Are we sedating more than just the brain?

Heavy sedation in the ICU is associated with coma, delirium, and prolonged stays, but links between sedatives and non-brain organ failure have rarely been described. In a post hoc analysis, Strøm and colleagues explored associations between sedation and acute kidney injury among ICU patients randomly assigned to one of two sedation strategies. The 'no sedation' protocol was associated with less kidney injury, but methodologic limitations preclude firm conclusions regarding mechanisms underlying this association. This hypothesis-generating study warns that sedation may harm organs other than the brain during critical illness, a possibility that warrants careful study in the future

Delirium in the intensive care unit

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients, occurring in up to 80% of the sickest intensive care unit (ICU) populations. Critically ill patients are subject to numerous risk factors for delirium. Some of these, such as exposure to sedative and analgesic medications, may be modified to reduce risk. Although dysfunction of other organ systems continues to receive more clinical attention, delirium is now recognized to be a significant contributor to morbidity and mortality in the ICU, and it is recommended that all ICU patients be monitored using a validated delirium assessment instrument. Patients with delirium have longer hospital stays and lower 6-month survival than do patients without delirium, and preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge. Little evidence exists regarding the prevention and treatment of delirium in the ICU, but multicomponent interventions reduce the incidence of delirium in non-ICU studies. Strategies for the prevention and treatment of ICU delirium are the subjects of multiple ongoing investigations

Delirium and mortality risk prediction: a story in evolution

Contains fulltext : 88249.pdf (publisher's version ) (Open Access

Speckle Observations of Binary Stars with the WIYN Telescope. I. Measures During 1997

Two hundred seventy-seven position angle and separation measures of 154 double stars are presented. Three of the systems were previously unknown to be double, and 16 other systems were discovered earlier this decade by the Hipparcos satellite. Measures are derived from speckle observations taken with the Wisconsin-Indiana-Yale-NOAO (WIYN) 3.5 m telescope located at Kitt Peak, Arizona. Speckle images were obtained using two different imaging detectors, namely, a multianode microchannel array (MAMA) detector and a fast-readout CCD. A measurement precision study was performed on a sample of binaries with extremely well known orbits by comparing the measures obtained here to the ephemeris predictions. For the CCD, the root mean square (rms) deviation of residuals was found to be 3.5 milliarcseconds (mas) in separation and 1.2d in position angle, while the residuals of the MAMA data varied depending on the magnification used and seeing conditions but can be comparable or superior to the CCD values. In addition, the two cameras were compared in terms of the detection limit in total magnitude and magnitude difference of the systems under study. The MAMA system has the ability to detect some systems with magnitude differences larger than 3.5, although reliable astrometry could not be obtained on these objects. Reliable astrometry was obtained on a system of magnitude difference of 5.3 with the CCD system (Refer to PDF file for exact formulas)

Lower locus coeruleus integrity in older COVID-19 survivors: initial findings from an international 7T MRI consortium

Background: The SARS-CoV-2 coronavirus has been associated with structural brain changes, consistent with its neurological manifestations. Recent studies showed a specific predilection for brainstem glial activation and hypometabolism, possibly indicating involvement of the locus coeruleus. The locus coeruleus (LC) modulates many cognitive functions and behaviors and its norepinephrine projections regulate both immune responses and vascular reactivity. We aimed to examine differences in LC integrity between COVID-19 survivors and controls. Method: Participants are enrolled across 3 US and 1 UK sites using harmonized cognitive and 7T MR-imaging protocols. Here, we analyzed data from 18 participants enrolled at Houston Methodist (12 COVID-19 survivors, 6 controls; Figure 1). COVID-19 survivors were required to have had a positive antigen test and an illness syndrome consistent with COVID-19. Healthy controls were required to have no significant pre-existing medical, neurologic, or psychiatric illness and no illness requiring hospitalization in the last 2 years. LC imaging was performed using a dedicated 7T MT-TFL sequence (0.4 x 0.4 x0.5mm). A site-specific normalized template was constructed using ANTs/FSL. The entire average LC integrity as well as voxel-wise integrity values were compared between COVID-19 survivors and controls using a robust linear regression (age-controlled and threshold free cluster enhancement corrected). LC integrity was correlated with age, sex, ethnicity and cognition using Spearman’s rank correlation. Result: Average LC integrity was not correlated with age, sex, or Hispanic ethnicity (p\u3e0.3). COVID-19 survivors did not differ from Controls when examining the entire LC (p=0.54). Voxel-wise analyses revealed a small cluster (19 voxels) in the middle portion of the left LC where COVID-19 survivors exhibited lower LC integrity than controls (p=0.005; Figure 2). Integrity of this cluster was not related to age or Hispanic ethnicity (p=0.9). LC integrity did not correlate with cognitive performance within the COVID-19 survivors (Trail Making Test B: p=0.43; Craft Story delayed recall p=0.47; MoCA p=0.84). Conclusion: Consistent with previous animal and human studies, our initial findings provide evidence for neuroinvasive potential of SARS-CoV-2 localized in the middle LC. In the future, we aim to expand our sample and link these observations to the neurocognitive sequelae of COVID-19

Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial

Abstract Introduction Benzodiazepines and α2 adrenoceptor agonists exert opposing effects on innate immunity and mortality in animal models of infection. We hypothesized that sedation with dexmedetomidine (an α2 adrenoceptor agonist), as compared with lorazepam (a benzodiazepine), would provide greater improvements in clinical outcomes among septic patients than among non-septic patients. Methods In this a priori-determined subgroup analysis of septic vs non-septic patients from the MENDS double-blind randomized controlled trial, adult medical/surgical mechanically ventilated patients were randomized to receive dexmedetomidine-based or lorazepam-based sedation for up to 5 days. Delirium and other clinical outcomes were analyzed comparing sedation groups, adjusting for clinically relevant covariates as well as assessing interactions between sedation group and sepsis. Results Of the 103 patients randomized, 63 (31 dexmedetomidine; 32 lorazepam) were admitted with sepsis and 40 (21 dexmedetomidine; 19 lorazepam) without sepsis. Baseline characteristics were similar between treatment groups for both septic and non-septic patients. Compared with septic patients who received lorazepam, the dexmedetomidine septic patients had 3.2 more delirium/coma-free days (DCFD) on average (95% CI for difference, 1.1 to 4.9), 1.5 (-0.1, 2.8) more delirium-free days (DFD) and 6 (0.3, 11.1) more ventilator-free days (VFD). The beneficial effects of dexmedetomidine were more pronounced in septic patients than in non-septic patients for both DCFDs and VFDs (P-value for interaction = 0.09 and 0.02 respectively). Additionally, sedation with dexmedetomidine, compared with lorazepam, reduced the daily risk of delirium [OR, CI 0.3 (0.1, 0.7)] in both septic and non-septic patients (P-value for interaction = 0.94). Risk of dying at 28 days was reduced by 70% [hazard ratio 0.3 (0.1, 0.9)] in dexmedetomidine patients with sepsis as compared to the lorazepam patients; this reduction in death was not seen in non-septic patients (P-value for interaction = 0.11). Conclusions In this subgroup analysis, septic patients receiving dexmedetomidine had more days free of brain dysfunction and mechanical ventilation and were less likely to die than those that received a lorazepam-based sedation regimen. These results were more pronounced in septic patients than in non-septic patients. Prospective clinical studies and further preclinical mechanistic studies are needed to confirm these results. Trial Registration NCT00095251

The Century Survey Galactic Halo Project III: A Complete 4300 deg^2 Survey of Blue Horizontal Branch Stars in the Metal-Weak Thick Disk and Inner Halo

We present a complete spectroscopic survey of 2414 2MASS-selected blue horizontal branch (BHB) candidates selected over 4300 deg^2 of the sky. We identify 655 BHB stars in this non-kinematically selected sample. We calculate the luminosity function of field BHB stars and find evidence for very few hot BHB stars in the field. The BHB stars located at a distance from the Galactic plane |Z|<4 kpc trace what is clearly a metal-weak thick disk population, with a mean metallicity of [Fe/H]= -1.7, a rotation velocity gradient of dv_{rot}/d|Z|= -28+-3.4 km/s in the region |Z|<6 kpc, and a density scale height of h_Z= 1.26+-0.1 kpc. The BHB stars located at 5<|Z|<9 kpc are a predominantly inner-halo population, with a mean metallicity of [Fe/H]= -2.0 and a mean Galactic rotation of -4+-31 km/s. We infer the density of halo and thick disk BHB stars is 104+-37 kpc^-3 near the Sun, and the relative normalization of halo to thick-disk BHB stars is 4+-1% near the Sun.Comment: 12 pages in emulateapj format, accepted for publication in February A