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Wang L, Jia H, Shen Y, Chu X, Chen Z, Ren Y, Zhang Y. Diagnostic Significance of Combined Calcitoninogen, Platelet, and D-Dimer Assay in Severe Heatstroke: with Clinical Data Analysis of 70 Patients with Severe Heatstroke. Ther Hypothermia Temp Manag 2023; 13:29-37. [PMID: 36067330 DOI: 10.1089/ther.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The significance of calcitoninogen detection among inpatients was discussed by analyzing the clinical characteristics of severe heatstroke (HS). HS patients who were admitted to the Second Hospital of Nantong University, Jiangsu Province, China, between July 1, 2015, and October 30, 2020, were reviewed. Patients' clinical characteristics and laboratory data were recorded, and they were divided into three groups, that is, a control group (heat cramps and heat exhaustion), an exertional HS (EHS) group, and a classical HS (CHS) group to compare the differences among them. Receiver operating characteristic (ROC) curves were plotted to evaluate patients' clinical utility. (1) The body temperatures in the EHS and CHS groups were significantly higher than in the control group (all p < 0.05). (2) The D-dimer (DD), procalcitonin (PCT), and Acute Physiology and Chronic Health Evaluation (APACHE) II score of the EHS group were significantly higher compared with the control and CHS groups (all p < 0.05); the platelets (PLT), C-reactive protein (CRP), blood sodium (Na), and intravenous glucose (GLU) of the EHS group were lower than in the control and CHS groups (all p < 0.05). (3) The ROC curve analysis showed the performance results for DD (area under the curve [AUC] 0.670, 95% confidence interval [CI] 0.547-0.777), PCT (AUC 0.705, 95% CI 0.584-0.808), and PLT (AUC 0.791, 95% CI 0.677-0.879). The sensitivity was 40.48%, 100%, and 73.81%, and the specificity was 96.43%, 32.14%, and 78.57%, respectively. Using three combined analyses, an elevated AUC of 0.838, 95% CI 0.731-0.916, with a sensitivity of 71.43% and a specificity of 85.71%, respectively, was revealed. Patients in the EHS group had higher DD, PCT, and APACHE II values, whereas PLT, CRP, Na, and GLU were reduced. The apparent decrease in the PLT, as well as the increase in PCT and DD values, could be considered as early sensitivity indicators of severe HS. A combined test of these three indicators presented significant diagnostic value for detecting severe cases of HS.
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Affiliation(s)
- Lei Wang
- Department of Emergency Center, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Hanyu Jia
- Research and Education Sector, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yiming Shen
- Department of Emergency Center, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xin Chu
- Department of Emergency Center, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Zhenghua Chen
- Department of Neurosurgery, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yuqin Ren
- Department of Emergency Center, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yi Zhang
- Research and Education Sector, Second Affiliated Hospital of Nantong University, Nantong, China.,Department of Neurosurgery, Second Affiliated Hospital of Nantong University, Nantong, China
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Convertino VA, Cardin S, Cap AP, Crowder AT, Stackle ME, Talley MJ, Lurie KG. Saving the brain after mild-to-moderate traumatic injury: A report on new insights of the physiology underlying adequate maintenance of cerebral perfusion. J Trauma Acute Care Surg 2021; 91:S33-S39. [PMID: 34039933 DOI: 10.1097/ta.0000000000003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Traumatic brain injury (TBI) is associated with increased morbidity and mortality in civilian trauma and battlefield settings. It has been classified across a continuum of dysfunctions, with as much as 80% to 90% of cases diagnosed as mild to moderate in combat casualties. In this report, a framework is presented that focuses on the potential benefits for acute noninvasive treatment of reduced cerebral perfusion associated with mild TBI by harnessing the natural transfer of negative intrathoracic pressure during inspiration. This process is known as intrathoracic pressure regulation (IPR) therapy, which can be applied by having a patient breath against a small inspiratory resistance created by an impedance threshold device. Intrathoracic pressure regulation therapy leverages two fundamental principles for improving blood flow to the brain: (1) greater negative intrathoracic pressure enhances venous return, cardiac output, and arterial blood pressure; and (2) lowering of intracranial pressure provides less resistance to cerebral blood flow. These two effects work together to produce a greater pressure gradient that results in an improvement in cerebral perfusion pressure. In this way, IPR therapy has the potential to counter hypotension and hypoxia, potentially significant contributing factors to secondary brain injury, particularly in conditions of multiple injuries that include severe hemorrhage. By implementing IPR therapy in patients with mild-to-moderate TBI, a potential exists to provide early neuroprotection at the point of injury and a bridge to more definitive care, particularly in settings of prolonged delays in evacuation such as those anticipated in future multidomain operations. LEVEL OF EVIDENCE Report.
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Affiliation(s)
- Victor A Convertino
- From the US Army Institute of Surgical Research (V.A.C., A.P.C., A.T.C., M.E.S.); Naval Medical Research Unit-San Antonio (S.C.), Joint Base San Antonio-Fort Sam Houston, Texas; US Army Medical Research and Development Command (M.J.T.), Fort Detrick, Maryland; and Department of Emergency Medicine (K.G.L.), University of Minnesota, Minneapolis, Minnesota
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Huang M, Brothers RM, Ganio MS, Lucas RAI, Cramer MN, Moralez G, Convertino VA, Crandall CG. Tolerance to a haemorrhagic challenge during heat stress is improved with inspiratory resistance breathing. Exp Physiol 2018; 103:1243-1250. [PMID: 29947436 PMCID: PMC6119106 DOI: 10.1113/ep087102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/22/2018] [Indexed: 02/06/2023]
Abstract
NEW FINDINGS What is the central question of this study? Does inspiratory resistance breathing improve tolerance to simulated haemorrhage in individuals with elevated internal temperatures? What is the main finding and its importance? The main finding of this study is that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress. These findings demonstrate a scenario in which exploitation of the respiratory pump can ameliorate serious conditions related to systemic hypotension. ABSTRACT Heat exposure impairs human blood pressure control and markedly reduces tolerance to a simulated haemorrhagic challenge. Inspiratory resistance breathing enhances blood pressure control and improves tolerance during simulated haemorrhage in normothermic individuals. However, it is unknown whether similar improvements occur with this manoeuvre in heat stress conditions. In this study, we tested the hypothesis that inspiratory resistance breathing improves tolerance to simulated haemorrhage in individuals with elevated internal temperatures. On two separate days, eight subjects performed a simulated haemorrhage challenge [lower-body negative pressure (LBNP)] to presyncope after an increase in internal temperature of 1.3 ± 0.1°C. During one trial, subjects breathed through an inspiratory impedance device set at 0 cmH2 O of resistance (Sham), whereas on a subsequent day the device was set at -7 cmH2 O of resistance (ITD). Tolerance was quantified as the cumulative stress index. Subjects were more tolerant to the LBNP challenge during the ITD protocol, as indicated by a > 30% larger cumulative stress index (Sham, 520 ± 306 mmHg min; ITD, 682 ± 324 mmHg min; P < 0.01). These data indicate that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress.
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Affiliation(s)
- Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Matthew Brothers
- Department of Kinesiology, University of Texas, Arlington, Arlington, TX, USA
| | - Matthew S Ganio
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Rebekah A I Lucas
- School of Sport, Exercise & Rehabilitation Sciences, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Matthew N Cramer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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James RH, Henning DCW, Smith JE. The use of impedance threshold devices in spontaneously breathing, hypotensive trauma patients. TRAUMA-ENGLAND 2015. [DOI: 10.1177/1460408614539146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Impedance threshold devices are a novel therapeutic option to increase blood pressure in the spontaneously breathing, hypotensive, trauma patient. They have multiple potential mechanisms of action. The most important is their ability to induce a more negative intrathoracic pressure during inspiration. They achieve this by the presence of a series of valves. These valves only open once the patient has generated a more negative intrathoracic pressure than is normally required for inspiration to occur. This negative intrathoracic pressure is thought to increase venous return and therefore cardiac output and subsequently blood pressure. This narrative review examines the evidence pertaining to the use of these devices in spontaneously breathing, hypotensive, trauma patients. While the literature supports the ability of these devices to increase systolic blood pressure in both animal and human models of hypotension, and more recently in patients with true pathological hypotension, potential flaws are discussed, and several key questions that have not been addressed by studies to date are highlighted. Notwithstanding these problems, impedance threshold devices may have a role in hypotensive trauma patients, particularly during the pre-hospital phase of care when available resources limit treatment options. Further work is required to prove both their clinical effectiveness and safety.
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Affiliation(s)
- RH James
- Emergency Department, Derriford Hospital, Plymouth, Devon, UK
| | - DCW Henning
- Emergency Department, Derriford Hospital, Plymouth, Devon, UK
| | - JE Smith
- Emergency Department, Derriford Hospital, Plymouth, Devon, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Medical Directorate, Joint Medical Command, Birmingham, UK
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Segal N, Yannopoulos D, Truchot J, Laribi S, Plaisance P, Convertino VA. [Improving vital organs perfusion by the respiratory pump: physiology and clinical use]. ACTA ACUST UNITED AC 2013; 32:572-9. [PMID: 23932268 DOI: 10.1016/j.annfar.2013.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE In this article, we review the effects of the respiratory pump to improve vital organ perfusion by the use of an inspiratory threshold device. DATA SOURCES Medline and MeSH database. STUDY SELECTION All papers with a level of proof of I to III have been used. DATA EXTRACTION The analysis of the papers has focused on the physiological modifications induced by intrathoracic pressure regulation. DATA SYNTHESIS Primary function of breathing is to provide gas exchange. Studies of the mechanisms involved in animals and humans provide the physiological underpinnings for "the other side of breathing": to increase circulation to the heart and brain. We describe studies that focus on the fundamental relationship between the generation of negative intrathoracic pressure during inspiration through a low-level of resistance created by an impedance threshold device and the physiologic effects of a respiratory pump. A decrease in intrathoracic pressure during inspiration through a fixed resistance resulting in an intrathoracic pressure of -7 cmH2O has multiple physiological benefits including: enhanced venous return, cardiac stroke volume and aortic blood pressure; lower intracranial pressure; resetting of the cardiac baroreflex; elevated cerebral blood flow oscillations and increased tissue blood flow/pressure gradient. CONCLUSION The clinical and animal studies support the use of the intrathoracic pump to treat different clinical conditions: hemorrhagic shock, orthostatic hypotension, septic shock, and cardiac arrest.
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Affiliation(s)
- N Segal
- Service des urgences, hôpital Lariboisière, S2, rue Ambroise-Paré, 75010 Paris, France.
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Segal N, Rees J, Convertino VA, Metzger A, Zarama D, Voulgaropoulos L, McKnite SH, Yannopoulos D, Tang W, Vicaut E, Lurie K. Improving microcirculation with therapeutic intrathoracic pressure regulation in a porcine model of hemorrhage. Resuscitation 2011; 82 Suppl 2:S16-22. [DOI: 10.1016/s0300-9572(11)70146-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Convertino VA, Ryan KL, Rickards CA, Glorsky SL, Idris AH, Yannopoulos D, Metzger A, Lurie KG. Optimizing the respiratory pump: harnessing inspiratory resistance to treat systemic hypotension. Respir Care 2011; 56:846-57. [PMID: 21333089 DOI: 10.4187/respcare.01018] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We review the physiology and affects of inspiration through a low level of added resistance for the treatment of hypotension. Recent animal and clinical studies demonstrated that one of the body's natural response mechanisms to hypotension is to harness the respiratory pump to increase circulation. That finding is consistent with observations, in the 1960s, about the effect of lowering intrathoracic pressure on key physiological and hemodynamic variables. We describe studies that focused on the fundamental relationship between the generation of negative intrathoracic pressure during inspiration through a low level of resistance created by an impedance threshold device and the physiologic sequelae of a respiratory pump. A decrease in intrathoracic pressure during inspiration through a fixed resistance resulting in a pressure difference of 7 cm H(2)O has multiple physiological benefits, including: enhanced venous return and cardiac stroke volume, lower intracranial pressure, resetting of the cardiac baroreflex, elevated cerebral blood flow oscillations, increased tissue blood flow/pressure gradient, and maintenance of the integrity of the baroreflex-mediated coherence between arterial pressure and sympathetic nerve activity. While breathing has traditionally been thought primarily to provide gas exchange, studies of the mechanisms involved in animals and humans provide the physiological underpinnings for "the other side of breathing": to increase circulation to the heart and brain, especially in the setting of physiological stress. The existing results support the use of the intrathoracic pump to treat clinical conditions associated with hypotension, including orthostatic hypotension, hypotension during and after hemodialysis, hemorrhagic shock, heat stroke, septic shock, and cardiac arrest. Harnessing these fundamental mechanisms that control cardiopulmonary physiology provides new opportunities for respiratory therapists and others who have traditionally focused on ventilation to also help treat serious and often life-threatening circulatory disorders.
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Affiliation(s)
- Victor A Convertino
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA.
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