Critical care : the official journal of the Critical Care Forum
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Applying tidal volumes of less than 6 mL/kg might improve lung protection in patients with acute respiratory distress syndrome. In a recent article, Retamal and colleagues showed that such a reduction is feasible with conventional mechanical ventilation and leads to less tidal recruitment and overdistension without causing carbon dioxide retention or auto-positive end-expiratory pressure. However, whether the compensatory increase in the respiratory rate blunts the lung protection remains unestablished.
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One of the rationales for the use of vasopressin in septic shock has been its potential cardioprotective mechanisms. Lower heart rates, higher arterial pressures, and fewer norepinephrine doses during vasopressin therapy were hypothesized to protect the heart from myocardial ischemia. In a prospective sub-study of the VASST (Vasopressin in Septic Shock Trial) project, Mehta and colleagues specifically evaluated this hypothesis but failed to find lower cardiac biomarkers or fewer ischemic electrocardiogram changes in patients receiving vasopressin compared with subjects receiving norepinephrine alone. After recent evidence of a lacking survival benefit, the present study results further challenge the future role of vasopressin as a vasopressor in septic shock.
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Editorial Comment
The assessment and risk stratification of psychological morbidity in critical care survivors.
Along with the ageing population, there is an expanding number of critical care survivors in the community. This group is at risk for both physical and psychological morbidity following their stay. ⋯ A tool to identify and stratify survivors at discharge may improve outcomes by allowing early and targeted intervention. Looking forward, the identification of aspects of practice associated with long-term adverse consequences should allow us to evolve our current protocols in a way that provides long-term benefit for patients.