Articles: function.
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Am. J. Respir. Crit. Care Med. · Jan 2014
Impact of Forced Vital Capacity Loss on Survival After the Onset of Chronic Lung Allograft Dysfunction.
Emerging evidence suggests a restrictive phenotype of chronic lung allograft dysfunction (CLAD) exists; however, the optimal approach to its diagnosis and clinical significance is uncertain. ⋯ At CLAD onset, a subset of patients demonstrating physiology more suggestive of restriction experience worse clinical outcomes. Further study of the biologic mechanisms underlying CLAD phenotypes is critical to improving long-term survival after lung transplantation.
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Organ failure in the heart or kidney can initiate various complex metabolic, cell-mediated and humoral pathways affecting distant organs, contributing to the high therapeutic costs and significantly higher morbidity and mortality. The universal outreach of cells in an injured state has myriad consequences to distant organ cells and their milieu. Heart performance and kidney function are closely interconnected and communication between these organs occurs through a variety of bidirectional pathways. ⋯ Clinical evidence suggests that tissue injury in both acute kidney injury and heart failure has immune-mediated inflammatory consequences that can initiate remote organ dysfunction. Acute cardiorenal syndrome (CRS type 1) and acute renocardiac syndrome (CRS type 3) are particularly relevant in high-acuity medical units. This review briefly summarizes relevant research and focuses on the role of signaling in heart-kidney crosstalk in the critical care setting.
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Randomized Controlled Trial
Therapeutic effect of inhaled budesonide (Pulmicort(®) Turbuhaler) on the inflammatory response to one-lung ventilation.
Pre-operative nebulised budenoside may improve ventilation pressures and compliance, and reduce the inflammatory response to one-lung ventilation.
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Review
Pre-operative co-morbidity and postoperative survival in the elderly: beyond one lunar orbit.
Mortality is a good measure of killing, but it is a poor measure of cure, palliation or the maintenance of function. Nevertheless, it has remained the primary metric of hospital care for 200 years. ⋯ This article discusses how disparate factors can usefully combine to generate an 'elderly' group with a monthly mortality in excess of 1% and a median life expectancy less than 3.5 years. A downloadable spreadsheet is provided that combines risk factors to generate mortality risks and their associated survival curves, emphasising the importance of looking beyond one postoperative month.
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Reg Anesth Pain Med · Jan 2014
Case ReportsAn Epidural Blood Patch Causing Acute Neurologic Dysfunction Necessitating a Decompressive Laminectomy.
One risk with placement of an epidural blood patch (EDBP) is spinal cord or nerve root compression resulting from the epidural blood volume injected, a complication necessitating immediate surgical decompression. We could not find a previous report of this in the literature. Here, we review and discuss one such case. ⋯ A cauda equina syndrome from an epidural hematoma may occur as a rare complication of an EDBP, even with direct fluoroscopic guidance. Early diagnosis of symptoms and prompt surgical evacuation of an epidural hematoma is essential and may result in the resolution of symptoms. This complication remains a rare occurrence and should not deter the performance of an EDBP, when indicated.