Critical care : the official journal of the Critical Care Forum
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There is an increasing interest in biphasic positive airway pressure with spontaneous breathing (BIPAP+SBmean), which is a combination of time-cycled controlled breaths at two levels of continuous positive airway pressure (BIPAP+SBcontrolled) and non-assisted spontaneous breathing (BIPAP+SBspont), in the early phase of acute lung injury (ALI). However, pressure support ventilation (PSV) remains the most commonly used mode of assisted ventilation. To date, the effects of BIPAP+SBmean and PSV on regional lung aeration and ventilation during ALI are only poorly defined. ⋯ In this model of ALI, the reduction of tidal re-aeration and hyperaeration during BIPAP+SBmean compared to PSV is not due to decreased nonaerated areas at end-expiration or different distribution of ventilation, but to lower tidal volumes during BIPAP+SBspont. The ratio between spontaneous to controlled breaths seems to play a pivotal role in reducing tidal re-aeration and hyperaeration during BIPAP+SBmean.
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Acute kidney injury is commonly encountered and in the critically ill treatment is principally supportive. A recent large, multicentre study has used retrospective analysis to try and identify patient outcomes when commencing renal replacement therapy using conventional biochemical and physiological markers. The authors have also made an attempt to decipher when to commence renal replacement therapy.
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Survivors of critical illnesses are at increased risk for posttraumatic stress disorder and major depression. In the present issue of Critical Care, Myhren and colleagues report on an investigation of predictors of posttraumatic stress, general anxiety, and depressive symptoms up to 1 year following intensive care unit admission for critical illnesses. The present study found that an endogenous patient characteristic, the personality trait pessimism, was associated with posttraumatic stress and depressive symptoms. Myhren and colleagues' study sheds light on potential predictors of psychopathology in critical illness survivors as well as stimulating directions for future research to address these complex problems.
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In a recent issue of Critical Care, Brandt and colleagues report the effects of a 'liberal' fluid loading protocol compared to a more 'restrictive' protocol on hemodynamics and mortality in pigs in which septic shock had been induced. It appears that the former protocol was associated with higher mortality in spite of improved hemodynamics compared to the latter. ⋯ They also do not exclude a specific toxic effect of the larger volumes of hydroxyethyl starch in the 'liberal' strategy. The precise nature of a toxic effect remains obscure, however, but may involve the kidneys.
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Certain noble gases, though inert, exhibit remarkable biological properties. Notably, xenon and argon provide neuroprotection in animal models of central nervous system injury. ⋯ Their data are of interest as argon is more abundant, and therefore cheaper, than xenon (the latter of which is currently in clinical trials for perinatal hypoxic-ischemic brain injury; TOBYXe; NCT00934700). We eagerly await in vivo data to complement the promising in vitro data hailing argon neuroprotection.