Articles: function.
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Fluid resuscitation in the critically ill is a hot topic. The current strategy of rapid and adequate resuscitation in shock followed by conservative fluid administration is often difficult to achieve with standard crystalloid solutions. Research into alternative intravenous fluids tailored to individual patient needs is required. ⋯ The results not only suggest unimpaired lactate metabolism during shock in children but document improvement in endothelial barrier function, limited coagulopathy, and avoidance of fluid overload with hypertonic sodium lactate. Their study invites several important questions to be answered. Is hypertonicity or lactate per se important for the beneficial effects? Are the metabolic or anti-inflammatory effects responsible? Is the raised lactate in shock an adaptive response? Should reduction in lactate levels be the goal of resuscitation? These questions may trigger further research into the role of lactate and lactate-based intravenous fluids in resuscitation of the critically ill.
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A major consequence of ICU-acquired weakness (ICUAW) is diaphragm weakness, which prolongs the duration of mechanical ventilation. Hyperglycemia (HG) is a risk factor for ICUAW. However, the mechanisms underlying HG-induced respiratory muscle weakness are not known. Excessive reactive oxygen species (ROS) injure multiple tissues during HG, but only one study suggests that excessive ROS generation may be linked to HG-induced diaphragm weakness. We hypothesized that HG-induced diaphragm dysfunction is mediated by excessive superoxide generation and that administration of a specific superoxide scavenger, polyethylene glycol superoxide dismutase (PEG-SOD), would ameliorate these effects. ⋯ HG-induced reductions in diaphragm force generation occur largely at the level of the contractile proteins, are associated with depletion of troponin T and increased indices of oxidative stress, findings not previously reported. Importantly, administration of PEG-SOD largely ablated these derangements, indicating that superoxide generation plays a major role in hyperglycemia-induced diaphragm dysfunction. This new mechanistic information could explain how HG alters diaphragm function during critical illness.
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Labels and medications with similar appearances have the potential to harm patients and cause delays in hospital services. We report a problem involving the Maxtec MAX-1 and MAX-11 oxygen sensors which are commonly used on anesthesia machines. ⋯ The incident required the replacement of a MAX-11 sensor with a MAX-1 sensor to ensure proper functioning of the anesthesia machine. Identification of these cases can educate health care professionals of potential sources of labeling errors and safety issues and can also bring about Food and Drug Administration policy changes.
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How do physicians in the specialty of anesthesiology perceive the working conditions regarding stress and job satisfaction? The health system in Germany has been confronted with a rapidly changing framework over the last 20 years: For example, an increased influence of economic patterns on the workflow and the medical decision of physicians has been established forcing them to always take the economic aspects into account. Moreover, a new generation (generation Y) of physicians with other requirements of the work place, meaning mainly a demand for a better work-life balance, has gained a foothold in hospitals. These changes make it very important to investigate the status quo of current working conditions. ⋯ This study revealed a high prevalence of unfavorable working conditions for anesthetists in hospitals. Taking the forthcoming shortage of qualified physicians in German hospitals into account, these results have to be considered as a cause for concern. Constant unfavorable working conditions have a negative effect on the mental and physical health of employees. Sooner or later a migration of qualified physicians abroad could be the consequence. To prevent a future shortage of qualified physicians and to make the hospital work place more appealing, working conditions have to be adapted to current needs and expectations of employees. The focus should be put on balanced working conditions according to stress models shown in this study.
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Multicenter Study
Differential expression of the nuclear-encoded mitochondrial transcriptome in pediatric septic shock.
Increasing evidence supports a role for mitochondrial dysfunction in organ injury and immune dysregulation in sepsis. Although differential expression of mitochondrial genes in blood cells has been reported for several diseases in which bioenergetic failure is a postulated mechanism, there are no data about the blood cell mitochondrial transcriptome in pediatric sepsis. ⋯ Based on a focused analysis of a pediatric septic shock transcriptomic database, nuclear-encoded mitochondrial genes were differentially regulated early in pediatric septic shock compared to healthy controls, as well as across genotypic and phenotypic distinct pediatric septic shock subclasses. The nuclear genome may be an important mechanism contributing to alterations in mitochondrial bioenergetic function and outcomes in pediatric sepsis.