Critical care : the official journal of the Critical Care Forum
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In sepsis, inflammation and thrombosis are both the cause and the result of interactions between circulating (for example, leukocytes and platelets), endothelial and smooth muscle cells. Microparticles are proinflammatory and procoagulant fragments originating from plasma membrane generated after cellular activation and released in body fluids. In the vessel, they constitute a pool of bioactive effectors pulled from diverse cellular origins and may act as intercellular messengers. ⋯ Microparticles may participate in the pathogenesis of sepsis through multiple ways. They are able to regulate vascular tone and are potent vascular proinflammatory and procoagulant mediators. Microparticles' abilities are of increasing interest in deciphering the mechanisms underlying the multiple organ dysfunction of septic shock.
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A decade after the introduction of lung-protective ventilation strategies with low tidal volumes, the adverse effects of mechanical ventilation remain a scientific and clinical challenge. This situation has fueled the search for adjuvant pharmacological strategies to advance the benefit of protective ventilation in an additive or synergistic manner. In a recent issue of Critical Care, Müller and coworkers demonstrate convincingly that the initiation of high-dose simvastatin treatment prior to the onset of mechanical ventilation can attenuate adverse effects in overventilated mice. The present commentary discusses the need for adjuvant therapy in mechanical ventilation, the scientific rational for statin therapy in this context, and potential limitations for its implementation into clinical practice.
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Studies in intensive care unit (ICU) patients have suggested that anemia and blood transfusions can influence outcomes, but these effects have not been widely investigated specifically in surgical ICU patients. ⋯ In this group of surgical ICU patients, anemia was common and was associated with higher morbidity and mortality. Higher hemoglobin concentrations and receipt of a blood transfusion were independently associated with a lower risk of in-hospital death. Randomized control studies are warranted to confirm the potential benefit of blood transfusions in these subpopulations.
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To study the level and predictors of posttraumatic stress, anxiety and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge. ⋯ The mean level of posttraumatic stress symptoms in patients one year following ICU treatment was high and one of four were above case level Predictors of posttraumatic stress symptoms were mainly demographics and experiences during hospital stay whereas clinical injury related variables were insignificant. Pessimism was a predictor of posttraumatic stress, anxiety and depression symptoms. A subgroup of patients developed clinically significant distress symptoms during the follow-up period.
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Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. ⋯ This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients.