Exploring Horizons in the Treatment of Vasoplegia in Shock Syndromes.

Vasoplegic endothelial dysfunction stands out as one of the most prominent shock syndromes in the intensive care unit, and despite continual therapeutic advances, it is still associated with poor prognosis in critical cases. This scenario is compatible with a significant inflammatory disturbance, with a propensity for increased vascular permeability and deterioration of endothelial response to modulators: a microcirculation disaster. The hemodynamic support's backbone is based primarily on fluid replacement and the use of vasopressor and inotropic agents in nonresponsive patients, aiming to establish a mean arterial pressure of at least 65 mmHg and therefore promote adequate tissue reperfusion. The present study's primary target is to discuss the combination of 3 concepts as a useful strategy for improving results against the high rates of mortality in critically ill patients. These 3 concepts are (1) the use of "broad-spectrum vasopressors," (2) vasopressorsparing strategy, and (3) microcirculation protection.

Penetrating cardiac injuries: a 13-year retrospective evaluation from a Brazilian trauma center.

To present our experience with penetrating cardiac injuries. We have retrospectively reviewed the records of 70 victims of penetrating cardiac injuries. A logistic regression has been performed in order to determine the association between death and clinical predictors. Penetrating injuries consisted of 43 stab wounds (61.4%) and 27 (38.6%) gunshot injuries (P=0.72). There were 63 (90%) male and 7 female (10%, P<0.001) victims. The mean age was 27.36+/-11.51, ranging from 3 to 65 years. The overall mortality was 32.9%, 47.8% for gunshot wounds and 52.2% for stab wounds (P=0.266). Eight victims (11.4%) had associated intra-thoracic great vessel injuries and 17 (24.3%) presented associated intra-abdominal organ injuries. The incidence of injured chamber was: right ventricle 37.1%, right atrium 27.1%, left ventricle 25.7%, and left atrium 5.7%. Non-survivors had lower systolic blood pressure (37.50+/-39.18 mmHg) than survivors (79.04+/-41.04 mmHg; P<0.001) upon arrival at the hospital. Thirteen non-survival (56.5%) and 10 (21.3%) survival victims had systolic blood pressure (SBP)