2010 Mar 4 - Pandemic 2009 Influenza A(H1N1) in Argentina: A Study of 337 Patients on Mechanical Ventilation
Rationale: The rapid spread of the 2009 Influenza A(H1N1) around the world underscores the need for a better knowledge of epidemiology, clinical features, outcomes, and mortality predictors, especially in the most severe presentations.
Rationale: The effects of high positive end-expiratory pressure (PEEP) strictly depend on lung recruitability, which varies widely during acute respiratory distress syndrome (ARDS). Unfortunately, increasing PEEP may lead to opposing effects on two main factors potentially worsening the lung injury, that is, alveolar strain and intratidal opening and closing, being detrimental (increasing the former) or beneficial (decreasing the latter).
2010 Mar 1 - Ecological Effects of Selective Decontamination on Resistant Gram-negative Bacterial Colonization
Rationale: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) eradicate gram-negative bacteria (GNB) from the intestinal and respiratory tract in intensive care unit (ICU) patients, but their effect on antibiotic resistance remains controversial.
2010 Feb 15 - Critical Care Perspective: Influenza A/H1N1_09: Australia and New Zealand's Winter of Discontent
Influenza A/H1N1_09 emerged in Mexico at the end of the Northern Hemisphere winter. Within weeks, the focus shifted to the Southern Hemisphere as the introduction of the novel virus coincided with the beginning of the influenza season. Intensive public health and health services planning had occurred in Australia and New Zealand as preparation for an influenza pandemic before 2009. However,
2010 Feb 1 - Dual Inhibition of Cathepsin G and Chymase Is Effective in Animal Models of Pulmonary Inflammation
Rationale: Mast cells and neutrophils are key contributors to the pathophysiological inflammatory processes that underpin asthma and chronic obstructive pulmonary disease, partly through the release of noxious serine proteases, including cathepsin G (Cat G) and chymase. From this standpoint, a dual inhibitor of neutrophil Cat G and mast cell chymase could protect against these disease-related inflammatory responses.
2010 Feb 1 - Milk Fat Globule Epidermal Growth Factor 8 Attenuates Acute Lung Injury in Mice after Intestinal Ischemia and Reperfusion
Rationale: Milk fat globule epidermal growth factor 8 (MFG-E8) is a potent opsonin for the clearance of apoptotic cells and is produced by mononuclear cells of immune competent organs including the spleen and lungs. It attenuates chronic and acute inflammation such as autoimmune glomerulonephritis and bacterial sepsis by enhancing apoptotic cell clearance. Ischemia-reperfusion (I/R) injury of the gut results in severe inflammation, apoptosis, and remote organ damage, including acute lung injury (ALI).
2010 Feb 1 - Recovery of Multipotent Progenitors from the Peripheral Blood of Patients Requiring Extracorporeal Membrane Oxygenation Support
Rationale: Studies have demonstrated that bone marrow–derived cells can be recruited to injured lungs through an unknown mechanism. We hypothesize that marrow progenitors are mobilized into the circulation of patients with cardiac and/or respiratory failure, and may then traffic to and incorporate into the sites of tissue injury.
Rationale: The CysGlyGln haplotype of the β2-adrenergic receptor gene (ADRB2) is functional and associated with altered responses to adrenergic agonists in patients with asthma. Whether this functional haplotype alters outcome in patients receiving adrenergic agonists in septic shock is unknown.
2010 Jan 15 - Selected Medical Errors in the Intensive Care Unit: Results of the IATROREF Study: Parts I and II
Rationale: Although intensive care units (ICUs) were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention.
2010 Jan 1 - Early Protection from Burn-induced Acute Lung Injury by Deletion of Preprotachykinin-A Gene
Rationale: Burn-induced acute lung injury (ALI) is a common clinical disorder associated with high mortality even in the absence of inhalational injury. Identification of endogenous triggers that mediate the early onset of remote ALI after burn represents an important goal but remains poorly defined.
2009 Dec 15 - Bβ15–42 Protects against Acid-induced Acute Lung Injury and Secondary Pseudomonas Pneumonia In Vivo
Rationale: Acute lung injury (ALI) is a serious condition in critically ill patients that predisposes to secondary bacterial pneumonia. Vascular leak is a hallmark in the pathogenesis of ALI. The fibrin-derived peptide Bβ15–42 was shown to preserve endothelial barriers, thereby reducing vascular leak. The potential therapeutic role of Bβ15–42 in ALI has not been addressed so far.
Rationale: Myeloid-related protein-8 (MRP8) and MRP14 can form heterodimers that elicit a variety of inflammatory responses. We showed that MRP8/14 is a ligand for Toll-like receptor-4, and that mice deficient in MRP8/14 are protected against endotoxic shock–induced lethality.
2009 Dec 1 - Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population
Rationale: Delirium is a frequent occurrence in older intensive care unit (ICU) patients, but the importance of the duration of delirium in contributing to adverse long-term outcomes is unclear.
2009 Nov 1 - Use of Intensive Care Services during Terminal Hospitalizations in England and the United States.
Rationale: Despite broad concern regarding the provision and cost of health care at the end of life, country-specific patterns of care have rarely been compared.
2009 Nov 1 - The Triterpenoid CDDO-Imidazolide Confers Potent Protection against Hyperoxic Acute Lung Injury in Mice
Rationale: Oxygen supplementation (e.g., hyperoxia) is used to support critically ill patients with noninfectious and infectious acute lung injury (ALI); however, hyperoxia exposure can potentially further contribute to and/or perpetuate preexisting ALI. Thus, developing novel therapeutic agents to minimize the side effects of hyperoxia is essential to improve the health of patients with severe ALI and respiratory dysfunction. We have previously shown that mice with a genetic disruption of the Nrf2 transcription factor, which squelches cellular stress by up-regulating the induction of several antioxidant enzymes and proteins, have greater susceptibility to hyperoxic lung injury. Moreover, we have recently demonstrated that Nrf2-deficiency impairs the resolution of lung injury and inflammation after nonlethal hyperoxia exposure.
2009 Nov 15 - Exogenous Natural Surfactant for Treatment of Acute Lung Injury and the Acute Respiratory Distress Syndrome
Rationale: Compositional changes in surfactant and/or decreased surfactant content of the lungs are common features in patients with acute respiratory failure. Instillation of exogenous surfactant into the lungs of neonates with respiratory distress syndrome or pediatric patients with acute respiratory distress syndrome (ARDS) has resulted in improved survival.
Tension–Time Index as a Predictor of Extubation Outcome in Ventilated Children. Am. J. Respir. Crit. Care Med. 2009; 180: 982-988. First published online August 20 2009
Rationale: Indices that assess the load on the respiratory muscles, such as the tension–time index (TTI), may predict extubation outcome.
Rationale: Hyperoxia-induced acute lung injury has been used for many years as a model of oxidative stress mimicking clinical acute lung injury and the acute respiratory distress syndrome. Excess quantities of reactive oxygen species (ROS) are responsible for oxidative stress–induced lung injury. ROS are produced by mitochondrial chain transport, but also by NADPH oxidase (NOX) family members. Although NOX1 and NOX2 are expressed in the lungs, their precise function has not been determined until now.
2009 Nov 1 - Effectiveness of Treatments for Severe Sepsis. A Prospective, Multicenter, Observational Study
Rationale: Several Surviving Sepsis Campaign Guidelines recommendations are reevaluated.
Objectives: To analyze the effectiveness of treatments recommended in the sepsis guidelines.
Rationale: Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs.