Critical care medicine
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Critical care medicine · Feb 2009
Comparative StudyExtracorporeal cell therapy with granulocytes in a pig model of Gram-positive sepsis.
Granulocyte transfusions have been used to treat immune cell dysfunction in sepsis. As granulocyte transfusions can trigger tissue injury via local effects of neutrophils, we hypothesized that extracorporeal treatment of plasma using granulocytes would prove beneficial while having less side effects. ⋯ Extracorporeal therapy with granulocytic cells significantly improved survival in a pig model of sepsis. Further studies with this approach are encouraged.
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Critical care medicine · Feb 2009
Comparative StudyBbeta15-42 (FX06) reduces pulmonary, myocardial, liver, and small intestine damage in a pig model of hemorrhagic shock and reperfusion.
The fibrin-derived peptide Bbeta15-42 (also called FX06) has been shown to reduce myocardial infarct size following ischemia/reperfusion. Hemorrhagic shock (HS) followed by volume resuscitation represents a similar scenario, whereby a whole organism is vulnerable to reperfusion injury. ⋯ We conclude that in a pig model of HS and reperfusion, administration of FX06 during reperfusion protects shock- susceptible organs such as heart, lung, liver, and small intestine.
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Critical care medicine · Feb 2009
Comparative StudyActivation of coagulation and inhibition of fibrinolysis in the human lung on bronchial instillation of lipoteichoic acid and lipopolysaccharide.
Pneumonia is characterized by an acute inflammatory response in the lung, which is frequently associated with changes in coagulation and fibrinolysis in the bronchoalveolar space. Here, we compared the effects of lipoteichoic acid (LTA), a major cell wall component of Gram-positive bacteria, and lipopolysaccharide (LPS), in the human bronchoalveolar space. ⋯ This study is the first to describe the effects of LTA on hemostasis in humans, demonstrating that LTA induces similar changes in the human bronchoalveolar space as LPS, characterized by activation of coagulation with concurrent inhibition of anticoagulant and fibrinolytic pathways.
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Critical care medicine · Feb 2009
Admission of incompetent patients to intensive care: doctors' responsiveness to family wishes.
When a patient is incompetent, the family is often considered to be a natural surrogate. The doctors' responsiveness to family wishes may vary. We explored if doctors' personal characteristics were associated with responsiveness to the relatives' wishes when admission to the intensive care unit (ICU) is considered. ⋯ Older doctors and those working in regional hospitals were more responsive to family wishes when assessing an incompetent patient for ICU admission. These findings emphasize the need for effective advance care planning.
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Critical care medicine · Feb 2009
Intra-abdominal pressure effects on porcine thoracic compliance in weightlessness: implications for physiologic tolerance of laparoscopic surgery in space.
Laparoscopic surgery (LS) is envisioned as an option for spaceflight, but requires intra-abdominal hypertension (IAH) to create the surgical domain. Prolonged weightlessness induces physiologic deconditioning that questions the ability of ill or injured astronauts to tolerate IAH. On earth, IAH results in marked ventilatory embarrassment. As there has been no previous study of physiologic changes related to LS in weightlessness, we studied anesthetized pigs in parabolic flight. ⋯ Weightlessness protects against thoracic compliance changes that are inherent in IAH during induced pneumoperitoneum in gravity. The technique-related physiologic cost of performing LS in space deconditioned astronauts should be incorporated into design concepts for space surgery systems.