Critical care : the official journal of the Critical Care Forum
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You are concerned about the escalating use of antibiotics in your intensive care unit (ICU). This has put a strain on the ICU budget and is possibly resulting in the emergence of resistant bacteria. You review the situation with your team and one suggestion is to consider using biomarkers such as procalcitonin to better guide appropriate antibiotic decision making.
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Postischemic injury to the coronary vascular endothelium, in particular to the endothelial glycocalyx, may provoke fluid extravasation. Shedding of the glycocalyx is triggered by redox stress encountered during reperfusion and should be alleviated by the radical scavenger nitric oxide (NO). The objective of this study was to investigate the effect of exogenous administration of NO during reperfusion on both coronary endothelial glycocalyx and vascular integrity. ⋯ The cardioprotective effect of NO in postischemic reperfusion includes prevention of coronary vascular leak and interstitial edema and a tendency to forestall both no-reflow and degradation of the endothelial glycocalyx.
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Editorial Comment
The essential nature of healthcare databases in critical care medicine.
Medical databases serve a critical function in healthcare, including the areas of patient care, administration, research and education. The quality and breadth of information collected into existing databases varies tremendously, between databases, between institutions and between national boundaries. The field of critical care medicine could be advanced substantially by the development of comprehensive and accurate databases.
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Comment
The inflammation-coagulation axis as an important intermediate pathway in acute lung injury.
Markers of inflammation, coagulation, and fibrinolysis predict an adverse outcome in patients with sepsis. These markers also seem predictive of an adverse outcome in patients with localized infection and inflammation, such as in acute lung injury. ⋯ In the present issue of Critical Care, McClintock and colleagues demonstrate that these biomarkers retain their predictive effect even if lung-protective ventilation strategies are applied. Besides being biomarkers that predict outcome in patients with acute lung injury, their activation of inflammation and coagulation seems also to play a pivotal role in the pathogenesis of acute lung injury, and may thereby represent an interesting novel target for therapeutic intervention.
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Recent papers discussed include two large, multicentre, high-positive end-expiratory pressure trials in acute lung injury and reflects upon the usefulness of such trial designs. Further papers considered include the emerging story of beta2-agonists for pulmonary oedema, highlights the newly described, iatrogenic demon, of ventilator-induced diaphragm injury, promotes the addition of B-type natriuretic peptide testing to the prediction of extubation success, and muses again over the oxygen debate.