2012 Apr 15 - A Critical Role for Muscle Ring Finger-1 in Acute Lung Injury–associated Skeletal Muscle Wasting
Rationale: Acute lung injury (ALI) is a debilitating condition associated with severe skeletal muscle weakness that persists in humans long after lung injury has resolved. The molecular mechanisms underlying this condition are unknown.
2012 Apr 1 - Calpastatin Controls Polymicrobial Sepsis by Limiting Procoagulant Microparticle Release
Rationale: Sepsis, a leading cause of death worldwide, involves widespread activation of inflammation, massive activation of coagulation, and lymphocyte apoptosis. Calpains, calcium-activated cysteine proteases, have been shown to increase inflammatory reactions and lymphocyte apoptosis. Moreover, calpain plays an essential role in microparticle release.
2012 Apr 1 - Twenty-four–Hour Intensivist Presence A Pilot Study of Effects on Intensive Care Unit Patients, Families, Doctors, and Nurses
Rationale: Around-the-clock intensivist presence in intensive care units (ICUs) has been promoted as necessary to optimize outcomes. Little data have addressed how it affects the multiple stakeholders in such care.
2012 Mar 15 - Automatic Control of Pressure Support for Ventilator Weaning in Surgical Intensive Care Patients
Rationale: Despite its ability to reduce overall ventilation time, protocol-guided weaning from mechanical ventilation is not routinely used in daily clinical practice. Clinical implementation of weaning protocols could be facilitated by integration of knowledge-based, closed-loop controlled protocols into respirators.
2012 Mar 15 - Disruption of Platelet-derived Chemokine Heteromers Prevents Neutrophil Extravasation in Acute Lung Injury
Rationale: Acute lung injury (ALI) causes high mortality, but its molecular mechanisms and therapeutic options remain ill-defined. Gram-negative bacterial infections are the main cause of ALI, leading to lung neutrophil infiltration, permeability increases, deterioration of gas exchange, and lung damage. Platelets are activated during ALI, but insights into their mechanistic contribution to neutrophil accumulation in the lung are elusive.
Rationale: Survivors of acute lung injury (ALI) frequently have substantial depressive symptoms and physical impairment, but the longitudinal epidemiology of these conditions remains unclear.
Sedation and analgesia are important components of care for the mechanically ventilated patient in the intensive care unit (ICU). An understanding of commonly used medications is essential to formulate a sedation plan for individual patients.
2012 Feb 15 - Activin-A Overexpression in the Murine Lung Causes Pathology That Simulates Acute Respiratory Distress Syndrome
Rationale: Activin-A is up-regulated in various respiratory disorders. However, its precise role in pulmonary pathophysiology has not been adequately substantiated in vivo.
Rationale: Lymphocytes have been shown to facilitate systemic inflammation and physiologic dysfunction in experimental models of severe sepsis. Our previous studies show that natural killer (NK) cells migrate into the peritoneal cavity during intraabdominal sepsis, but the trafficking of NKT and T lymphocytes has not been determined. The factors that regulate lymphocyte trafficking during sepsis are currently unknown.
Despite more than 5 decades of study and debate, the role of corticosteroid treatment in patients with severe sepsis and septic shock remains controversial. Data support a beneficial effect on systemic blood pressure in patients with septic shock. However, the ability of corticosteroid therapy to improve mortality in patients with severe sepsis and septic shock remains controversial, with contradictory results from recent large multicenter clinical trials.
2012 Jan 15 - Lung Endothelial Ca2+ and Permeability Response to Platelet-Activating Factor Is Mediated by Acid Sphingomyelinase and Transient Receptor Potential Classical 6
Rationale: Platelet-activating factor (PAF) increases lung vascular permeability within minutes by activation of acid sphingomyelinase (ASM) and a subsequent nitric oxide (NO)-inhibitable and Ca2+-dependent loss in barrier function.
2011 Dec 15 - Absence of Integrin αvβ3 Enhances Vascular Leak in Mice by Inhibiting Endothelial Cortical Actin Formation
Rationale: Sepsis and acute lung injury (ALI) have devastatingly high mortality rates. Both are associated with increased vascular leak, a process regulated by complex molecular mechanisms.
2011 Dec 15 - The Implications of Long-Term Acute Care Hospital Transfer Practices for Measures of In-Hospital Mortality and Length of Stay
Rationale: The National Quality Forum recently endorsed in-hospital mortality and intensive care unit length of stay (LOS) as quality indicators for patients in the intensive care unit. These measures may be affected by transferring patients to long-term acute care hospitals (LTACs).
2011 Dec 1 - Intestinal Injury and Endotoxemia in Children Undergoing Surgery for Congenital Heart Disease
Rationale: Children with congenital heart disease are at risk of gut barrier dysfunction and translocation of gut bacterial antigens into the bloodstream. This may contribute to inflammatory activation and organ dysfunction postoperatively.
Rationale: The stressful work environment of ICUs can lead to burnout. Burnout can impact on the welfare and performance of caregivers, and may lead them to resign their job. The shortage of ICU caregivers is becoming a real threat for health care leaders.
2011 Nov 15 - Attributable Mortality of Ventilator-Associated Pneumonia: A Reappraisal Using Causal Analysis
Rationale: Measuring the attributable mortality of ventilator-associated pneumonia (VAP) is challenging and prone to different forms of bias. Studies addressing this issue have produced variable and controversial results.
2011 Nov 1 - The Effect of Insurance Status on Mortality and Procedural Use in Critically Ill Patients
Rationale: Lack of health insurance may be an independent risk factor for mortality and differential treatment in critical illness.
2011 Nov 1 - Continuity of Care in Intensive Care Units: Cluster-Randomized Trial of Intensivist Staffing
Rationale: Little is known about the consequences of intensivists’ work schedules, or intensivist continuity of care.
2011 Sep 15 - Prompting Physicians to Address a Daily Checklist and Process of Care and Clinical Outcomes: A Single-Site Study
Rationale: Checklists may reduce errors of omission for critically ill patients.
2011 Sep 15 - Noninvasive Ventilation and Weaning in Patients with Chronic Hypercapnic Respiratory Failure: A Randomized Multicenter Trial
Rationale: The use of noninvasive ventilation (NIV) as an early weaning/extubation technique from mechanical ventilation remains controversial.