Central venous oxygen saturation and emergency intubation – another piece in the puzzle?

A recent multicentre observational study examined the effect of emergency intubation on central venous oxygen saturation (SCVo2) in critically ill patients. The main finding was that SCVo2 significantly increases 15 minutes after emergency intubation and institution of mechanical ventilation with 100% oxygen, especially in those patients with pre-intubation SCVo2 values <70%, regardless of whether these patients suffered from severe sepsis. However, in only one-quarter of this subgroup was the SCVo2 normalized to ≥70% solely by this intervention. In contrast, in patients with pre-intubation SCVo2 ≥70%, the SCVo2 failed to increase after intubation. A rise in SCVo2 can be expected when whole body oxygen extraction remains unchanged after intubation and ventilation with pure oxygen

Sepsis therapy: what's the best for the mitochondria?

It is suspected that mitochondrial dysfunction is a major cause of organ failure in sepsis and septic shock. A study presented in this issue of Critical Care revealed that liver mitochondria from pigs treated with norepinephrine during endotoxaemia exhibit greater in vitro respiratory activity. The investigators provide an elegant demonstration of how therapeutic interventions in sepsis may profoundly influence mitochondrial respiration, but many aspects of mitochondrial function in sepsis remain to be clarified

Which variables are associated with blood glucose levels outside the target range in surgical critically ill patients? A retrospective observational study

<p>Abstract</p> <p>Background</p> <p>The aim of the present study is to determine the variables affecting blood glucose concentrations outside the target range of 80 and 150 mg/dl in critically ill surgical patients.</p> <p>Methods</p> <p>All critically ill surgical patients admitted to a university ICU, from 01/2007 to 12/2008, were surveyed daily using computer assistance with respect to minimal and maximal daily blood glucose concentrations, application of insulin and demographic/clinical variables. Multiple logistic regression for clustered data with backward elimination was performed to identify variables strongly associated with blood glucose concentrations < 80 mg/dl or ≥ 150 mg/dl in 804 patients with an ICU stay > 72 hours.</p> <p>Results</p> <p>Application of insulin (odds ratio (OR) 2.1, with corresponding 95% confidence interval (CI) 1.7; 2.6), noradrenaline (OR 1.4, 95% CI 1.2 - 1.8) or steroids (1.3, 1.003 - 1.7), and age (per year) (1.02, 1.01 - 1.03) were associated with an increased risk of blood glucose concentrations < 80 mg/dl. In analogy, application of insulin (OR 2.4, 95% CI 2.0 - 2.7), noradrenaline (1.4, 1.2 - 1.6) or steroids (1.4, 1.2 - 1.7), severe sepsis (1.2, 1.1 - 1.4), neurosurgery (OR 1.0) compared to abdominal, vascular and trauma surgery, and age (per year) (1.01, 1.01 - 1.02), were associated with an increased risk of blood glucose concentrations ≥ 150 mg/dl.</p> <p>Conclusions</p> <p>Critically ill surgical patients are at an increased risk for fluctuating blood glucose concentrations ranging < 80 mg/dl or ≥ 150 mg/dl in particular if they are of advanced age and require administration of insulin, noradrenaline, and/or steroids. Patients who underwent neurosurgery and/or presented with severe sepsis/shock are those in particular at risk for blood glucose concentrations ≥ 150 mg/dl.</p

Ubiquitous Computing. Summary

Ubiquitous computing - the complex electronic networking of things that communicate - is considered a promising innovation path worldwide. Intensive R&D activities and political strategies are aimed at promoting practical technologies and applications. Where do we currently stand on the path to the "Internet of Things"? Which practical projects already show the potential that can be exploited by implementing the basic idea of ubiquitous computing? What technical, legal and social challenges must be overcome to achieve this - and what can be the contribution of politics? In the light of these questions, the authors analyse the status quo and the perspectives of ubiquitous computing and illustrate their findings with examples from trade, logistics and health care, among others. the fascinating "Brownie technology" of ubiquitous computing must, however, still be comprehensively made fit by those involved in business, society and politics if its applications are really to become economically attractive, socially acceptable and helpful in overcoming social problems

Vasopressin in vasodilatory shock: is the heart in danger?

In patients with hyperdynamic hemodynamics, infusing arginine vasopressin (AVP) in advanced vasodilatory shock is usually accompanied by a decrease in cardiac output and in visceral organ blood flow. Depending on the infusion rate, this vasoconstriction also reduces coronary blood flow despite an increased coronary perfusion pressure. In a porcine model of transitory myocardial ischemia-induced left ventricular dysfunction, Müller and colleagues now report that the AVP-related coronary vaso-constriction may impede diastolic relaxation while systolic contraction remains unaffected. Although any AVP-induced myocardial ischemia undoubtedly is a crucial safety issue, these findings need to be discussed in the context of the model design, the dosing of AVP as well as the complex direct, afterload-independent and systemic, vasoconstriction-related effects on the heart

Year in review 2007: Critical Care – shock

The research papers on shock published in Critical Care throughout 2007 are related to three major subjects: the modulation of the macrocirculation and microcirculation during shock, focusing on arginine vasopressin, erythropoietin and nitric oxide; studies on metabolic homeostasis (acid–base status, energy expenditure and gastrointestinal motility); and basic supportive measures in critical illness (fluid resuscitation and sedation, and body-temperature management). The present review summarizes the key results of these studies and provides a brief discussion in the context of the relevant scientific and clinical background

Of mice and men (and sheep, swine etc.): The intriguing hemodynamic and metabolic effects of hydrogen sulfide (H2S)

Whether the hydrogen sulfide (H2S)-induced metabolic depression observed in awake rodents exists in larger species is controversial. Therefore, Derwall and colleagues exposed anesthetized and ventilated sheep to incremental H2S concentrations by means of an extracorporeal membrane oxygenator. H2S caused pulmonary vasoconstriction and metabolic acidosis at the highest concentration studied. Oxygen uptake and carbon dioxide production remained in the physiological range. The authors concluded that, beyond the effect of temperature, H2S hardly modifies metabolism at all. Since the highest H2S concentration caused toxic side effects (possibly due to an inhibition of mitochondrial respiration), the therapeutic use of inhaled H2S should be cautioned

Methylene Blue as a Facilitator to Reverse Effects of Developmental Iron Deficiency

Faculty Advisor: Dr. Michael GeorgieffThis research was supported by the Undergraduate Research Opportunities Program (UROP) and NIH National Institute of Child Health and Development Grant R01-HD094809

Developmental and regional changes in the neurochemical profile of the rat brain determined by in vivo 1H NMR spectroscopy

Sixteen metabolites were quantified from 11-24 micro l volumes in three different brain regions (hippocampus, striatum, and cerebral cortex) during postnatal development. Rat pups from the same litter were repeatedly measured on postnatal days 7, 10, 14, 21, and 28 using a completely noninvasive and longitudinal study design. Metabolite quantification was based on ultra-short echo-time (1)H NMR spectroscopy at 9.4 T and LCModel processing. Most of the brain metabolites were quantified with Cramer-Rao lower bounds (CRLB) less than 20%, which corresponded to an estimated concentration error <0.2 micro mol/g. Taurine and total creatine were quantified with CRLB < or = 5% from all 114 processed spectra. The resulting high reliability and reproducibility revealed significant regional and age-related changes in metabolite concentrations. The most sensitive markers for developmental and regional variations between hippocampus, striatum, and cerebral cortex were N-acetylaspartate, myo-inositol, taurine, glutamate, and choline compounds. Absolute values of metabolite concentrations were in very good agreement with previously published in vitro results based on chromatographic measurements of brain extracts. The current data may serve as a reference for studies focused on developmental defects and pathologies using neonatal rat models

Mitophagy-Related Cell Death Mediated by Vacquinol-1 and TRPM7 Blockade in Glioblastoma IV

Glioblastoma IV (GBM) is one of the deadliest malignant diseases in adults and is characterized by a high mutation rate and multiple traits to suppress inborn and acquired immunity. We here approached autophagy-related cell death in newly established GBM cell lines derived from individual tumor isolates. Treatment with a small molecule, termed Vacquinol-1 (Vac) exhibited 100% GBM cell death, which was related to mitochondrial dysfunction, calcium-induced endoplasmic reticulum (ER)-stress, and autophagy. The toxicity of Vac was significantly increased by the inhibition of transient receptor potential cation channel, subfamily M, member 7 (TRPM7). TRPM7 is overexpressed in GBM as well as in many other tumors and thus may be a potential target by the natural compound carvacrol. Of note, at higher concentrations, Vac also induced growth inhibition and cell death in non-transformed cell types. However, in the presence of the TRPM7 inhibitor carvacrol, the tumor-selective effect of Vac was very much increased. Results given in the present study are based on long-term video microscopy using IncuCyteZOOM®, calcium measurements, and 3D ultrastructural analysis using the cryofixed material