Critical care medicine
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Critical care medicine · Nov 2010
CommentAn alternative point of view: getting by with less: what's wrong with perfection?
Predictions about the future impact of technologic and process innovations inspire optimistic visions. Optimism and speculation require a counterweight. Because results often do not turn out as expected, anticipating failure is useful, and anticipating unintended consequences is visionary. ⋯ Ideal goals are useful but speculative and subjective. There in fact might be several ideals and contingency is important. The detours and incidental stops on the way to an ideal are more fruitful than the goal itself.
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Critical care medicine · Nov 2010
Recruitment maneuver in experimental acute lung injury: the role of alveolar collapse and edema.
In acute lung injury, recruitment maneuvers have been used to open collapsed lungs and set positive end-expiratory pressure, but their effectiveness may depend on the degree of lung injury. This study uses a single experimental model with different degrees of lung injury and tests the hypothesis that recruitment maneuvers may have beneficial or deleterious effects depending on the severity of acute lung injury. We speculated that recruitment maneuvers may worsen lung mechanical stress in the presence of alveolar edema. ⋯ In the presence of alveolar edema, regional mechanical heterogeneities, and hyperinflation, recruitment maneuvers promoted a modest but consistent increase in inflammatory and fibrogenic response, which may have worsened lung function and potentiated alveolar and renal epithelial injury.
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Critical care medicine · Nov 2010
Cognitive decline following major surgery is associated with gliosis, β-amyloid accumulation, and τ phosphorylation in old mice.
Elderly patients undergoing major surgery often develop cognitive dysfunction and the mechanism of this postoperative complication remains elusive. We sought to determine whether postoperative cognitive dysfunction in old mice is associated with the pathogenesis of Alzheimer's disease. ⋯ These data suggest that surgery can provoke astrogliosis, β-amyloid accumulation, and τ phosphorylation in old subjects, which is likely to be associated with the cognitive decline seen in postoperative cognitive dysfunction.
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Critical care medicine · Nov 2010
Editorial CommentWhy do intensivists still use hydroxyethyl starch?