• MeSH
• anafylaxe diagnóza   patofyziologie   terapie   MeSH
• diferenciální diagnóza MeSH
• embolie plodovou vodou diagnóza   patofyziologie   terapie   MeSH
• hemoragický šok etiologie   patofyziologie   terapie   MeSH
• kardiogenní šok etiologie   patofyziologie   terapie   MeSH
• komplikace porodu MeSH
• komplikace těhotenství etiologie   patofyziologie   MeSH
• lidé MeSH
• plicní embolie diagnóza   patofyziologie   terapie   MeSH
• šok * etiologie   klasifikace   patofyziologie   MeSH
• syndrom systémové zánětlivé reakce diagnóza   komplikace   terapie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

Hemoragický šok je závažnou komplikací stavů, které jsou provázeny masivním krvácením, a je spojený s vysokou mortalitou a morbiditou. Autoři shrnují poznatky v patofyziologii koagulopatie v jeho průběhu vznikající a přinášejí možnost léčebné strategie.

Hemorrhagic shock is a severe complication of conditions that are accompanied by massive bleeding and is associated with high mortality and morbidity. The authors summarize the recent knowledge in the pathophysiology of coagulopathy in the course of its development and some options in treatment strategy

• MeSH
• hemoragický šok * diagnóza   etiologie   patofyziologie   terapie   MeSH
• koagulopatie patofyziologie   MeSH
• lidé MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

OBJECTIVES: Investigation of the effects of hyperoxia during resuscitation from hemorrhagic shock in swine with preexisting coronary artery disease. DESIGN: Prospective, controlled, randomized trial. SETTING: University animal research laboratory. SUBJECTS: Nineteen hypercholesterolemic pigs with preexisting coronary artery disease. INTERVENTIONS: Anesthetized, mechanically ventilated, and surgically instrumented pigs underwent 3 hours of hemorrhagic shock (removal of 30% of the calculated blood volume and subsequent titration of mean arterial blood pressure ≈40 mm Hg). Postshock resuscitation (48 hr) comprised retransfusion of shed blood, crystalloids (balanced electrolyte solution), and norepinephrine support. Pigs were randomly assigned to "control" (FIO2 0.3, adjusted for arterial oxygen saturation ≥ 90%) and "hyperoxia" (FIO2 1.0 for 24 hr) groups. MEASUREMENTS AND MAIN RESULTS: Before, at the end of shock and every 12 hours of resuscitation, datasets comprising hemodynamics, calorimetry, blood gases, cytokines, and cardiac and renal function were recorded. Postmortem, organs were sampled for immunohistochemistry, western blotting, and mitochondrial high-resolution respirometry. Survival rates were 50% and 89% in the control and hyperoxia groups, respectively (p = 0.077). Apart from higher relaxation constant τ at 24 hours, hyperoxia did not affect cardiac function. However, troponin values were lower (2.2 [0.9-6.2] vs 6.9 [4.8-9.8] ng/mL; p < 0.05) at the end of the experiment. Furthermore, hyperoxia decreased cardiac 3-nitrotyrosine formation and increased inducible nitric oxide synthase expression. Plasma creatinine values were lower in the hyperoxia group during resuscitation coinciding with significantly improved renal mitochondrial respiratory capacity and lower 3-nitrotyrosine formation. CONCLUSIONS: Hyperoxia during resuscitation from hemorrhagic shock in swine with preexisting coronary artery disease reduced renal dysfunction and cardiac injury, potentially resulting in improved survival, most likely due to increased mitochondrial respiratory capacity and decreased oxidative and nitrosative stress. Compared with our previous study, the present results suggest a higher benefit of hyperoxia in comorbid swine due to an increased susceptibility to hemorrhagic shock.

• MeSH
• analýza krevních plynů MeSH
• cytokiny metabolismus   MeSH
• funkční vyšetření srdce MeSH
• hemodynamika MeSH
• hemoragický šok epidemiologie   mortalita   patofyziologie   terapie   MeSH
• hypercholesterolemie epidemiologie   MeSH
• hyperoxie patofyziologie   MeSH
• krevní tlak MeSH
• náhodné rozdělení MeSH
• nemoci koronárních tepen epidemiologie   MeSH
• prasata MeSH
• prospektivní studie MeSH
• resuscitace metody   MeSH
• vyšetření funkce ledvin MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

The maintenance of plasma sodium concentration within a narrow limit is crucial to life. When it differs from normal physiological patterns, several mechanisms are activated in order to restore body fluid homeostasis. Such mechanisms may be vegetative and/or behavioral, and several regions of the central nervous system (CNS) are involved in their triggering. Some of these are responsible for sensory pathways that perceive a disturbance of the body fluid homeostasis and transmit information to other regions. These regions, in turn, initiate adequate adjustments in order to restore homeostasis. The main cardiovascular and autonomic responses to a change in plasma sodium concentration are: i) changes in arterial blood pressure and heart rate; ii) changes in sympathetic activity to the renal system in order to ensure adequate renal sodium excretion/absorption, and iii) the secretion of compounds involved in sodium ion homeostasis (ANP, Ang-II, and ADH, for example). Due to their cardiovascular effects, hypertonic saline solutions have been used to promote resuscitation in hemorrhagic patients, thereby increasing survival rates following trauma. In the present review, we expose and discuss the role of several CNS regions involved in body fluid homeostasis and the effects of acute and chronic hyperosmotic challenges.

• MeSH
• centrální nervový systém účinky léků   fyziologie   MeSH
• hemoragický šok farmakoterapie   patofyziologie   MeSH
• homeostáza účinky léků   fyziologie   MeSH
• hypertonický solný roztok aplikace a dávkování   MeSH
• krevní tlak účinky léků   fyziologie   MeSH
• ledviny účinky léků   fyziologie   MeSH
• lidé MeSH
• nervová síť fyziologie   MeSH
• osmóza účinky léků   fyziologie   MeSH
• srdeční frekvence účinky léků   fyziologie   MeSH
• tělesné tekutiny účinky léků   fyziologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: Hemorrhagic shock-induced tissue hypoxia induces hyperinflammation, ultimately causing multiple organ failure. Hyperoxia and hypothermia can attenuate tissue hypoxia due to increased oxygen supply and decreased demand, respectively. Therefore, we tested the hypothesis whether mild therapeutic hypothermia and hyperoxia would attenuate postshock hyperinflammation and thereby organ dysfunction. DESIGN: Prospective, controlled, randomized study. SETTING: University animal research laboratory. SUBJECTS: Thirty-six Bretoncelles-Meishan-Willebrand pigs of either gender. INTERVENTIONS: After 4 hours of hemorrhagic shock (removal of 30% of the blood volume, subsequent titration of mean arterial pressure at 35 mm Hg), anesthetized and instrumented pigs were randomly assigned to "control" (standard resuscitation: retransfusion of shed blood, fluid resuscitation, norepinephrine titrated to maintain mean arterial pressure at preshock values, mechanical ventilation titrated to maintain arterial oxygen saturation > 90%), "hyperoxia" (standard resuscitation, but FIO2, 1.0), "hypothermia" (standard resuscitation, but core temperature 34°C), or "combi" (hyperoxia plus hypothermia) (n = 9 each). MEASUREMENTS AND MAIN RESULTS: Before, immediately at the end of and 12 and 22 hours after hemorrhagic shock, we measured hemodynamics, blood gases, acid-base status, metabolism, organ function, cytokine production, and coagulation. Postmortem kidney specimen were taken for histological evaluation, immunohistochemistry (nitrotyrosine, cystathionine γ-lyase, activated caspase-3, and extravascular albumin), and immunoblotting (nuclear factor-κB, hypoxia-inducible factor-1α, heme oxygenase-1, inducible nitric oxide synthase, B-cell lymphoma-extra large, and protein expression of the endogenous nuclear factor-κB inhibitor). Although hyperoxia alone attenuated the postshock hyperinflammation and thereby tended to improve visceral organ function, hypothermia and combi treatment had no beneficial effect. CONCLUSIONS: During resuscitation from near-lethal hemorrhagic shock, hyperoxia attenuated hyperinflammation, and thereby showed a favorable trend toward improved organ function. The lacking efficacy of hypothermia was most likely due to more pronounced barrier dysfunction with vascular leakage-induced circulatory failure.

• MeSH
• analýza krevních plynů MeSH
• cytokiny metabolismus   MeSH
• hemodynamika MeSH
• hemokoagulace fyziologie   MeSH
• hemoragický šok patofyziologie   terapie   MeSH
• hyperoxie * MeSH
• imunoblotting MeSH
• imunohistochemie MeSH
• ledviny patologie   MeSH
• náhodné rozdělení MeSH
• prasata MeSH
• prospektivní studie MeSH
• resuscitace metody   MeSH
• tekutinová terapie MeSH
• terapeutická hypotermie metody   MeSH
• umělé dýchání MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Intensive care of severe trauma patients focuses on the treatment of haemorrhagic shock. Tissues should be perfused sufficiently with blood and with sufficient oxygen content to ensure adequate tissue oxygen delivery. Tissue metabolism can be monitored by microdialysis, and the lactate/pyruvate ratio (LPR) may be used as a tissue ischemia marker. The aim of this study was to determine the adequate cardiac output and haemoglobin levels that avoid tissue ischemia. METHODS: Adult patients with serious traumatic haemorrhagic shock were enrolled in this prospective observational study. The primary observed parameters included haemoglobin, cardiac output, central venous saturation, arterial lactate and the tissue lactate/pyruvate ratio. RESULTS: Forty-eight patients were analysed. The average age of the patients was 39.8 ± 16.7, and the average ISS was 43.4 ± 12.2. Hb < 70 g/l was associated with pathologic arterial lactate, ScvO2 and LPR. Tissue ischemia (i.e., LPR over 25) developed when CI ≤ 3.2 l/min/m(2) and Hb between 70 and 90 g/l were observed. Severe tissue ischemia events were recorded when the Hb dropped below 70 g/l and CI was 3.2-4.8 l/min/m(2). CI ≥ 4.8 l/min/m(2) was not found to be connected with tissue ischemia, even when Hb ≤ 70 g/l. CONCLUSION: LPR could be a useful marker to manage traumatic haemorrhagic shock therapies. In initial traumatic haemorrhagic shock treatments, it may be better to maintain CI ≥ 3.2 l/min/m(2) and Hb ≥ 70 g/l to avoid tissue ischemia. LPR could also be a useful transfusion trigger when it may demonstrate ischemia onset due to low local DO2 and early reveal low/no tissue perfusion.

• MeSH
• dospělí MeSH
• hemoglobiny metabolismus   MeSH
• hemoragický šok patofyziologie   terapie   MeSH
• kyselina mléčná metabolismus   MeSH
• kyselina pyrohroznová metabolismus   MeSH
• kyslík metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrodialýza metody   MeSH
• minutový srdeční výdej fyziologie   MeSH
• mladý dospělý MeSH
• prospektivní studie MeSH
• resuscitace metody   MeSH
• stupeň závažnosti nemoci MeSH
• traumatický šok patofyziologie   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

• MeSH
• antifibrinolytika terapeutické užití   MeSH
• fibrinogen terapeutické užití   MeSH
• hemoragický šok diagnóza   farmakoterapie   patofyziologie   terapie   MeSH
• krevní plazma MeSH
• krevní transfuze MeSH
• krvácení * diagnóza   etiologie   farmakoterapie   patofyziologie   terapie   MeSH
• lidé MeSH
• péče o pacienty v kritickém stavu * metody   MeSH
• resuscitace metody   trendy   MeSH
• tromboelastografie trendy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• novinové články MeSH

BACKGROUND: We evaluated the effect of hypertension on hemodynamic responses and serum nitrite concentrations in normotensive (NT) and deoxycorticosteron acetate (DOCA)-Salt hypertensive (HT) rats. METHODS: Uncontrolled hemorrhagic shock was induced in NT and HT rats (n=7 each) by preliminary bleed of 25 ml/kg followed by a 75% tail amputation. The mean arterial pressure (MAP), heart rate and serum nitrite were measured pre-hemorrhage and during hemorrhage. RESULTS: Changes in time-averaged MAP after hemorrhage were significantly greater in HT group than NT. After resuscitation, the HT rats failed to restore MAP to baseline level. Serum nitrite level in both groups was significantly increased during shock period. Survival rate of HT animals was lower than NT group, although it was not statistically significant. CONCLUSIONS: Marked reduction of MAP and less improvement after resuscitation suggested the less adaptation of cardiovascular system in HT animals which may interfere with management of these subjects during uncontrolled hemorrhagic shock.

• MeSH
• arteriální tlak * MeSH
• chlorid sodný farmakologie   MeSH
• dusitany krev   MeSH
• hemoragický šok krev   komplikace   patofyziologie   MeSH
• hypertenze komplikace   MeSH
• krysa rodu rattus MeSH
• potkani Wistar MeSH
• resuscitace MeSH
• srdeční frekvence * MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Fluid resuscitation in trauma patients with hemorrhagic shock is controversially discussed in the literature. The coincidence of brain injury complicates management of these patients. This article summarizes the current knowledge on nonblood component fluid resuscitation and choice of fluids in patients with multiple trauma. RECENT FINDINGS: Whereas current evidence suggests the efficacy of fluid therapy in hemorrhagic shock without active bleeding, experimental and clinical data demonstrate that aggressive volume challenge may be futile or even deleterious in the setting of uncontrolled hemorrhage. Large amounts of isotonic crystalloids may be associated with hypothermia, acidosis and inflammation. In patients with traumatic brain injury hypertonic solutions may positively influence inflammation and intracranial pressure without affecting neurologic outcome or mortality. SUMMARY: To date no large-scale clinical studies exist to either support or refute the use of nonblood component fluid resuscitation of hemorrhagic shock in trauma patients. The optimal choice of fluid remains to be determined, but existing evidence suggests avoiding crystalloids in favor of hypertonic solutions. The role of modern, iso-oncotic colloids in the treatment of hemorrhagic shock has not yet been sufficiently defined. In patients with concomitant brain injury, arterial hypotension must be avoided and infusion of hypotonic solutions is obsolete, whereas administration of hypertonic solutions may exert beneficial effects beyond hemodynamic stabilization.

• MeSH
• hemoragický šok farmakoterapie   patofyziologie   terapie   MeSH
• hypertonické roztoky terapeutické užití   MeSH
• isotonické roztoky terapeutické užití   MeSH
• koloidy terapeutické užití   MeSH
• lidé MeSH
• náhražky plazmy terapeutické užití   MeSH
• polytrauma patofyziologie   terapie   MeSH
• poranění mozku terapie   MeSH
• resuscitace metody   MeSH
• tekutinová terapie MeSH
• urgentní zdravotnické služby MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Léčba hemoragického šoku je i v současné medicíně stále závažný problém. Změnám na úrovni makrocirkulace a globálního metabolismu předcházejí změny na úrovni buněk, nejmenších cév a extracelulární tekutiny. Dominantní porucha se odehrává na úrovni buněk a mikrocirkulace. Přímá monitorace extracelulární tekutiny je možná metodou mikrodialýzy. Metoda je ověřena v řadě prací na animálních modelech, ale začíná být i podstatou mnoha klinických studií. Jedná se především o sledování tkáňových hodnot laktátu, pyruvátu, glukózy a glycerolu jako hlavních markerů energetického metabolismu buněk. O stavu tkání informují jak absolutní hodnoty, tak především vzájemné poměry hodnot laktát/pyruvát a laktát/glukóza. Sledované veličiny neupozorňují jen na nastupující anaerobní metabolismus, ale také na míru centralizace oběhu, resp. reperfuzi. Velmi cenné jsou i informace o mitochondriální dysfunkci, která je buněčnou podstatou multiorgánového selhávání v intenzivní péči. Dle dynamiky těchto parametrů můžeme posuzovat kvalitu resuscitační péče s ohledem na rychlost eliminace šoku, zvyšování dodávky kyslíku tkáním a léčbu mitochondriální dysfunkce.

Therapy of haemorrhagic shock presents a huge challenge nowadays. Changes in circulation and metabolism are preceded with changes in cells, vessels and extracellular fluid. The main disorder takes place in microcirculation. Monitoring of extracellular fluid is possible with microdialysis. This method was verified on animal models and a became base of many clinical examinations in the world. First of all it is monitoring of lactate, pyruvate, glucose and glycerole as main markers of cell metabolism. Tissue condition can be described not only with absolute values but also as relations between individual parameters e.g. lactate/pyruvate and lactate/glucose. These values do not only inform us about forthcoming change from aerobic to anaerobic metabolism but also about the degree of reperfusion. Precious information about mitochondrial dysfunction which is the essence of multiorgan dysfunction in intensive care is collected as well. Based on changes we can asses the quality of resuscitation care together with speed of shock elimination, increasing oxygen delivery and mitochondrial dysfunction treatment.

• Klíčová slova
• laktát, svalová tkáň.,
• MeSH
• biologické markery MeSH
• extracelulární tekutina fyziologie   MeSH
• financování organizované MeSH
• hemoragický šok diagnóza   patofyziologie   prevence a kontrola   MeSH
• ischemie diagnóza   MeSH
• laktáty diagnostické užití   MeSH
• lidé MeSH
• mikrocirkulace MeSH
• mikrodialýza metody   trendy   MeSH
• mitochondrie patologie   MeSH
• péče o pacienty v kritickém stavu metody   trendy   MeSH
• spotřeba kyslíku MeSH
• svaly patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH