Critical care : the official journal of the Critical Care Forum
-
Promising preclinical results have been obtained with blood purification therapies as adjuvant treatment for sepsis. However, the mechanisms by which these therapies exert beneficial effects remain unclear. Some investigators have suggested that removal of activated leukocytes from the circulation might help ameliorate remote organ injury. We designed an extracorporeal hemoadsorption device capable of capturing both cytokines and leukocytes in order to test the hypothesis that leukocyte capture would alter circulating cytokine profiles and influence immunological cell-cell interactions in whole blood taken from patients with sepsis. ⋯ Monocyte and neutrophil capture using a sorbent polymer results in upregulation of IL-8 and modulation of cell-mediated immunity. Further studies are needed to understand better these cellular interactions in order to help design better blood purification therapies.
-
Observational Study
Feasibility of absolute cerebral tissue oxygen saturation during cardiopulmonary resuscitation.
Current monitoring during cardiopulmonary resuscitation (CPR) is limited to clinical observation of consciousness, breathing pattern and presence of a pulse. At the same time, the adequacy of cerebral oxygenation during CPR is critical for neurological outcome and thus survival. Cerebral oximetry, based on near-infrared spectroscopy (NIRS), provides a measure of brain oxygen saturation. Therefore, we examined the feasibility of using NIRS during CPR. ⋯ Both the FORE-SIGHT™ and EQUANOX™ technology allow non-invasive monitoring of the cerebral oxygen saturation during CPR. Moreover, changes in SctO2 values might be used to monitor the efficacy of CPR efforts.
-
Prior reports suggest that restrictive ICU visitation policies can negatively impact patients and their loved ones. However, visitation practices in US ICUs, and the hospital factors associated with them, are not well described. ⋯ In 2008 the overwhelming majority of US ICUs in this study had restrictive visitation policies. Wide variability in visitation policies suggests that further study into the impact of ICU visitations on care and outcomes remains necessary to standardize practice.
-
Editorial Comment
Serum adipocyte fatty acid-binding protein in the critically ill.
Sepsis due to unabated inflammation is common. Increased production of pro-inflammatory cytokines, free radicals, and eicosanoids has been detected in sepsis and other critical illnesses but could also be due to decreased synthesis and release of anti-inflammatory molecules. ⋯ Unsaturated fatty acids and their anti-inflammatory products, such as lipoxins, resolvins, and protectins, may suppress A-FABP expression, inhibit macrophage and COX-2 activation, and decrease production of pro-inflammatory cytokines and ultimately could lead to a decrease in insulin resistance and resolution of inflammation and recovery from sepsis. Serial measurement of these pro- and anti-inflammatory molecules and correlation of their levels to the progression to or recovery from (or both) sepsis and other inflammatory processes may form a new approach to predict prognosis in inflammatory conditions and eventually could lead to the development of new therapeutic strategies.
-
Optic nerve sheath diameter enlargement measured by ultrasound is known to be associated with raised intracranial pressure (ICP). Magnetic resonance imaging (MRI) of the cerebrospinal fluid (CSF) surrounding the optic nerve has been found, in an elegant study published in Critical Care, to correlate well with lumbar CSF opening pressure, confirming previously published studies. A simple and rapid T2-weighted fat-suppressed sequence was used to noninvasively measure the CSF width surrounding the optic nerve, allowing one to predict lumbar CSF pressure with relatively good performances, taking into consideration the body mass index and the mean arterial blood pressure. Based on these results and when brain MRI is indicated in situations at risk for increased ICP, the optic CSF thickness measurement could be systematically performed and used as a surrogate marker of raised ICP.