Critical care : the official journal of the Critical Care Forum
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A relative immunosuppression is observed in patients after sepsis, trauma, burns, or any severe insults. It is currently proposed that selected patients will benefit from treatment aimed at boosting their immune systems. ⋯ Indeed, the immune status of leukocytes is not universally decreased and their activated status in tissues contributes to organ failure. Accordingly, any new immune-stimulatory therapeutic intervention should take into consideration potentially deleterious effects in some situations.
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Oxidative stress has been postulated as a mechanism of organ dysfunction - and thus a potential therapeutic target - in sepsis. Lorente and colleagues report increased serum levels of malondialdehyde, a biomarker of oxidative stress-induced lipid peroxidation, in adults with severe sepsis, particularly in non-survivors. ⋯ These findings suggest that there is increased oxidative stress in sepsis and that membrane lipids in particular are targeted by free radical species. Further study is required to validate the utility of malondialdehyde as a prognostic biomarker in sepsis and to determine a role for antioxidant therapy.
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Comment
Is intra-abdominal hypertension a missing factor that drives multiple organ dysfunction syndrome?
In a recent issue of Critical Care, Cheng and colleagues conducted a rabbit model study that demonstrated that intra-abdominal hypertension (IAH) may damage both gut anatomy and function. With only 6 hours of IAH at 25 mmHg, these authors observed an 80% reduction in mucosal blood flow, an exponential increase in mucosal permeability, and erosion and necrosis of the jejunal villi. Such dramatic findings should remind all caring for the critically ill that IAH may severely damage the normal gut barrier functions and thus may be reasonably expected to facilitate bacterial and mediator translocation. The potential contribution of IAH as a confounding factor in the efficacy of selective decontamination of the digestive tract should be considered.
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Clinical practice guidelines are useful in improving quality of care and outcomes, reducing inappropriate variation in practice, promoting efficient use of resources, informing and empowering patients and informing public policy. However, difficulties arise when guidelines are poorly introduced into routine daily practice and, as a consequence, many patients do not receive the care intended or receive harmful or unnecessary care.
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Review Meta Analysis
Protective mechanical ventilation in the non-injured lung: review and meta-analysis.