Anesthesiology
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Acute respiratory distress syndrome is a devastating disease that causes substantial morbidity and mortality. Mechanical ventilation can worsen lung injury, whereas ventilatory strategies that reduce lung stretch, resulting in a "permissive" hypercapnic acidosis (HCA), improve outcome. HCA directly reduces nonsepsis-induced lung injury in preclinical models and, therefore, has therapeutic potential in these patients. ⋯ Recent studies suggest that HCA is protective in the earlier phases of bacterial pneumonia-induced sepsis but may worsen injury in the setting of prolonged lung sepsis. In contrast, HCA is protective in preclinical models of early and prolonged systemic sepsis. Buffering of the HCA is not beneficial and may worsen pneumonia-induced injury.
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Clinical Trial
Coding of incisional pain in the brain: a functional magnetic resonance imaging study in human volunteers.
In this study, the activation of different brain areas after an experimental surgical incision was assessed by functional magnetic resonance imaging, and the pathophysiological role of distinct brain activation patterns for pain perception after incision was analyzed. ⋯ These findings show different and distinct cortical and subcortical activation patterns over a relevant time period after incision. Pain sensitivity hereby has an influence on the activity profile. This may have important implications for encoding ongoing pain after a tissue injury, for example, resting pain in postoperative patients.
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Permissive hypercapnia is a widely practiced protective ventilatory strategy that has significant protective effects on several models of in vitro and in vivo neuronal injury. However, conclusive effects of permissive hypercapnia on cerebral ischemia are still unknown. ⋯ Mild to moderate hypercapnia (Paco2 60-100 mmHg) is neuroprotective after transient global cerebral I/R injury. Such a protection might be associated with apoptosis-regulating proteins. In contrast, severe hypercapnia (Paco2 100-120 mmHg) increased brain injury, which may be caused by increased brain edema.