Low Shock Index Research Articles

ABSTRACT 502

Background and aims: we want to know the Shock Index (SI) and its association with disease severity patients with Sepsis. Aims: Determine SI in patients with Sepsis. Methods: We designed a cross-sectional study. Results: We found that over 95 patients admitted to the PICU with Sepsis, 46,3% had Dengue Fever Sepsis, the 53,6% of the population had Sepsis Other than Dengue. In the Sepsis Other than Dengue group, pulmonary and intraabdominal causes accounted for 35,2% and 33,3% of patients. the SI cutoff point of greater than 0,9 as abnormal. the 73,7% had an SI greater than 0,9. This proportion was higher in patients with Sepsis Other than Dengue compared with Dengue Fever Sepsis (82,4% vs. 63,6%), in addition to statistically significant lesser values of Shock Index between patients with or without Dengue (1,1 vs 1,3). the age showed a tendency of lower SI Values as age increases, with a p-value of 0,02. The most frecuent indicator of severity in Sepsis was the inotropic support 93,7%, mechanical ventilation in a 62,1%. Liver impairment was of 44,2%. Other indicators were multi-organ failure 38,9%,steroid use 14,7%, death (12,6%) and dialysis (6,3%). Conclusions: The SI and severity indicators behaved similarly in patients with Dengue, in the bivariate as well as the multivariate analysis. we found a statistically significant difference in the multivariate analysis of patients with Sepsis Other than Dengue in relation to the severity indicators of age and inotropic support requirement. SI diminished in about 0.03 units for each year of increasing age and increased in about 0,38 units in patients that received inotropic support.

Central venous pressure and shock index predict lack of hemodynamic response to volume expansion in septic shock: A prospective, observational study

PurposeVolume expansion is a common therapeutic intervention in septic shock, although patient response to the intervention is difficult to predict. Central venous pressure (CVP) and shock index have been used independently to guide volume expansion, although their use is questionable. We hypothesize that a combination of these measurements will be useful. MethodsIn a prospective, observational study, patients with early septic shock received 10-mL/kg volume expansion at their treating physician's discretion after brief initial resuscitation in the emergency department. Central venous pressure and shock index were measured before volume expansion interventions. Cardiac index was measured immediately before and after the volume expansion using transthoracic echocardiography. Hemodynamic response was defined as an increase in a cardiac index of 15% or greater. ResultsThirty-four volume expansions were observed in 25 patients. A CVP of 8 mm Hg or greater and a shock index of 1 beat min−1 mm Hg−1 or less individually had a good negative predictive value (83% and 88%, respectively). Of 34 volume expansions, the combination of both a high CVP and a low shock index was extremely unlikely to elicit hemodynamic response (negative predictive value, 93%; P = .02). ConclusionsVolume expansion in patients with early septic shock with a CVP of 8 mm Hg or greater and a shock index of 1 beat min−1 mm Hg−1 or less is unlikely to lead to an increase in cardiac index.

Are Shock Index and Adjusted Shock Index useful in predicting mortality and length of stay in community-acquired pneumonia?

Background Community Acquired Pneumonia (CAP) is a common infection which is associated with a significant mortality. Shock index, heart rate divided by blood pressure, has been shown to predict mortality in several conditions including sepsis, acute myocardial infarction and traumatic injuries. Very little is known about the prognostic value of shock index in community acquired pneumonia (CAP). Objective To examine the usefulness of shock index (SI) and adjusted shock index (corrected to temperature) (ASI) in predicting mortality and hospital length of stay in patients admitted to hospital with CAP. Methods A prospective study was conducted in three hospitals in Norfolk & Suffolk, UK. We compared risk of mortality and longer length of stay for low (=<1.0, i.e. heart rate =< systolic BP) and high (> 1.0, i.e. heart rate > systolic BP) SI and ASI adjusting for age, sex and other parameters which have been shown to be associated with mortality in CAP. Results A total of 190 patients were included (males = 53%). The age range was 18–101 years (median = 76 years). Patients with SI & ASI > 1.0 had higher likelihood of dying within 6 weeks from admission. The adjusted odds ratio for 30 days mortality were 2.48 (1.04–5.92; p = 0.04) for SI and 3.16 (1.12–8.95; p = 0.03) for ASI. There was no evidence to suggest that they predict longer length of stay. Conclusion Both SI and ASI of > 1.0 predict 6 weeks mortality but not longer length of stay in CAP.

Transarterial Embolization for Intractable Oronasal Hemorrhage Associated With Craniofacial Trauma: Evaluation of Prognostic Factors

This study analyzed the outcomes for clinical application of transarterial embolization (TAE) to treat intractable posttraumatic oronasal hemorrhage in patients who suffered from craniofacial injuries. The charts and radiologic and operative records of 34 patients from January 2002 to December 2007 were retrospectively reviewed. Inclusion criteria focused on the patients whose intractable posttraumatic oronasal hemorrhage associated with craniofacial trauma required TAE treatment. The patients' survival was correlated with prognostic factors with Spearman's rank correlation coefficients. Wilcoxon signed ranks test was used to analyze the differences between the severity of shock before and after TAE, and Fisher's exact test was used to analyze unvaried factors. TAE successfully stopped the posttraumatic oronasal hemorrhage in 27 of 34 patients (79.4%). The internal maxillary artery was the most common hemorrhaging vessel requiring embolization. Successful hemostasis by TAE significantly contributed to patient survival (p = 0.001). In addition, higher Glasgow Coma Scale score (>/=8) at presentation, lower shock index (calculated as heart rate/systolic blood pressure; </=1.1 and 0.8, before and after TAE, respectively), and injury severity score </=32 positively contributed to the patients' higher survival rate (p < 0.05). During the acute treatment of posttraumatic oronasal hemorrhage, need for craniotomy was not correlated with patient survival, but need for laparotomy to treat the second abdominal hemorrhagic source decreased the rate of patient survival (p = 0.023). TAE may stop intractable posttraumatic oronasal hemorrhage when conventional packing fails to achieve hemostasis. Glasgow Coma Scale score at presentation, shock index before and after TAE, injury severity score, and need for emergent laparotomy can be used to predict the patient prognosis.

Petrology of the Baszkówka L5 chondrite: A record of surface‐forming processes on the parent body

Abstract— We review the petrology of Baszkówka, present new microprobe data on mineral constituents, and propose a model for surface properties of the parent body consistent with these data.The low shock index and high porosity of the Baszkówka L5 chondrite mean that considerable primary textural and petrographic detail is preserved, allowing insight into the structure and evolution of the parent body. This meteorite formed in a sedimentary environment resembling that in which pyroclastic rocks are deposited. The origin of the component chondrules, achondritic fragments (mostly olivine and pyroxene aggregates), chondritic‐achondritic aggregates, and compound chondrules can be explained by invoking collision of 2 melted or partially melted planetesimals, each covered with a thin crust. This could have happened at an early stage in the evolution of the solar system, between 1 and 2 Myr after its origin. The collision resulted in the formation of a cloud containing products of earlier magmatic crystallization (chondrite and achondrite fragments) from which new chondrules were created. Particle collision in this cloud produced fragmented chondrules, chondritic‐achondritic aggregates, and compound chondrules. Within this low‐density medium, these particles were accreted on the surface of the larger of the planetesimals involved in the collision. The density of the medium was low enough to prevent grain‐size sorting of the components but high enough to prevent the total loss of heat and to enable the welding of fragments on the surface of the body. The rock material was homogenized within the cloud and, in particular, within the zone close to the planetesimal surface. The hot material settled on the surface and became welded as molten or plastic metal, and sulfide components cemented the grains together. The process resembled the formation of welded ignimbrites. Once these processes on the planetesimal surface were completed, no subsequent recrystallization occurred. The high porosity of the Baszkówka chondrite indicates that the meteorite comes from a near‐surface part of the parent body. Deeper parts of the planetesimal would have been more massive because of compaction.