Critical care : the official journal of the Critical Care Forum
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Mechanical ventilation (MV) could prime the lung toward an inflammatory response if exposed to another insult such as bacterial invasion. The underlying mechanisms are not so far clear. Toll-like receptors (TLRs) allow the host to recognize selectively bacterial pathogens and in turn to trigger an immune response. We therefore hypothesized that MV modulates TLR2 expression and in turn modifies responsiveness to agonists such as bacterial lipopeptide (BLP). ⋯ Mild-stretch MV increases lung expression of TLR2 and sensitizes the lung to bacterial TLR2 ligands. This may account for the propensity of mechanically ventilated patients to develop acute lung injury in the context of airway bacterial colonization/infection.
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Computed tomography of the lung has shown that ventilation shifts from dependent to nondependent lung regions. In this study, we investigated whether, at the bedside, electrical impedance tomography (EIT) at the cranial and caudal thoracic levels can be used to visualize changes in ventilation distribution during a decremental positive end-expiratory pressure (PEEP) trial and the relation of these changes to global compliance in mechanically ventilated patients. ⋯ At the bedside, EIT measured at two thoracic levels showed different behavior between the caudal and cranial lung levels during a decremental PEEP trial. These results indicate that there is probably no single optimal PEEP level for all lung regions.
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Postoperative delirium is an important problem in patients undergoing major surgery. Cerebral oximetry is a non-invasive method to detect imbalances in the cerebral oxygen supply/demand-ratio. Low preoperative cerebral oxygen saturation (ScO₂) levels have been associated with postoperative delirium in non-cardiac surgery patients. The present prospective observational study determines the relationship between pre- and intra-operative ScO₂ levels and postoperative delirium in patients undergoing on-pump cardiac surgery. ⋯ The presented study shows that a low preoperative ScO₂ is associated with postoperative delirium after on-pump cardiac surgery.
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Mortality associated with nosocomial bloodstream infection is multifactorial. Source of infection, etiology, age, underlying disease, acute illness, and appropriateness of antimicrobial therapy all contribute to the final outcome. ⋯ Yet, in settings with a high standard of care in terms of infection prevention and control, the occurrence rate of bloodstream infection is relatively low and therefore its impact on overall ICU mortality rather limited. As a consequence, untargeted interventional studies focused on infection prevention should use occurrence rate of infection rather than mortality as outcome variable.
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Substantial basic and translational research has been directed to detect earlier and more sensitive acute kidney injury (AKI) biomarkers over the past decade. Much of the seminal AKI biomarker validation research has been performed in children undergoing cardiopulmonary bypass since they represent an ideal clinical model for AKI biomarker study: the timing of the injury is known and children do not have many of the co-morbidities seen in adult patient populations, which can confound the clinical situation. ⋯ They demonstrate that fenoldopam administration led to decreased postoperative urine NGAL and urine cystatin C concentrations, suggesting a renoprotective effect. Given the high sensitivity of NGAL for AKI post cardiopulmonary bypass, this study provides a model to use novel AKI biomarkers in a novel manner.