Abstract Fluid bolus therapy (FBT) is fundamental to the management of circulatory shock in critical care but balancing benefits and toxicities FBT has proven challenging individual patients. Improved predictors hemodynamic response a fluid bolus, commonly referred as challenge, are needed limit non-beneficial administration enable automated clinical decision support patient-specific precision management. In this study we retrospectively analyzed data from 394 boluses 58 pigs subjected...

Abstract Background Volume expansion and vasopressors for the treatment of shock is an intensive process that requires frequent assessments adjustments. Strict blood pressure goals in multiple physiologic states (traumatic brain injury, sepsis, hemorrhagic) have been associated with improved outcomes. The availability continuous data amenable to closed-loop automated critical care improve goal-directed resuscitation. Methods Five adult swine were anesthetized subjected a controlled 30%...

BACKGROUND Partial and intermittent resuscitative endovascular balloon occlusion of the aorta (pREBOA iREBOA, respectively) are lifesaving techniques designed to extend therapeutic duration, mitigate ischemia, bridge patients definitive hemorrhage control. We hypothesized that automated pREBOA titration compared with iREBOA would reduce blood loss hypotensive episodes over a 90-minute intervention phase in an uncontrolled liver swine model. METHODS Twenty-four pigs underwent by transection...

Complications from systemic inflammation are reported in neonates following exposure to cardiopulmonary bypass. Although the use of asanguinous primes can reduce these complications, neonates, this result significant haemodilution, requiring addition blood. This study investigates whether blood after institution bypass alters inflammatory response compared with a prime. Neonatal swine were randomised into four groups: prime, but before cooling, cooling low flow, and re-warming. All groups...

Reperfusion injury is a complex inflammatory response involving numerous mechanisms and pathways. Mechanical tissue resuscitation newly described therapeutic strategy that reduces reperfusion injury. This study further investigates potential for the protective effects of mechanical while utilizing bio-absorbable matrix.Anesthetized swine were subjected to 80 minutes coronary ischemia three hours reperfusion. An absorbable matrix was used cover ischemic-reperfused myocardium apply (-50 mmHg)...

Background We sought to determine the magnitude of inherent inter-animal physiologic variability by automating a porcine Resuscitative Endovascular Balloon Occlusion Aorta (REBOA) protocol minimize external influences that might alter physiology and confound experimental results. Methods Swine (n = 42) underwent controlled 30% blood volume hemorrhage followed 30 minutes REBOA (ie, ischemic phase). The animals were weaned from autonomously over 15 minutes, beginning reperfusion phase, while...

Ischemia reperfusion injury causes a profound hyperdynamic distributive shock. Endovascular perfusion augmentation for critical care (EPACC) has emerged as hemodynamic adjunct to vasopressors and crystalloid. The objective of this study was examine varying levels mechanical support the treatment ischemiareperfusion in swine.Fifteen swine underwent anesthesia then controlled 30% blood volume hemorrhage followed by 30 min supra-celiac aortic occlusion create an ischemia-reperfusion Animals...

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving intervention for major truncal hemorrhage. Balloon-tipped arterial catheters are inserted via femoral artery to create temporary aorta, which minimizes rate internal bleeding until definitive surgery can be conducted. There growing concern over resultant hypoperfusion and potential damage tissues organs downstream REBOA. To better understand acute hemodynamic changes imposed by REBOA, we developed...

CONTEXT: Near infrared spectroscopy (NIRS) is a noninvasive tool for assessing local oxygen balance. In circulatory shock, the microcirculatory environment as measured by NIRS during resuscitation may provide additional diagnostic tools of value to critical care physician. HYPOTHESIS: To assess whether relative increase in peripheral was correlated with clinically relevant cardiac output following fluid bolus swine model shock. METHODS AND MODELS: Nine healthy young adult median weight 80 kg...

Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides hemodynamic support to patients with non-compressible truncal hemorrhage. As cardiac output increases due aortic (AO), diameter will increase as a function compliance, potentially causing unintended flow around balloon.Swine (N = 10) were instrumented collect proximal mean arterial blood pressure (pMAP), distal MAP (dMAP), (bP), volume (bV), and (Qaorta). A 7-Fr automated REBOA catheter was positioned in Zone 1. At...

Background: Critical care management of shock is a labor-intensive process. Precision Automated Care Management (PACC-MAN) an automated closed-loop system incorporating physiologic and hemodynamic inputs to deliver interventions while avoiding excessive fluid or vasopressor administration. To understand PACC-MAN efficacy, we compared provider-directed (PDM). We hypothesized that would achieve equivalent resuscitation outcomes PDM maintaining normotension with lower requirements. Methods :...

Background: Death due to hemorrhagic shock, particularly, noncompressible truncal hemorrhage, remains one of the leading causes potentially preventable deaths. Automated partial and intermittent resuscitative endovascular balloon occlusion aorta (i.e., pREBOA iREBOA, respectively) are lifesaving strategies aimed achieve quick hemostatic control while mitigating distal ischemia. In is titrated from full no intermittently, whereas in pREBOA, a maintained. Therefore, these two interventions...

Goal-directed blood pressure management in the intensive care unit can improve trauma outcomes but is labor-intensive. Automated critical systems deliver scaled interventions to avoid excessive fluid or vasopressor administration. We compared a first-generation automated drug and delivery platform, Precision Critical Care Management (PACC-MAN), more refined algorithm, incorporating additional physiologic inputs therapeutics. hypothesized that enhanced algorithm would achieve equivalent...

Point of care testing (POCT) is increasingly utilized in clinical medicine. Small, portable devices can now deliver reliable and accurate diagnostic results during a patient encounter. With these increases POCT, the issue data management quickly emerges. Results need to be cataloged accurately efficiently while providers/support staff are simultaneously managing encounters. The integration electronic medical records (EMR) as repositories requires that point imports automatically into EMR....

Background and Aim Myocardial ischemia-reperfusion injury is known to trigger an inflammatory response involving edema, apoptosis, neutrophil activation/accumulation. Recently, mechanical tissue resuscitation (MTR) was described as a potent cardioprotective strategy for reduction of myocardial injury. Here, we further describe the protective actions MTR begin define its therapeutic window. Methods A left ventricular, free-wall ischemic area created in anesthetized swine 85 minutes then...

BACKGROUND Partial resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown promise as a method to extend REBOA, but there lacks standard definition technique. The purpose this study was investigate relationships between distal and proximal mean arterial pressure (MAP) aortic flow past REBOA catheter. We hypothesize that relationship MAP in Zone 1 partial (pREBOA) is conserved no apparent MAP. METHODS A retrospective data analysis swine performed. Cohort underwent 20%...

Background Reperfusion injury results in the continued loss of myocardial cells following revascularization ischemic myocardium. Therapeutics which decrease cell death may improve morbidity and mortality associated with AMI. MTR has been demonstrated to reduce infarct size when initiated at time reperfusion. Here we hypothesize that this therapeutic approach remains efficacious even further into Methods A left, anterior free‐wall lesion (85 min.) was created using reversible tourniquets...

Background Reperfusion following an ischemic myocardial event increases cell death by activation of inflammatory processes. Reducing reperfusion injury may improve morbidity and mortality AMI. We have previously shown MTR to reduce infarct size MI/R. Here, we determine the effects on apoptosis edema using a novel, bio‐absorbable patch. Methods A left, anterior free‐wall lesion (80 minutes) was created reversible tourniquets in swine. Animals were randomized receive either no treatment...

Introduction: The delivery of cell therapies may be an important frontier to treat different respiratory diseases in the near future. However, size, conditions, viability, and effect pulmonary function are critical factors. We performed a proof-of-concept experiment using ex vivo lungs novel subglottic airway device that allows for selective lobar isolation administration drugs biologics liquid solution deep into lung tissues, while simultaneously ventilating rest lobes. Methods: used...

ObjectiveRestoration of distal blood flow is critical to successfully salvage patients with resuscitative endovascular balloon occlusion the aorta (REBOA). Yet, ideal methods for REBOA deflation restore and simultaneously avoid proximal hypotension remain undefined. Adaptive titration algorithms guide may prevent large hemodynamic fluctuations during weaning. We hypothesize that automated weaning can both augment hemodynamics attempts completely deflate in a swine model hemorrhagic...