Critical care : the official journal of the Critical Care Forum
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To test the hypothesis that open lung (OL) ventilatory strategies using high-frequency oscillatory ventilation (HFOV) or controlled mechanical ventilation (CMV) compared to CMV with lower positive end-expiratory pressure (PEEP) improve respiratory function while minimizing lung injury as well as systemic inflammation, a prospective randomized study was performed at a university animal laboratory using three different lung conditions. ⋯ Open lung ventilatory strategies associated with HFOV or BP-CMV improved respiratory function and minimized lung injury compared to LP-CMV. Therefore, HFOV with PmeanHFOV set 2 cm H2O above the PmeanBP-CMV following a recruitment manoeuvre is as beneficial as BP-CMV.
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Arterial pressure optimization in septic shock is a critical, yet poorly understood component of resuscitation. New data suggest that, during the routine management of patients with severe sepsis, there is no association between mean arterial pressure achieved and outcome as long as the mean arterial pressure is maintained at or above 70 mmHg. Although these data add important new evidence to our understanding of arterial pressure management, there are still many unanswered questions upon which future investigations should focus.
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The exact cellular and molecular mechanisms of sepsis-induced encephalopathy remain elusive. The breakdown of the blood-brain barrier (BBB) is considered a focal point in the development of sepsis-induced brain damage. ⋯ However, recent studies suggest that bacterial proteins may readily cross the functional BBB and trigger an inflammatory response in the subarachnoid space, in absence of a bacterial invasion. A better understanding of the pathophysiological events leading to septic encephalopathy appears crucial to advance the clinical care for this vulnerable patient population.
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Clinicians depend on recognizing particular critical illnesses (such as sepsis and cardiac failure) from patterns of vital signs. The relationship between a vital sign pattern and a specific condition is explored.
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Several recent reports have highlighted the utility of transcutaneous electrical muscle stimulation to preserve muscle mass and strength in ICU patients. Specifically, Serafim Nanas and colleagues report a significant reduction in the odds of ICU-acquired weakness with its use. ⋯ As critical care studies attempt to study the outcome of physical recovery, significant additional data need to be provided in order for the results to be reported in the appropriate context. Future studies need to be performed in a setting where secondary injuries like sedation and immobilization are quantified so any benefit can be weighed against other interventions available.