Prehospital shock index and pulse pressure/heart rate ratio to predict massive transfusion after severe trauma

This study compared the effects of self-selected exercise intensity (SEI) versus predetermined exercise intensity (PEI) on blood pressure (BP) and arterial stiffness in adolescents with obesity. A total of 37 adolescents, 14.7 (1.6) years old, body mass index ≥95th percentile were randomly allocated into SEI (n = 18; 12 boys) or PEI (n = 19; 13 boys). Both groups exercised for 35 minutes on a treadmill, 3 times per week, for 12 weeks. The SEI could set the speed at the beginning of the sessions and make changes every 5 minutes. The PEI adolescents were trained at an intensity set at 60% to 70% of heart rate reserve. Brachial and central BP, pulse pressure, augmentation index, and carotid–femoral pulse wave were determined at baseline and after 12 weeks. Both groups reduced brachial systolic BP (SEI, Δ = −9 mm Hg; PEI, Δ = −4 mm Hg; P < .01), central systolic BP (SEI, Δ = −4 mm Hg; PEI, Δ = −4 mm Hg; P = .01), and central pulse pressure (SEI, Δ = −4 mm Hg; PEI, Δ = −3 mm Hg; P = .02) without differences between groups. No changes in the augmentation index and carotid–femoral pulse wave were observed in either group. The SEI induced similar changes in various cardiovascular outcomes compared with PEI in adolescents with obesity.

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A Study on Shock Index in Early Diagnosis of Sepsis in Emergency Department of Tertiary Care Centre of Nepal

Nepal Medical Journal ◽

10.37080/nmj.68 ◽

2019 ◽

Vol 2 (2) ◽

pp. 37-42

Author(s):

Manish Nath Pant ◽

Subash Dawadi ◽

Ashish Thapa

Keyword(s):

Emergency Department ◽

Heart Rate ◽

Severe Sepsis ◽

Early Diagnosis ◽

Blood Lactate ◽

Lactate Level ◽

Tertiary Care ◽

Serum Lactate ◽

Shock Index ◽

Tertiary Care Centre

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4. Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.

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Early predictors for massive transfusion in older adult severe trauma patients

Injury ◽

10.1016/j.injury.2016.12.028 ◽

2017 ◽

Vol 48 (5) ◽

pp. 1006-1012 ◽

Cited By ~ 18

Author(s):

Takao Ohmori ◽

Taisuke Kitamura ◽

Junko Ishihara ◽

Hirokazu Onishi ◽

Tsuyoshi Nojima ◽

...

Keyword(s):

Older Adult ◽

Massive Transfusion ◽

Severe Trauma ◽

Trauma Patients ◽

Early Predictors

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Effects of pacing modality on noninvasive assessment of heart rate dependency of indices of large artery function

Journal of Applied Physiology ◽

10.1152/japplphysiol.00445.2016 ◽

2016 ◽

Vol 121 (3) ◽

pp. 771-780 ◽

Cited By ~ 10

Author(s):

Isabella Tan ◽

Hosen Kiat ◽

Edward Barin ◽

Mark Butlin ◽

Alberto P. Avolio

Keyword(s):

Heart Rate ◽

Arterial Stiffness ◽

Pulse Pressure ◽

Wave Reflection ◽

Pulse Wave ◽

Augmentation Index ◽

Large Artery ◽

Rate Dependency ◽

Wave Reflections

Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences affect the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects [mean age, 78 ± 10 (SD), 9 women] with in situ cardiac pacemakers were paced at 60, 70, 80, 90, and 100 beats per min under atrial, atrioventricular, or ventricular pacing. At each paced HR, brachial cuff-based pulse wave analysis was used to determine central hemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have significant effects on the HR relationship with ED ( P = 0.01), central aortic pulse pressure ( P = 0.01), augmentation pressure ( P < 0.0001), and magnitudes of both forward and reflected waves ( P = 0.05 and P = 0.003, respectively), but not cfPWV ( P = 0.57) or AIx ( P = 0.38). However, at a fixed HR, significant differences in pulse pressure amplification ( P < 0.001), AIx ( P < 0.0001), RM ( P = 0.03), and RI ( P = 0.03) were observed with different pacing modalities. These results demonstrate that although the HR relationships with arterial stiffness and systolic loading as measured by cfPWV and AIx were unaffected by pacing modality, it should still be taken into account for studies in which mixed pacing modalities are present, in particular, for wave reflection studies.

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