Advances in resuscitation strategies

Abstract

Shock, regardless of etiology is characterized by decreased delivery of oxygen and nutrients to the tissues and our interventions are directed towards reversing the cellular ischemia and preventing its consequences. The treatment strategies that are most effective in achieving this goal obviously depend upon the different types of shock (hemorrhagic, septic, neurogenic and cardiogenic). This brief review focuses on the two leading etiologies of shock in the surgical patients: bleeding and sepsis, and addresses a number of new developments that have profoundly altered the treatment paradigms. The emphasis here is on new research that has dramatically altered our treatment strategies rather than the basic pathophysiology of shock.

Damage control resuscitation

“…Yet, leaving blood pressure low is often counterintuitive to clinicians due to the misconception that blood pressure always equates to organ perfusion. 18,19 During World War I, the Harvard Medical Unit, run by Walter Cannon and John Fraser, observed that when higher blood pressures were targeted with the administration of more crystalloid fluid, "blood that is sorely needed may be lost." 20 In World War II, the same observation was made by Henry Beecher; a systolic blood pressure (SBP) goal of 80 to 90 mmHg was deemed "beneficial" before surgery.…”

Modelling for conflict: the legacy of ballistic research and current extremity in vivo modelling

“…The animal of choice for physiological resuscitation studies,10 porcine models, are used to investigate management options in the blast injured casualty 11–21. To study gunshot wounding (GSW), however, anatomical projectile interaction with tissues is key in the choice of model.…”

MFG-E8 and Inflammation

“…Increase in circulating platelet microvesicles have been detected in antiphospholipid antibody syndrome [ 106 ], cancer associated deep vein thrombosis [ 107 ], heparin-induced thrombocytopenia [ 108 ], thrombotic thrombocytopenic purpura [ 109 ], acute coronary syndromes [ 110 ], ischemic stroke [ 111 ], diabetes [ 112 ], cirrhosis [ 113 ] and sepsis [ 114 , 115 ]. All these conditions are associated with a procoagulant state and/or vascular dysfunction.…”

“…While fl uid resuscitation decreases the risk of death in severe hemorrhage, it increases the risk of death in less severe hemorrhage. However, in two recent multicenter clinical trials, hypertonic saline treated patients experienced early high mortality in comparison to normal saline treatment and thus, hypertonic saline is not recommended for resuscitation in trauma patients [ 109 ]. Advances in trauma care systems and emergency medical services have resulted in a significantly large percentage of patients who survive to hospital admission [ 96 ].…”