.

Hemorrhagic shock (HS) is a life-threatening condition resulting from rapid and significant loss of intravascular volume, leading to hemodynamic instability and death. Inflammation contributes to the multiple organ injury in HS. Type I interferons (IFNs), such as IFN-α and IFN-β, are a family of cytokines that regulate the inflammatory response through binding to IFN-α receptor (IFNAR) which consists of IFNAR1 and IFNAR2 chains. We hypothesized that type I IFNs provoke inflammation and worsen organ injury in HS. Male C57BL/6 mice (20-25 g) underwent hemorrhage by controlled bleeding via the femoral artery to maintain a mean arterial pressure of 27 ± 2.5 mm Hg for 90 minutes, followed by resuscitation for 30 minutes with two times shed blood volume of Ringer's lactate solution containing 1 mg/kg body weight of anti-IFNAR1 antibody (Ab) or control isotype-matched IgG (IgG). Blood and tissue samples were collected at 20 hours after the resuscitation for various analyses. The expression of IFN-α and IFN-β mRNAs was significantly elevated in lungs and liver of the mice after HS. The IFNAR1-Ab treatment significantly decreased serum levels of organ injury markers lactate dehydrogenase and aspartate aminotransferase, as well as improved the integrity of lung and liver morphology, compared to the IgG control. The protein levels of proinflammatory cytokines TNF-α and IL-6, and mRNA expression of proinflammatory chemokines monocyte chemoattractant protein (MCP)-1, MCP-2, macrophage inflammatory protein 2 (MIP-2), and keratinocyte cytokine (KC) in the lungs of the HS mice were significantly decreased after treated with IFNAR1-Ab. Moreover, the myeloperoxidase activity and number of apoptotic cells in the lungs of HS mice treated with IFNAR1-Ab were decreased in comparison to the IgG control. Administration of IFNAR1-Ab reduces inflammation and tissue injury. Thus, type I IFN signaling may be a potential therapeutic target for mitigating organ dysfunction in patients suffering from HS. Translational animal model.

The Nomenclature, Definition and Distinction of Types of Shock.

A severe mismatch between the supply and demand of oxygen is the common feature of all types of shock. We present a newly developed, clinically oriented classification of the various types of shock and their therapeutic implications. This review is based on pertinent publications (1990-2018) retrieved by a selective search in PubMed, and on the relevant guidelines and meta-analyses. There are only four major categories of shock, each of which is mainly related to one of four organ systems. Hypovolemic shock relates to the blood and fluids compartment while distributive shock relates to the vascular system; cardiogenic shock arises from primary cardiac dysfunction; and obstructive shock arises from a blockage of the circulation. Hypovolemic shock is due to intravascular volume loss and is treated by fluid replacement with balanced crystalloids. Distributive shock, on the other hand, is a state of relative hypovolemia resulting from pathological redistribution of the absolute intravascular volume and is treated with a combination of vasoconstrictors and fluid replacement. Cardiogenic shock is due to inadequate function of the heart, which shall be treated, depending on the situation, with drugs, surgery, or other interventional procedures. In obstructive shock, hypoperfusion due to elevated resistance shall be treated with an immediate life-saving intervention. The new classification is intended to facilitate the goal-driven treatment of shock in both the pre-hospital and the inpatient setting. A uniform treatment strategy should be established for each of the four types of shock.

Peripheral i.v. analysis (PIVA) of venous waveforms for volume assessment in patients undergoing haemodialysis

BackgroundThe assessment of intravascular volume status remains a challenge for clinicians. Peripheral i.v. analysis (PIVA) is a method for analysing the peripheral venous waveform that has been used to monitor volume status. We present a proof-of-concept study for evaluating the efficacy of PIVA in detecting changes in fluid volume. MethodsWe enrolled 37 hospitalized patients undergoing haemodialysis (HD) as a controlled model for intravascular volume loss. Respiratory rate (F0) and pulse rate (F1) frequencies were measured. PIVA signal was obtained by fast Fourier analysis of the venous waveform followed by weighing the magnitude of the amplitude of the pulse rate frequency. PIVA was compared with peripheral venous pressure and standard monitoring of vital signs. ResultsRegression analysis showed a linear correlation between volume loss and change in the PIVA signal (R2=0.77). Receiver operator curves demonstrated that the PIVA signal showed an area under the curve of 0.89 for detection of 20 ml kg−1 change in volume. There was no correlation between volume loss and peripheral venous pressure, blood pressure or pulse rate. PIVA-derived pulse rate and respiratory rate were consistent with similar numbers derived from the bio-impedance and electrical signals from the electrocardiogram. ConclusionsPIVA is a minimally invasive, novel modality for detecting changes in fluid volume status, respiratory rate and pulse rate in spontaneously breathing patients with peripheral i.v. cannulas.

Endothelial Regulator of Calcineurin 1 Promotes Barrier Integrity and Modulates Histamine-Induced Barrier Dysfunction in Anaphylaxis.

Anaphylaxis, the most serious and life-threatening allergic reaction, produces the release of inflammatory mediators by mast cells and basophils. Regulator of calcineurin 1 (Rcan1) is a negative regulator of mast-cell degranulation. The action of mediators leads to vasodilation and an increase in vascular permeability, causing great loss of intravascular volume in a short time. Nevertheless, the molecular basis remains unexplored on the vascular level. We investigated Rcan1 expression induced by histamine, platelet-activating factor (PAF), and epinephrine in primary human vein (HV)-/artery (HA)-derived endothelial cells (ECs) and human dermal microvascular ECs (HMVEC-D). Vascular permeability was analyzed in vitro in human ECs with forced Rcan1 expression using Transwell migration assays and in vivo using Rcan1 knockout mice. Histamine, but neither PAF nor epinephrine, induced Rcan1-4 mRNA and protein expression in primary HV-ECs, HA-ECs, and HMVEC-D through histamine receptor 1 (H1R). These effects were prevented by pharmacological inhibition of calcineurin with cyclosporine A. Moreover, intravenous histamine administration increased Rcan1 expression in lung tissues of mice undergoing experimental anaphylaxis. Functional in vitro assays showed that overexpression of Rcan1 promotes barrier integrity, suggesting a role played by this molecule in vascular permeability. Consistent with these findings, in vivo models of subcutaneous and intravenous histamine-mediated fluid extravasation showed increased response in skin, aorta, and lungs of Rcan1-deficient mice compared with wild-type animals. These findings reveal that endothelial Rcan1 is synthesized in response to histamine through a calcineurin-sensitive pathway and may reduce barrier breakdown, thus contributing to the strengthening of the endothelium and resistance to anaphylaxis. These new insights underscore its potential role as a regulator of sensitivity to anaphylaxis in humans.

Pediatric Sepsis: Clinical Markers

AbstractPediatric sepsis can be caused by infection agents such as viruses, bacteria, protozoa, or their toxins. Clinical features cover a remarkably wide spectrum. Early recognition of the disease and prompt initiation of therapy substantially improve mortality and the outcome of potential complications. After an initial phase of very mild symptoms, the spread of microbes or toxins in the bloodstream presents as septic shock through vasoregulatory disturbance, absolute or relative intravascular volume loss, and consequential tachycardia and hypotension. The most common accompanying symptom is fever. In physical examination, features such as altered mental status, excess respiratory effort, tachycardia, and prolonged capillary refill time are present at an early stage of the disease. Laboratory tests for the assessment of early stage severity and subsequent monitoring of treatment efficacy include point-of-care arterial blood gas analysis and lactate assay. In early stage disease, it is imperative to promptly start adequate antimicrobial and supportive treatment once bacterial cultures have been taken. Despite the availability of a wide range of laboratory and imaging tests today, diagnosis and severity assessment of sepsis still primarily rely on medical history and clinical examination. In light of this, it is possible for trained care providers to detect the early signs of a septic child during repetitive physical examinations. This is still the mainstay of diagnosis and can provide in all care settings a significant reduction in therapeutic delay; this, in turn, helps to reduce sepsis-related mortality and morbidity.

Renal tissue pro-inflammatory gene expression is reduced by erythropoietin in rats subjected to hemorrhagic shock.

BackgroundHemorrhagic shock (HS) is a condition produced by considerable loss of intravascular volume, which may eventually lead to organ damage and death.ObjectivesIn the present study, the potential implication of the kidney tissue tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) were evaluated in the protective effects of erythropoietin (EPO) during HS.Materials and MethodsMale Wistar rats were randomized into three experimental groups; Sham, HS (hemorrhagic shock and resuscitation), and EPO (erythropoietin). HS was induced by 50% blood volume hemorrhage over 30 minutes. After 2 hours, resuscitation was performed within 30 minutes. In the EPO group, EPO (300 IU/kg, i.v.) was administered 10 minutes before HS induction. Urine was collected to determine urinary N-acetyl-β-D-glucosaminidase (NAG) activity level. The kidney cytokines (TNF-α, IL-6 and IL-10) mRNA expressions were measured by real-time polymerase chain reaction (PCR).ResultsHS rats showed significant increase in urinary NAG activity compared to the sham group. EPO significantly attenuated the rises in urinary NAG activity compared to the HS group. In the HS animals, renal TNF-α and IL-6 mRNA expressions increased whereas no difference was observed in IL-10 mRNA expression between the HS and sham groups. EPO was able to decrease renal TNF-α and IL-6 production and increase IL-10 mRNA expression.ConclusionsIn this study, we demonstrated that EPO attenuates kidney damage in rats subjected to HS. The beneficial effects of EPO may be at least partly mediated by modifications in the inflammatory cascade.

Physiopathologie du choc hémorragique

This review addresses the pathophysiology of hemorrhagic shock, a condition produced by rapid and significant loss of intravascular volume, which may lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death. The initial neuroendocrine response is mainly a sympathetic activation. Haemorrhagic shock is associated altered microcirculatory permeability and visceral injury. It is also responsible for a complex inflammatory response associated with hemostasis alteration.

A Study On Maternal And Neonatal Outcomes In Placenta Previa In A Tertiary Level Hospital In India

Background: Placenta previa should be suspected in any woman beyond 20 weeks of gestation who presents with painless vaginal bleeding. Rapid and significant loss of intravascular volume can lead to hemodynamic instability, decreased tissue perfusion, cellular hypoxia, organ damage, and death. The aim of this study was to describe the clinical outcomes in placenta previa patients. Methods: We enrolled patients presenting to our emergency ward or outpatient clinic with diagnosis of placenta previa from October 1, 2013 till September 30, 2015. Detailed maternal history and demographic profile was obtained for all included patients. Results of all ordered laboratory and ultrasound examination were noted for all included patients. Results: 44 patients satisfied our inclusion and exclusion criteria during the study period. With 3.8 as the mean parity and 35.7 years as the mean age at delivery, 13 had previous vaginal deliveries, 14 had lower section cesarean sections and 10 had a history of abortions. 8 patients had type I placenta previas, 12 type II, 9 type III and 10 type IV placenta previa. Estimated blood loss was approxiamtely 811.7 mL. 2 mothers had to admitted to the intensive care unit after delivery and 14 were admitted to the maternal indoor unit. Mean post-operative hospital stay was 4.2 days. During the study period there were 27 live births, 7 neonatal deaths, 8 were still births. There were 12 babies who were admitted in the neonatal intensive care unit. Mean birth weight of the neonates was 3.8 kgs. There were 13 neonates with an APGAR score of less than 7. Conclusion: Placenta previa increases the risk of antepartum intrapartum and postpartum hemorrhage. In this article we have described our experience of maternal and neonatal outcomes in patients presenting with placenta previa at a tertiary level hospital in Aurangabad

Ultrasound in Pediatric Resuscitation

An infant arrives with fever, dyspnea and poor perfusion. Should you intubate, provide a fluid bolus or administer pressor medication? A teenager presents with depressed consciousness, rapid breathing and dehydration. Does she have increased intra-cranial pressure? Bedside ultrasound can provide immediate answers to critical questions that arise during pediatric resuscitation. Drawing from various ultrasound resuscitation models, we will discuss how the clinician can utilize this remarkable technology to improve and expedite the assessment of the ill or injured child. Case-based discussion will focus on strategies intended to evaluate cardiovascular, respiratory and neurologic compromise using bedside ultrasound. We will review how the usual assessment of “the tank” and “the pump” can be supplemented by a number of inquires intended to identify various possible causes of intravascular volume loss that may occur in children. The strategic synergism of ultrasound and clinical judgment will be emphasized. An infant arrives with fever, dyspnea and poor perfusion. Should you intubate, provide a fluid bolus or administer pressor medication? A teenager presents with depressed consciousness, rapid breathing and dehydration. Does she have increased intra-cranial pressure? Bedside ultrasound can provide immediate answers to critical questions that arise during pediatric resuscitation. Drawing from various ultrasound resuscitation models, we will discuss how the clinician can utilize this remarkable technology to improve and expedite the assessment of the ill or injured child. Case-based discussion will focus on strategies intended to evaluate cardiovascular, respiratory and neurologic compromise using bedside ultrasound. We will review how the usual assessment of “the tank” and “the pump” can be supplemented by a number of inquires intended to identify various possible causes of intravascular volume loss that may occur in children. The strategic synergism of ultrasound and clinical judgment will be emphasized.