203 research outputs found
Dysfunction of respiratory muscles in critically ill patients on the intensive care unit.
No full textMuscular weakness and muscle wasting may often be observed in critically ill patients on intensive care units (ICUs) and may present as failure to wean from mechanical ventilation. Importantly, mounting data demonstrate that mechanical ventilation itself may induce progressive dysfunction of the main respiratory muscle, i.e. the diaphragm. The respective condition was termed 'ventilator-induced diaphragmatic dysfunction' (VIDD) and should be distinguished from peripheral muscular weakness as observed in 'ICU-acquired weakness (ICU-AW)'. Interestingly, VIDD and ICU-AW may often be observed in critically ill patients with, e.g. severe sepsis or septic shock, and recent data demonstrate that the pathophysiology of these conditions may overlap. VIDD may mainly be characterized on a histopathological level as disuse muscular atrophy, and data demonstrate increased proteolysis and decreased protein synthesis as important underlying pathomechanisms. However, atrophy alone does not explain the observed loss of muscular force. When, e.g. isolated muscle strips are examined and force is normalized for cross-sectional fibre area, the loss is disproportionally larger than would be expected by atrophy alone. Nevertheless, although the exact molecular pathways for the induction of proteolytic systems remain incompletely understood, data now suggest that VIDD may also be triggered by mechanisms including decreased diaphragmatic blood flow or increased oxidative stress. Here we provide a concise review on the available literature on respiratory muscle weakness and VIDD in the critically ill. Potential underlying pathomechanisms will be discussed before the background of current diagnostic options. Furthermore, we will elucidate and speculate on potential novel future therapeutic avenues
La Rente
No full textContributions to rent theory in a Sraffian approach.Papers by G. Abraham-Frois, A. d'Agata, E. Berrebi, C. Bidard, J.-P. Butault, A. Delarue, J.-P. Guichard, A. Jeanclaude, A.M. Nassisi, N. Salvadori, P. Saucier, B. Schefold, A. Soubeyran
Steroid use in elderly critically ill COVID-19 patients.
No full textFunding Information: Support statement: This work was supported by the European Commission, APHP and Health Region West (Norway). Funding information for this article has been deposited with the Crossref Funder Registry. Funding Information: Conflict of interest: C. Jung has nothing to disclose. B. Wernly has nothing to disclose. J. Fjølner has nothing to disclose. R.R. Bruno has nothing to disclose. D. Dudzinski has nothing to disclose. A. Artigas reports grants from Grifols and Fisher&Paykel, personal fees for advisory board work from Grifols, Novartis and Lilly Foundation, outside the submitted work. B. Bollen Pinto has nothing to disclose. J.C. Schefold has nothing to disclose. G. Wolff has nothing to disclose. M. Kelm has nothing to disclose. M. Beil has nothing to disclose. S. Sigal has nothing to disclose. P.V. van Heerden has nothing to disclose. W. Szczeklik has nothing to disclose. M. Czuczwar has nothing to disclose. M. Elhadi has nothing to disclose. M. Joannidis has nothing to disclose. S. Oeyen has nothing to disclose. T. Zafeiridis has nothing to disclose. B. Marsh has nothing to disclose. F.H. Andersen has nothing to disclose. R. Moreno has nothing to disclose. M. Cecconi has nothing to disclose. S. Leaver has nothing to disclose. A. Boumendil has nothing to disclose. D.W. De Lange has nothing to disclose. B. Guidet has nothing to disclose. H. Flaatten has nothing to disclose.publishersversionpublishe
Critical Illness Myopathy: Glucocorticoids revisited?
No full textOver the past decades, survival rates of critical illness have constantly increased. As a consequence, the incidences of important complications of intensive care unit (ICU) treatment become more and more prevalent. Critical illness myopathy (CIM) belongs to one of the most frequent neuromuscular complications and its presence is associated with prolonged need for mechanical ventilation and ICU stay, increased morbidity and mortality 1,2. High-dose glucocorticoid (GC) treatment was early after the initial description of CIM postulated to be a major triggering factor for the development of the disease. In the current issue of Acta Physiologica, Akkad et al. investigate the effects of two GC drugs (prednisolone and a new dissociative GC termed vamorolone) on CIM development3. This article is protected by copyright. All rights reserved
A survey on general and temperature management of post cardiac arrest patients in large teaching and university hospitals in 14 European countries : the SPAME trial results
No full textINTRODUCTION:
International guidelines recommend a bundle of care, including targeted temperature management (TTM), in post cardiac arrest survivors. Aside from a few small surveys in different European countries, adherence to the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recommendations are unknown.
METHODS:
This international European telephone survey was conducted to provide an overview of current clinical practice of post cardiac arrest management with a main focus on TTM. We targeted large teaching and university hospitals within Europe as leading facilities and key opinion leaders in the field of post cardiac arrest care. Selected national principal investigators conducted the survey, which was based on a predefined questionnaire, between December 2014 and March 2015, before the publication of the ERC Guidelines 2015.
RESULTS:
The return rate was 94% from 268 participating intensive care units (ICU). The majority had a predefined standard operating procedure (SOP) protocol for post cardiac arrest patients. Altogether, 68% of the ICUs provided TTM at a target temperature of 32-34°C for 24h, and 33% had changed the target temperature to 36°C. The minority provided a written SOP for neurological prognostication, which was generally initiated 72h after return of spontaneous circulation (ROSC). Electroencephalography and somatosensory evoked potentials were used by most ICUs for early prognostication. Treating more than fifty patients a year was significantly associated with providing written SOPs for TTM and prognostication (p<0.01), as well as the use of a computer feedback device (p=0.03) for TTM.
CONCLUSION:
This international European telephone survey revealed a high rate of implementation of TTM in post cardiac arrest patients in university and teaching hospitals. Most participants also provided a SOP, but only a minority had a SOP for neurological prognostication
Electrocautery smoke exposure and efficacy of smoke evacuation systems in minimally invasive and open surgery: a prospective randomized study
No full textWorldwide, health care professionals working in operating rooms (ORs) are exposed to electrocautery smoke on a daily basis. Aims of this study were to determine composition and concentrations of electrocautery smoke in the OR using mass spectrometry. Prospective observational study at a tertiary care academic center, involving 122 surgical procedures of which 84 were 1:1 computer randomized to smoke evacuation system (SES) versus no SES use. Irritating, toxic, carcinogenic and mutagenic VOCs were observed in OR air, with some exceeding permissible exposure limits (OSHA/NIOSH). Mean total concentration of harmful compounds was 272.69 ppb (± 189 ppb) with a maximum total concentration of harmful substances of 8991 ppb (at surgeon level, no SES). Maximum total VOC concentrations were 1.6 ± 1.2 ppm (minimally-invasive surgery) and 2.1 ± 1.5 ppm (open surgery), and total maximum VOC concentrations were 1.8 ± 1.3 ppm at the OR table 'at surgeon level' and 1.4 ± 1.0 ppm 'in OR room air' away from the operating table. Neither difference was statistically significant. In open surgery, SES significantly reduced maximum concentrations of specific VOCs at surgeon level, including aromatics and aldehydes. Our data indicate relevant exposure of health care professionals to volatile organic compounds in the OR. Surgical technique and distance to cautery devices did not significantly reduce exposure. SES reduced exposure to specific harmful VOC's during open surgery.Trial Registration Number: NCT03924206 (clinicaltrials.gov)
Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis.
No full textOBJECTIVE
Metabolic acidosis is associated with high mortality. Despite theoretical benefits of sodium-bicarbonate (SB), current evidence remains controversial. We investigated SB-related effects on outcomes in ICU patients with metabolic acidosis.
DESIGN
Retrospective analysis.
SETTING
Academic medical center.
PATIENTS OR PARTICIPANTS
971 ICU patients with metabolic acidosis defined as arterial pH<7.3 and CO2<45mmHg treated between 2012 and 2016. A propensity score (PS) was estimated using logistic regression. Patients were matched in pairs using the PS.
INTERVENTIONS
441 patients were treated with SB 8.4% (SB-group) and n=530 patients were not (control group).
MAIN VARIABLES OF INTEREST
Primary outcome was all-cause mortality at ICU-discharge. Average Treatment Effect (ATE), Average Treatment effect in Treated (ATT), and estimated relative survival effects at 20 days were computed.
RESULTS
In the full cohort, we observed considerable differences in pH, base excess, additional acidosis-related indices, and ICU mortality (controls 31% vs. SB-group 56%, p<.001) at baseline between the two groups. After PS-matching (n=174 in each group), no significant difference in ICU mortality was observed (controls 32% vs. SB-group 41%; p=.07). Odds ratios (OR) for ATE and ATT showed no association with ICU mortality (OR ATE: 1.08, 95%-CI 0.99-1.17; p=.08; OR ATT 1.09; 95%-CI 0.99-1.2; p=.09). Hazard ratios at 20-days (multivariable HR, matched sample n=348: 1.16, 95%-CI 0.86-1.56, p=.33) showed similar survival in the two study groups.
CONCLUSIONS
We did not observe effects of SB infusion on all-cause mortality in critically ill patients with metabolic acidosis
Is (TIMP-2)X(IGFBP7) an early renal biomarker for the prediction of acute kidney injury in aortic surgery? Results from a single center observational study
No full textDysphagia in COVID-19 -multilevel damage to the swallowing network?
No full textWe read with great interest the article "COVID-19: what if the brain had a role in causing the deaths?" by Tassorelli and co-workers, in which the authors generate and summarize hypotheses how SARS-CoV-2 may enter the peripheral and central nervous system and cause life-threatening complications [1]. With this letter we would like to contribute to this discussion by highlighting how different complications of COVID-19 may result in damage to central and peripheral parts of the swallowing network leading to dysphagia in critically ill COVID-survivors
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