ICU-acquired weakness: what is preventing its rehabilitation in critically ill patients?

Intensive care unit-acquired weakness (ICUAW) has been recognized as an important and persistent complication in survivors of critical illness. The absence of a consistent nomenclature and diagnostic criteria for ICUAW has made research in this area challenging. Although many risk factors have been identified, the data supporting their direct association have been controversial. Presently, there is a growing body of literature supporting the utility and benefit of early mobility in reducing the morbidity from ICUAW, but few centers have adopted this into their ICU procedures. Ultimately, the implementation of such a strategy would require a shift in the knowledge and culture within the ICU, and may be facilitated by novel technology and patient care strategies. The purpose of this article is to briefly review the diagnosis, risk factors, and management of ICUAW, and to discuss some of the barriers and novel treatments to improve outcomes for our ICU survivors

Buoyancy-induced time delays in Babcock-Leighton flux-transport dynamo models

The Sun is a magnetic star whose cyclic activity is thought to be linked to internal dynamo mechanisms. A combination of numerical modelling with various levels of complexity is an efficient and accurate tool to investigate such intricate dynamical processes. We investigate the role of the magnetic buoyancy process in 2D Babcock-Leighton dynamo models, by modelling more accurately the surface source term for poloidal field. Methods. To do so, we reintroduce in mean-field models the results of full 3D MHD calculations of the non-linear evolution of a rising flux tube in a convective shell. More specifically, the Babcock-Leighton source term is modified to take into account the delay introduced by the rise time of the toroidal structures from the base of the convection zone to the solar surface. We find that the time delays introduced in the equations produce large temporal modulation of the cycle amplitude even when strong and thus rapidly rising flux tubes are considered. Aperiodic modulations of the solar cycle appear after a sequence of period doubling bifurcations typical of non-linear systems. The strong effects introduced even by small delays is found to be due to the dependence of the delays on the magnetic field strength at the base of the convection zone, the modulation being much less when time delays remain constant. We do not find any significant influence on the cycle period except when the delays are made artificially strong. A possible new origin of the solar cycle variability is here revealed. This modulated activity and the resulting butterfly diagram are then more compatible with observations than what the standard Babcock-Leighton model produces.Comment: 13 pages, 10 figures, accepted for publication in A&

Outcomes of interfacility critical care adult patient transport: a systematic review

INTRODUCTION: We aimed to determine the adverse events and important prognostic factors associated with interfacility transport of intubated and mechanically ventilated adult patients. METHODS: We performed a systematic review of MEDLINE, CENTRAL, EMBASE, CINAHL, HEALTHSTAR, and Web of Science (from inception until 10 January 2005) for all clinical studies describing the incidence and predictors of adverse events in intubated and mechanically ventilated adult patients undergoing interfacility transport. The bibliographies of selected articles were also examined. RESULTS: Five studies (245 patients) met the inclusion criteria. All were case-series and two were prospective in design. Due to the paucity of studies and significant heterogeneity in study population, outcome events, and results, we synthesized data in a qualitative manner. Pre-transport severity of illness was reported in only one study. The most common indication for transport was a need for investigations and/or specialist care (three studies, 220 patients). Transport modalities included air (fixed or rotor wing; 66% of patients) and ground (31%) ambulance, and commercial aircraft (3%). Transport teams included a physician in three studies (220 patients). Death during transfer was rare (n = 1). No other adverse events or significant therapeutic interventions during transport were reported. One study reported a 19% (28/145) incidence of respiratory alkalosis on arrival and another study documented a 30% overall intensive care unit mortality, while no adverse events or outcomes were reported after arrival in the three other studies. CONCLUSION: Insufficient data exist to draw firm conclusions regarding the mortality, morbidity, or risk factors associated with the interfacility transport of intubated and mechanically ventilated adult patients. Further study is required to define the risks and benefits of interfacility transfer in this patient population. Such information is important for the planning and allocation of resources related to transporting critically ill adults