Bibliographies thématiques / Trauma hemorrhagic shock

Littérature scientifique sur le sujet « Trauma hemorrhagic shock »

Auteur : Grafiati
Publié le 7 juillet 2024

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Articles de revues sur le sujet "Trauma hemorrhagic shock"

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Horton, J. W. « Cardiac contractile effects of ethanolism and hemorrhagic shock ». American Journal of Physiology-Heart and Circulatory Physiology 262, no 4 (1 avril 1992) : H1096—H1103. http://dx.doi.org/10.1152/ajpheart.1992.262.4.h1096.

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Moderate ethanol consumption, associated with cardiac depression, occurs in greater than 50% of trauma. Hemorrhagic shock, a significant component of trauma in the clinical setting, causes intrinsic cardiac contractile dysfunction. In this study, we used an isolated heart model to determine whether acute ethanolism increases the cardiovascular risk associated with hemorrhagic shock. We hypothesized that hemorrhagic shock in the acutely intoxicated subject would cause significantly greater cardiac dysfunction compared with that observed in a nonintoxicated subject. A total of 116 guinea pigs was divided into four groups: control (no ethanol, no shock), ethanol intoxication alone (1 mg/kg iv), hemorrhagic shock alone (mean arterial blood pressure, 30 mmHg for 2 h), and a combination of hemorrhagic shock plus ethanol. Half of the hearts in each group were used for isolated heart studies, and half were used to assess myocardial cell membrane integrity. Ethanol alone reduced peak isovolumic pressure by 36%, maximal rate of left ventricular pressure (LVP) rise by 27%, and maximal rate of LVP fall by 35%; however, contractile depression was significantly greater in the intoxicated, hemorrhaged, group compared with the nonintoxicated, hemorrhaged, group (P less than 0.05). Both ethanol and hemorrhage independently altered myocardial cell volume regulation; however, abnormalities in myocardial cell volume regulation induced by hemorrhage were similar in the intoxicated and nonintoxicated groups. Our data show that hemorrhagic shock causes significantly greater cardiac contractile dysfunction in the intoxicated subject.
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D'Alessandro, Angelo, Hunter B. Moore, Ernest E. Moore, Matthew Wither, Travis Nemkov, Eduardo Gonzalez, Anne Slaughter et al. « Early hemorrhage triggers metabolic responses that build up during prolonged shock ». American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 308, no 12 (15 juin 2015) : R1034—R1044. http://dx.doi.org/10.1152/ajpregu.00030.2015.

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Metabolic staging after trauma/hemorrhagic shock is a key driver of acidosis and directly relates to hypothermia and coagulopathy. Metabolic responses to trauma/hemorrhagic shock have been assayed through classic biochemical approaches or NMR, thereby lacking a comprehensive overview of the dynamic metabolic changes occurring after shock. Sprague-Dawley rats underwent progressive hemorrhage and shock. Baseline and postshock blood was collected, and late hyperfibrinolysis was assessed (LY30 >3%) in all of the tested rats. Extreme and intermediate time points were collected to assay the dynamic changes of the plasma metabolome via ultra-high performance liquid chromatography-mass spectrometry. Sham controls were used to determine whether metabolic changes could be primarily attributable to anesthesia and supine positioning. Early hemorrhage-triggered metabolic changes that built up progressively and became significant during sustained hemorrhagic shock. Metabolic phenotypes either resulted in immediate hypercatabolism, or late hypercatabolism, preceded by metabolic deregulation during early hemorrhage in a subset of rats. Hemorrhagic shock consistently promoted hyperglycemia, glycolysis, Krebs cycle, fatty acid, amino acid, and nitrogen metabolism (urate and polyamines), and impaired redox homeostasis. Early dynamic changes of the plasma metabolome are triggered by hemorrhage in rats. Future studies will determine whether metabolic subphenotypes observed in rats might be consistently observed in humans and pave the way for tailored resuscitative strategies.
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GODINHO, MAURICIO, PEDRO PADIM, PAULO ROBERTO B. EVORA et SANDRO SCARPELINI. « Curbing Inflammation in hemorrhagic trauma : a review ». Revista do Colégio Brasileiro de Cirurgiões 42, no 4 (août 2015) : 273–78. http://dx.doi.org/10.1590/0100-69912015004013.

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Trauma is one of the world's leading causes of death within the first 40 years of life and thus a significant health problem. Trauma accounts for nearly a third of the lost years of productive life before 65 years of age and is associated with infection, hemorrhagic shock, reperfusion syndrome, and inflammation. The control of hemorrhage, coagulopathy, optimal use of blood products, balancing hypo and hyperperfusion, and hemostatic resuscitation improve survival in cases of trauma with massive hemorrhage. This review discusses inflammation in the context of trauma-associated hemorrhagic shock. When one considers the known immunomodulatory effects of traumatic injury, allogeneic blood transfusion, and the overlap between patient populations, it is surprising that so few studies have assessed their combined effects on immune function. We also discuss the relative benefits of curbing inflammation rather than attempting to prevent it.
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Napolitano, Lena M. « Resuscitation following trauma and hemorrhagic shock ». Critical Care Medicine 23, no 5 (mai 1995) : 795–97. http://dx.doi.org/10.1097/00003246-199505000-00001.

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Laserna, Anna Karen Carrasco, Yiyang Lai, Guihua Fang, Rajaseger Ganapathy, Mohamed Shirhan Bin Mohamed Atan, Jia Lu, Jian Wu, Mahesh Uttamchandani, Shabbir M. Moochhala et Sam Fong Yau Li. « Metabolic Profiling of a Porcine Combat Trauma-Injury Model Using NMR and Multi-Mode LC-MS Metabolomics—A Preliminary Study ». Metabolites 10, no 9 (16 septembre 2020) : 373. http://dx.doi.org/10.3390/metabo10090373.

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Profiles of combat injuries worldwide have shown that penetrating trauma is one of the most common injuries sustained during battle. This is usually accompanied by severe bleeding or hemorrhage. If the soldier does not bleed to death, he may eventually succumb to complications arising from trauma hemorrhagic shock (THS). THS occurs when there is a deficiency of oxygen reaching the organs due to excessive blood loss. It can trigger massive metabolic derangements and an overwhelming inflammatory response, which can subsequently lead to the failure of organs and possibly death. A better understanding of the acute metabolic changes occurring after THS can help in the development of interventional strategies, as well as lead to the identification of potential biomarkers for rapid diagnosis of hemorrhagic shock and organ failure. In this preliminary study, a metabolomic approach using the complementary platforms of nuclear magnetic resonance (NMR) spectroscopy and liquid chromatography coupled with mass spectrometry (LC-MS) was used to determine the metabolic changes occurring in a porcine model of combat trauma injury comprising of penetrating trauma to a limb with hemorrhagic shock. Several metabolites associated with the acute-phase reaction, inflammation, energy depletion, oxidative stress, and possible renal dysfunction were identified to be significantly changed after a thirty-minute shock period.
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Liu, Fu-Chao, Chih-Wen Zheng et Huang-Ping Yu. « Maraviroc-Mediated Lung Protection following Trauma-Hemorrhagic Shock ». BioMed Research International 2016 (2016) : 1–8. http://dx.doi.org/10.1155/2016/5302069.

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Objectives.The peroxisome proliferator-activated receptor gamma (PPARγ) pathway exerts anti-inflammatory effects in response to injury. Maraviroc has been shown to have potent anti-inflammatory effects. The aim of this study was to investigate whether PPARγplays an important role in maraviroc-mediated lung protection following trauma-hemorrhage.Methods.Male Sprague-Dawley rats underwent trauma-hemorrhage (mean blood pressure maintained at approximately 35–40 mmHg for 90 minutes), followed by fluid resuscitation. During resuscitation, a single dose of maraviroc (3 mg/kg, intravenously) with and without a PPARγinhibitor GW9662 (1 mg/kg, intravenously), GW9662, or vehicle was administered. Lung water content, tissue histology, and other various parameters were measured (n=8rats/group) 24 hours after resuscitation. One-way ANOVA and Tukey’s testing were used for statistical analysis.Results.Trauma-hemorrhage significantly increased lung water content, myeloperoxidase activity, intercellular adhesion molecule-1, interleukin-6, and interleukin-1βlevels. These parameters significantly improved in the maraviroc-treated rats subjected to trauma-hemorrhage. Maraviroc treatment also decreased lung tissue damage as compared to the vehicle-treated trauma-hemorrhaged rats. Coadministration of GW9662 with maraviroc abolished the maraviroc-induced beneficial effects on these parameters and lung injury.Conclusion.These results suggest that PPARγmight play a key role in maraviroc-mediated lung protection following trauma-hemorrhage.
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Chu, Xiaogang, Kumar Subramani, Marie Warren et Raghavan Pillai Raju. « Innate immune response in acute lung injury following hemorrhagic shock ». Journal of Immunology 198, no 1_Supplement (1 mai 2017) : 70.9. http://dx.doi.org/10.4049/jimmunol.198.supp.70.9.

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Abstract Trauma is the major cause of death for Americans under the age of 46 years. Hemorrhagic shock accounts for up to 40% of trauma-related deaths. Hemorrhagic shock evokes an acute, non-specific, systemic inflammatory response syndrome (SIRS) resulting in the damage to multiple organs. Acute lung injury (ALI) is one of the most serious complications in traumatic patients, however, the immunological mechanisms in ALI are still not well understood. Recently studies suggest that mitochondria play an important role in physical injury, leading to the onset of the SIRS. In order to address the mechanistic basis of ALI following hemorrhagic shock, we subjected rats to severe hemorrhage and shock (hemorrhagic injury - HI) or sham procedure and lung tissue was tested. We demonstrate that NLRX1, a mitochondria-targeted protein, that negatively regulates innate immunity and cell death responses, was markedly decreased in HI lung. The decrease of NLRX1 was concomitant with the activation of NF/κB and TBK1 signaling pathways. Lung histochemistry was used to establish pathologic effect on the lung. Significant increases in pulmonary expression of inflammatory signaling molecules IL-6, IL-1β, IL-10, TNF-α and MIP-1α further confirmed HI induced pulmonary inflammation and injury. Our results suggest NLRX1 participate in the pathogenesis of HI related pulmonary diseases and support its important role in the regulation of innate immune response following hemorrhagic shock.
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Schneider, Christian P., Martin G. Schwacha, T. S. Anantha Samy, Kirby I. Bland et Irshad H. Chaudry. « Androgen-mediated modulation of macrophage function after trauma-hemorrhage : central role of 5α-dihydrotestosterone ». Journal of Applied Physiology 95, no 1 (juillet 2003) : 104–12. http://dx.doi.org/10.1152/japplphysiol.00182.2003.

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Androgens have been implicated as the causative factor for the postinjury immune dysfunction in males; however, it remains unknown whether androgens directly affect macrophages. To study this, male mice were sham operated or subjected to trauma (i.e., midline laparotomy) and hemorrhagic shock (mean arterial pressure, 30 ± 5 mmHg for 90 min and then resuscitated). The mice received the 5α-reductase inhibitor 4-hydroxyandrostenedione (4-OHA) before resuscitation. Plasma TNF-α, IL-6, and IL-10 levels were elevated after trauma-hemorrhage and normalized by 4-OHA. TNF-α and IL-6 production by splenic macrophages was decreased after injury, whereas Kupffer cell production of these mediators was enhanced. 4-OHA normalized cytokine production. Androgens suppressed cytokine production by splenic macrophages from hemorrhaged mice, whereas it enhanced TNF-α and IL-6 production by Kupffer cells. The addition of 4-OHA in vitro normalized cytokine production by cells treated with testosterone, but it had no effect on dihydrotestosterone-treated cells. These results indicate that androgens directly affect macrophage function in males after trauma and hemorrhagic shock and that the intracellular conversion of testosterone to dihydrotestosterone is of particular importance in mediating the androgen-induced effects.
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Gauss, Tobias, Justin E. Richards, Costanza Tortù, François-Xavier Ageron, Sophie Hamada, Julie Josse, François Husson et al. « Association of Early Norepinephrine Administration With 24-Hour Mortality Among Patients With Blunt Trauma and Hemorrhagic Shock ». JAMA Network Open 5, no 10 (7 octobre 2022) : e2234258. http://dx.doi.org/10.1001/jamanetworkopen.2022.34258.

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ImportanceHemorrhagic shock is a common cause of preventable death after injury. Vasopressor administration for patients with blunt trauma and hemorrhagic shock is often discouraged.ObjectiveTo evaluate the association of early norepinephrine administration with 24-hour mortality among patients with blunt trauma and hemorrhagic shock.Design, Setting, and ParticipantsThis retrospective, multicenter, observational cohort study used data from 3 registries in the US and France on all consecutive patients with blunt trauma from January 1, 2013, to December 31, 2018. Patients were alive on admission with hemorrhagic shock, defined by prehospital or admission systolic blood pressure less than 100 mm Hg and evidence of hemorrhage (ie, prehospital or resuscitation room transfusion of packed red blood cells, receipt of emergency treatment for hemorrhage control, transfusion of >10 units of packed red blood cells in the first 24 hours, or death from hemorrhage). Blunt trauma was defined as any exposure to nonpenetrating kinetic energy, collision, or deceleration. Statistical analysis was performed from January 15, 2021, to February 22, 2022.ExposureContinuous administration of norepinephrine in the prehospital environment or resuscitation room prior to hemorrhage control, according to European guidelines.Main Outcomes and MeasuresThe primary outcome was 24-hour mortality, and the secondary outcome was in-hospital mortality. The average treatment effect (ATE) of early norepinephrine administration on 24-hour mortality was estimated according to the Rubin causal model. Inverse propensity score weighting and the doubly robust approach with 5 distinct analytical strategies were used to determine the ATE.ResultsA total of 52 568 patients were screened for inclusion, and 2164 patients (1508 men [70%]; mean [SD] age, 46 [19] years; median Injury Severity Score, 29 [IQR, 17-36]) presented with acute hemorrhage and were included. A total of 1497 patients (69.1%) required emergency hemorrhage control, 128 (5.9%) received a prehospital transfusion of packed red blood cells, and 543 (25.0%) received a massive transfusion. Norepinephrine was administered to 1498 patients (69.2%). The 24-hour mortality rate was 17.8% (385 of 2164), and the in-hospital mortality rate was 35.6% (770 of 2164). None of the 5 analytical strategies suggested any statistically significant association between norepinephrine administration and 24-hour mortality, with ATEs ranging from –4.6 (95% CI, –11.9 to 2.7) to 2.1 (95% CI, –2.1 to 6.3), or between norepinephrine administration and in-hospital mortality, with ATEs ranging from –1.3 (95% CI, –9.5 to 6.9) to 5.3 (95% CI, –2.1 to 12.8).Conclusions and RelevanceThe findings of this study suggest that early norepinephrine infusion was not associated with 24-hour or in-hospital mortality among patients with blunt trauma and hemorrhagic shock. Randomized clinical trials that study the effect of early norepinephrine administration among patients with trauma and hypotension are warranted to further assess whether norepinephrine is safe for patients with hemorrhagic shock.
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Rushing, G. D., R. C. Britt, J. N. Collins, F. J. Cole, L. J. Weireter et L. D. Britt. « Adrenal Insufficiency in Hemorrhagic Shock ». American Surgeon 72, no 6 (juin 2006) : 552–54. http://dx.doi.org/10.1177/000313480607200619.

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Adrenal insufficiency during sepsis is well documented. The association between hemorrhagic shock and adrenal insufficiency is unclear and may be related to ischemia, necrosis, or resuscitation. This study was designed to determine the incidence of relative adrenal insufficiency in hemorrhagic shock. A retrospective review of a prospectively gathered database for patients admitted to the trauma intensive care unit with hemorrhagic shock was undertaken. A random serum cortisol of <25 mcg/dL defined relative adrenal insufficiency. All of the cortisol levels were drawn within the first 24 hours of admission. Data analyzed included demographics, length of stay, injury mechanism, infections, and mortality. Fifteen patients presented with hemorrhagic shock, with 14 of 15 meeting the criteria for relative adrenal insufficiency. The average serum cortisol level was 15.8 (9–26.8). The average APACHE II score was 18.3 (4–33), and the average Injury Severity Score was 22.5 (8–41). The mechanism was blunt trauma in 10 patients and penetrating trauma in 5. The average intensive care unit and hospital length of stay were 13.2 and 27.4 days, respectively. There were five urinary tract infections, four blood stream infections, and two wound infections. Two of the 15 patients died. Relative adrenal insufficiency appears to be common in hemorrhagic shock. Future research is warranted to elucidate the pathophysiology, as well as to prospectively determine which patients may benefit from steroid replacement.
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Thèses sur le sujet "Trauma hemorrhagic shock"

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Talving, Peep. « Aspects of hepatoduodenal trauma and fluid therapy in hemorrhagic shock / ». Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-740-5/.

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Alexander, Geoffrey C. « The Effect of Adding Drag-Reducing Polymers to Resuscitation Fluid During Hemorrhagic Shock on Skeletal Muscle Microcirculation ». VCU Scholars Compass, 2006. http://scholarscompass.vcu.edu/etd/1522.

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Previous studies have shown an increase in survival when a minute amount of drag-reducing polymers were added to a resuscitation fluid. The purpose of this investigation was to examine the effect of adding a minute amount of the drag-reducing polymer polyethylene glycol to a resuscitation fluid, on the microcirculation of skeletal muscle during a volume-controlled hemorrhage model. The spinotrapezius muscle in twelve male Sprague Dawley rats was exteriorized for microvascular measurements of the arterioles. The diameters of the three levels of arterioles, interstitial fluid PO2, and RBC velocity in the feed arteriole were measured. Flow in the feed arteriole was calculated using the diameter and RBC velocity. Heart rate, mean arterial pressure, respiratory rate, arterial blood gases, arterial blood electrolytes, and arterial blood metabolites were measured. No significant physiological differences were observed between the DRP group and the Control group.
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Labruto, Fausto. « Modifications of cardiovascular response to ischemia and trauma / ». Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-379-5/.

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Ji, Soo-Yeon. « COMPUTER-AIDED TRAUMA DECISION MAKING USING MACHINE LEARNING AND SIGNAL PROCESSING ». VCU Scholars Compass, 2008. http://scholarscompass.vcu.edu/etd/1628.

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Over the last 20 years, much work has focused on computer-aided clinical decision support systems due to a rapid increase in the need for management and processing of medical knowledge. Among all fields of medicine, trauma care has the highest need for proper information management due to the high prevalence of complex, life-threatening injuries. In particular, hemorrhage, which is encountered in most traumatic injuries, is a dominant factor in determining survival in both civilian and military settings. This complication can be better managed using a more in-depth analysis of patient information. Trauma physicians must make precise and rapid decisions, while considering a large number of patient variables and dealing with stressful environments. The ability of a computer-aided decision making system to rapidly analyze a patient’s condition can enable physicians to make more accurate decisions and thereby significantly improve the quality of care provided to patients. The first part of this study is focused on classification of highly complex databases using a hierarchical method which combines two complementary techniques: logistic regression and machine learning. This method, hereafter referred to as Classification Using Significant Features (CUSF), includes a statistical process to select the most significant variables from the correlated database. Then a machine learning algorithm is used to identify the data into classes using only the significant variables. As the main application addressed by CUSF, a set of computer-assisted rule-based trauma decision making system are designed. Computer aided decision-making system not only provides vital assistance for physicians in making fast and accurate decisions, proposed decisions are supported by transparent reasoning, but also can confirm a physicians’ current knowledge, enabling them to detect complex patterns and information which may reveal new knowledge not easily visible to the human eyes. The second part of this study proposes an algorithm based on a set of novel wavelet features to analyze physiological signals, such as Electrocardiograms (ECGs) that can provide invaluable information typically invisible to human eyes. These wavelet-based method, hereafter referred to as Signal Analysis Based on Wavelet-Extracted Features (SABWEF), extracts information that can be used to detect and analyze complex patterns that other methods such as Fourier cannot deal with. For instance, SABWEF can evaluate the severity of hemorrhagic shock (HS) from ECG, while the traditional technique of applying power spectrum density (PSD) and fractal dimension (FD) cannot distinguish between the ECG patterns of patients with HS (i.e. blood loss), and those of subjects undergoing physical activity. In this study, as the main application of SABWEF, ECG is analyzed to distinguish between HS and physical activity, and show that SABWEF can be used in both civilian and military settings to detect HS and its extent. This is the first reported use of an ECG analysis method to classify blood volume loss. SABWEF has the capability to rapidly determine the degree of volume loss from hemorrhage, providing the chance for more rapid remote triage and decision making.
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Lundin, Sandra, et Jonas Molin. « Räddar liv eller slösar tid ? : prehospital vätskebehandlings effekter på patienter i hemorragisk chock ». Thesis, Sophiahemmet Högskola, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3742.

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Trauma är den ledande dödsorsaken i Sverige för människor mellan 15 och 44 år och en stor andel dör till följd av blödning som uppkommer vid skadetillfället. Blödning fortsätter också vara den ledande orsaken till traumarelaterad död som kunde ha varit förebyggbar både civilt och militärt. Traumaomhändertagandet är komplext, ofta tidskritiskt och ambulanspersonalen är ofta de som först får vårda dessa patienter ute på skadeplats och därav blir ambulanspersonalens första bedömning och omhändertagande av stor betydelse. Vätskebehandling för kritiskt skadade traumapatienter i hemorragisk chock eller hotande hemorragisk chock är ett omdiskuterat ämne och Sverige saknar nationella riktlinjerna för omhändertagande och behandling prehospitalt vid hemorragisk chock och trauma och de regionala riktlinjer som finns skiljer sig ibland till viss del åt mellan länen. Syftet med studien var att undersöka effekten av ambulanssjuksköterskans vätskebehandling för patienter i hemorragisk chock vid trauma. Som metod har en litteraturöversikt genomförts där totalt 15 studier inkluderats som är publicerade mellan 2009 och 2019. I resultatet framkom två huvudteman – vätskebehandlingens effekt på mortalitet och vätskebehandlingens effekt på koagulation. Samtliga fyra studier som undersökt hur koagulationsförmågan påverkas av kristalloid hyperton och/eller isoton vätskebehandling hos patienter med eller med risk för hemorragisk chock utsatta för trauma har kommit fram till att den försämras desto mer vätska patienten får. Resultatet visade oklar evidens gällande vätskebehandlingens effekt för mortaliteten på patienter i hemorragisk chock vid trauma. Däremot påvisade ingen av studierna att mortaliteten minskade. Slutsats var att majoriteten av artiklarna talar för att stora mängder vätska prehospitalt minskar eller inte gör någon skillnad för överlevnaden för kritiskt skadade traumapatienter vid hemorragisk chock. Många faktorer spelar in och det är svårt att dra några slutsatser utifrån resultatet och mer forskning behövs inom området.
Trauma is the leading cause of death in Sweden for people between the age of 15 and 44 years and a large proportion of people die because of bleeding that occurs at the time of the injury. Bleeding also continues to be the leading cause of trauma-related death that could have been preventable both in a civilian and military setting. Trauma care is complex, often time-critical, and the ambulance nurses are often the first to care for these patients on the scene and therefore the first assessment and care of these patients is of great importance. Fluid resuscitation for critically injured trauma patients in hemorrhagic shock or threatening hemorrhagic shock is a debated topic and Sweden lacks national guidelines for trauma care and treatment prehospital. The regional guidelines sometimes for some manner differ between the counties in Sweden. The aim of this study was to determine the impact of fluid resuscitation for patients with hemorrhagic shock after trauma. As a method, a literature review was carried out, which included a total of 15 studies published between 2009 and 2019. The result revealed two main themes - the impact of fluid resuscitation on mortality and the impact of fluid resuscitation on coagulation. All four studies that examined how coagulation ability is affected by crystalloid hypertonic and/or isotonic fluid resuscitation in patients at risk of hemorrhagic shock after trauma, the severity seems to be dependent on the amount of fluid infused, the more fluid the more severe coagulation abnormalities. The result showed unclear evidence of the effect of fluid resuscitation in mortality for trauma patients in hemorrhagic shock. However, none of the studies showed it decreased in mortality. In conclusion, the majority of articles show that large amount of fluid given in prehospital care have no impact or did have a negative impact on survival of critically injured trauma patients in hemorrhagic shock. Many factors come into play and it is difficult to draw any conclusions based on the results and more research are needed.
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Dufour-Gaume, Frédérique. « Enjeux, préparation et évaluation de produits sanguins labiles innovants adaptés aux blessés de guerre ». Electronic Thesis or Diss., université Paris-Saclay, 2023. http://www.theses.fr/2023UPASQ076.

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Le blessé de guerre est un blessé grave qui associe choc hémorragique et polytraumatisme. Malgré les progrès thérapeutiques des dernières années, l'hémorragie reste la première cause de décès évitable chez ce type de blessés. Les patients qui survivent aux premières heures de leurs blessures voient leur pronostic vital et fonctionnel menacé par les complications secondaires. Les protocoles de prise en charge des blessés de guerre basés sur le principe de damage control ressuscitation et la transfusion massive de sang total ont permis de réduire considérablement les décès par choc hémorragique. Toutefois, les contraintes logistiques des théâtres d'opérations extérieures et les afflux massifs de blessés ne permettent pas d'administrer du sang total à tous, en tout lieu. Le développement de produits sanguins labiles modifiés qui répondent aux contraintes opérationnelles pourrait améliorer la survie des blessés. Pour répondre à cet objectif, nous avons développé deux formulations de plasma lyophilisé hyperconcentré porcin, l'une sans (PLYO-H) et l'autre avec lyophilisat plaquettaire (PLYO-H/LP). Les produits obtenus présentaient des critères de qualité de production optimaux. Le PLYO-H et le PLYO-H/LP étaient riches en protéines, dont l'albumine, et présentent une hyperosmolarité à deux fois celle du plasma. Dans le PLYO-H/LP, les plaquettes lysées au cours du processus de fabrication ont libéré dans le plasma des facteurs de coagulation, dont le fibrinogène, en quantité importante. L'intérêt thérapeutique des PLYO-H et PLYO-H/LP a été évalué à l'aide d'un modèle porcin représentatif du blessé de guerre. La comparaison entre les animaux traités par PLYO, PLYO-H, PLYO-H/LP ou sang total n'a pas montré de supériorité d'un groupe par rapport aux autres. Toutefois, l'analyse des paramètres de la fonction cardiovasculaire et de l'hémostase a révélé des effets bénéfiques du PLYO-H et du PLYO- H/LP qui ouvrent la porte à des études complémentaires portant cette fois sur des formulations issues de plasmaphérèse humaine
War casualties associate multiple injuries with shock hemorrhage. Despite the therapeutic progress of recent years, hemorrhage is the leading cause of preventable deaths and secondary multiple organ failure can lead to vital and functional prognosis. Management of war-injured patients based on damage control resuscitation and massive transfusion of whole blood reduced considerably the number of deaths. Nevertheless, during foreign operations whole blood is sometimes lacking because of logistic limitations and massive casualties. Modified blood products that are free from constraints could help war-injured patients to survive. To achieve this objective, we developed two French hyper-concentrated lyophilized plasmas with (FLYP-H/LP) or not (FLYP-H) lyophilized platelets. The production of these products is of a high quality. FLYP-H and FLYP-H/LP are high protein products, especially albumin, which confer them a hyperosmolarity twice that of plasma. In FLYP-H/LP, platelets were lysed during the manufacturing process and liberated high quantities of coagulation factors, such as fibrinogen. The therapeutic effects of FLYP-H and FLYP-H/LP were evaluated thanks to our war-injured porcin model. Statistical analysis highlighted the beneficial effects of FLYP-H and FLYP-H/LP on cardiovascular function and hemostasis. These results open the door to more analysis but on human FLYP-H and FLYP-H/LP
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Prunet, Bertrand. « Contusion pulmonaire : aspects physiopathologiques et conséquences thérapeutiques ». Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM5001.

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L’association lésionnelle d’une contusion pulmonaire et d’un état de choc hémorragique est fréquente et constitue un réel chalenge thérapeutique. La prise en charge de ce choc va nécessiter une réanimation hémodynamique dans laquelle le remplissage vasculaire tient une place centrale. Mais dans ce contexte de poumon contus, il devra être raisonné car délétère sur le plan pulmonaire, notamment en terme d'oedème et d'altération de la compliance. Ce remplissage devra donc être titré, basé sur des objectifs tensionnels clairs et un monitorage hémodynamique fiable. L'utilisation de solutés à haut pouvoir d'expansion volémique (sérum salé hypertonique, colloïdes) présente un intérêt, de même que l'introduction précoce de vasopresseurs. Le monitorage hémodynamique permettra de conduire cette réanimation sur des objectifs de pression artérielle, sur des indices de précharge dépendance et sur la mesure de l'eau pulmonaire extravasculaire. Notre travail, basé sur des études expérimentales et cliniques, a pour objectif de caractériser les modalités actuelles de prise en charge d’une contusion pulmonaire, sur les plans hémodynamiques et respiratoires
Pulmonary contusion is often associated with hemorrhagic shock, constituting a challenge in trauma care. For patients who have sustained lung contusions, fluid resuscitation should be carefully performed, because injured lungs are particularly vulnerable to massive fluid infusions with an increased risk of pulmonary edema and compliance impairment. Fluid administration should be included in an optimized and goal directed resuscitation, based on blood pressure objectives and hemodynamical monitoring. The use of fluids with high volume-expanding capacities (hypertonic saline, colloids) is probably interesting, as well as early introduction of vasopressors. Hemodynamic monitoring will allow to conduct resuscitation on blood pressure objectives, on preload parameters and on extravascular lung water measurement.Our work, based on experimental and clinical studies, objective to characterize the current modalities of ventilatory and hemodynamical aspect of pulmonary contusion care
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Morrison, C. Anne Horwitz Irwin Hwang Lu-Yu. « Hypotensive resuscitation versus standard fluid resuscitation for the management of trauma patients in hemorrhagic shock : the safety phase of a randomized controlled trial ». 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1465583.

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Fraga, Caroline Anne Pires. « The use of Tranexamic acid in trauma patients with hemorrhagic shock - a retrospective study in a tertiary care hospital ». Master's thesis, 2020. https://hdl.handle.net/10216/128787.

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Introdução - O choque hemorrágico é a maior complicação e causa de morbi-mortalidade em doentes com trauma. Neste estudo, pretendemos avaliar o impacto do ácido tranexâmico em doentes com choque hemorrágico por trauma num hospital terciário. Material e métodos - Este estudo, realizado no Centro Hospitalar e Universitário São João, incluiu doentes adultos, admitidos no Serviço de Medicina Intensiva, por choque hemorrágico secundário a trauma. Definimos choque hemorrágico como pressão arterial sistólica ≤90 mmHg e/ou frequência cardíaca ≥110 bpm. Na ausência destes parâmetros, prevaleceu o juízo clínico do médico assistente. Efetuámos coorte de doentes com e sem administração de acido tranexâmico: avaliámos mortalidade global, tempo de ventilação mecânica invasiva, tempo de internamento na Unidade de Cuidados Intensivos e no hospital, unidades de glóbulos rubros transfundidas e eventos trombóticos. Resultados - Incluíram-se 105 doentes dos 1045 que foram admitidos por trauma entre Janeiro 2017 e Dezembro 2018: destes, 38 receberam ácido tranexâmico (36,2%) versus 67 sem ácido tranexâmico (63,8%). O grupo tratado com ácido tranexâmico apresentou maior gravidade (APACHE II p=0,038) e mortalidade na Unidade de Cuidados Intensivos, tanto na população global (p=0,003) como no subgrupo estratificado por traumatismo crânio-encefálico (p=0,037). Não se observaram diferenças estatisticamente significativas nos outcomes secundários. Discussão - Os doentes com choque hemorrágico por trauma admitidos no Serviço de Medicina Intensiva e tratados com ácido tranexâmico apresentam maior mortalidade, provavelmente pela maior gravidade clínica. Não encontrámos no mesmo grupo aumento do número de eventos trombóticos. Conclusões - Torna-se necessário complementar com mais estudos e coortes mais numerosas para avaliar o verdadeiro benefício do uso de ácido tranexâmico nestes doentes. Palavras-chave: Ácido Tranexâmico; Trauma; Choque hemorrágico
Introduction - Hemorrhagic shock is the major complication and cause of morbi-mortality in trauma patients. We aimed to study the impact of tranexamic acid in trauma patients with hemorrhagic shock in a tertiary hospital. Material and methods - Our study, performed at Centro Hospitalar e Universitário São João, included adult trauma patients with hemorrhagic shock admitted to the Intensive Care Department. We defined hemorrhagic shock as Systolic Blood Pressure ≤90 mmHg and/or Heat Rate ≥110 bpm. In the absence of these, the clinical judgment of the attending physician prevailed. We did patients cohort with and without tranexamic acid use: we assessed global mortality, invasive mechanical ventilation duration, Intensive Care Unit and hospital length of stay, red blood cells units transfused and vascular occlusive events. Results - 105 patients were included from the 1045 admitted for trauma between January 2017 and December 2018: of those, 38 received tranexamic acid (36,2%) versus 67 without it (63,8%). Tranexamic acid group registered a higher severity (APACHE II p=0,038) and mortality in the Intensive Care Unit either in the global population (p=0,003) or in the stratified Traumatic Brain Injury subgroup (p=0,037). We found no statistically significant differences in the secondary outcomes. Discussion - Trauma patients with hemorrhagic shock admitted in the Intensive Care Department and treated with tranexamic acid had higher mortality, probably explained by the higher severity observed. We didnt find increased vascular occlusive events in tranexamic acid group. Conclusions - It is necessary to complement these findings with more studies and larger cohorts to assess the real benefits of tranexamic acid use in these patients.
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Fraga, Caroline Anne Pires. « The use of Tranexamic acid in trauma patients with hemorrhagic shock - a retrospective study in a tertiary care hospital ». Dissertação, 2020. https://hdl.handle.net/10216/128787.

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Introdução - O choque hemorrágico é a maior complicação e causa de morbi-mortalidade em doentes com trauma. Neste estudo, pretendemos avaliar o impacto do ácido tranexâmico em doentes com choque hemorrágico por trauma num hospital terciário. Material e métodos - Este estudo, realizado no Centro Hospitalar e Universitário São João, incluiu doentes adultos, admitidos no Serviço de Medicina Intensiva, por choque hemorrágico secundário a trauma. Definimos choque hemorrágico como pressão arterial sistólica ≤90 mmHg e/ou frequência cardíaca ≥110 bpm. Na ausência destes parâmetros, prevaleceu o juízo clínico do médico assistente. Efetuámos coorte de doentes com e sem administração de acido tranexâmico: avaliámos mortalidade global, tempo de ventilação mecânica invasiva, tempo de internamento na Unidade de Cuidados Intensivos e no hospital, unidades de glóbulos rubros transfundidas e eventos trombóticos. Resultados - Incluíram-se 105 doentes dos 1045 que foram admitidos por trauma entre Janeiro 2017 e Dezembro 2018: destes, 38 receberam ácido tranexâmico (36,2%) versus 67 sem ácido tranexâmico (63,8%). O grupo tratado com ácido tranexâmico apresentou maior gravidade (APACHE II p=0,038) e mortalidade na Unidade de Cuidados Intensivos, tanto na população global (p=0,003) como no subgrupo estratificado por traumatismo crânio-encefálico (p=0,037). Não se observaram diferenças estatisticamente significativas nos outcomes secundários. Discussão - Os doentes com choque hemorrágico por trauma admitidos no Serviço de Medicina Intensiva e tratados com ácido tranexâmico apresentam maior mortalidade, provavelmente pela maior gravidade clínica. Não encontrámos no mesmo grupo aumento do número de eventos trombóticos. Conclusões - Torna-se necessário complementar com mais estudos e coortes mais numerosas para avaliar o verdadeiro benefício do uso de ácido tranexâmico nestes doentes. Palavras-chave: Ácido Tranexâmico; Trauma; Choque hemorrágico
Introduction - Hemorrhagic shock is the major complication and cause of morbi-mortality in trauma patients. We aimed to study the impact of tranexamic acid in trauma patients with hemorrhagic shock in a tertiary hospital. Material and methods - Our study, performed at Centro Hospitalar e Universitário São João, included adult trauma patients with hemorrhagic shock admitted to the Intensive Care Department. We defined hemorrhagic shock as Systolic Blood Pressure ≤90 mmHg and/or Heat Rate ≥110 bpm. In the absence of these, the clinical judgment of the attending physician prevailed. We did patients cohort with and without tranexamic acid use: we assessed global mortality, invasive mechanical ventilation duration, Intensive Care Unit and hospital length of stay, red blood cells units transfused and vascular occlusive events. Results - 105 patients were included from the 1045 admitted for trauma between January 2017 and December 2018: of those, 38 received tranexamic acid (36,2%) versus 67 without it (63,8%). Tranexamic acid group registered a higher severity (APACHE II p=0,038) and mortality in the Intensive Care Unit either in the global population (p=0,003) or in the stratified Traumatic Brain Injury subgroup (p=0,037). We found no statistically significant differences in the secondary outcomes. Discussion - Trauma patients with hemorrhagic shock admitted in the Intensive Care Department and treated with tranexamic acid had higher mortality, probably explained by the higher severity observed. We didnt find increased vascular occlusive events in tranexamic acid group. Conclusions - It is necessary to complement these findings with more studies and larger cohorts to assess the real benefits of tranexamic acid use in these patients.
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Livres sur le sujet "Trauma hemorrhagic shock"

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J, Sugerman Harvey, et DeMaria Eric J. 1959-, dir. Cytokines in trauma and hemorrhage. New York : Chapman & Hall, 1997.

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1950-, Pope Andrew MacPherson, French Geoffrey, Longnecker David E. 1939- et Institute of Medicine (U.S.). Committee on Fluid Resuscitation for Combat Casualties, dir. Fluid resuscitation : State of the science for treating combat casualties and civilian injuries. Washington, D.C : National Academy Press, 1999.

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SUGERMAN, HARVEY J. Cytokines In Trauma & Hemorrhage. Thomson Publishing Group, 1997.

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Sabato, Stefan. Massive Transfusion in a Child. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0024.

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The traditional early management of hemorrhagic shock is currently being challenged, and many centers around the world have already changed their practice. Damage-control resuscitation, in conjunction with damage-control surgery, has been shown to improve major morbidity and mortality outcomes in adults. In children there is little direct evidence for these new approaches, but supporting evidence is accumulating. This chapter will introduce these concepts while also reinforcing the core principles of managing acute hemorrhage in the trauma setting.
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Medicine, Institute of, et Committee on Fluid Resuscitation for Combat Casualties. Fluid Resuscitation : State of the Science for Treating Combat Casualties and Civilian Injuries. National Academies Press, 1999.

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Medicine, Institute of, et Committee on Fluid Resuscitation for Combat Casualties. Fluid Resuscitation : State of the Science for Treating Combat Casualties and Civilian Injuries. National Academies Press, 1999.

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Medicine, Institute of, et Committee on Fluid Resuscitation for Combat Casualties. Fluid Resuscitation : State of the Science for Treating Combat Casualties and Civilian Injuries. National Academies Press, 1999.

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Medicine, Institute of, et Committee on Fluid Resuscitation for Combat Casualties. Fluid Resuscitation : State of the Science for Treating Combat Casualties and Civilian Injuries. National Academies Press, 1999.

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Weyker, Paul David, Christopher Allen-John Webb et Tricia E. Brentjens. Hypovolemic Shock. Sous la direction de Matthew D. McEvoy et Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0097.

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Broadly defined, hypovolemia represents inadequate circulating plasma volume leading to decreased cardiac preload and thus decreased cardiac output and blood pressure. Many classification schemes have been proposed to categorize hypovolemia based on relative levels of decreased plasma volume. Common causes of hypovolemic shock during the perioperative period include hemorrhage and diuretic use. In general, studies support a conservative hemoglobin goal of about 7 g/dL as compared with a liberal goal of 10 g/dL in hemodynamically stable patients without active cardiac ischemia or risk factors. In patients with large volume blood loss, institutionally approved massive transfusion protocols can help provide blood products quickly. The trauma literature supports a balanced massive transfusion protocol using a 1:1:1 (plasma:platelet:red blood cell) strategy of transfusion.
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Finn, Patrick C., et Michael C. Reade. Bleeding Emergencies (DRAFT). Sous la direction de Raghavan Murugan et Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0010.

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This chapter is concerned with coagulopathic and non-coagulopathic bleeding in the perioperative period, after trauma, and spontaneously, as a result of hematologic and other disease. The initial assessment and management of all potentially bleeding patients is to stop any obvious bleeding through mechanical first aid measures, then address airway or breathing compromise, and obtain intravenous (or intraosseous) access. Obvious external hemorrhage is easily identified, but most patients with bleeding emergencies who are already hospitalized will have occult blood loss. Physical examination should identify signs of shock and identify or exclude potential bleeding locations. This chapter will cover initial assessment and management, laboratory and bedside testing, as well as disease-specific therapies in the context of rapid response team (RRT) calls.
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Chapitres de livres sur le sujet "Trauma hemorrhagic shock"

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Zhao, Zi-Gang, Yu-Ping Zhang, Li-Min Zhang et Ya-Xiong Guo. « Lymph Formation and Transport : Role in Trauma-Hemorrhagic Shock ». Dans Severe Trauma and Sepsis, 67–95. Singapore : Springer Singapore, 2019. http://dx.doi.org/10.1007/978-981-13-3353-8_5.

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Livingston, D. H., J. Hseih, T. Murphy et B. F. Rush. « Hemorrhagic Shock Inhibits Myelopoiesis Independent of Bacterial Translocation ». Dans Host Defense Dysfunction in Trauma, Shock and Sepsis, 339–48. Berlin, Heidelberg : Springer Berlin Heidelberg, 1993. http://dx.doi.org/10.1007/978-3-642-77405-8_36.

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Ochoa, J. B., T. R. Billiar et A. B. Peitzman. « The Role of Nitric Oxide in Hemorrhagic Shock and Trauma ». Dans Shock, Sepsis, and Organ Failure — Nitric Oxide, 84–101. Berlin, Heidelberg : Springer Berlin Heidelberg, 1995. http://dx.doi.org/10.1007/978-3-642-79343-1_4.

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Livingston, D. H., et M. A. Malangoni. « Effect of Therapeutic Gamma-Interferon Administration on Wound Infection After Resuscitated Hemorrhagic Shock ». Dans Immune Consequences of Trauma, Shock, and Sepsis, 551–55. Berlin, Heidelberg : Springer Berlin Heidelberg, 1989. http://dx.doi.org/10.1007/978-3-642-73468-7_66.

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Ertel, W., E. Faist et I. H. Chaudry. « The Biological Characteristics of Cytokines and Their Interactions with Prostaglandins Following Hemorrhagic Shock ». Dans Host Defense Dysfunction in Trauma, Shock and Sepsis, 655–64. Berlin, Heidelberg : Springer Berlin Heidelberg, 1993. http://dx.doi.org/10.1007/978-3-642-77405-8_83.

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Tolentino, Rafael, Timothy J. Holleran et Laura S. Johnson. « Futility of Care in Hemorrhagic Shock : When Prolonging the Massive Transfusion Protocol Is of No Benefit ». Dans Difficult Decisions in Trauma Surgery, 35–44. Cham : Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-81667-4_4.

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Stadlbauer, K. H., H. G. Wagner-Berger, C. Raedler, W. Voelckel, V. Wenzel, A. C. Krismer, K. Rheinberger, K. H. Lindner et A. Koenigsrainer. « Survival with Full Vital Organ Function Recovery after Uncontrolled Hemorrhagic Shock in a Penetrating Liver Trauma Model with Vasopressin in Pigs ». Dans Zurück in die Zukunft, 638. Berlin, Heidelberg : Springer Berlin Heidelberg, 2003. http://dx.doi.org/10.1007/978-3-642-55611-1_443.

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Chaudry, I. H., R. N. Stephan, J. M. Harkema et R. E. Dean. « Immunological Alterations Following Simple Hemorrhage ». Dans Immune Consequences of Trauma, Shock, and Sepsis, 363–73. Berlin, Heidelberg : Springer Berlin Heidelberg, 1989. http://dx.doi.org/10.1007/978-3-642-73468-7_47.

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Chaudry, I. H., A. Ayala, D. Meldrum et W. Ertel. « Hemorrhage-Induced Alterations in Cell-Mediated Immune Function ». Dans Host Defense Dysfunction in Trauma, Shock and Sepsis, 149–59. Berlin, Heidelberg : Springer Berlin Heidelberg, 1993. http://dx.doi.org/10.1007/978-3-642-77405-8_16.

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Clemens, M. G. « Hepatic Parenchymal and Nonparenchymal Cells in Hemorrhage and Ischemia ». Dans Host Defense Dysfunction in Trauma, Shock and Sepsis, 127–37. Berlin, Heidelberg : Springer Berlin Heidelberg, 1993. http://dx.doi.org/10.1007/978-3-642-77405-8_14.

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Actes de conférences sur le sujet "Trauma hemorrhagic shock"

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Rahbar, Elaheh, Bryan A. Cotton, John B. Holcomb et Charles E. Wade. « Reduced Plasma Oncotic Pressure is Indicative of Injury Severity in Trauma Patients ». Dans ASME 2013 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/sbc2013-14539.

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Trauma is the leading cause of death in people aged 1–44 years old, with hemorrhagic shock accounting for nearly half of these deaths. These fatalities often occur early, within 24 hours, but many are deemed potentially preventable with appropriate resuscitation. 1–2 The term “appropriate resuscitation” is somewhat ambiguous and subjective because of the lack of a standardized resuscitation protocol. We attribute this deficiency to our rudimentary understanding of the mechanisms of hemorrhagic shock and resuscitation.
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Thau, M. R., T. Liu, N. A. Sathe, G. O'Keefe, C. E. Wade, E. E. Fox, J. B. Holcomb et al. « Latent Class Analysis in a Trauma Cohort with Hemorrhagic Shock Identifies Two Distinct Sub-Phenotypes with a Differential Treatment Response to Blood Transfusion Ratios ». Dans American Thoracic Society 2022 International Conference, May 13-18, 2022 - San Francisco, CA. American Thoracic Society, 2022. http://dx.doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a5038.

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Sotudeh-Chafi, M., N. Abolfathi, A. Nick, V. Dirisala, G. Karami et M. Ziejewski. « A Multi-Scale Finite Element Model for Shock Wave-Induced Axonal Brain Injury ». Dans ASME 2008 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2008. http://dx.doi.org/10.1115/sbc2008-192342.

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Traumatic brain injuries (TBIs) involve a significant portion of human injuries resulting from a wide range of civilian accidents as well as many military scenarios. Axonal damage is one of the most common and important pathologic features of traumatic brain injury. Axons become brittle when exposed to rapid deformations associated with brain trauma. Accordingly, rapid stretch of axons can damage the axonal cytoskeleton, resulting in a loss of elasticity and impairment of axoplasmic transport. Subsequent swelling of the axon occurs in discrete bulb formations or in elongated varicosities that accumulate organelles. Ultimately, swollen axons may become disconnected [1]. The shock waves generated by a blast, subject all the organs in the head to displacement, shearing and tearing forces. The brain is especially vulnerable to these forces — the fronts of compressed air waves cause rapid forward or backward movements of the head, so that the brain rattles against the inside of the skull. This can cause subdural hemorrhage and contusions. The forces exerted on the brain by shock waves are known to damage axons in the affected areas. This axonal damage begins within minutes of injury, and can continue for hours or days following the injury [2]. Shock waves are also known to damage the brain at the subcellular level, but exactly how remains unclear. Kato et al., [3] described the effects of a small controlled explosion on rats’ brain tissue. They found that high pressure shock waves led to contusions and hemorrhage in both cortical and subcortical brain regions. Based on their result, the threshold for shock wave-induced brain injury is speculated to be under 1 MPa. This is the first report to demonstrate the pressure-dependent effect of shock wave on the histological characteristics of brain tissue. An important step in understanding the primary blast injury mechanism due to explosion is to translate the global head loads to the loading conditions, and consequently damage, of the cells at the local level and to project cell level and tissue level injury criteria towards the level of the head. In order to reach this aim, we have developed a multi-scale non-linear finite element modeling to bridge the micro- and macroscopic scales and establish the connection between microstructure and effective behavior of brain tissue to develop acceptable injury threshold. Part of this effort has been focused on measuring the shock waves created from a blast, and studying the response of the brain model of a human head exposed to such an environment. The Arbitrary Lagrangian Eulerian (ALE) and Fluid/Solid Interactions (FSI) formulation have been used to model the brain-blast interactions. Another part has gone into developing a validated fiber-matrix based micro-scale model of a brain tissue to reproduce the effective response and to capturing local details of the tissue’s deformations causing axonal injury. The micro-model of the axon and matrix is characterized by a transversely isotropic viscoelastic material and the material model is formulated for numerical implementation. Model parameters are fit to experimental frequency response of the storage and loss modulus data obtained and determined using a genetic algorithm (GA) optimizing method. The results from macro-scale model are used in the micro-scale brain tissue to study the effective behavior of this tissue under injury-based loadings. The research involves the development of a tool providing a better understanding of the mechanical behavior of the brain tissue against blast loads and a rational multi-scale approach for driving injury criteria.
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Nemeth, Christopher, Adam Amos-Binks, Gregory Rule, Dawn Laufersweiler, Natalie Keeney, Yuliya Pinevich et Vitaly Herasevich. « Real Time Battlefield Casualty Care Decision Support ». Dans 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1002112.

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Tactical combat casualty care (TCCC) involves care for casualties in armed conflict from one’s own service (e.g., U.S. Marine Corps), other services (i.e., U.S. Army, Air Force,), allied forces, adversaries, and civilians. To minimize injury and preserve life, medics perform TCCC which includes casualty retrieval, stabilization and documentation, transport, triage, and treatment. In future scenarios, delays in evacuation are expected to require extended care including prolonged field care (PFC) over hours to days, increasing the potential for complications such as bloodstream infection (sepsis). Most medics have only simple equipment and essential medications and will need assistance at point of care to make decisions on how to treat more complex cases and perform procedures in an austere setting.We describe a project for the Defense Health Agency (DHA) over 3 years to develop and evaluate the Trauma Triage Treatment and Training Decision Support (4TDS), a real-time decision support system (DSS) to monitor casualty health. The operating 4TDS prototype uses the Samsung smart phone and tablet certified for use in the Department of Defense (DoD) Nett Warrior program. Connection to a simple VitalTag (Pacific Northwest National Laboratory, Richland, WA) vital signs monitor placed on a casualty at point of injury (PoI) will stream patient data including heart rate, respiration rate, peripheral oxygen saturation (SpO2), and diastolic and systolic blood pressure. Nurses, technicians, and physicians can use the tablet to display an expanded data set including lab values while providing care at a Battalion Aid Station (BAS) and Field Hospital (FH).4TDS includes a Machine Learning (ML) model to indicate shock probability, risk of internal hemorrhage, and probability of the need for a massive transfusion. The shock model was trained on Mayo Clinic Intensive Care Unit (ICU) patient data, then evaluated in a 6-month “silent test” comparing shock prediction with actual clinician diagnoses. The model only uses 6 vital signs, which is suited to battlefield care, while other published results include lab tests (e.g., lactate), and produces a Receiver Operator Characteristic Curve (ROC) of 0.83 for shock detection. The model only decreases by 0.05 90 minutes, identifying shock probability well before its onset. Medic reviews indicate a 30-minute advanced warning would be more than sufficient to initiate treatment.Medics who provide PFC may need to perform life-critical procedures such as shock management, cricothyroidotomy intubation, and transfusion that may not have been used for an extended period. 4TDS includes refresher training in how to perform such a procedure, as well as whether to perform the procedure. Usability assessments with healthcare providers from the Army, Navy, and Air Force at Joint Base San Antonio, TX have demonstrated 4TDS and its capabilities align with TCCC practice. This work is supported by the US Army Medical Research and Materiel Command under Contract No. W81XWH‐15‐9‐0001.
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Guzas, Emily L., Stephen E. Turner, Matthew Babina, Brandon Casper, Thomas N. Fetherston et Joseph M. Ambrico. « Validation of a Surrogate Model for Marine Mammal Lung Dynamics Under Underwater Explosive Impulse ». Dans ASME 2019 Verification and Validation Symposium. American Society of Mechanical Engineers, 2019. http://dx.doi.org/10.1115/vvs2019-5143.

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Abstract Primary blast injury (PBI), which relates gross blast-related trauma or traces of injury in air-filled tissues or those tissues adjacent to air-filled regions (rupture/lesions, contusions, hemorrhaging), has been documented in a number of marine mammal species after blast exposure [1, 2, 3]. However, very little is known about marine mammal susceptibility to PBI except in rare cases of opportunistic studies. As a result, traditional techniques rely on analyses using small-scale terrestrial mammals as surrogates for large-scale marine mammals. For an In-house Laboratory Independent Research (ILIR) project sponsored by the Office of Naval Research (ONR), researchers at the Naval Undersea Warfare Center, Division Newport (NUWCDIVNPT), have undertaken a broad 3-year effort to integrate computational fluid-structure interaction techniques with marine mammal anatomical structure. The intent is to numerically simulate the dynamic response of a marine mammal thoracic cavity and air-filled lungs to shock loading, to enhance understanding of marine mammal lungs to shock loading in the underwater environment. In the absence of appropriate test data from live marine mammals, a crucial part of this work involves code validation to test data for a suitable surrogate test problem. This research employs a surrogate of an air-filled spherical membrane structure subjected to shock loading as a first order approximation to understanding marine mammal lung response to underwater explosions (UNDEX). This approach incrementally improves upon the currently used one-dimensional spherical air bubble approximation to marine mammal lung response by providing an encapsulating boundary for the air. The encapsulating structure is membranous, with minimal simplified representation not accounting for marine mammal species-specific and individual animal differences in tissue composition, rib mechanics, and mechanical properties of interior lung tissue. NUWCDIVNPT partnered with the Naval Submarine Medical Research Laboratory (NSMRL) to design and execute a set of experiments to investigate the shock response of an air-filled rubber dodgeball in a shallow underwater environment. These tests took place in the 2.13 m (7-ft) diameter pressure tank at the University of Rhode Island, with test measurements including pressure data and digital image correlation (DIC) data captured with high-speed cameras in a stereo setup. The authors developed 3-dimensional computational models of the dodgeball experiments using Dynamic System Mechanics Advanced Simulation (DYSMAS), a Navy fluid-structure interaction code. DYSMAS models of a variety of different problems involving submerged pressure vessel structures responding to hydrostatic and/or UNDEX loading have been validated against test data [4]. Proper validation of fluid structure interaction simulations is quite challenging, requiring measurements in both the fluid and structure domains. This paper details the development of metrics for comparison between test measurements and simulation results, with a discussion of potential sources of uncertainty.
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Rapports d'organisations sur le sujet "Trauma hemorrhagic shock"

1

Tweardy, David J. Prevention of Trauma/Hemorrhagic Shock-Induced Mortality,Apoptosis, Inflammation and Mitochondrial Dysfunction. Fort Belvoir, VA : Defense Technical Information Center, décembre 2013. http://dx.doi.org/10.21236/ada612817.

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2

Tweardy, David J. Prevention of Trauma/Hemorrhagic Shock-Induced Mortality, Apoptosis, Inflammation and Mitochondrial Dysfunction. Fort Belvoir, VA : Defense Technical Information Center, décembre 2012. http://dx.doi.org/10.21236/ada612818.

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3

Tweardy, David J. Prevention of Trauma/Hemorrhagic Shock-Induced Mortality, Apoptosis, Inflammation and Mitochondrial Dysfunction Using IL-6 as a Resuscitation Adjuvant. Fort Belvoir, VA : Defense Technical Information Center, décembre 2011. http://dx.doi.org/10.21236/ada612819.

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