Critical care medicine
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Critical care medicine · Dec 2013
Connection Between Cardiac Vascular Permeability, Myocardial Edema, and Inflammation During Sepsis: Role of the α1AMP-Activated Protein Kinase Isoform.
As adenosine monophosphate (AMP)-activated protein kinase both controls cytoskeleton organization in endothelial cells and exerts anti-inflammatory effects, we here postulated that it could influence vascular permeability and inflammation, thereby counteracting cardiac wall edema during sepsis. ⋯ Our results demonstrate for the first time the involvement of a signaling pathway in the control of left ventricular wall edema during sepsis. AMP-activated protein kinase exerts a protective action through the preservation of interendothelial tight junctions. Interestingly, exaggerated left ventricular wall edema was not coupled with aggravated systolic dysfunction. However, it could contribute to diastolic dysfunction in patients with sepsis.
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Critical care medicine · Dec 2013
Mild Hypothermia Attenuates Circulatory and Pulmonary Dysfunction During Experimental Endotoxemia.
We tested whether mild hypothermia impacts on circulatory and respiratory dysfunction during experimental endotoxemia. ⋯ The induction of mild hypothermia attenuates cardiac and respiratory dysfunction and counteracts sympathetic activation during experimental endotoxemia. This was not associated with lower plasma cytokine levels, indicating a reduction of cytokine responsiveness by mild hypothermia.
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Critical care medicine · Dec 2013
Understanding Changes in Established Practice: Pulmonary Artery Catheter Use in Critically Ill Patients.
Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of "uptake" of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use. ⋯ Use of pulmonary artery catheters in ICU patients has declined but with significant variation across units. Removal of this technology has occurred most in nonsurgical ICUs and patients.
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The therapeutic approach to sepsis is following an evolutionary process of scientific discovery as articulated in the landmark work by Kuhn, The Structure of Scientific Revolutions, first published 50 years ago. ⋯ A sustained paradigm shift in the approach to treating sepsis has yet to emerge, but recent data suggest that an open-minded posture informed by novel pathobiologic findings may eventually bear fruit.
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Critical care medicine · Dec 2013
Clonidine and Dexmedetomidine Increase the Pressor Response to Norepinephrine in Experimental Sepsis: A Pilot Study.
During septic shock, vasopressors are a cornerstone of therapy. In septic shock, very high doses of vasopressors sometimes have to be used due to vascular desensitization, the mechanisms of which are poorly understood. This study assesses whether α-2 agonists increase pressor responsiveness following lipopolysaccharide administration. ⋯ The pressor response to norepinephrine was reduced following lipopolysaccharide and increased to baseline levels following α-2 agonists.