Inflammatory response to trauma

Pierce, Albert; Pittet, Jean–François

doi:10.1097/aco.0000000000000047

Cited by 52 publications

(25 citation statements)

References 78 publications

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“…The disturbance, traction and the compression of the thoracic cavity by pneumoperitoneum during surgery are the important elements of trauma 28 . Studies have demonstrated that trauma is closely associated with the stability of the internal environment 29 , 30 . Obese patients suffer from many underlying diseases and exhibit reduced cardiopulmonary function and operational tolerance; thus, their internal environment is relatively sensitive to trauma 31 .…”

Section: Discussionmentioning

confidence: 99%

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Gong¹,

Cao²,

Wang³

et al. 2015

J. Cancer

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Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical procedure that has achieved satisfactory results for obese patients in our surgical center. To fully elucidate the advantages of this procedure, in this study, comprehensive and in-depth comparative analyses were performed to assess clinical data from obese gastric cancer patients who underwent HALG, laparoscopic-assisted D2 radical gastrectomy (LAG), and open D2 radical gastrectomy (OG) in our surgical center during a specific time period. For the 3 groups, incision length was 1.25 cm longer for the HALG group than for the LAG group but was significantly shorter for the HALG group than for the OG group (P =0.00). The rate of conversion to laparotomy , the pneumoperitoneum time and the number of recovered lymph nodes were significantly better for the HALG group than for the LAG group (P <0.05). The pain score at day 2 after surgery, intestinal function recovery time, and duration of postoperative hospital stay were not significantly different for the HALG and LAG groups ( P >0.05) but were significantly better for the HALG group than for the OG group (P <0.05). There were significantly fewer postoperative complications for the HALG group than for the LAG and OG groups (P =0.049). According to the results, the “three-step HALG method” incorporates both the thoroughness of the radical OG approach and the minimal invasiveness of the LAG approach for obese patients. Thus, the HALG approach is a relatively safe and extremely feasible surgical procedure for the treatment of these patients.

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Section: Discussionmentioning

confidence: 99%

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Gong¹,

Cao²,

Wang³

et al. 2015

J. Cancer

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“…Disease states associated with inflammation like trauma, burns, sepsis, and acute pancreatitis are characterized by a marked reduction in the vascular endothelial glycocalyx [ 45 ]-[ 47 ]. The glycocalyx is the primary structure limiting free fluid flux across the vascular space [ 35 ].…”

Section: Reviewmentioning

confidence: 99%

Choices in fluid type and volume during resuscitation: impact on patient outcomes

Lira

Pinsky

2014

Ann. Intensive Care

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We summarize the emerging new literature regarding the pathophysiological principles underlying the beneficial and deleterious effects of fluid administration during resuscitation, as well as current recommendations and recent clinical evidence regarding specific colloids and crystalloids. This systematic review allows us to conclude that there is no clear benefit associated with the use of colloids compared to crystalloids and no evidence to support the unique benefit of albumin as a resuscitation fluid. Hydroxyethyl starch use has been associated with increased acute kidney injury (AKI) and use of renal replacement therapy. Other synthetic colloids (dextran and gelatins) though not well studied do not appear superior to crystalloids. Normal saline (NS) use is associated with hyperchloremic metabolic acidosis and increased risk of AKI. This risk is decreased when balanced salt solutions are used. Balanced crystalloid solutions have shown no harmful effects, and there is evidence for benefit over NS. Finally, fluid resuscitation should be applied in a goal-directed manner and targeted to physiologic needs of individual patients. The evidence supports use of fluids in volume-responsive patients whose end-organ perfusion parameters have not been met.

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“…The endothelial glycocalyx plays an important role in vascular barrier regulation [4] , WBC adhesion [43] , coagulation [44; 45] , angiogenesis [46] , and tissue repair [47] . Nearly all of these functions are relevant to perioperative clinicians.…”

Section: Discussionmentioning

confidence: 99%

The Biomechanical Effects of Resuscitation Colloids on the Compromised Lung Endothelial Glycocalyx

Job

O'Callaghan

Hlady

et al. 2016

Anesthesia &Amp; Analgesia

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Background The endothelial glycocalyx is an important component of the vascular permeability barrier, forming a scaffold that allows serum proteins to create a gel-like layer on the endothelial surface, and transmitting mechanosensing and mechanotransduction information that influences permeability. During acute inflammation the glycocalyx is degraded, changing how it interacts with serum proteins and colloids used during resuscitation and altering its barrier properties and biomechanical characteristics. We quantified changes in the biomechanical properties of lung endothelial glycocalyx during control conditions and after degradation by hyaluronidase using biophysical techniques that can probe mechanics at: 1) the aqueous/glycocalyx interface and 2) inside the glycocalyx. Our goal was to discern the location-specific effects of albumin and hydroxyethyl starch (HES) on glycocalyx function. Methods The effects of albumin and HES on the mechanical properties of bovine lung endothelial glycocalyx were studied using a combination of atomic force microscopy (AFM) and reflectance interference contrast microscopy (RICM). Logistic regression was used to determine the odds ratios for comparing the effects of varying concentrations of albumin and HES on the glycocalyx with and without hyaluronidase (HA’ase). Results AFM measurements demonstrated that both 0.1 % and 4% albumin increased the thickness and reduced the stiffness of glycocalyx when compared with 1% albumin. The effect of HES on glycocalyx thickness was similar to albumin, with thickness increasing significantly between 0.1% and 1% HES and a trend towards a softer glycocalyx at 4% HES. RICM revealed a concentration-dependent softening of the glycocalyx in the presence of albumin but a concentration dependent increase in stiffness with HES. After glycocalyx degradation with HA’ase, stiffness was increased only at 4% albumin and 1% HES. Conclusions Albumin and HES induced markedly different effects on glycocalyx mechanics and had notably different effects after glycocalyx degradation by hyaluronidase. We conclude that HES is not comparable to albumin for studies of vascular permeability and glycocalyx-dependent signaling. Characterizing the molecular and biomechanical effects of resuscitation colloids on the glycocalyx should clarify their indicated uses and permit a better understanding of how HES and albumin affect vascular function.

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Inflammatory response to trauma

Cited by 52 publications

References 78 publications

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Choices in fluid type and volume during resuscitation: impact on patient outcomes

The Biomechanical Effects of Resuscitation Colloids on the Compromised Lung Endothelial Glycocalyx

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