Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Objective: Our study aims to evaluate the association between heart rate variability (HRV) and short- and long-term prognosis in patients admitted to intensive care unit (ICU). Methods and Results: Adult patients continuously monitored for over 24 h in ICUs from the the American Medical Information Mart for Intensive Care (MIMIC)-IV Waveform Database were recruited in our study. Twenty HRV-related variables (8 time domain, 6 frequency domain, and 6 nonlinear variables) were calculated based on RR intervals. ⋯ All the time domain, frequency domain, and nonlinear HRV parameters did not differ significantly between survivors and nonsurvivors with or without AF (all P > 0.05). Presence of renal failure, malignancy, and elevated blood urea nitrogen level were associated with increased 30-day all-cause mortality in SR patients, while presence of sepsis, infection, higher platelet count, and magnesium level were associated with increased 30-day all-cause mortality in AF patients. Conclusions: Heart rate variability variables were not associated with increased 30-day all-cause mortality in ICU patients with or without AF.
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Background : Nutritional management is crucial for severely ill patients. Measuring metabolism is believed to be necessary for the acute sepsis phase to accurately estimate nutrition. Indirect calorimetry (IDC) is assumed to be useful for acute intensive care; however, there are few studies on long-term IDC measurement in patients with systemic inflammation. ⋯ Muscle atrophy caused body weight loss, but fat tissue loss did not occur. Conclusions : We observed metabolic changes with IDC during the acute systemic inflammation phase owing to differences in calorie intake. This is the first report of long-term IDC measurement using the LPS-induced systemic inflammation rat model.
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Background: Protein kinase ataxia telangiectasia mutated (ATM) regulates the function of endothelial cells and responds quickly to endotoxin. However, the function of ATM in lipopolysaccharide (LPS)-induced blood-brain barrier (BBB) disruption remains unknown. This study aimed to investigate the role and underlying mechanism of ATM in the regulation of the BBB function in sepsis. ⋯ By activating ATM, doxorubicin increased the protein binding between ATM and AKT and promoted the phosphorylated activation of AKT at S473, which could directly phosphorylate DRP1 at S637 to repress excessive mitochondrial fission. Consistently, the protective role of ATM was abolished by the AKT inhibitor MK-2206. Conclusions: Ataxia telangiectasia mutated protects against LPS-induced BBB disruption by regulating mitochondrial homeostasis, at least in part, through the AKT/DRP1 pathway.
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Background : Accurate prediction of fluid responsiveness is important for postoperative critically ill elderly patients. The objective of this study was to evaluate the predictive values of peak velocity variation (ΔVpeak) and passive leg raising (PLR)-induced changes in ΔVpeak (ΔVpeak PLR ) of the left ventricular outflow tract to predict fluid responsiveness in postoperative critically ill elderly patients. Method : Seventy-two postoperative elderly patients with acute circulatory failure who were mechanically ventilated with sinus rhythm were enrolled in our study. ⋯ Results : Thirty-two patients were fluid responders. The area under the receiver operating characteristic curves (AUC) for baseline PPV and ΔVpeak to predict fluid responsiveness was 0.768 (95% confidence interval [CI], 0.653-0.859; P < 0.001) and 0.899 (95% CI, 0.805-0.958; P < 0.001) with gray zones of 7.63% to 12.66% that included 41 patients (56.9%) and 9.92% to 13.46% that included 28 patients (38.9%). ΔPPV PLR predicted fluid responsiveness with an AUC of 0.909 (95% CI, 0.818-0.964; P < 0.001), and the gray zone was 1.49% to 2.93% and included 20 patients (27.8%). ΔVpeak PLR predicted fluid responsiveness with an AUC of 0.944 (95% CI, 0.863-0.984; P < 0.001), and the gray zone was 1.48% to 2.46% and included six patients (8.3%). Conclusions : Passive leg raising-induced changes in peak velocity variation of blood flow in the left ventricular outflow tract accurately predicted fluid responsiveness with a small gray zone in postoperative critically ill elderly patients.
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During and immediately after cardiac arrest, cerebral oxygen delivery is impaired mainly by microthrombi and cerebral vasoconstriction. This may narrow capillaries so much that it might impede the flow of red blood cells and thus oxygen transport. The aim of this proof-of-concept study was to evaluate the effect of M101, an extracellular hemoglobin-based oxygen carrier (Hemarina SA, Morlaix, France) derived from Arenicola marina , applied during cardiac arrest in a rodent model, on markers of brain inflammation, brain damage, and regional cerebral oxygen saturation. ⋯ While M101 applied during cardiac arrest did not significantly change inflammation or brain oxygenation, the data suggest cerebral damage reduction due to hypoxic brain injury, measured by phospho-tau. Global burden of ischemia appeared reduced because acidosis was less severe. Whether postcardiac arrest infusion of M101 improves brain oxygenation is unknown and needs to be investigated.