The convergent model of coagulation

Journal of Thrombosis and Haemostasis, Journal Year: 2024, Volume and Issue: 22(8), P. 2140 - 2146

Published: May 28, 2024

It is increasingly apparent that the pathologic interplay between coagulation and innate immunity, ie, immunothrombosis, forms common basis of many challenges across boundaries specialized medicine cannot be fully explained by conventional concepts cascade cell-based coagulation. To improve our understanding coagulation, we propose a model converges with inflammation immune activation as unified response toward vascular injury. Evolutionarily integral to convergent are damage-associated molecular patterns, which released consequence Damage-associated patterns facilitate diverse interactions within systems, not only complement reinforce clot formation but also steer resolution wound healing. By extending beyond its current boundaries, aims deliver novel diagnostics therapeutics for contemporary unexpected medicine, exposed COVID-19 vaccine-induced thrombotic thrombocytopenia.

Language: Английский

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Advancements in Prehospital, En-Route, and Damage Control Casualty Care and Areas of Future Research for Large-Scale Combat Operations

Current Trauma Reports, Journal Year: 2025, Volume and Issue: 11(1)

Published: Feb. 20, 2025

Abstract Purpose of Review The purpose this review is to describe the advancements in combat casualty care from prehospital environment, through en route care, and into damage control resuscitative surgical during recent military conflict. We also explore potential areas future research needed enhance survivability on battlefield large-scale operations (LSCO). Recent Findings In space, use tourniquets has become standard practice for controlling severe hemorrhage, while techniques like Resuscitative Endovascular Balloon Occlusion Aorta (REBOA) continue be researched managing hemorrhagic shock. Implementing whole blood transfusions freeze-dried plasma enables hemostatic resuscitation. Pain management strategies are evolving, with ketamine, Penthrox, fentanyl. During concept “golden hour” emphasizes urgency delivering timely medical intervention, critical paramedics play an essential role setting. En resuscitation teams enable rapid, lifesaving interventions patient transport. Within surgery, focus shifted towards products counteract coagulopathy prevent further bleeding. Damage laparotomy remains a intervention abdominal injuries, vascular shunting being utilized extensively stabilize patients limb-threatening injuries. Likewise, acellular vessel conduits novel, promising innovation, offering bioengineered solution repair. For LSCO, novel must delve anti-shock drugs aimed at enhancing hemodynamic stability, Extracorporeal Membrane Oxygenation trauma, development antimicrobials post-traumatic infections. Directed energy technologies, telemedicine, decision-assist tools, autonomous systems investigated, transform trauma by improving response times treatment efficacy remote or resource-limited environments. Summary advancements, such as hemorrhage methods REBOA, alongside innovations plasma, exemplify care. golden hour policy, resuscitation, improvement capabilities highlight importance saving lives. Novel areas, including drugs, ECMO, antimicrobials, directed systems, could operations.

Language: Английский

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21st century critical care medicine: An overview

World Journal of Critical Care Medicine, Journal Year: 2024, Volume and Issue: 13(1)

Published: March 5, 2024

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes intensive units (ICUs). This abstract provides a concise summary of latest developments critical care, highlighting key areas innovation. Recent include Precision Medicine: Tailoring treatments based on individual characteristics, genomics, and biomarkers to enhance effectiveness therapies. The objective is describe recent Care Medicine. Telemedicine: integration telehealth technologies for remote monitoring consultation, facilitating timely interventions. Artificial intelligence (AI): AI-driven tools early disease detection, predictive analytics, treatment optimization, enhancing clinical decision-making. Organ Support: Advanced life support systems, such as Extracorporeal Membrane Oxygenation Continuous Renal Replacement Therapy provide better organ support. Infection Control: Innovative infection control measures combat emerging pathogens reduce healthcare-associated infections. Ventilation Strategies: ventilation modes lung-protective strategies minimize ventilator-induced lung injury. Sepsis Management: Early recognition aggressive management sepsis with tailored Patient-Centered Care: A shift towards patient-centered focusing psychological emotional well-being addition medical needs. We conducted thorough literature search PubMed, EMBASE, Scopus using our strategy, incorporating keywords telemedicine, management. total 125 articles meeting criteria were included qualitative synthesis. To ensure reliability, we focused only published English language within last two decades, excluding animal studies,

Language: Английский

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Use of extracorporeal blood purification therapies in sepsis: the current paradigm, available evidence, and future perspectives

Critical Care, Journal Year: 2024, Volume and Issue: 28(1)

Published: Dec. 25, 2024

Sepsis is the result of a dysregulated immune response to infection and associated with acute organ dysfunction. The syndrome's complexity contingent upon underlying pathology individual patient characteristics, including their response. involvement multiple organs physiological functions adds complexity, "organ cross-talk" emerging as pivotal pathophysiological clinical aspect. This narrative review evaluate rationale available evidence supporting use extracorporeal blood purification therapies adjunctive therapy in patients sepsis septic shock. A search PubMed, Embase, Web Science Scopus databases for relevant literature from August 2002 May 2024 has been conducted. was performed using terms: 1) "blood purification" or "hemadsorption" "plasma exchange" AND 2) "sepsis" "septic shock". Therefore authors have focused our discussion on several key areas such conducting well-designed trials, developing more personalized protocols, ensuring optimal management monitoring. Given heterogeneity sepsis, traditional randomized trials this domain can be daunting task. However, statistical techniques Bayesian methods, propensity score analysis, emulated hold promise enhancing comparability between study groups. Indeed, comprehend efficacy it imperative assemble homogeneous groups receiving uniform treatments. Clinical strategies should individualized, signaling end "one size fits all" approach need Current suggested best practice cytokine hemadsorption sepsis.

Language: Английский

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Extracorporeal Blood Purification in European Pediatric Intensive Care Units

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(2), P. e2457657 - e2457657

Published: Feb. 3, 2025

Importance Important advances have been made in extracorporeal blood purification therapies (EBPTs) due to new technologies and biomaterials; however, the lack of established guidelines is a factor great variability clinical practice. This aspect accentuated pediatric intensive care given small number patients with diverse diagnoses treated EBPT technical challenges treating children, potentiating risk adverse events. Objective To understand what experienced users think about its relevant issues, insight that may implications for design future studies, application EBPTs patient care. Evidence Review Literature search was conducted using PubMed Embase databases between January 1, 2020, July 15, 2024, combination key medical terms. A panel experts formed (composed 15 authors intensivists) develop consensus statement modified Delphi-based model 2022 2024. The panel’s core team drafted initial questionnaire, which explored use units (PICUs), including indications initiating discontinuing outcomes assessing effectiveness safety. SurveyMonkey used distribution, completion, revision findings were analyzed. Panelists asked rank answer choices. Numerical value each ranking translated percentage defining strength (>90% agreement from panelists signifying strong consensus; <49% no consensus). Findings total 116 survey responses received 8 European countries. Strong achieved on 6 24 questions (75%-90% agreement) reached 18 questions. According panelists, continuous renal replacement therapy standard or enhanced adsorption hemofilter plasma exchange interest, representing most applied across various applications. While evidence hemoadsorption growing, it remains limited. Conclusions Relevance critically ill developed by an international areas where still could support intensivists bedside decision-making guide research PICUs.

Language: Английский

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Investigation of Inflammatory Reduction During Extracorporeal Membrane Oxygenation Using a Novel Cytokine Adsorption Column: A Rat Model Study

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(5), P. 1686 - 1686

Published: March 2, 2025

Background: Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are widely used. Previous methods to reduce inflammation have shown inconsistent results. We developed a cytokine adsorption column using polymethyl methacrylate (PMMA) investigated its anti-inflammatory effects during ECMO. Materials Methods: Male Sprague–Dawley rats were divided into three groups (seven in each group): SHAM, ECMO, ECMO with PMMA (PMMA group). Experiments comprised 180 min of cannulation only the SHAM group 60 followed by 120 observation groups. was conducted from 30 after initiation completion group. Blood parameters cytokines measured experiments. Lung tissues collected experiment for evaluation tissue edema. Results: The showed significantly lower levels tumor necrosis factor alpha (TNF-α) interleukin(IL)-6 compared at completing However, there no significant differences IL-10 between same time points. edema incidence Conclusions: effectively suppressed systemic inflammatory reactions

Language: Английский

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Real-World Outcomes of Hemoadsorption with CytoSorb ^® in Patients with Septic Shock: Insights from a Single-Center Study

Journal of Intensive Care Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Background Hemoadsorption is currently employed to treat septic shock and other clinical conditions involving massive inflammatory mediator release. CytoSorb ® , a device utilizing synthetic resin microbeads, provides large adsorption surface for blood purification. This study aimed review the course of patients with treated in our hospital's intensive care unit (ICU). Patients Methods retrospectively analyzed focusing on treatment timing volume processed. Results Between July 1, 2016, December 31, 2023, 175 (106 men, 69 women; median age: 67 years, interquartile [IQR]: 58-85) received therapy. Survivors exhibited significantly lower simplified acute physiology score at admission than nonsurvivors. was initiated within 24 h onset 102 (58%, early starters) between 25 48 73 (42%, late starters). Hemodynamic improvements elevated mean arterial pressure reduced lactate, procalcitonin, C-reactive protein, sequential organ failure assessment scores, noradrenaline doses survivors. These effects were more pronounced starters receiving treatment, who also demonstrated lactate levels higher end Overall, 86 (49%) died ICU. underwent longer durations processed greater volumes Conclusions In onset, intensity–rather timing–was associated ICU mortality rates.

Language: Английский

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Synthesis, characterization and antimicrobial activity of functionalized amberlite polymer for biomedical application

Spectrochimica Acta Part A Molecular and Biomolecular Spectroscopy, Journal Year: 2025, Volume and Issue: unknown, P. 126411 - 126411

Published: May 1, 2025

Language: Английский

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Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies

Journal of Personalized Medicine, Journal Year: 2024, Volume and Issue: 14(2), P. 176 - 176

Published: Feb. 3, 2024

Sepsis and septic shock are associated with high mortality, diagnosis treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, focus control; however, there aspects that have changed. This narrative review highlights current avant-garde methods of handling patients experiencing based on the experience its authors best available evidence in context uncertainty. Following first recommendation Surviving Campaign guidelines, it is recommended specific sepsis care performance improvement programs implemented hospitals, i.e., “Sepsis Code” programs, designed ad hoc, to achieve this goal. Regarding hemodynamics, importance perfusion coherence stand out, which allow recognition different phenotypes, determination ideal time commencing vasopressor appropriate fluid therapy dosage. At present, not only important initial timing, but also de-resuscitation, involves early weaning support therapies, directed elimination fluids, tolerance concept. Finally, regarding blood purification those aimed at eliminating endotoxins cytokines attractive shock.

Language: Английский

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Efferent methods of therapy for critical illness

Physical and rehabilitation medicine medical rehabilitation, Journal Year: 2024, Volume and Issue: 6(1), P. 49 - 72

Published: March 22, 2024

Extracorporeal blood purification is intended to eliminate dysregulation of the immune system. The concept extracorporeal therapy based on nonspecific clearance inflammatory mediators and triggers, which attenuates systemic expression mediators. main types are hemoadsorption plasma exchange. Hemoadsorption used primarily as an adjuvant treatment for septic shock other severe conditions, including forms COVID-19 with cytokine storm. Reliable data demonstrating benefit in critically ill patientsis limited. Recommendations use devices often incomplete or questionable interpretations available data. Given lack evidence inflammation, sepsis, liver failure rhabdomyolysis, its routine clinical practice not justified until mechanisms underlying these findings fully elucidated. Plasma replacement a potentially life-saving invasive procedure that replaces substitute fluid (saline, albumin solution, fresh frozen plasma, combination these) risk side effects complications. There still uncertainty regarding timing, type exchange, volume frequency filtration. Although considered be relatively safe, there insufficient support inclusion sepsis protocols. Reports methods patients refractory inflammation provide decreased levels biomarkers, improved hemodynamic parameters, organ failure. However, according results randomized trials, does affect outcomes, some even increases mortality. To clarify effectiveness therapy, it necessary study interaction target non-target components large-scale controlled trials assessing ability this improve outcomes.

Language: Английский

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