Steroids in sepsis: another swing of the pendulum in our clinical trials

Many studies have been conducted to try and find interventions to treat patients with severe sepsis, but with little success. In several cases, initial apparent beneficial effects have not been confirmed in later trials. The story of steroids in sepsis is one example of this pendulum effect, with initial success in the study by Annane et al. tempered by the more recent negative results of the Corticus study. The reasons for this pendulum effect are likely related, at least in part, to issues of clinical trial design and the way in which clinical trials in intensive care unit patients are developed, conducted and assessed needs to be critically reassessed

Microvascular endothelial dysfunction: a renewed appreciation of sepsis pathophysiology

Severe sepsis, defined as sepsis associated with acute organ dysfunction, results from a generalized inflammatory and procoagulant host response to infection. Coagulopathy in severe sepsis is commonly associated with multiple organ dysfunction, and often results in death. The molecule that is central to these effects is thrombin, although it may also have anticoagulant and antithrombotic effects through the activation of Protein C and induction of prostacyclin. In recent years, it has been recognized that chemicals produced by endothelial cells play a key role in the pathogenesis of sepsis. Thrombomodulin on endothelial cells coverts Protein C to Activated Protein C, which has important antithrombotic, profibrinolytic and anti-inflammatory properties. A number of studies have shown that Protein C levels are reduced in patients with severe infection, or even in inflammatory states without infection. Because coagulopathy is associated with high mortality rates, and animal studies have indicated that therapeutic intervention may result in improved outcomes, it was rational to initiate clinical studies

A reappraisal for the use of pulmonary artery catheters

EditorialSCOPUS: ed.jinfo:eu-repo/semantics/publishedSuppl

Fluid management: the pharmacoeconomic dimension

Cost is a key concern in fluid management. Relatively few data are available that address the comparative total costs of care between different fluid management regimens in particular clinical indications. Relevant costs of fluid-associated morbidity and mortality, including those incurred after intensive care unit or hospital discharge, also need to be considered in evaluating the cost-benefit ratios of administered fluids. Rigorously designed pharmacoeconomic studies are needed to delineate the costs and benefits of various approaches to fluid management

Understanding cardiac output

Cardiac output is the amount of blood the heart pumps in 1 minute, and it is dependent on the heart rate, contractility, preload, and afterload. Understanding of the applicability and practical relevance of each of these four components is important when interpreting cardiac output values. In the present article, we use a simple analogy comparing cardiac output with the speed of a bicycle to help appreciate better the effects of various disease processes and interventions on cardiac output and its four components

Critical Care's move to fund open access

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

Inter-sensor propagation delay estimation using sources of opportunity

Propagation delays are intensively used for Structural Health Monitoring or Sensor Network Localization. In this paper, we study the performances of acoustic propagation delay estimation between two sensors, using sources of opportunity only. Such sources are defined as being uncontrolled by the user (activation time, location, spectral content in time and space), thus preventing the direct estimation with classical active approaches, such as TDOA, RSSI and AOA. Observation models are extended from the literature to account for the spectral characteristics of the sources in this passive context and we show how time-filtered sources of opportunity impact the retrieval of the propagation delay between two sensors. A geometrical analogy is then proposed that leads to a lower bound on the variance of the propagation delay estimation that accounts for both the temporal and the spatial properties of the sources field

On the Voting Power of an Alliance and the Subsequent Power of its Members

Even, and in fact chiefly, if two or more players in a voting gamehave on a binary issue independent opinions, they may haveinterest to form a single voting alliance giving an average gainof influence for all of them. Here, assuming the usualindependence of votes, we first study the alliance voting powerand obtain new results in the so-called asymptotic limit for whichthe number of players is large enough and the alliance weightremains a small fraction of the total of the weights. Then, wepropose to replace the voting game inside the alliance by a randomgame which allows new possibilities. The validity of theasymptotic limit and the possibility of new alliances are examinedby considering the decision process in the Council of Ministers ofthe European Union.Voting Power; Alliance