المؤلفون: Jaber, Samir¹ (AUTHOR) s-jaber@chu-montpellier.fr, Paugam, Catherine² (AUTHOR), Futier, Emmanuel³ (AUTHOR), Lefrant, Jean-Yves⁴ (AUTHOR), Lasocki, Sigismond⁵ (AUTHOR), Lescot, Thomas⁶ (AUTHOR), Pottecher, Julien⁷ (AUTHOR), Demoule, Alexandre^8,9 (AUTHOR), Ferrandière, Martine¹⁰ (AUTHOR), Asehnoune, Karim¹¹ (AUTHOR), Dellamonica, Jean¹² (AUTHOR), Velly, Lionel¹³ (AUTHOR), Abback, Paër-Sélim² (AUTHOR), de Jong, Audrey¹ (AUTHOR), Brunot, Vincent¹⁴ (AUTHOR), Belafia, Fouad¹ (AUTHOR), Roquilly, Antoine¹¹ (AUTHOR), Chanques, Gérald¹ (AUTHOR), Muller, Laurent⁴ (AUTHOR), Constantin, Jean-Michel³ (AUTHOR)

المصدر: Lancet. 7/7/2018, Vol. 392 Issue 10141, p31-40. 10p. 1 Diagram, 2 Charts, 2 Graphs.

مصطلحات موضوعية: *RESEARCH, *RESEARCH funding, SODIUM bicarbonate, ACIDOSIS, INTENSIVE care patients, LACTATES, MORTALITY, THERAPEUTICS, HEMORRHAGIC shock treatment, AMBULANCES, BLOOD plasma, COMPARATIVE studies, EMERGENCY medical services, HEMORRHAGIC shock, RESEARCH methodology, MEDICAL cooperation, RESUSCITATION, SALT, SURVIVAL, TRAUMA centers, EVALUATION research

مصطلحات جغرافية: COLORADO

مستخلص: Background: Plasma is integral to haemostatic resuscitation after injury, but the timing of administration remains controversial. Anticipating approval of lyophilised plasma by the US Food and Drug Administration, the US Department of Defense funded trials of prehospital plasma resuscitation. We investigated use of prehospital plasma during rapid ground rescue of patients with haemorrhagic shock before arrival at an urban level 1 trauma centre.Methods: The Control of Major Bleeding After Trauma Trial was a pragmatic, randomised, single-centre trial done at the Denver Health Medical Center (DHMC), which houses the paramedic division for Denver city. Consecutive trauma patients in haemorrhagic shock (defined as systolic blood pressure [SBP] ≤70 mm Hg or 71-90 mm Hg plus heart rate ≥108 beats per min) were assessed for eligibility at the scene of the injury by trained paramedics. Eligible patients were randomly assigned to receive plasma or normal saline (control). Randomisation was achieved by preloading all ambulances with sealed coolers at the start of each shift. Coolers were randomly assigned to groups 1:1 in blocks of 20 according to a schedule generated by the research coordinators. If the coolers contained two units of frozen plasma, they were defrosted in the ambulance and the infusion started. If the coolers contained a dummy load of frozen water, this indicated allocation to the control group and saline was infused. The primary endpoint was mortality within 28 days of injury. Analyses were done in the as-treated population and by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01838863.Findings: From April 1, 2014, to March 31, 2017, paramedics randomly assigned 144 patients to study groups. The as-treated analysis included 125 eligible patients, 65 received plasma and 60 received saline. Median age was 33 years (IQR 25-47) and median New Injury Severity Score was 27 (10-38). 70 (56%) patients required blood transfusions within 6 h of injury. The groups were similar at baseline and had similar transport times (plasma group median 19 min [IQR 16-23] vs control 16 min [14-22]). The groups did not differ in mortality at 28 days (15% in the plasma group vs 10% in the control group, p=0·37). In the intention-to-treat analysis, we saw no significant differences between the groups in safety outcomes and adverse events. Due to the consistent lack of differences in the analyses, the study was stopped for futility after 144 of 150 planned enrolments.Interpretation: During rapid ground rescue to an urban level 1 trauma centre, use of prehospital plasma was not associated with survival benefit. Blood products might be beneficial in settings with longer transport times, but the financial burden would not be justified in an urban environment with short distances to mature trauma centres.Funding: US Department of Defense. [ABSTRACT FROM AUTHOR]

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المؤلفون: Stern, Jean-Baptiste, Bernard, Oana, Paugam, Catherine, Silve, Caroline, Mantz, Jean, Aubier, Michel, Crestani, Bruno

المصدر: CHEST; Mar2002, Vol. 121 Issue 3, p852-857, 6p, 2 Charts, 5 Graphs

مصطلحات موضوعية: LUNG injuries, PARATHYROID hormone-related protein, EPITHELIAL cells, ADULT respiratory distress syndrome, PROTEIN analysis, BODY fluids, COMPARATIVE studies, EPITHELIUM, LONGITUDINAL method, LUNGS, RESEARCH methodology, MEDICAL cooperation, PARATHYROID hormone, PEPTIDE hormones, PULMONARY alveoli, RESEARCH, EVALUATION research, ACUTE diseases

مستخلص: Objective: To determine the concentration of parathyroid hormone-related protein (PTHrP; an autocrine/paracrine regulator of type-2 alveolar epithelial cells proliferation and apoptosis) in the epithelial lining fluid (ELF) from patients without pulmonary disease and from patients with acute lung injury (ALI), and to evaluate whether PTHrP concentrations correlated with the intensity of lung injury.Design: Prospective study.Setting: An adult trauma/surgical ICU in an urban teaching hospital.Patients: A total of 20 patients with ALI receiving mechanical ventilation (patients), and 10 patients without pulmonary disease not receiving mechanical ventilation (control subjects).Interventions: None.Measurements and Results: PTHrP was detected in all BAL fluids, and ELF PTHrP concentrations (median; 25% to 75% percentiles) tended to be higher in patients (52.2 nmol/mL; 20.8 to 65.6 nmol/mL) than in control subjects (25.4 nmol/mL; 20.5 to 35.4 nmol/mL; p = 0.18). In patients, ELF PTHrP concentration correlated positively with the PaO(2)/fraction of inspired oxygen ratio (r = 0.53; p = 0.005), and negatively with lung injury score (r = - 0.44; p = 0.02), radiologic score (r = - 0.40; p = 0.04), and BAL albumin concentration (r = - 0.42; p = 0.02).Conclusion: PTHrP is present in biologically significant concentrations in the alveolar milieu in humans. In patients with ALI, the PTHrP concentration correlates negatively with the degree of lung injury. [ABSTRACT FROM AUTHOR]

: Copyright of CHEST is the property of American College of Chest Physicians and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)