Critical care : the official journal of the Critical Care Forum
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Editorial Comment
How to prevent leaky vessels during reperfusion? Just keep that glycocalyx sealant in place!
Myocardial edema is a hallmark of ischemia-reperfusion-related cardiac injury. Ischemia-reperfusion has been shown to result in degradation of the endothelial glycocalyx. The glycocalyx is the gel-like mesh of polysaccharide structures and absorped plasma proteins on the luminal side of the vasculature, and in the past decade has been shown to play an important role in protection of the vessel wall, including its barrier properties. Prevention of glycocalyx loss or restoration of a damaged glycocalyx may be a promising therapeutic target during clinical procedures involving ischemia-reperfusion.
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Acute kidney injury occurs in approximately one-quarter to one-third of patients with major burn injury. Apart from the usual suspects - such as older age, severity of burn injury, sepsis and multiple organ dysfunction - volume overload probably has an important role in the pathogenesis of acute kidney injury.
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Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) remain important causes of morbidity and mortality in the critically ill patient, with far-reaching short-term and long-term implications for individual patients and for healthcare providers. It is well accepted that mechanical ventilation can worsen lung injury, potentially worsening systemic organ function, and can thus impact on mortality in acute lung injury (ALI)/ARDS. ⋯ The authors also report hypothesis-generating data on the implications of statin use in this population. The present commentary reviews aspects of this work, with particular attention to the implementation of low-tidal-volume/lung-protective ventilatory strategies in ALI/ARDS.
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Comparative Study
Circulating angiopoietin-1 and angiopoietin-2 in critically ill patients: development and clinical application of two new immunoassays.
In critically ill patients, the massive release of angiopoietin-2 (Ang-2) from endothelial Weibel-Palade bodies interferes with constitutive angiopoietin-1 (Ang-1)/Tie2 signaling in endothelial cells, thus leading to vascular barrier breakdown followed by leukocyte transmigration and capillary leakage. The use of circulating Ang-1 and Ang-2 as novel biomarkers of endothelial integrity has therefore gained much attention. The preclinical characteristics and clinical applicability of angiopoietin immunoassays, however, remain elusive. ⋯ Ang-1 and Ang-2 might serve as a novel class of biomarker in critically ill patients. According to preclinical and clinical validation, circulating Ang-1 and Ang-2 can be reliably assessed by novel immunoassays in the intensive care unit setting.
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The report by Chase and coworkers in the previous issue of Critical Care describes the implementation into clinical practice of the Specialized Relative Insulin Nutrition Table (SPRINT) for tight glycaemic control in critically ill patients. SPRINT is a simple, wheel-based system that modulates both insulin rate and nutritional inputs. It achieved a better glycaemic control in a severely ill critical cohort than their previous method for glycaemic control in a matched historical cohort. Reductions in mortality were also observed.