Articles: human.
-
Anesthesia and analgesia · Apr 2014
When does apparatus dead space matter for the pediatric patient?
Physiologic dead space is defined as the volume of the lung where gas exchange does not occur. Apparatus dead space increases dead space volume, causing either increased PaCO2 or the need to increase minute ventilation to maintain normocapnia. Children are especially vulnerable because small increases in apparatus dead space can significantly increase dead space to tidal volume ratio (Vd/Vt). ⋯ Similarly, RR required to maintain PaCO2 of 40 mm·Hg increased exponentially with increasing dead space. Increasing apparatus Vd can lead to exponential increases in PaCO2 and/or RR required to maintain normal PaCO2. The effect on PaCO2 is less as patient weight increases, but these data suggest it can be significant for typical circuit components up to at least 17 kg or aged 36 months.
-
Curr Opin Crit Care · Apr 2014
ReviewFever and therapeutic normothermia in severe brain injury: an update.
Fever is common in the ICU among patients with severe brain injury. Fever has been consistently shown to exacerbate brain injuries in animal models and has been consistently associated with poor outcome in human studies. However, whether fever control improves outcome and the ideal means of fever control remain unknown. This review will address recent literature on the impact of fever on severe brain injury and on interventions to maintain normothermia. ⋯ The value of therapeutic normothermia in the neurocritical care unit (NCCU) is increasingly accepted, yet prospective trials that demonstrate a functional benefit to patients are lacking.
-
Anesthesia and analgesia · Apr 2014
Dexamethasone produces dose-dependent inhibition of sugammadex reversal in in vitro innervated primary human muscle cells.
Corticosteroids are frequently used during anesthesia to provide substitution therapy in patients with adrenal insufficiency, as a first-line treatment of several life-threatening conditions, to prevent postoperative nausea and vomiting, and as a component of multimodal analgesia. For these last 2 indications, dexamethasone is most frequently used. Due to the structural resemblance between aminosteroid muscle relaxants and dexamethasone, concerns have been raised about possible corticosteroid inhibition in the reversal of neuromuscular block by sugammadex. We thus investigated the influence of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular block, which could be relevant in certain clinical situations. ⋯ This is the first report in which the effects of rocuronium and sugammadex interactions with dexamethasone have been studied in a highly accessible in vitro experimental model of functionally innervated human muscle cells. Sugammadex reverses rocuronium-induced neuromuscular block; however, concomitant addition of high dexamethasone concentrations diminishes the efficiency of sugammadex. Further studies are required to determine the clinical relevance of these interactions.
-
Curr Opin Anaesthesiol · Apr 2014
ReviewInflammatory response to trauma: implications for coagulation and resuscitation.
Recent studies have changed our understanding of the timing and interactions of the inflammatory processes and coagulation cascade following severe trauma. This review highlights this information and correlates its impact on the current clinical approach for fluid resuscitation and treatment of coagulopathy for trauma patients. ⋯ Traumatic injuries continue to be a significant cause of mortality worldwide. Recent advances in understanding the mechanisms of end-organ failure, and modulation of the inflammatory response has important clinical implications regarding fluid resuscitation and treatment of coagulopathy.
-
Int. J. Clin. Pract. · Apr 2014
Meta AnalysisAnti-TNF-α therapy for patients with sepsis: a systematic meta-analysis.
In humans, the role of anti-tumour necrosis factor (TNF)-α therapy in severe sepsis and septic shock is debatable. The aim of this meta-analysis was to determine the efficacy of anti-TNF-α therapies against placebo in patients with severe sepsis or septic shock. ⋯ This meta-analysis suggests that in patients with severe sepsis (before shock), immunotherapy with anti-TNF-α monoclonal antibodies reduces overall mortality. In patients with shock or high levels of IL-6 (> 1000 pg/ml), anti-TNF-α therapy may improve survival.