{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:46:31Z","timestamp":1791924391371,"version":"4.3.4"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["ICMx"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hemorrhagic shock is a leading cause of preventable trauma death, marked by impaired oxygen delivery and endothelial dysfunction. Bioactive adrenomedullin (bio-ADM) regulates endothelial barrier integrity, but its dynamics during hemorrhagic shock and resuscitation remain unclear. This secondary analysis of a porcine hemorrhagic shock model investigated bio-ADM and its association with macro- and microcirculatory parameters during resuscitation. All animals received crystalloid infusion (10\u00a0mL\/kg\/h) from anesthesia induction onward. Shock was induced by blood withdrawal to maintain MAP at 40 \u00b1 5\u00a0mmHg for 60\u00a0min (T5), before randomization to control (n = 7), fluid (n = 6), or noradrenaline (n = 7) groups, with intervention groups titrated to MAP targets of 65 then 90\u00a0mmHg (60\u00a0min each). Macrocirculation was assessed via vital signs and pulse contour analysis; microcirculation via hyperspectral imaging (tissue oxygenation, hemoglobin, water index).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fluid resuscitation improved macrohemodynamics and microcirculatory oxygenation versus control and noradrenaline, which failed to sustain perfusion and impaired microcirculatory oxygenation. Bio-ADM increased after shock induction (p &lt; 0.001), peaking at T9 (120\u00a0min of therapy). At T5, levels were comparable among control (16.8 [13.6\u201318.9] pg\/ml), fluid (15.65 [15.43\u201316.55] pg\/ml), and noradrenaline (14.3 [7.85\u201318.95] pg\/ml). Thereafter, bio-ADM continued to rise in control (19.7 [17.4\u201332.6] pg\/ml) and noradrenaline (21.2 [14.4\u201333.45] pg\/ml), while stabilizing in the fluid group (12.05 [10.65\u201315.18] pg\/ml); accordingly, the T5\u2013T9 increase was smaller in the fluid group than in control (p = 0.022) or noradrenaline (p = 0.003). The fluid group received ~3-fold more fluid by T9. Higher bio-ADM correlated with lower MAP, higher lactate, and lower ScvO\u2082, but not oxygen delivery (DO\u2082); a higher tissue water index correlated with a smaller rise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bio-ADM increased during hemorrhagic shock, extending previous observations from cardiogenic and septic shock, and represents a comparatively non-specific marker of endothelial and microcirculatory stress rather than specific to any single shock etiology. Effective resuscitation was associated with stabilization, rather than a clear decrease, of bio-ADM levels, though this coincided with higher fluid administration, and dilution cannot be excluded. Whether bio-ADM offers therapeutic utility to guide resuscitation remains unclear, warranting further prospective evaluation in animal and human studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40635-026-00976-4","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T08:09:36Z","timestamp":1791878976000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bioactive adrenomedullin dynamics and microcirculatory changes in a porcine model of hemorrhagic shock"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3479-5573","authenticated-orcid":false,"given":"Carolin","family":"Vekla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian O.","family":"Decker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maik","family":"von der Forst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Uhle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Studier-Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berkin","family":"\u00d6zdemir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Nickel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Katzenschlager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Weilbacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Brenner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Popp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus A.","family":"Weigand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Dietrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gruneberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"6 Suppl","key":"976_CR1","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1097\/01.ta.0000199961.02677.19","volume":"60","author":"DS Kauvar","year":"2006","unstructured":"Kauvar DS, Lefering R, Wade CE (2006) Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. 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Int J Mol Sci. https:\/\/doi.org\/10.3390\/ijms242417429","journal-title":"Int J Mol Sci"}],"container-title":["Intensive Care Medicine Experimental"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40635-026-00976-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40635-026-00976-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40635-026-00976-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:02:45Z","timestamp":1791921765000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40635-026-00976-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["976"],"URL":"https:\/\/doi.org\/10.1186\/s40635-026-00976-4","relation":{},"ISSN":["2197-425X"],"issn-type":[{"value":"2197-425X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"12 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This secondary analysis is based on data from a previously conducted study on hemorrhagic shock in a porcine model [\n                      \n                      ]. The original study design was approved by by the appropriate governmental body (Regierungspr\u00e4sidium Karlsruhe, file reference G-261\/19) and conducted in accordance with the European law on the protection of animals used for scientific purposes (EU-Directive 2010\/63).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"SK is currently the Research Committee Representative of the Trauma and Emergency Medicine Section of the European Society of Intensive Care Medicine. No financial conflicts. All other authors state no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"136"}}