Biomarkers of acute lung injury: worth their salt?

The validation of biomarkers has become a key goal of translational biomedical research. The purpose of this article is to discuss the role of biomarkers in the management of acute lung injury (ALI) and related research. Biomarkers should be sensitive and specific indicators of clinically important processes and should change in a relevant timeframe to affect recruitment to trials or clinical management. We do not believe that they necessarily need to reflect pathogenic processes. We critically examined current strategies used to identify biomarkers and which, owing to expedience, have been dominated by reanalysis of blood derived markers from large multicenter Phase 3 studies. Combining new and existing validated biomarkers with physiological and other data may add predictive power and facilitate the development of important aids to research and therapy

The European Respiratory Society and European Society of Thoracic Surgeon guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer.

The European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS) established a joint task force with the purpose to develop clinical evidence-based guidelines on evaluation of fitness for radical therapy in patients with lung cancer. The following topics were discussed, and are summarized in the final report along with graded recommendations: Cardiologic evaluation before lung resection; lung function tests and exercise tests (limitations of ppoFEV1; DLCO: systematic or selective?; split function studies; exercise tests: systematic; low-tech exercise tests; cardiopulmonary (high tech) exercise tests); future trends in preoperative work-up; physiotherapy/rehabilitation and smoking cessation; scoring systems; advanced care management (ICU/HDU); quality of life in patients submitted to radical treatment; combined cancer surgery and lung volume reduction surgery; compromised parenchymal sparing resections and minimally invasive techniques: the balance between oncological radicality and functional reserve; neoadjuvant chemotherapy and complications; definitive chemo and radiotherapy: functional selection criteria and definition of risk; should surgical criteria be re-calibrated for radiotherapy?; the patient at prohibitive surgicalrisk: alternatives to surgery; who should treat thoracic patients and where these patients should be treated

Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice? A survey among members of the European Society of Thoracic Surgeons (ESTS) and the Thoracic Oncology Section of the Europen Respiratory Society (ERS)

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Intraoperative ventilation: incidence and risk factors for receiving large tidal volumes during general anesthesia

<p>Abstract</p> <p>Background</p> <p>There is a growing concern of the potential injurious role of ventilatory over-distention in patients without lung injury. No formal guidelines exist for intraoperative ventilation settings, but the use of tidal volumes (V_T) under 10 mL/kg predicted body weight (PBW) has been recommended in healthy patients. We explored the incidence and risk factors for receiving large tidal volumes (V_T> 10 mL/kg PBW).</p> <p>Methods</p> <p>We performed a cross-sectional analysis of our prospectively collected perioperative electronic database for current intraoperative ventilation practices and risk factors for receiving large tidal volumes (V_T> 10 mL/kg PBW). We included all adults undergoing prolonged (≥ 4 h) elective abdominal surgery and collected demographic, preoperative (comorbidities), intraoperative (i.e. ventilatory settings, fluid administration) and postoperative (outcomes) information. We compared patients receiving exhaled tidal volumes > 10 mL/kg PBW with those that received 8-10 or < 8 mL/kg PBW with univariate and logistic regression analyses.</p> <p>Results</p> <p>Ventilatory settings were non-uniform in the 429 adults included in the analysis. 17.5% of all patients received V_T> 10 mL/kg PBW. 34.0% of all obese patients (body mass index, BMI, ≥ 30), 51% of all patients with a height < 165 cm, and 34.6% of all female patients received V_T> 10 mL/kg PBW.</p> <p>Conclusions</p> <p>Ventilation with V_T> 10 mL/kg PBW is still common, although poor correlation with PBW suggests it may be unintentional. BMI ≥ 30, female gender and height < 165 cm may predispose to receive large tidal volumes during general anesthesia. Further awareness of patients' height and PBW is needed to improve intraoperative ventilation practices. The impact on clinical outcome needs confirmation.</p

ERS-ESTS guidelines on fitness for surgery and radiochemotherapy in lung cancer patients.

The European Respiratory Society (ERS), in collaboration with the European Society of Thoracic Surgery (ESTS), has proposed to bring together multidisciplinary experts on functional evaluation of lung cancer patients to draw up recommendations in order to provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy.The subject was divided in different topics, which were in turn assigned to at least two experts. The authors searched the literature according to their own strategies, no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted by the entire expert panel. The evidence supporting each recommendation was summarized, and graded as described by the Scottish intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk-stratification of the lung resection candidatesemphasizing cardiologic evaluation, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before radio-chemotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialized settings by multidisciplinary teams

Myroides odoratimimus urinary tract infection in an immunocompromised patient: An emerging multidrug-resistant micro-organism

Myroides spp. are common environmental organisms and they can be isolated predominantly in water, soil, food and in sewage treatment plants. In the last two decades, an increasing number of infections such as urinary tract infections and skin and soft tissue infections, caused by these microorganisms has been reported. Selection of appropriate antibiotic therapy to treat the infections caused by Myroides spp. is difficult due to the production of a biofilm and the organism's intrinsic resistance to many antibiotic classes. Case presentation: We report the case of a 69-year-old immunocompromised patient who presented with repeated episodes of macroscopic haematuria, from Northern Italy. A midstream urine sample cultured a Gram negative rod in significant amounts (> 105 colony-forming units (cfu)/mL), which was identified as Myroides odoratimimus. The patient was successfully treated with trimethoprim/sulfamethoxazole after antibiotic susceptibility testing confirmed its activity. Conclusion: This case underlines the emergence of multidrug resistant Myroides spp. which are ubiquitous in the environment and it demands that clinicians should be more mindful about the role played by atypical pathogens, which may harbour or express multidrug resistant characteristics, in immunocompromised patients or where there is a failure of empiric antimicrobial therapy