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Cardiogenic shock is a condition in which a suddenly weakened heart isn't able to pump enough blood to meet the body's needs. The condition is a medical emergency and is fatal if not treated right away.

Results: 1 to 20 of 64

No evidence that medical anti‐shock trousers improve survival for people with trauma, and some suggestion they may worsen outcomes, but more trials are needed

About one third of injury deaths are due to shock from blood loss. Preventing shock in people with uncontrolled bleeding is therefore vital. Treatment aims to maintain blood pressure, so that tissue damage is minimised. Medical anti‐shock trousers (MAST) are believed to increase blood pressure and blood flow to the heart and brain, helping to stabilise the person until they receive further treatment. The review of trials found no evidence that MAST application decreases deaths, with some suggestion that it may even do harm. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Naloxone may improve blood pressure in people who are in shock but more trials are needed to show whether this reduces deaths

When people go into shock, their blood pressure drops and may be too low to sustain life. One theory about the cause of this is the effect of the opiates that the body produces after major blood loss or trauma. Naloxone is a drug that counteracts the effects of opiates. It has been tried as a treatment to reduce the impact of shock. This review of trials found that giving naloxone to people in shock improves their blood pressure. It is not clear whether or not this improves their overall condition or reduces their chances of dying. More trials are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Vasopressors for shock

Circulatory shock is broadly defined as circulatory failure resulting in the body's inability to maintain organ perfusion and to meet oxygen demands. It usually presents with low blood pressure. Up to every third patient with circulatory shock may be admitted to the intensive care unit because of circulatory failure, and mortality in the intensive care unit ranges from 16% to 60%. For treatment, fluid replacement is followed by vasopressor agents, if necessary. A vasopressor agent is an agent that causes a rise in blood pressure. Vasopressor therapy is an important part of haemodynamic support in patients with shock (where haemodynamics is defined as the flow of blood in the circulatory system). A number of different vasopressors are available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

A long course (five days or more) of a low dose of corticosteroids may be considered as an adjunct therapy in patients with septic shock.

Septic shock is the most severe form of infection. It may also interfere with the production of corticosteroids, a key hormone for host defence against infection. This review showed that corticosteroids did not impact on mortality overall. However, the trials conducted after the scientific community agreed upon a consensual definition of sepsis, in 1992, suggested that a low dose of corticosteroids for five days or more improved the survival of patients in septic shock without causing harm They did develop some metabolic disorders. Trials performed before 1992 showed no benefit from a short course of high dose corticosteroids.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones

Stones in the urinary tract are a common medical problem. Fifty per cent of patients with previous urinary stones have a recurrence within 10 years. Kidney stones can cause pain, blood in the urine, infection, decreased kidney function and kidney failure. The treatment is to remove the stones from kidney. Extracorporeal shock wave lithotripsy (ESWL) disintegrates stones using shock waves and is a minimally invasive technique. Other minimally invasive methods (percutaneous nephrolithotomy (PCNL)) and retrograde intrarenal surgery (RIRS)) are widely used for kidney stones management because ESWL had limited success rate. This review aimed to compare the effectiveness and complications between ESWL and stones removing using the nephroscopy through the skin at kidney level (PCNL) or ureteroscope through the bladder and ureter to the kidney (RIRS). Three small randomised studies (214 patients) were included. Two studies compared ESWL with PCNL and one study compared ESWL with RIRS. Patients with lower pole kidney stones who undergo PCNL have a higher success rate than ESWL whereas RIRS was not significantly different from ESWL. However, ESWL patients spent less time in hospital and the duration of treatment was shorter.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Inotropic and vasodilator strategies in patients with a heart attack (acute myocardial infarction) and cardiogenic shock or low cardiac output

Cardiogenic shock occurring in 5% to 10% of patients with acute myocardial infarction still remains a life‐threatening complication. As regards treatment options with inotropic and vasoactive drugs for infarct related cardiogenic shock, there is only very little evidence generated by randomised controlled trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Intra‐aortic Balloon counterpulsation in patients with acute myocardial infarction and cardiogenic shock

Patients with acute myocardial infarction complicated by cardiogenic shock still have a poor prognosis after primary revascularization procedures such as coronary artery bypass grafting or primary percutaneous coronary intervention. Under patho‐physiological considerations, the failing heart due to impaired left ventricular function following acute myocardial infarction is the main cause for the development of cardiogenic shock characterized by instable haemodynamics with reduced systolic and mean arterial pressures. The reduced blood pressure leads to hypoperfusion with reduced oxygen supply to vital organs. Following these pathophysiological considerations it seemed to be a consequent therapeutic concept to give haemodynamic support to these haemodynamically instable patients by a mechanical assist device, called intra‐aortic balloon pump (IABP). While the balloon becomes in‐ and deflated synchronal with the beats of the heart, it acts to increase blood flow to the heart as well as reduce the amount of work the heart is doing. This support can be provided for a few hours and up to several days. Recent evidence suggests that certain patients with acute myocardial infarction complicated by cardiogenic shock and treated by thrombolysis may have a benefit from a period of support with the IABP after revascularization by thrombolysis. Nowadays the most preferred revascularization procedure is primary percutaneous coronary intervention. For these patients a few number of heterogeneous randomised trials with only small patient numbers were not able to show convincing evidence, for either benefit or harm, supporting the use of the intra‐aortic counterpulsation beyond initial haemodynamic improvements. This present lack of evidence due to a small number of randomised controlled trials with small numbers of patients does not exclude, that there might be clinically significant effects, which only can be proven by larger randomised controlled trials. For this reason a larger multicenter trial (IABP‐SHOCK II) has been started in 2009, to clarify the use of the IABP in infarct related cardiogenic shock and its results will  provide better evidence at the beginning of 2013.  

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Adjustment of antimicrobial agents for adults with sepsis, severe sepsis or septic shock

Broad‐spectrum antimicrobial treatment is defined as the use of an antibiotic or a combination of antibiotics which act against a wide range of disease‐causing bacteria. Broad‐spectrum antimicrobial treatment can reduce mortality rates in patients with sepsis, severe sepsis or septic shock. Sepsis is a serious medical condition which is characterized by an inflammatory response to an infection that can affect the whole body. The patient may develop this inflammatory response to microbes in their blood, urine, lungs, skin or other tissues. However, there is a risk that empirical broad‐spectrum antimicrobial treatment can expose patients to overuse of antimicrobials and increase the resistance of micro‐organisms to treatment. De‐escalation has been proposed as a means of adjusting initial, adequate broad‐spectrum treatment by changing the antimicrobial agent or discontinuing an antimicrobial combination according to the patient's culture results (a means of identifying the microbe causing the infection). In this updated Cochrane review we searched the databases until October 2012. We found no published randomized controlled trials (RCTs). We found one ongoing RCT. There is no adequate or direct evidence on whether de‐escalation of antimicrobial agents is effective and safe for adults with sepsis, severe sepsis or septic shock. Appropriate studies are needed to investigate the potential benefits proposed by de‐escalation treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Human recombinant activated protein C for severe sepsis and septic shock in adult and paediatric patients

Sepsis and septic shock are major causes of death. Sepsis is a complex syndrome resulting from a presumed or known infection, and its pathogenesis involves interactions between inflammation and blood clotting pathways. This serious medical condition is characterized by an inflammatory response to an infection which can affect the whole body. Patients with sepsis may have developed the inflammatory response because of microbes in their blood, urine, lungs, skin, or other tissues. Severe sepsis can lead to multiple organ failure due to blood clotting in the finer blood vessels. This reduces the amount of blood reaching the organs and septic shock ensues. Protein C reduces the clotting process and a lack of protein C can lead to an exaggeration of blood clotting. Sepsis and septic shock decrease protein C levels in the body. It has been suggested that human recombinant activated protein C (APC) will increase the levels of protein C and ameliorate or prevent multiple organ failure. In this updated Cochrane review we searched the databases until June 2012. We included six randomized clinical trials which involved 6781 people (6307 adult and 474 paediatric participants) with either a high or low risk of death. All trials had high risk of bias and were sponsored by the pharmaceutical industry (Eli Lilly). We found no evidence suggesting that APC reduced the risk of death in adults or children with severe sepsis or septic shock. On the contrary, APC increased the risk of serious bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Can percussion, diuresis, and inversion therapy improve outcomes for people with lower pole kidney stones following shock wave lithotripsy?

Lower pole kidney stones are challenging to treat effectively. Many people with lower pole kidney stones undergo shock wave lithotripsy to break up stones so they can be passed from the body in the urine. In some cases, stone fragments can be retained, and these can be difficult to eliminate. Better techniques are needed to help people pass small lower pole kidney stones or fragments that remain following shock wave lithotripsy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Shock wave therapy for elbow pain

To answer this question, scientists analyzed 9 studies testing over 1000 people who had tennis elbow. Most people had pain for a long period of time and the pain had not improved with other treatments. People tested received either shock wave therapy or fake therapy 3 times over 3 weeks to 3 months. Improvement was tested after 1 week to 12 months. These studies provide the best evidence we have today.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Should health care providers arriving at scene of a cardiac arrest give a period of chest compressions first before providing a rapid electric shock

Out‐of‐hospital cardiac arrest (OHCA) is a major cause of death worldwide. Cardiac arrest occurs when the rhythm of the heart becomes disorganized and the heart becomes ineffective at pumping blood to the rest of the body. Prolonged periods of reduced oxygen to the brain can cause permanent damage. Cardiac arrest can be caused by, but is different from, a heart attack (myocardial infarction).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Intravenous immunoglobulins for treating patients with severe sepsis and septic shock

Sepsis is the inflammatory response of the body to severe infection, which can be caused by a variety of micro‐organisms including bacteria, viruses and fungi. Signs of sepsis include fever, hypothermia, rapid heart rate and respiration; and a laboratory finding of increased or decreased white blood cell count. Deaths as a result of sepsis and septic shock remain high despite giving antibiotics, especially if the functions of a persons's vital organs such as the lungs, heart and kidneys are affected. Several studies have looked into other agents than antibiotics to help the body fight the effects of sepsis. Intravenous immunoglobulin preparations contain antibodies that help the body to neutralize bacterial toxins. There are two types of preparations. These are polyclonal immunoglobulins that contain several antibodies directed at endotoxin and inflammatory mediators, and monoclonal immunoglobulins which target a specific inflammatory mediator or antigen. Intravenous immunoglobulins are blood products, specifically pooled sera derived from human donor blood.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Corticosteroids for treating dengue infection in children and adults

Dengue is a disease caused by a virus transmitted by mosquitoes, occurring in many resource‐limited countries, and children are often most severely affected. Most infected patients will recover with mild symptoms, but a few progress to severe dengue and may die. There is no specific treatment for dengue, but some clinicians provide corticosteroids at an early stage to prevent progression to severe dengue disease; and some treat patients with dengue‐related shock with corticosteroids to improve survival. It is important to summarise the effects of corticosteroids in dengue.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

High‐volume haemofiltration for sepsis

Severe sepsis and septic shock are among the most common causes of death in adults who are sufficiently ill to be admitted to an intensive care unit (ICU). Sepsis often arises following an infection. The organisms causing the infection can be bacterial, viral or fungal. If sepsis develops, the body responds by producing chemicals which cause massive inflammation in the whole body. (Inflammation is how body tissues react to infection, irritation or other injury). This inflammation can cause individual organs to fail e.g. the kidneys, heart, circulation and lungs. It is these organ failures, as a result of the inflammation, which lead to the high death rates associated with sepsis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Asthma: Can specific immunotherapy reduce the symptoms, and how safe is it?

Specific immunotherapy (“desensitisation”) can reduce the number of asthma attacks in people with allergic asthma. When injected, mild reactions in the tissue around the injection site are common. There is a small chance of a dangerous reaction to the injection that would need immediate medical treatment.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 27, 2010

Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults

Stress fractures are a type of overuse injury. They can be very painful and debilitating. Lower limb stress fractures are common in people undergoing military training and in athletes, particularly long distance runners. Measures to prevent stress fractures include modifications to footwear and changes to training schedules. We found some evidence that shock absorbing boot inserts help prevent stress fractures during military training. It is not clear what is the best design to use. Treatment of stress fractures generally involves a long period of activity restriction. We found some evidence that pneumatic braces may speed recovery of tibial stress fracture.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Varying the timing or the volume of intravenous fluids given to people with uncontrolled bleeding due to injury

About one third of injury deaths are due to shock from blood loss. Preventing shock in people with uncontrolled bleeding is, therefore, very important and is generally done by giving fluids intravenously. The aim is to maintain blood pressure and reduce tissue damage. The composition of these fluids can vary, and there have been systematic reviews comparing different fluid types, but the volume of fluid given and the time at which it is given can also vary. It not yet clear which timing and which volume are the most effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

How does the spine work?

The spine is our body’s central support structure. It keeps us upright and connects different parts of the skeleton to each other, such as the head, chest, pelvis, shoulders, arms and legs. Although the spine is made up of a chain of bones, it is flexible due to elastic ligaments and spinal discs.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 6, 2013

Two dialysis solutions for acute peritoneal dialysis

Acute kidney injury (AKI) can be treated with either bicarbonate or lactate in acute peritoneal dialysis (PD). The aim of this review was to compare the effectiveness of bicarbonate versus lactate solution.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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