How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?

INTRODUCTION: The aim of the study was to evaluate the ability of different static and dynamic measurements of preload to predict fluid responsiveness in patients with spontaneous respiratory movements. METHODS: The subjects were 21 critically ill patients with spontaneous breathing movements receiving mechanical ventilation with pressure support mode (n = 9) or breathing through a face mask (n = 12), and who required a fluid challenge. Complete hemodynamic measurements, including pulmonary artery occluded pressure (PAOP), right atrial pressure (RAP), pulse pressure variation (ΔPP) and inspiratory variation in RAP were obtained before and after fluid challenge. Fluid challenge consisted of boluses of either crystalloid or colloid until cardiac output reached a plateau. Receiver operating characteristics (ROC) curve analysis was used to evaluate the predictive value of the indices to the response to fluids, as defined by an increase in cardiac index of 15% or more. RESULTS: Cardiac index increased from 3.0 (2.3 to 3.5) to 3.5 (3.0 to 3.9) l minute(-1 )m(-2 )(medians and 25th and 75th centiles), p < 0.05. At baseline, ΔPP varied between 0% and 49%. There were no significant differences in ΔPP, PAOP, RAP and inspiratory variation in RAP between fluid responders and non-responders. Fluid responsiveness was predicted better with static indices (ROC curve area ± SD: 0.73 ± 0.13 for PAOP, p < 0.05 vs ΔPP and 0.69 ± 0.12 for RAP, p = 0.054 compared with ΔPP) than with dynamic indices of preload (0.40 ± 0.13 for ΔPP and 0.53 ± 0.13 for inspiratory changes in RAP, p not significant compared with ΔPP). CONCLUSION: In patients with spontaneous respiratory movements, ΔPP and inspiratory changes in RAP failed to predict the response to volume expansion

Trying to win the war against antibiotics resistance

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Antibiotic strategies in severe nosocomial sepsis: why do we not de-escalate more often?

To assess the use of antibiotic de-escalation in patients with hospital-acquired severe sepsis in an academic setting.Journal ArticleSCOPUS: re.jinfo:eu-repo/semantics/publishe

Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock?

Response to fluid challenge is often defined as an increase in cardiac index (CI) of more than 10-15%. However, in clinical practice CI values are often not available. We evaluated whether changes in mean arterial pressure (MAP) correlate with changes in CI after fluid challenge in patients with septic shock.Journal ArticleSCOPUS: re.jinfo:eu-repo/semantics/publishe

Does basiliximab induction trigger lifethreatening ARDS and shock in young patients after kidney transplantation?

Background. Kidney disease Improving Global Outcomes (KDIGO) guidelines strongly recommend administering an anti-IL-2R mAb (i.e. basiliximab) for induction in all kidney transplant recipients. We describe a life-threatening episode of shock following basiliximab injection and review the literature. Methods and Results: A 20-year-old male was given tacrolimus, methylprednisolone, mycophenolate, and basiliximab, 20 mg in the context of living-related kidney transplantation. On post-operative Day 1 (POD 1), he developed acute respiratory distress syndrome (ARDS), shock, multiple organ failure, and had a cardiac arrest. After effective resuscitation, he received rescue therapies (NO inhalation, extra-corporeal membrane oxygenation, and CVVHD) but lost the graft as the result of cortical necrosis. We conducted PubMed searches that yielded 7 similar cases; 6 required invasive ventilation. Three patients developed cardiac arrest, 3 required major inotropic support, and 2 developed MOF and myocardial depression. All but 1 patient recovered rapidly within a few days. There was no evidence for infectious, allergic, or over-hydration concerns. Although the direct causal role of basiliximab cannot be formally proven, the fact that ARDS at the time of induction therapy with other immunosuppressive agents is otherwise extremely rare suggests a direct role for basiliximab. Conclusions: Basiliximab could be associated with shock and ARDS.JOURNAL ARTICLESCOPUS: re.jinfo:eu-repo/semantics/publishe

Pulse pressure variations to predict fluid responsiveness: Influence of tidal volume

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock?

Response to fluid challenge is often defined as an increase in cardiac index (CI) of more than 10-15%. However, in clinical practice CI values are often not available. We evaluated whether changes in mean arterial pressure (MAP) correlate with changes in CI after fluid challenge in patients with septic shock.Journal ArticleSCOPUS: re.jinfo:eu-repo/semantics/publishe

Nuclear charge radii of neutron-deficeint lead isotopes beyond N=104 midshell investigated by in-source laser spectroscopy

info:eu-repo/semantics/publishe

Paediatric Strategy Forum for medicinal product development for acute myeloid leukaemia in children and adolescents

Purpose The current standard-of-care for front-line therapy for acute myeloid leukaemia (AML) results in short-term and long-term toxicity, but still approximately 40% of children relapse. Therefore, there is a major need to accelerate the evaluation of innovative medicines, yet drug development continues to be adult-focused. Furthermore, the large number of competing agents in rare patient populations requires coordinated prioritisation, within the global regulatory framework and cooperative group initiatives. Methods The fourth multi-stakeholder Paediatric Strategy Forum focused on AML in children and adolescents. Results CD123 is a high priority target and the paediatric development should be accelerated as a proof-of-concept. Efforts must be coordinated, however, as there are a limited number of studies that can be delivered. Studies of FLT3 inhibitors in agreed paediatric investigation plans present challenges to be completed because they require enrolment of a larger number of patients than actually exist. A consensus was developed by industry and academia of optimised clinical trials. For AML with rare mutations that are more frequent in adolescents than in children, adult trials should enrol adolescents and when scientifically justified, efficacy data could be extrapolated. Methodologies and definitions of minimal residual disease need to be standardised internationally and validated as a new response criterion. Industry supported, academic sponsored platform trials could identify products to be further developed. The Leukaemia and Lymphoma Society PedAL/EUpAL initiative has the potential to be a major advance in the field. Conclusion These initiatives continue to accelerate drug development for children with AML and ultimately improve clinical outcomes