Critical care : the official journal of the Critical Care Forum
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It is well established that during mechanical ventilation of patients with acute respiratory distress syndrome cyclic recruitment/derecruitment and overdistension are potentially injurious for lung tissues. We evaluated whether the forced oscillation technique (FOT) could be used to guide the ventilator settings in order to minimize cyclic lung recruitment/derecruitment and cyclic mechanical stress in an experimental model of acute lung injury. ⋯ Using FOT it was possible to measure EX5 both at end-expiration and at end-inspiration. The optimal PEEP strategy based on end-expiratory EX5 minimized intra-tidal recruitment/derecruitment as assessed by CT, and the concurrent attenuation of intra-tidal variations of EX5 suggests that it may also minimize tidal mechanical stress.
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There is mounting evidence that injury to one organ causes indirect damage to other organ systems with increased morbidity and mortality. The aim of this study was to determine the effects of acid aspiration pneumonitis (AAP) on extrapulmonary organs and to test the hypothesis that these could be due to circulatory depression or hypoxemia. ⋯ Acid aspiration pneumonitis induces extrapulmonary organ injury. Circulatory depression and hypoxemia are unlikely causative factors. ELWI is a sensitive bedside parameter of early lung damage.
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Sepsis leads to microcirculatory dysfunction and therefore a disturbed neurovascular coupling in the brain. To investigate if the dysfunction is also present in less severe inflammatory diseases we studied the neurovascular coupling in patients suffering from community acquired pneumonia. ⋯ Our study underlines the role of an early microcirculatory dysfunction in inflammatory syndromes that become evident in pre-septic conditions with a gradual decline according to disease severity.
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Editorial Comment
Parenteral omega-3 fatty acids: pouring oil on troubled waters?
A meta-analysis of parenteral fish oil in 23 studies in intensive care unit (ICU) and non-ICU patients reported a reduced infection rate (significant in ICU patients) and shorter lengths of ICU and hospital stays (both non-ICU and ICU patients). Parenteral fish oil reduced inflammation and improved oxygenation index and liver function. The findings of the meta-analysis are discussed in this report.
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Fever is considered a key actor of innate immunity aimed to fight infection. A new investigation reports an association of the use of antipyretic drugs with poorer outcome among patients with sepsis. In contrast, high temperature in non-infectious intensive care patients is associated with higher mortality.