Critical care : the official journal of the Critical Care Forum
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Assessing and managing pain in the critically ill patient is challenging. Reproducible and clinically applicable pain measurement scales have yet to be validated and ubiquitously applied in the intensive care unit setting. Critical care clinicians, both physicians and nurses, should thoughtfully monitor their patient's pain level, periodically reassess their practice and critically evaluate the efficacy of pharmacological and nonpharmacological analgesic interventions.
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The purpose of this study was to evaluate sedation practice in UK intensive care units (ICUs), particularly the implementation of daily sedation holding, written sedation guidelines, sedation scoring tools and choice of agents. ⋯ Most UK ICUs use a sedation guideline and sedation scoring tool. The concept of sedation holding has been implemented in the majority of units, and most ICUs have a written sedation guideline.
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The innate immune response to trauma hemorrhage involves inflammatory mediators, thus promoting cellular dysfunction as well as cell death in diverse tissues. These effects ultimately bear the risk of post-traumatic complications such as organ dysfunction, multiple organ failure, or adult respiratory distress syndrome. In this study, a murine model of resuscitated hemorrhagic shock (HS) was used to determine the apoptosis in spleen as a marker of cellular injury and reduced immune functions. ⋯ Our data suggest that HS induces apoptotic changes in spleen through a biphasic caspase-dependent mechanism and imply a detrimental imbalance of pro- and anti-apoptotic mitochondrial proteins Bax, Bcl-2, and Mcl-1, thereby promoting post-traumatic immunosuppression.
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Comment
Improving survival by increasing lung edema clearance: is airspace delivery of dopamine a solution?
In this issue of Critical Care Chamorro-Marin and coworkers provide new evidence that dopamine instilled into airspaces is beneficial in a rat model of ventilator-induced lung injury. This study is important because it is the first to explore the effects of dopamine on survival, albeit short term. ⋯ Dopamine appears to increase active Na+ transport via activation of amiloride-sensitive sodium channels and the basolateral Na+/K+-ATPase within minutes, and it has been shown to be effective in normal lungs and several models of lung injury. This information is relevant to current clinical trials exploring the effects of alveolar fluid clearance stimulation in patients with acute lung injury.