SHOCK trial

Not yet a first-line agent (the recent Vasopressin in Septic Shock Trial [VASST] showed no difference in 28-d mortality when vasopressin was compared with norepinephrine)... 

The pump s major advantages are its ease of use and wide availability. Frequent lABP use is speculated to have been a factor affecting the low 30-day mortality of the medically treated group in the SHOCK (Should we emergently revascularize Occluded Coronaries for cardiogenic shocK ) trial [7]. However, other studies suggest that the lABP only delays death and does not prevent it [8]. The lABP s main limitations are its short duration of use and requirement for partially intact left ventricular function [9]. 

Dzavik V, Sleeper LA, Cocke TP, Moscucci M, Saucedo J, Hosat S, Jiang X, Slater J, LeJemtel TH, Hochman JS. Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock a report from the SHOCK Trial Registry. Eur Heart J 2003 24 828-837. 

Derkx B, Wittes J, McCloskey R. Randomized, placebo-controlled trial of HA-IA, a human monoclonal antibody to endotoxin, in children with meningococcal septic shock. European Pediatric Meningococcal Septic Shock Trial Study Group. Clin Infect Dis 1999 28(4) 770-7. 

Strehlow (1975) achieved a solution by conducting a mass balance over the flow field. Such a balance can be drawn up under the assumptions of similarity and a constant density between shock and flame. The assumption of constant density violates the momentum-conservation equation, and is a drastic simplification. The maximum overpressure is, therefore, substantially underestimated over the entire flame speed range. An additional drawback is that the relationship of overpressure to flame speed is not produced in the form of a tractable analytical expression, but must be found by trial and error. 

Equations 1, 3 to 8, involving seven unknowns, may be solved by trial and error to give w = 0.0057. Thus the pressure upstream from the shock wave is ... 

Surgical embolectomy may be an alternative to IV thrombolysis in patients with decompensated shock (no prospective clinical trials)... 

A recent trial in bacteremic septic shock showed that each hour of delay in effective antimicrobial administration over the ensuing 6 h was associated with an average decrease in survival by 7.6%c... 

The recent CORTICUS trial (hydrocortisone vs placebo) does not support the routine use of corticosteroids in the management of septic shock. No difference in 28-d mortality was observed between groups, regardless of baseline relative adrenal insufficiency. Duration of shock was shorter in the hydrocortisone group however, an increased incidence of hyperglycemia, sepsis, and recurrent septic shock was observed. This section reflects the 2004 consensus guidelines... 

Upon stabilization, placement of a pulmonary artery (PA) catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from non-invasive measurements such as vital signs, cardiac rhythm, and urine output.9,10 Key measured parameters that can be obtained from a PA catheter are the pulmonary artery occlusion pressure, which is a measure of preload, and CO. From these values and simultaneous measurement of HR and blood pressure (BP), one can calculate the left ventricular SV and SVR.10 Placement of a PA catheter should be reserved for patients at high risk of death due to the severity of shock or preexisting medical conditions such as heart failure.11 Use of PA catheters in broad populations of critically ill patients is somewhat controversial because clinical trials have not shown consistent benefits with their use.12-14 However, critically ill patients with a high severity of illness may have improved outcomes from PA catheter placement. It is not clear why this was... 

Appropriate empiric anti-infective therapy decreases 28-day mortality compared to inappropriate empiric therapy (24% versus 39%).22 23,30 Additionally, appropriate therapy administered within 1 hour of sepsis recognition also decreases complications and mortality.22-23,30 Empiric anti-infective therapy should include one, two, or three drugs, depending on the site of infection and causative pathogens (Table 79-3). Anti-infective clinical trials in sepsis and septic shock patients are scarce and have not demonstrated differences among agents therefore, factors that determine selection are ... 

That first night, Hebert and I talked only of milkshakes and well-fed children. Next day Hebert and the Merrells invited me to eat at their table every day. The four of us were joined one day at lunch by Duke Minskoff. Hebert made his first reference to the trial. He said the "most shocking testimony" had been the proof of what went on at Auschwitz as it concerned the engineer Duerrfeld, who had directed the construction daily for four years. For two and a half days on the stand, Duerrfeld had put in the only defense he had — which was simply that the conditions hadn t existed at all. He described every installation at Auschwitz as if it were a luxury hotel. One version against the other was "like heaven and hell," as Duke pointed out. 

Recently, BN 52063 has been demonstrated to be effective against mastocytosis [304], a condition which was previously incurable. This suggests that PAF, as well as mast cell degranulation, may have a role in systemic mastocytosis. The injectable (pure) form of BN 52021 is much more powerful than BN 52063. Preliminary clinical investigations have shown a long and intense inhibition of ex vivo PAF-induced platelet aggregation. The injectable form is now under clinical trials in graft rejection, stroke, haemodialysis and shock. 

Such had been the trial which faced Cecile that day two years ago. Her one thought had been that mother must never know her heart had always been weak and the shock would kill her, simply kill her. Words her mother had once spoken to her returned to her mind as she had finished reading those letters. The remark had been caused by some little act of thoughtfulness on Philippe s part, some little gift he had sent her, for Philippe had always been careful to remember all the little household feast days with beautiful and often costly gifts. 

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