Articles

Allostasis and sedation practices in intensive care evaluation: an observational pilot study

A dysregulated stress response has been implicated in the pathogenesis of critical illness. Sedative agents utilised in the critically unwell patient may impact upon the stress response with a downstream negat...

Authors: John P. R. Moore, Chris Anstey, Lauren Murray, John F. Fraser and Mervyn Singer

In vitro comparison of the adsorption of inflammatory mediators by blood purification devices

Septic shock, a leading cause of acute kidney injury, induces release of pro-/anti-inflammatory mediators, leading to increased mortality and poor renal recovery. This is the first in vitro study directly comp...

Authors: Benjamin Malard, Corine Lambert and John A. Kellum

Bias flow rate and ventilation efficiency during adult high-frequency oscillatory ventilation: a lung model study

Bias flow (BF) is essential to maintain mean airway pressure (MAP) and to washout carbon dioxide (CO₂) from the oscillator circuit during high-frequency oscillatory ventilation (HFOV). If the BF rate is inadequat...

Authors: Osamu Nagano, Tetsuya Yumoto, Atsunori Nishimatsu, Shunsuke Kanazawa, Takahisa Fujita, Sunao Asaba and Hideo Yamanouchi

Serum chloride levels in critical illness—the hidden story

Chloride is the principal anion of the extracellular fluid and vital for both serum electroneutrality and acid-base homeostasis. The aim of this review is to investigate the relevance of dyschloremia in the cr...

Authors: Carmen Andrea Pfortmueller, Dominik Uehlinger, Stephan von Haehling and Joerg Christian Schefold

Positional effects on the distributions of ventilation and end-expiratory gas volume in the asymmetric chest—a quantitative lung computed tomographic analysis

Body positioning affects the configuration and dynamic properties of the chest wall and therefore may influence decisions made to increase or decrease ventilating pressures and tidal volume. We hypothesized th...

Authors: Gustavo A. Cortes-Puentes, Kenneth E. Gard, Alexander B. Adams, David J. Dries, Michael Quintel, Richard A. Oeckler, Luciano Gattinoni and John J. Marini

Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway

Catheter suctioning of respiratory secretions in intubated subjects is limited to the proximal airway and associated with traumatic lesions to the mucosa and poor tolerance. “Mechanical insufflation-exsufflati...

Authors: Miguel Sánchez-García, Passio Santos, Gema Rodríguez-Trigo, Fernando Martínez-Sagasti, Tomás Fariña-González, Ángela del Pino-Ramírez, Carlos Cardenal-Sánchez, Beatriz Busto-González, Mónica Requesens-Solera, Mercedes Nieto-Cabrera, Francisco Romero-Romero and Antonio Núñez-Reiz

A high-flow nasal cannula system with relatively low flow effectively washes out CO₂ from the anatomical dead space in a sophisticated respiratory model made by a 3D printer

Although clinical studies of the high-flow nasal cannula (HFNC) and its effect on positive end-expiratory pressure (PEEP) have been done, the washout effect has not been well evaluated. Therefore, we made an e...

Authors: Yu Onodera, Ryo Akimoto, Hiroto Suzuki, Masayuki Okada, Masaki Nakane and Kaneyuki Kawamae

Extracorporeal membrane oxygenation line-associated complications: in vitro testing of cyanoacrylate tissue adhesive and securement devices to prevent infection and dislodgement

Extracorporeal membrane oxygenation (ECMO) delivers cardiac and/or respiratory support to critically ill patients who have failed conventional medical therapies. If the large-bore cannulas used to deliver ECMO...

Authors: Taressa Bull, Amanda Corley, Danielle J. Smyth, David J. McMillan, Kimble R. Dunster and John F. Fraser

Intra-cellular lactate concentration in T lymphocytes from septic shock patients — a pilot study

Sepsis-associated hyperlactatemia is a widely used biomarker, associated with initial severity and poor outcomes. This increased circulating lactate concentration has been proposed to result in part from a mis...

Authors: Thibaut Girardot, Thomas Rimmelé, Guillaume Monneret, Julien Textoris and Fabienne Venet

Alterations in mitochondrial respiration and reactive oxygen species in patients poisoned with carbon monoxide treated with hyperbaric oxygen

Carbon monoxide (CO) poisoning is the leading cause of poisoning mortality and morbidity in the USA. Carboxyhemoglobin (COHb) levels are not predictive of severity or prognosis. At this time, the measurement o...

Authors: David H. Jang, Utsha G. Khatri, Brenna P. Shortal, Matthew Kelly, Kevin Hardy, David S. Lambert and David M. Eckmann

PEEP titration: the effect of prone position and abdominal pressure in an ARDS model

Prone position and PEEP can both improve oxygenation and other parameters, but their interaction has not been fully described. Limited data directly compare selection of mechanically “optimal” or “best” PEEP i...

Authors: Joseph C. Keenan, Gustavo A. Cortes-Puentes, Lei Zhang, Alex B. Adams, David J. Dries and John J. Marini

Fully automated life support: an implementation and feasibility pilot study in healthy pigs

Automated systems are available in various application areas all over the world for the purpose of reducing workload and increasing safety. However, such support systems that would aid caregivers are still lac...

Authors: Wilfried Klingert, Jörg Peter, Christian Thiel, Karolin Thiel, Wolfgang Rosenstiel, Kathrin Klingert, Christian Grasshoff, Alfred Königsrainer and Martin Schenk

HLA-DR expression in neonates after cardiac surgery under cardiopulmonary bypass: a pilot study

Monocyte HLA-DR expression has been reported as a marker of immunosuppression and a predictor of sepsis development. However, to date, there is no report on monocyte HLA-DR monitoring exclusively in neonates (...

Authors: Alexis Chenouard, Cécile Braudeau, Nicolas Cottron, Pierre Bourgoin, Nina Salabert, Antoine Roquilly, Régis Josien, Nicolas Joram and Karim Asehnoune

Volume-replacement ratio for crystalloids and colloids during bleeding and resuscitation: an animal experiment

Fluid resuscitation remains a cornerstone in the management of acute bleeding. According to Starling's “Three-compartment model”, four-times more crystalloids have the same volume effect as colloids. However, ...

Authors: Ildikó László, Gábor Demeter, Nándor Öveges, Dániel Érces, József Kaszaki, Krisztián Tánczos and Zsolt Molnár

Combinatorial therapy with two pro-coagulants and one osmotic agent reduces the extent of the lesion in the acute phase of spinal cord injury in the rat

Spinal cord injury (SCI) is a complex disease that leads to a motor, sensitive, and vegetative impairment. So far, single therapies are ineffective for treating SCI in humans and a multifactorial therapeutic a...

Authors: Mathieu Boutonnet, Elisabeth Laemmel, Eric Vicaut, Jacques Duranteau and Marc Soubeyrand

Effect of Ringer’s acetate in different doses on plasma volume in rat models of hypovolemia

Even though crystalloids are the first choice for fluid resuscitation in hemodynamically unstable patients, their potency as plasma volume expanders in hypovolemia of different etiologies is largely unknown. T...

Authors: Svajunas Statkevicius, Attila Frigyesi and Peter Bentzer

Assessment of immune organ dysfunction in critical illness: utility of innate immune response markers

In critically ill patients, organ dysfunctions are routinely assessed, monitored, and treated. Mounting data show that substantial critical illness-induced changes in the immune system can be observed in most ...

Authors: Carmen Andrea Pfortmueller, Christian Meisel, Michaela Fux and Joerg C. Schefold

Anthrax immune globulin improves hemodynamics and survival during B. anthracis toxin-induced shock in canines receiving titrated fluid and vasopressor support

Although anthrax immune globulin (AIG) improved survival in antibiotic-treated Bacillus anthracis-challenged animal models, whether it adds to the benefit of conventional hemodynamic support for B. anthracis toxi...

Authors: Dante A. Suffredini, Xizhong Cui, Dharmvir Jaswal, Kenneth E. Remy, Yan Li, Junfeng Sun, Steven B. Solomon, Yvonne Fitz, Mahtab Moayeri, Stephen Leppla and Peter Q. Eichacker

An experimental model to measure the ability of headphones with active noise control to reduce patient’s exposure to noise in an intensive care unit

Defining the association between excessive noise in intensive care units, sleep disturbance and morbidity, including delirium, is confounded by the difficulty of implementing successful strategies to reduce pa...

Authors: Stuart Gallacher, Doyo Enki, Sian Stevens and Mark J. Bennett

Effects of regional perfusion block in healthy and injured lungs

Severe hypoperfusion can cause lung damage. We studied the effects of regional perfusion block in normal lungs and in the lungs that had been conditioned by lavage with 500 ml saline and high V ...

Authors: Barbara Cambiaghi, Francesco Vasques, Onnen Mörer, Christian Ritter, Tommaso Mauri, Nils Kunze-Szikszay, Karin Holke, Francesca Collino, Giorgia Maiolo, Francesca Rapetti, Elias Schulze-Kalthoff, Tommaso Tonetti, Günter Hahn, Michael Quintel and Luciano Gattinoni

Cardiopulmonary bypass in the newborn: effects of circulatory cell-free hemoglobin and hyperoxia evaluated in a novel rat pup model

Infants with congenital heart defects (CHD) are at risk for white matter brain injury. This novel rat pup model characterizes the systemic effects of intravasal cell-free hemoglobin and hyperoxia, hypothesizin...

Authors: Åsa Jungner, Suvi Vallius, Matteo Bruschettini, Olga Romantsik, Magnus Gram and David Ley

ESICM LIVES 2017

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Myeloperoxidase can differentiate between sepsis and non-infectious SIRS and predicts mortality in intensive care patients with SIRS

Systemic inflammatory response syndrome (SIRS) is a clinical syndrome following inflammation. Clinically, it is difficult to distinguish SIRS following an infection, i.e., sepsis, from non-infectious SIRS. Mye...

Authors: Irene T. Schrijver, Hans Kemperman, Mark Roest, Jozef Kesecioglu and Dylan W. de Lange

Sepsis 2017 Paris

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Fluid loading and norepinephrine infusion mask the left ventricular preload decrease induced by pleural effusion

Pleural effusion (PLE) may lead to low blood pressure and reduced cardiac output. Low blood pressure and reduced cardiac output are often treated with fluid loading and vasopressors. This study aimed to determ...

Authors: Kristian Borup Wemmelund, Viktor Kromann Ringgård, Simon Tilma Vistisen, Janus Adler Hyldebrandt, Erik Sloth and Peter Juhl-Olsen