Critical care : the official journal of the Critical Care Forum
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Data continue to emerge demonstrating the poor quality of life of ICU survivors in the months and years following critical illness. In this issue of Critical Care, Cuthbertson and colleagues present new data on quality of life from a cohort of ICU survivors who were followed for 5 years. ⋯ Studies are now needed that seek to identify potentially modifiable factors both during and following an ICU admission to allow for eventual improvement in long-term morbidity. Such studies will likely need to incorporate extensive planning for data collection, as well as coordinated linkage with other available datasets that include substantial amounts of patient information from outside of the ICU.
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In a randomised trial comparing early enteral feeding by gastric and post-pyloric routes, White and colleagues have shown that gastric feeding is possible and efficient in the vast majority of critically ill patients. But the authors' conclusion that gastric is equivalent to post-pyloric is true in only the least severe patients. Given the extra workload and costs, post-pyloric is now clearly indicated in case of gastric feeding failure.
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Comment
Inhaled activated protein C: a new therapy for the prevention of ventilator-induced lung injury?
Systemic administration of activated protein C (APC) has been shown to reduce pulmonary inflammation in preclinical models of acute lung injury. However, there is only limited information concerning the effects of inhaled APC in modulating the severity of pulmonary inflammation. In a study reported in this issue of Critical Care, Maniatis and colleagues show that pretreatment of mice with inhaled APC is protective against ventilator-induced lung injury. While the mechanisms responsible for this effect require additional elucidation, inhaled APC appears to be a potentially useful intervention in diminishing the severity of ventilator-induced lung injury and other forms of acute lung injury.
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Several recent reports have highlighted the utility of transcutaneous electrical muscle stimulation to preserve muscle mass and strength in ICU patients. Specifically, Serafim Nanas and colleagues report a significant reduction in the odds of ICU-acquired weakness with its use. ⋯ As critical care studies attempt to study the outcome of physical recovery, significant additional data need to be provided in order for the results to be reported in the appropriate context. Future studies need to be performed in a setting where secondary injuries like sedation and immobilization are quantified so any benefit can be weighed against other interventions available.
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Mechanical ventilation (MV) is a life saving intervention in acute respiratory failure without alternative. However, particularly in pre-injured lungs, even protective ventilation strategies may evoke ventilator-induced lung injury (VILI), which is characterized by pulmonary inflammation and vascular leakage. Adjuvant pharmacologic strategies in addition to lung protective ventilation to attenuate VILI are lacking. Simvastatin exhibited anti-inflammatory and endothelial barrier stabilizing properties in vitro and in vivo. ⋯ High-dose simvastatin attenuated VILI in mice by reducing MV-induced pulmonary inflammation and hyperpermeability.