Intensive care medicine
-
Intensive care medicine · Oct 2012
ReviewThe receptor for advanced glycation end products and acute lung injury/acute respiratory distress syndrome.
The receptor for advanced glycation end products (RAGE) is a pattern-recognition receptor and evolutionary member of the immunoglobulin superfamily that is involved in the host response to infection, injury, and inflammation. It exists in two forms: membrane-bound and soluble forms (sRAGE). RAGE recognizes a variety of ligands and, via a receptor-driven signaling cascade, activates the transcription factor NF-κB, leading to the expression of proinflammatory cytokines. ⋯ This expression is enhanced during inflammatory states such as with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). This review summarizes the characteristics of RAGE, RAGE isoforms, RAGE ligands, and signaling pathways in the pathogenesis of ALI and ARDS. Additionally, the review explores the potential of RAGE as an important therapeutic target in ALI/ARDS.
-
Intensive care medicine · Oct 2012
The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material.
Our objective was to revise the definition of acute respiratory distress syndrome (ARDS) using a conceptual model incorporating reliability and validity, and a novel iterative approach with formal evaluation of the definition. ⋯ This panel addressed some of the limitations of the prior ARDS definition by incorporating current data, physiologic concepts, and clinical trials results to develop the Berlin definition, which should facilitate case recognition and better match treatment options to severity in both research trials and clinical practice.
-
Intensive care medicine · Oct 2012
Randomized Controlled TrialNoninvasive ventilation after early extubation in patients recovering from hypoxemic acute respiratory failure: a single-centre feasibility study.
The use of noninvasive ventilation (NIV) to facilitate discontinuation of mechanical ventilation in patients with acute hypoxemic respiratory failure (hypoxemic ARF) has never been explored. This pilot study aims to assess the feasibility of early extubation followed by immediate NIV, compared conventional weaning, in patients with resolving hypoxemic ARF. ⋯ In a highly experienced centre NIV may be used to facilitate discontinuation of mechanical ventilation in selected patients with resolving hypoxemic ARF.
-
Intensive care medicine · Oct 2012
Comparative StudyPulse oximetry and high-dose vasopressors: a comparison between forehead reflectance and finger transmission sensors.
Pulse oximetry (SpO(2)) measured at finger site via transmission mode may fail in situations of hypoperfusion. Forehead sensors using reflectance technology might be useful in these circumstances. We hypothesized that reflectance SpO(2) would be more accurate than finger SpO(2) in patients with severe shock. ⋯ Forehead SpO(2) measurements were more accurate than finger SpO(2) when compared with SaO(2) in critically ill patients requiring high-dose vasopressor therapy and should therefore be the preferred method considered.
-
Intensive care medicine · Oct 2012
Multicenter StudySurrogate decision makers' attitudes towards research decision making for critically ill patients.
To examine the attitudes and preferences of surrogate decision makers (SDMs) regarding their involvement in the consent to research process for ICU patients. ⋯ Most of the interviewed SDMs wished to be involved in research decision making for critically ill and incapable loved ones. Variability existed, however, in their desire to be involved when decisions were time-sensitive or perceived risk was greater.