Critical care : the official journal of the Critical Care Forum
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Vascular hyporeactivity is an important problem associated with sepsis. Although the mechanism involves inflammatory pathway activation, specific therapeutic approaches have not been defined. Glutamine (Gln) has been shown to provide some anti-inflammatory effects and improve outcomes in sepsis. Here, we tested the hypothesis that Gln could reduce Escherichia coli lipopolysaccharide (LPS)-induced vascular hyporeactivity and evaluated the role of heat-shock protein 70 (HSP70) induction in this process. ⋯ Gln effectively improves vascular reactivity by inducing the expression of HSP70, reducing inflammatory cytokine release and peroxide biosynthesis in LPS shock rats. These results suggest that Gln has a potentially beneficial therapeutic effect for septic shock patients.
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Editorial Comment
Number needed to treat = six: therapeutic hypothermia following cardiac arrest--an effective and cheap approach to save lives.
In 2005, the European Resuscitation Council (ERC) guidelines stated: Unconscious adult patients with spontaneous circulation after out-of-hospital ventricular fibrillation cardiac arrest should be cooled to 32 to 34 degrees C for 12 to 24 hours. Patients with cardiac arrest from a non-shockable rhythm, in-hospital patients and children may also benefit from hypothermia. There is no argument to wait. We have to treat the next unconscious cardiac arrest patient with hypothermia.
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Acute renal failure (ARF) is common among hospitalized HIV-infected patients. To our knowledge, however, data regarding ARF in HIV-infected patients in the intensive care unit are still lacking.
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Editorial Comment
Selenium supplementation in critically ill patients: can too much of a good thing be a bad thing?
A recent study by Forceville and colleagues evaluated the effect of high-dose selenium administration as a treatment for septic shock. The study was negative and conflicts with existing clinical data regarding selenium administration in critically ill patients. Perhaps the key to understanding the differences between these discrepant observations lies in considering the dose and timing of selenium administration.