2010 Jul 15 - Long-term Cognitive and Psychological Outcomes in the Awakening and Breathing Controlled Trial
Rationale: Studies have shown that reducing sedation of critically ill patients shortens time on the ventilator and in the intensive care unit (ICU). Little is known, however, of how such strategies affect long-term cognitive, psychological, and functional outcomes.
2010 Jul 15 - Nrf2-regulated PPAR Expression Is Critical to Protection against Acute Lung Injury in Mice
Rationale: The NF-E2 related factor 2 (Nrf2)–antioxidant response element (ARE) pathway is essential for protection against oxidative injury and inflammation including hyperoxia-induced acute lung injury. Microarray expression profiling revealed that lung peroxisome proliferator activated receptor (PPAR) induction is suppressed in hyperoxia-susceptible Nrf2-deficient (Nrf2–/–) mice compared with wild-type (Nrf2+/+) mice. PPAR has pleiotropic beneficial effects including antiinflammation in multiple tissues.
2010 Jul 1 - Patient-derived Granulocyte/Macrophage Colony–Stimulating Factor Autoantibodies Reproduce Pulmonary Alveolar Proteinosis in Nonhuman Primates
Rationale: Granulocyte/macrophage colony–stimulating factor (GM-CSF) autoantibodies (GMAb) are strongly associated with idiopathic pulmonary alveolar proteinosis (PAP) and are believed to be important in its pathogenesis. However, levels of GMAb do not correlate with disease severity and GMAb are also present at low levels in healthy individuals.
Rationale: Urokinase-type plasminogen activator (uPA) regulates extracellular proteolysis in lung injury and repair. Although alveolar expression of uPA increases, procoagulant activity predominates.
2010 Jun 15 - Inhaled Granulocyte/Macrophage–Colony Stimulating Factor as Therapy for Pulmonary Alveolar Proteinosis
Rationale: Inhaled granulocyte/macrophage–colony stimulating factor (GM-CSF) is a promising therapy for pulmonary alveolar proteinosis (PAP) but has not been adequately studied.
Rationale: Surfactant protein A (SP-A) is a collectin family member that has multiple immunomodulatory roles in lung host defense. SP-A levels are altered in the bronchoalveolar lavage (BAL) fluid and serum of patients with acute lung injury and acute respiratory distress syndrome, suggesting the importance of SP-A in the pathogenesis of acute lung injury.
2010 May - Efficacy of Corticosteroids in Community-acquired Pneumonia: A Randomized Double-Blinded Clinical Trial
Rationale: Some studies have shown a beneficial effect of corticosteroids in patients with community-acquired pneumonia (CAP), possibly by diminishing local and systemic antiinflammatory host response.
2010 Jun 1 - AJRCCM Editorial: More Doctors to the Rescue in the Intensive Care Unit: A Cautionary Note
At first blush, the idea of 24-hour intensivist physician staffing in the intensive care unit (ICU) must seem to have a strong theoretical rationale.
2010 Jun 1 - Reorganizing Adult Critical Care Delivery: The Role of Regionalization, Telemedicine, and Community Outreach
Variation in the quality of critical care services across hospitals coupled with an emerging workforce crisis necessitates system-level change in the organization of intensive care. In this review, we evaluate three alternative organizational models that may expand access to high-quality critical care: tiered regionalization, intensive care unit telemedicine, and quality improvement through regional outreach.
Mortality in National Heart, Lung and Blood Institute–sponsored clinical trials of treatments for acute lung injury (ALI) has decreased dramatically during the past two decades.
2010 May 15 - An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: An International Consensus Conference in Intensive Care Medicine
Objectives: To address the issues of Prevention and Management of Acute Renal Failure in the ICU Patient, using the format of an International Consensus Conference.
This article reviews selected contributions published in 2009 regarding the epidemiology, clinical course, pathogenesis, and treatment of acute lung injury (ALI). Articles in critical care medicine that relate to multiorgan failure are also included.
2010 May 1 - Immunopathology and Dexamethasone Therapy in a New Model for Malaria-associated Acute Respiratory Distress Syndrome
Rationale: Malaria infection is often complicated by malaria-associated acute respiratory distress syndrome (MA-ARDS), characterized by pulmonary edema and hemorrhages. No efficient treatments are available for MA-ARDS and its pathogenesis remains poorly understood.
2010 May 1 - Early Growth Response-1 Worsens Ventilator-induced Lung Injury by Up-Regulating Prostanoid Synthesis
Rationale: Ventilator-induced lung injury (VILI) is common and serious and may be mediated in part by prostanoids. We have demonstrated increased expression of the early growth response-1 (Egr1) gene by injurious ventilation, but whether—or how—such up-regulation contributes to injury is unknown.
Rationale: The involvement of neutrophil activation in the sentinel, potentially reversible, events in the pathogenesis of acute lung injury (ALI) is only partially understood. -Defensins are the most abundant proteins secreted by activated human neutrophils, but their contribution to ALI in mouse models is hindered by their absence from murine neutrophils and the inability to study their effects in isolation in other species.
The year of 2009 has turned out to be a fruitful year in terms of scientific publications in the field of Chronic Obstructive Pulmonary Disease (COPD). As reviewed below, these publications helped us to better understand the natural history of this devastating disease, to better phenotype patients, to validate new composite outcomes and, which is even more important for our patients, to demonstrate that by treating patients adequately, they live longer and better.
Rationale: Acute lung injury (ALI) is an inflammatory disorder characterized by hypoxemia and diffuse infiltration of neutrophils into the alveolar space. The migration and extravasation of neutrophils is guided through positive guidance cues, such as chemokines. Recent work has identified the neuronal guidance protein netrin-1 to be a negative guidance cue for leukocyte migration and to hold antiinflammatory potential.
Extracorporeal membrane oxygenation (ECMO) provides continuous cardiopulmonary support on a long-term basis, typically on the order of days to weeks, as adjunctive management of severe respiratory and cardiac failure.
2010 Feb 4 - Efficacy of Corticosteroids in Community-acquired Pneumonia - A Randomized Double Blinded Clinical Trial
Background: Some studies have shown a beneficial effect of corticosteroids in patients with Community-Acquired Pneumonia (CAP), possibly by diminishing local and systemic anti-inflammatory host response.
Increasingly in the United States and other countries, medical decisions, including those at the end of life, are made using a shared decision-making model. Under this model, physicians and other clinicians help patients clarify their values and reach consensus about treatment courses consistent with them.