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81. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock

seconds with specific evaluation after each bolus for signs of fluid overload, as well as first-hour antibiotic administration and 2) subsequent ICU hemodynamic support directed to goals of ScVO 2 greater than 70% and cardiac index (CI) 3.3–6.0 L/min/m 2 with appropriate antibiotic coverage and source control.” The major new recommendation in the 2014 update is that hemodynamic support of septic shock now be addressed at the institutional level rather than only at the practitioner level with well (...) should be made to improve coronary perfusion pressure and reverse the tachycardia by giving volume if the end-diastolic volume is low, or an inotrope if contractility is low. Because CO = HR × SV, therapies directed to increasing SV will often reflexively reduce HR and improve CO. This will be evident in improvement of the shock index (HR/systolic blood pressure [SBP]) ( ), as well as CO. Children have limited HR reserve compared with adults because they are already starting with high basal HRs

2017 Society of Critical Care Medicine

82. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

and clinical or laboratory signs of hypoperfusionClinical hypoperfusion: Cold extremities, oliguria, mental confusion, dizziness, narrow pulse pressureLaboratory hypoperfusion: Metabolic acidosis, elevated serum lactate, elevated serum creatinine CI indicates cardiac index; CS, cardiogenic shock; ESC, European Society of Cardiology; HF, heart failure; IABP-SHOCK II, Intraaortic Balloon Pump in Cardiogenic Shock II; LV, left ventricular; MI, myocardial infarction; PCWP, pulmonary capillary wedge pressure (...) with chronic HF with a subacute decompensation but also represents a reported 28% of patients with MI-associated CS. , Compared with patients with classic CS, those with euvolemic CS were less likely to have had a previous MI or chronic kidney disease and had significantly lower PCWPs. Figure 2. Potential hemodynamic presentations of cardiogenic shock. CI indicates cardiac index; PCWP, pulmonary capillary wedge pressure; and SVRI, systemic vascular resistance index. There is growing recognition

2017 American Heart Association

83. Restricted fluid bolus volume in early septic shock: results of the Fluids in Shock pilot trial. (PubMed)

Restricted fluid bolus volume in early septic shock: results of the Fluids in Shock pilot trial. To determine the feasibility of Fluids in Shock, a randomised controlled trial (RCT) of restricted fluid bolus volume (10 mL/kg) versus recommended practice (20 mL/kg).Nine-month pilot RCT with embedded mixed-method perspectives study.13 hospitals in England.Children presenting to emergency departments with suspected infection and shock after 20 mL/kg fluid.Patients were randomly allocated (1:1 (...) ) to further 10 or 20 mL/kg fluid boluses every 15 min for up to 4 hours if still in shock.These were based on progression criteria, including recruitment and retention, protocol adherence, separation, potential trial outcome measures, and parent and staff perspectives.Seventy-five participants were randomised; two were withdrawn. 23 (59%) of 39 in the 10 mL/kg arm and 25 (74%) of 34 in the 20 mL/kg arm required a single trial bolus before the shock resolved. 79% of boluses were delivered per protocol

2018 Archives of Disease in Childhood Controlled trial quality: predicted high

84. Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction - The Randomized SHOCK-COOL Trial. (PubMed)

).In this randomized trial, mild therapeutic hypothermia failed to show a substantial beneficial effect on cardiac power index at 24 hours in patients with cardiogenic shock after acute myocardial infarction.URL: https://www.clinicaltrials.gov . Unique identifier: NCT01890317. (...) Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction - The Randomized SHOCK-COOL Trial. Experimental trials suggest improved outcome by mild therapeutic hypothermia for cardiogenic shock after acute myocardial infarction. The objective of this study was to investigate the hemodynamic effects of mild therapeutic hypothermia in patients with cardiogenic shock complicating acute myocardial infarction.Patients (n=40) with cardiogenic shock undergoing primary percutaneous

2018 Circulation Controlled trial quality: predicted high

85. Is There an Optimum Duration of Fluid Bolus in Pediatric Septic Shock? A Critical Appraisal of "Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial" by Sankar et a (PubMed)

nonsignificant p values greater than 0.05. Analysis of the results did not support the early stopping of this trial at the interim period.The article reviewed does not support a change in practice to a longer duration of fluid bolus. The "push" technique for titration of fluid boluses in pediatric septic shock should continue to be the method of choice. Critical Care trials using binary outcomes as endpoints should publish Fragility Index results to aid interpretation and generate stronger conclusions. (...) Is There an Optimum Duration of Fluid Bolus in Pediatric Septic Shock? A Critical Appraisal of "Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial" by Sankar et a To review the findings and discuss the implications of a longer duration for fluid boluses in the resuscitation of children with septic shock.We performed a PubMed.gov search using the criteria "Fluid Bolus" and "Children" and "Septic Shock

2018 Pediatric Critical Care Medicine

86. Extracorporeal shock wave therapy in musculoskeletal disorders

shock waves might be an alternative to treat calcific tendinitis of the shoulder and recalcitrant plantar fasciitis refractory to initial medical management. There are many types and forms for shock wave administration used in the different studies. The clinical practice guidelines are heterogeneous on the use of this technology and most coverage policies surveyed do not cover its use to treat musculoskeletal disorders. Final publication URL www.iecs.org.ar Indexing Status Subject indexing assigned (...) Extracorporeal shock wave therapy in musculoskeletal disorders Extracorporeal shock wave therapy in musculoskeletal disorders Extracorporeal shock wave therapy in musculoskeletal disorders Klappenbach R, García Martí S, Pichon-Riviere A, Augustovski F, Alcaraz A, Bardach A, Ciapponi A, López A, Rey-Ares L Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA

2016 Health Technology Assessment (HTA) Database.

87. Shock Index and Prediction of Traumatic Hemorrhagic Shock 28-Day Mortality: Data from the DCLHb Resuscitation Clinical Trials (PubMed)

Shock Index and Prediction of Traumatic Hemorrhagic Shock 28-Day Mortality: Data from the DCLHb Resuscitation Clinical Trials To assess the ability of the shock index (SI) to predict 28-day mortality in traumatic hemorrhagic shock patients treated in the diaspirin cross-linked hemoglobin (DCLHb) resuscitation clinical trials.We used data from two parallel DCLHb traumatic hemorrhagic shock efficacy trials, one in U.S. emergency departments, and one in the European Union prehospital setting (...) patients with SI values below these cutoffs (p<0.001). Similarly, after 120 minutes of resuscitation, patients with a SI≥1.0 were 3.9× times more likely to die by 28 days (40 vs. 15%, p<0.001). Although the distribution of SI values differed based on treatment group, the receiver operator characeristics data showed no difference in SI predictive ability for 28-day mortality in patients treated with DCLHb.In these traumatic hemorrhagic shock patients, the shock index correlates with 28-day mortality

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2014 Western Journal of Emergency Medicine

88. Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction

hypothermia failed to show a substantial beneficial effect on cardiac power index at 24 hours in patients with cardiogenic shock after acute myocardial infarction.URL: https://www.clinicaltrials.gov . Unique identifier: NCT01890317. (...) Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction Experimental trials suggest improved outcome by mild therapeutic hypothermia for cardiogenic shock after acute myocardial infarction. The objective of this study was to investigate the hemodynamic effects of mild therapeutic hypothermia in patients with cardiogenic shock complicating acute myocardial infarction.Patients (n=40) with cardiogenic shock undergoing primary percutaneous coronary intervention without classic

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2019 EvidenceUpdates

89. Protocolised Management In Sepsis (ProMISe): a multicentre randomised controlled trial of the clinical effectiveness and cost-effectiveness of early, goal-directed, protocolised resuscitation for emerging septic shock

Protocolised Management In Sepsis (ProMISe): a multicentre randomised controlled trial of the clinical effectiveness and cost-effectiveness of early, goal-directed, protocolised resuscitation for emerging septic shock Protocolised Management In Sepsis (ProMISe): a multicentre, randomised controlled trial of the clinical and cost-effectiveness of early protocolised resuscitation for emerging septic shock Journals Library An error occurred retrieving content to display, please try again (...) . >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from the navigation or try a website search above to find the information you need. >> >> >> >> Issue {{metadata .Issue }} Toolkit 1)"> 0)"> 1)"> {{metadata.Title}} {{metadata.Headline}} {{author}} {{($index , , , , , , , , , , , , , & . Paul R Mouncey 1 , Tiffany M Osborn 2 , G Sarah Power 1 , David A Harrison 1 , M Zia Sadique 3 , Richard D Grieve 3 , Rahi Jahan 1 , Jermaine CK Tan 1

2015 NIHR HTA programme

90. Inova Cardiogenic Shock Registry (INOVA SHOCK)

Inova Cardiogenic Shock Registry (INOVA SHOCK) Inova Cardiogenic Shock Registry (INOVA SHOCK) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Inova Cardiogenic Shock Registry (INOVA SHOCK) (INOVASHOCK (...) by (Responsible Party): Alexander G. Truesdell, Inova Health Care Services Study Details Study Description Go to Brief Summary: To collect retrospective clinical outcomes related to acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock and compare current versus historical survival rates. To collect Inova Heart and Vascular Institute (IHVI) site specific outcomes before and after initiation of the Cardiogenic Shock team on January 1, 2017. To collect outcomes

2017 Clinical Trials

91. Hemodynamic Analysis of Pediatric Septic Shock and Cardiogenic Shock Using Transpulmonary Thermodilution (PubMed)

higher in the cardiogenic group (p < 0.05). Cardiac index was significantly lower in the nonsurvivors of cardiogenic shock at the time of initial admission and after the first 24 hours (both p < 0.05), while systemic vascular resistance index (SVRI) was significantly lower in the nonsurvivors of septic shock (p < 0.001). Therefore, during the first 24 hours after intensive care, SVRI and cardiac index are the most important hemodynamic parameters associated with mortality. (...) Hemodynamic Analysis of Pediatric Septic Shock and Cardiogenic Shock Using Transpulmonary Thermodilution Septic shock and cardiogenic shock are the two most common types of shock in children admitted to pediatric intensive care units (PICUs). The aim of the study was to investigate which hemodynamic variables were associated with mortality in children with shock. We retrospectively analyzed 50 children with shock (37 septic shock cases and 13 cardiogenic shock cases) in the PICU and monitored

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2017 BioMed research international

92. Experience in the use of non-pneumatic anti-shock garment (NASG) in the management of postpartum haemorrhage with hypovolemic shock in the Fundación Valle Del Lili, Cali, Colombia (PubMed)

in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application.Fifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour (...) Experience in the use of non-pneumatic anti-shock garment (NASG) in the management of postpartum haemorrhage with hypovolemic shock in the Fundación Valle Del Lili, Cali, Colombia The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals.Descriptive case series of 77 women that received NASG

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2017 Reproductive health

93. Noncontrast computed tomography factors predictive of extracorporeal shock wave lithotripsy outcomes in patients with pancreatic duct stones (PubMed)

Noncontrast computed tomography factors predictive of extracorporeal shock wave lithotripsy outcomes in patients with pancreatic duct stones To assess the usefulness of factors unique to NCCT for the prediction of ESWL outcomes in patients with pancreatic duct stones.We retrospectively evaluated 148 patients with multiple PDS who had undergone ESWL therapy. All patients received an examination for NCCT both before and after ESWL. The following parameters were measured and recorded: patient (...) characteristics including sex and age; NCCT parameters including mean stone length, mean stone volumes before and after ESWL, mean value of CT attenuation, standard deviation of CT attenuation, variation coefficient of CT attenuation, skin-to-stone distance, and pancreatic duct diameter; ESWL outcome indexes including stone clearance rate calculated using the formula [Formula: see text], and the number of ESWL sessions. All patients were divided into groups based on their SCR: A group (SCR ≥ 90%), B group

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2018 Abdominal radiology (New York)

94. An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Dr. Smith's ECG Blog: An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Wednesday, October 31, 2018 Written by Pendell Meyers 84 yo M with history of a “valve problem” presented for sudden onset chest pain and trouble breathing while eating lunch. He was sitting bolt upright, diaphoretic, tachypneic, with bilateral crackles. Although his BP was 126/84, he was in acute (...) cardiogenic shock. Here is his initial ECG: Sinus tach with occasional PACs. Relatively normal QRS complex with diffuse significant ST depression including leads V2-V6, I, aVL, II, III, and aVF, with ST elevation in aVR. The vector of ST depression is maximal in leads V5 and II, consistent with diffuse subendocardial ischemia. There is no evidence of any single vessel OMI (Occlusion MI). This is not consistent with posterior OMI, which would have ST depression maximal in V2-V4 usually without diffuse ST

2018 Dr Smith's ECG Blog

95. Hyaluronic Acid (HA), Platelet-Rich Plasm and Extracorporeal Shock Wave Therapy (ESWT) promote human chondrocyte regeneration in vitro and ESWT-mediated increase of CD44 expression enhances their susceptibility to HA treatment. (PubMed)

Hyaluronic Acid (HA), Platelet-Rich Plasm and Extracorporeal Shock Wave Therapy (ESWT) promote human chondrocyte regeneration in vitro and ESWT-mediated increase of CD44 expression enhances their susceptibility to HA treatment. Novel strategies have been proposed for articular cartilage damage occurring during osteoarthritis (OA) and -among these- Extracorporeal Shock Wave Therapy (ESWT), intra-articular injections of Platelet-Rich Plasma (PRP) or Hyaluronic Acid (HA) revealed encouraging (...) during prolonged chondrocyte culture. We then attested the efficiency of all such treatments to stimulate the expression of markers of chondrogenic potential such as SOX9 and COL2A, to increase the Ki67 proliferation index as well as to antagonize the traditional marker of chondrosenescence p16INK4a (known as Cdkn2a). Furthermore, all our samples showed an ESW- and HA-mediated enhancement of migratory and anti-inflammatory activity onto the cytokine-rich environment characterizing OA. Taken together

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2019 PLoS ONE

96. Acute heart failure following myocardial infarction: complement activation correlates with the severity of heart failure in patients developing cardiogenic shock (PubMed)

percutaneous coronary intervention-treated ST-elevation myocardial infarction herein underwent a post hoc analysis. Blood samples were drawn from inclusion to Day 5 and at 42 day follow-up, and biomarkers were measured with enzyme immunoassays. Regional myocardial contractility was measured by echocardiography as wall motion score index (WMSI). The cardiogenic shock group (n = 9) was compared with the non-shock group (n = 52). Controls (n = 44) were age-matched and sex-matched healthy individuals. C4bc (...) Acute heart failure following myocardial infarction: complement activation correlates with the severity of heart failure in patients developing cardiogenic shock Heart failure (HF) is an impending complication to myocardial infarction. We hypothesized that the degree of complement activation reflects severity of HF following acute myocardial infarction.The LEAF trial (LEvosimendan in Acute heart Failure following myocardial infarction) evaluating 61 patients developing HF within 48 h after

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2018 ESC heart failure Controlled trial quality: uncertain

97. Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States. (PubMed)

total net worth at study entry.Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 (...) Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States. A sudden loss of wealth-a negative wealth shock-may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.To determine whether a negative wealth shock was associated with all-cause

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2018 JAMA

98. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction

efficacy endpoint, cardiac index evolution was similar between the 2 groups (p = 0.43) from baseline (H0) to H72. For the main safety endpoint, the observed higher incidence of refractory shock in the epinephrine group (10 of 27 [37%] vs. norepinephrine 2 of 30 [7%]; p = 0.008) led to early termination of the study. Heart rate increased significantly with epinephrine from H2 to H24 while remaining unchanged with norepinephrine (p < 0.0001). Several metabolic changes were unfavorable to epinephrine (...) compared with norepinephrine, including an increase in cardiac double product (p = 0.0002) and lactic acidosis from H2 to H24 (p < 0.0001).In patients with CS secondary to acute myocardial infarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743

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2018 EvidenceUpdates

99. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock

and consumption, gastric mucosal PCO 2 , RBC velocity, or skin capillary flow. Another single-center ( ) trial compared, in norepinephrine-treated septic shock , dose titration to maintain MAP at 65 mm Hg versus achieving 85 mm Hg. In this trial, targeting high MAP increased cardiac index from 4.8 (3.8–6.0) to 5.8 (4.3–6.9) L/min/m 2 but did not change renal function, arterial lactate levels, or oxygen consumption. A third single-center trial ( ) found improved microcirculation, as assessed by sublingual (...) , including small study size, using an initial index time of an arbitrary time point such as emergency department arrival, and indexing of outcome to delay in time to the first antimicrobial (regardless of activity against the putative pathogen) ( , ). Other negative studies not included in this meta-analysis are compromised by equating bacteremia with sepsis (as currently defined to include organ failure) and septic shock ( ). Many of these studies are also compromised by indexing delays to easily

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2016 European Respiratory Society

100. Cardiogenic shock with wide complex tachycardia and poor LV function in a young woman

Cardiogenic shock with wide complex tachycardia and poor LV function in a young woman Dr. Smith's ECG Blog: Cardiogenic shock with wide complex tachycardia and poor LV function in a young woman Saturday, October 14, 2017 A 30-something woman presented with CP and SOB. She was hypoxic and intubated. She had very poor LV systolic function on bedside echo. There were no B-lines and the RV was normal. The following ECG was recorded: Wide complex regular tachycardia at a rate of 140, no P-waves What (...) remained in cardiogenic shock due to severely decreased LV systolic function. The remainder of the management is beyond the scope of this blog. Later in the day, this ECG was recorded: Sinus with LBBB. So the LBBB is definitely baseline. This is the same morphology that she had while in tachycardia, proving that the rhythm was supraventricular. The patient recovered neurologically, but with a persistently very low ejection fraction (20%, due to new cardiomyopathy). She also had very frequent

2017 Dr Smith's ECG Blog

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