Is inhaled prophylactic heparin useful for prevention and management of pneumonia in ventilated ICU patients?

Purpose: The purpose was to determine the efficacy of prophylactic inhaled heparin for the prevention and treatment of pneumonia in patients receiving mechanical ventilation (MV)

Intraaortic Balloon Pump Counterpulsation and Cerebral Autoregulation: an observational study

The use of Intra-aortic counterpulsation is a well established supportive therapy for patients in cardiac failure or after cardiac surgery. Blood pressure variations induced by counterpulsation are transmitted to the cerebral arteries, challenging cerebral autoregulatory mechanisms in order to maintain a stable cerebral blood flow. This study aims to assess the effects on cerebral autoregulation and variability of cerebral blood flow due to intra-aortic balloon pump and inflation ratio weaning

The lung in multiorgan failure

The lung is almost invariably involved in the syndrome of multiorgan failure. However the mortality of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) is largely determined by concurrent non-lung organ failures. Increasingly, the role of mechanical ventilation has been recognized not only as a cause of ALI/ARDS, but also potentially contributing to the development of mutilorgan failure by the release of inflammatory and programmed cell death biological signals acting on organs distant from the lungs. This review summarizes the current epidemiology of ALI/ARDS, particularly with regards to its contribution to multiorgan failure. The potential mechanisms by which lung injury including that caused by mechanical ventilation are analyzed and current treatment strategies detailed

A new paradigm for treating infections: "go hard and go home"

Abstract: There is now significant evidence that initial use of the correct antibiotic saves more lives than virtually all other intensive care therapy. This means covering all possible causative organisms with the initial empirical choice. For nosocomial sepsis, broad-spectrum antibiotics must be started as soon as the relevant samples have been taken for culture, with deescalation of therapy targeted to the causative organisms when results and susceptibilities are available. There is an international trend to use shorter antibiotic courses. Pseudomonas pneumonia probably needs a 7-10 day course. In our ICU, provided the infection source is controlled, we seldom use antibiotic courses longer than 7 days. Evaluation of the kill characteristics of antibiotics in experimental models suggests that different classes of antibiotics should have different dosing regimens. For β- lactam antibiotics, the kill characteristic is almost entirely related to the time that tissue and plasma levels exceed a certain threshold, with no significant post-antibiotic effect, particularly against gram-negative organisms. Kill characteristics of other antibiotics, such as aminoglycosides, relate to adequate peak concentrations and a significant post-antibiotic effect. Clinically, these kill characteristics translate into the need for appropriate doses of the various antibiotics in patients with sepsis. We have shown that some patients with normal serum creatinine levels have very high creatinine clearance rates; in ICU patients with sepsis, blood pressure and tissue perfusion are maintained with large fluid loads and inotropic agents, thereby raising creatinine clearance. High clearances produce low trough concentrations of antibiotic, with important implications for underdosing and the development of antibiotic resistance. The new paradigm for treating sepsis, particularly nosocomial sepsis, is: get it right the first time, hit hard up front, and use large doses of broad-spectrum antibiotics for a short period

Physiopathology of anemia and transfusion thresholds in isolated head injury

BACKGROUND: Blood transfusion strategies among patients with critical illness use a restrictive hemoglobin threshold. However, among patients with head injury, no outcome differences have been shown between either liberal or restrictive strategies. Several studies and literature reviews suggest that anemia is associated with markers of tissue ischemia. The paucity of prospective data confuses the association between surrogates of tissue ischemia and neurological outcome

Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill

Background: Atrial fibrillation is a common rhythm disturbance in the general medical-surgical intensive care unit. Amiodarone is a popular drug in this setting but evidence to inform clinical practice remains scarce. We aimed to identify whether variation in the clinical use of amiodarone was associated with recurrent atrial fibrillation

The role of host phenology in determining the incidence of an insect sexually transmitted infection

the NERC. Grant Number: NE/G003246/1 Univ. of Liverpool studentship (DP