American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Sep 2016
Sevoflurane for Sedation in ARDS: A Randomized Controlled Pilot Study.
Sevoflurane improves gas exchange, reduces alveolar edema and inflammation in preclinical studies of lung injury but its therapeutic effects have never been investigated in acute respiratory distress syndrome (ARDS). ⋯ In ARDS patients, use of inhaled sevoflurane improved oxygenation and decreased levels of a marker of epithelial injury and of some inflammatory markers, compared to midazolam. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02166853.
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Am. J. Respir. Crit. Care Med. · Sep 2016
On the Neuroendocrinopathy of Critical Illness: Perspectives for Feeding and Novel Treatments.
Typical for critical illnesses are substantial alterations within the hypothalamic-anterior-pituitary-peripheral-hormonal axes that are proportionate to the risk of poor outcome. These neuroendocrine responses to critical illness follow a biphasic pattern. The acute phase (first hours to days) is characterized by an increased release of anterior pituitary hormones while altered target-organ sensitivity and hormone metabolism result in low levels of the anabolic peripheral effector hormones and contribute to the substantailly elevated levels of the catabolic hormone cortisol. ⋯ In contrast, the neuroendocrine alterations that occur in the chronic phase of illness while patients are fully fed contribute to bone and skeletal muscle wasting and impose risk of adrenocortical atrophy. The combined administration of those hypothalamic releasing factors, that have been identified as suppressed or deficient during prolonged critical illness, may be a promising strategy to enhance recovery. The potential impact of treatment with such hypothalamic releasing factors on recovery from critical illness as well as on long-term rehabilitation should be investigated in future randomized controlled clinical trials.