Critical care : the official journal of the Critical Care Forum
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Editorial Comment
Epinephrine for prehospital cardiac arrest with non-shockable rhythm.
Cardiopulmonary arrest research and guidelines have generally focused on the treatment and management of ventricular fibrillation and pulseless ventricular fibrillation (electrical shockable rhythms). Less investigation has been done on the subpopulation of cardiopulmonary arrest victims that present with non-shockable rhythms. ⋯ While there is a lack of evidence to support epinephrine for management of cardiopulmonary arrest presenting with initial shockable rhythms (presumed primary cardiac origin), there is now evidence that epinephrine may potentially benefit those presenting with non-shockable cardiopulmonary arrest (presumed heterogeneous origins). Further research on non-shockable rhythm cardiopulmonary arrest is needed to understand the subpopulation and develop better treatment guidelines.
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Glycyrrhizin (GL) was recently found to suppress high-mobility group box 1 (HMGB1)-induced injury by binding directly to it. However, the effect of GL on HMGB1 expression in endotoxemia as well as its underlying molecular mechanism remained unclear. ⋯ GL improved systemic hemodynamics and protected vital organs against porcine endotoxemia through modulation of the systemic inflammatory response. By reducing the serum level and gene expression of HMGB1 and other pro-inflammatory cytokines, GL may become a potential agent for the treatment of sepsis.
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The overall outcome of septic shock has been recently improved. We sought to determine whether this survival gain extends to the high-risk subgroup of patients with cirrhosis. ⋯ In the light of advances in management of both cirrhosis and septic shock, survival of such patients substantially increased over recent years. The stage of the underlying liver disease and the related therapeutic options should be included in the decision-making process for ICU admission.
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Metformin has anti-inflammatory and anti-thrombotic effects that may improve the outcome of critical illness, but clinical data are limited. We examined the impact of preadmission metformin use on mortality among intensive care unit (ICU) patients with type 2 diabetes. ⋯ Preadmission metformin use was associated with reduced 30-day mortality among medical and surgical intensive care patients with type 2 diabetes.
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Editorial Comment
The gut-brain axis in the critically ill: Is glucagon-like peptide-1 protective in neurocritical care?
Enteral nutrient is a potent glucagon-like peptide-1 (GLP-1) secretagogue. In vitro and animal studies indicate that GLP-1 has immune-modulatory and neuroprotective effects. To determine whether these immune-modulatory and neuroprotective effects of GLP-1 are beneficial in the critically ill, studies achieving pharmacological GLP-1 concentrations are warranted.