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Intensive Care Medicine Experimental

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https://www.readbyqxmd.com/read/29926288/allostasis-and-sedation-practices-in-intensive-care-evaluation-an-observational-pilot-study
#1
John P R Moore, Chris Anstey, Lauren Murray, John F Fraser, Mervyn Singer
BACKGROUND: A dysregulated stress response has been implicated in the pathogenesis of critical illness. Sedative agents utilised in the critically unwell patient may impact upon the stress response with a downstream negative effect on multiple organ systems. This study was designed to assess the feasibility of investigating components of the stress response as a sub-study of the current SPICE-III study (NCT01728558). METHODS: This pilot observational cohort study was conducted in a single intensive care unit in Queensland, Australia...
June 20, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29728790/in-vitro-comparison-of-the-adsorption-of-inflammatory-mediators-by-blood-purification-devices
#2
Benjamin Malard, Corine Lambert, John A Kellum
BACKGROUND: Septic shock, a leading cause of acute kidney injury, induces release of pro-/anti-inflammatory mediators, leading to increased mortality and poor renal recovery. This is the first in vitro study directly comparing three single-use blood purification devices in terms of removing sepsis-associated mediators and endotoxins. METHODS: In vitro hemoperfusion was performed using oXiris® , CytoSorb® , and Toraymyxin® . Heparinized human plasma from healthy volunteers was pre-incubated with pathologic quantities of inflammatory mediators and filtered in a closed-loop circulation model for 2 h...
May 4, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29675732/bias-flow-rate-and-ventilation-efficiency-during-adult-high-frequency-oscillatory-ventilation-a-lung-model-study
#3
Osamu Nagano, Tetsuya Yumoto, Atsunori Nishimatsu, Shunsuke Kanazawa, Takahisa Fujita, Sunao Asaba, Hideo Yamanouchi
BACKGROUND: Bias flow (BF) is essential to maintain mean airway pressure (MAP) and to washout carbon dioxide (CO2 ) from the oscillator circuit during high-frequency oscillatory ventilation (HFOV). If the BF rate is inadequate, substantial CO2 rebreathing could occur and ventilation efficiency could worsen. With lower ventilation efficiency, the required stroke volume (SV) would increase in order to obtain the same alveolar ventilation with constant frequency. The aim of this study was to assess the effect of BF rate on ventilation efficiency during adult HFOV...
April 19, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29654387/serum-chloride-levels-in-critical-illness-the-hidden-story
#4
REVIEW
Carmen Andrea Pfortmueller, Dominik Uehlinger, Stephan von Haehling, Joerg Christian Schefold
No abstract text is available yet for this article.
April 13, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29633056/positional-effects-on-the-distributions-of-ventilation-and-end-expiratory-gas-volume-in-the-asymmetric-chest-a-quantitative-lung-computed-tomographic-analysis
#5
Gustavo A Cortes-Puentes, Kenneth E Gard, Alexander B Adams, David J Dries, Michael Quintel, Richard A Oeckler, Luciano Gattinoni, John J Marini
BACKGROUND: Body positioning affects the configuration and dynamic properties of the chest wall and therefore may influence decisions made to increase or decrease ventilating pressures and tidal volume. We hypothesized that unlike global functional residual capacity (FRC), component sector gas volumes and their corresponding regional tidal expansions would vary markedly in the setting of unilateral pleural effusion (PLEF), owing to shifting distributions of aeration and collapse as posture changed...
April 10, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29616357/preliminary-experience-on-the-safety-and-tolerability-of-mechanical-insufflation-exsufflation-in-subjects-with-artificial-airway
#6
Miguel Sánchez-García, Passio Santos, Gema Rodríguez-Trigo, Fernando Martínez-Sagasti, Tomás Fariña-González, Ángela Del Pino-Ramírez, Carlos Cardenal-Sánchez, Beatriz Busto-González, Mónica Requesens-Solera, Mercedes Nieto-Cabrera, Francisco Romero-Romero, Antonio Núñez-Reiz
BACKGROUND: Catheter suctioning of respiratory secretions in intubated subjects is limited to the proximal airway and associated with traumatic lesions to the mucosa and poor tolerance. "Mechanical insufflation-exsufflation" exerts positive pressure, followed by an abrupt drop to negative pressure. Potential advantages of this technique are aspiration of distal airway secretions, avoiding trauma, and improving tolerance. METHODS: We applied insufflation of 50 cmH2 O for 3 s and exsufflation of - 45 cmH2 O for 4 s in patients with an endotracheal tube or tracheostomy cannula requiring secretion suctioning...
April 3, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29546563/a-high-flow-nasal-cannula-system-with-relatively-low-flow-effectively-washes-out-co-2-from-the-anatomical-dead-space-in-a-sophisticated-respiratory-model-made-by-a-3d-printer
#7
Yu Onodera, Ryo Akimoto, Hiroto Suzuki, Masayuki Okada, Masaki Nakane, Kaneyuki Kawamae
BACKGROUND: Although clinical studies of the high-flow nasal cannula (HFNC) and its effect on positive end-expiratory pressure (PEEP) have been done, the washout effect has not been well evaluated. Therefore, we made an experimental respiratory model to evaluate the respiratory physiological effect of HFNC. METHODS: An airway model was made by a 3D printer using the craniocervical 3D-CT data of a healthy 32-year-old male. CO2 was infused into four respiratory lung models (normal-lung, open- and closed-mouth models; restrictive- and obstructive-lung, open-mouth models) to maintain the partial pressure of end-tidal CO2 (PET CO2 ) at 40 mmHg...
March 15, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29532189/extracorporeal-membrane-oxygenation-line-associated-complications-in-vitro-testing-of-cyanoacrylate-tissue-adhesive-and-securement-devices-to-prevent-infection-and-dislodgement
#8
Taressa Bull, Amanda Corley, Danielle J Smyth, David J McMillan, Kimble R Dunster, John F Fraser
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) delivers cardiac and/or respiratory support to critically ill patients who have failed conventional medical therapies. If the large-bore cannulas used to deliver ECMO become infected or dislodged, the patient consequences can be catastrophic. ECMO cannula-related infection has been reported to be double the rate of other vascular devices (7.1 vs 3.4 episodes/1000 ECMO days respectively). The aim of this study was to assess the ability of cyanoacrylate tissue adhesive (TA) to inhibit bacterial growth at the ECMO cannulation site, and the effectiveness of TA and securement devices in securing ECMO cannulas and tubing...
March 12, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29404815/intra-cellular-lactate-concentration-in-t-lymphocytes-from-septic-shock-patients-a-pilot-study
#9
Thibaut Girardot, Thomas Rimmelé, Guillaume Monneret, Julien Textoris, Fabienne Venet
BACKGROUND: Sepsis-associated hyperlactatemia is a widely used biomarker, associated with initial severity and poor outcomes. This increased circulating lactate concentration has been proposed to result in part from a mismatch between oxygen delivery and demand in organs. However, other mechanisms may participate. In particular, a metabolic reprogramming similar to the Warburg effect initially described in cancer cells could lead to increased lactate production by immune cells such as T lymphocytes after sepsis...
February 5, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29383459/alterations-in-mitochondrial-respiration-and-reactive-oxygen-species-in-patients-poisoned-with-carbon-monoxide-treated-with-hyperbaric-oxygen
#10
David H Jang, Utsha G Khatri, Brenna P Shortal, Matthew Kelly, Kevin Hardy, David S Lambert, David M Eckmann
BACKGROUND: Carbon monoxide (CO) poisoning is the leading cause of poisoning mortality and morbidity in the USA. Carboxyhemoglobin (COHb) levels are not predictive of severity or prognosis. At this time, the measurement of mitochondrial respiration may serve as a biomarker in CO poisoning. The primary objective of this study was to assess changes in mitochondrial function consisting of respiration and generation of reactive oxygen species (ROS) in peripheral blood mononuclear cells (PBMCs) obtained from patients with CO poisoning...
January 30, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29380160/peep-titration-the-effect-of-prone-position-and-abdominal-pressure-in-an-ards-model
#11
Joseph C Keenan, Gustavo A Cortes-Puentes, Lei Zhang, Alex B Adams, David J Dries, John J Marini
BACKGROUND: Prone position and PEEP can both improve oxygenation and other parameters, but their interaction has not been fully described. Limited data directly compare selection of mechanically "optimal" or "best" PEEP in both supine and prone positions, either with or without changes in chest wall compliance. To compare best PEEP in these varied conditions, we used an experimental ARDS model to compare the mechanical, gas exchange, and hemodynamic response to PEEP titration in supine and prone position with varied abdominal pressure...
January 30, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29340799/fully-automated-life-support-an-implementation-and-feasibility-pilot-study-in-healthy-pigs
#12
Wilfried Klingert, Jörg Peter, Christian Thiel, Karolin Thiel, Wolfgang Rosenstiel, Kathrin Klingert, Christian Grasshoff, Alfred Königsrainer, Martin Schenk
BACKGROUND: Automated systems are available in various application areas all over the world for the purpose of reducing workload and increasing safety. However, such support systems that would aid caregivers are still lacking in the medical sector. With respect to workload and safety, especially, the intensive care unit appears to be an important and challenging application field. Whereas many closed-loop subsystems for single applications already exist, no comprehensive system covering multiple therapeutic aspects and interactions is available yet...
January 16, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29327145/hla-dr-expression-in-neonates-after-cardiac-surgery-under-cardiopulmonary-bypass-a-pilot-study
#13
LETTER
Alexis Chenouard, Cécile Braudeau, Nicolas Cottron, Pierre Bourgoin, Nina Salabert, Antoine Roquilly, Régis Josien, Nicolas Joram, Karim Asehnoune
Monocyte HLA-DR expression has been reported as a marker of immunosuppression and a predictor of sepsis development. However, to date, there is no report on monocyte HLA-DR monitoring exclusively in neonates (< 28 days of life) who underwent cardiac surgery under cardiopulmonary bypass (CPB), which have a high risk of nosocomial infection. In this pilot study, we studied nine neonates with a diagnosis of congenital heart disease requiring surgery under CPB. There was a significant reduction in monocyte HLA-DR expression for the first two postoperative days, as compared to preoperatively (p = 0...
January 11, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29264668/volume-replacement-ratio-for-crystalloids-and-colloids-during-bleeding-and-resuscitation-an-animal-experiment
#14
Ildikó László, Gábor Demeter, Nándor Öveges, Dániel Érces, József Kaszaki, Krisztián Tánczos, Zsolt Molnár
BACKGROUND: Fluid resuscitation remains a cornerstone in the management of acute bleeding. According to Starling's "Three-compartment model", four-times more crystalloids have the same volume effect as colloids. However, this volume-replacement ratio remains a controversial issue as it may be affected by the degradation of the endothelial glycocalyx layer, a situation often found in the critically ill. Our aim was to compare colloid and crystalloid based fluid resuscitation during an experimental stroke volume index (SVI) guided hemorrhage and resuscitation animal model...
December 20, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29230608/combinatorial-therapy-with-two-pro-coagulants-and-one-osmotic-agent-reduces-the-extent-of-the-lesion-in-the-acute-phase-of-spinal-cord-injury-in-the-rat
#15
Mathieu Boutonnet, Elisabeth Laemmel, Eric Vicaut, Jacques Duranteau, Marc Soubeyrand
BACKGROUND: Spinal cord injury (SCI) is a complex disease that leads to a motor, sensitive, and vegetative impairment. So far, single therapies are ineffective for treating SCI in humans and a multifactorial therapeutic approach may be required. The aim of this work was to assess the effect of a triple therapy (TT) associating two pro-coagulant therapies (tranexamic acid and fibrinogen) with an anti-edema therapy (hypertonic saline solution), on the extent of the lesion 24 h post-injury...
December 11, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28779451/hemoadsorption-corrects-hyperresistinemia-and-restores-anti-bacterial-neutrophil-function
#16
Anthony Bonavia, Lauren Miller, John A Kellum, Kai Singbartl
BACKGROUND: Mounting evidence suggests that sepsis-induced morbidity and mortality are due to both immune activation and immunosuppression. Resistin is an inflammatory cytokine and uremic toxin. Septic hyperresistinemia (plasma resistin >20 ng/ml) has been associated with greater disease severity and worse outcomes, and it is further exacerbated by concomitant acute kidney injury (AKI). Septic hyperresistinemia disturbs actin polymerization in neutrophils leading to impaired neutrophil migration, a crucial first-line mechanism in host defense to bacterial infection...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28770541/optimal-esophageal-balloon-volume-for-accurate-estimation-of-pleural-pressure-at-end-expiration-and-end-inspiration-an-in-vitro-bench-experiment
#17
Yan-Lin Yang, Xuan He, Xiu-Mei Sun, Han Chen, Zhong-Hua Shi, Ming Xu, Guang-Qiang Chen, Jian-Xin Zhou
BACKGROUND: Esophageal pressure, used as a surrogate for pleural pressure, is commonly measured by air-filled balloon, and the accuracy of measurement depends on the proper balloon volume. It has been found that larger filling volume is required at higher surrounding pressure. In the present study, we determined the balloon pressure-volume relationship in a bench model simulating the pleural cavity during controlled ventilation. The aim was to confirm whether an optimal balloon volume range existed that could provide accurate measurement at both end-expiration and end-inspiration...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28766276/impact-of-membrane-lung-surface-area-and-blood-flow-on-extracorporeal-co2-removal-during-severe-respiratory-acidosis
#18
Christian Karagiannidis, Stephan Strassmann, Daniel Brodie, Philine Ritter, Anders Larsson, Ralf Borchardt, Wolfram Windisch
BACKGROUND: Veno-venous extracorporeal CO2 removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates through the device range from 200 ml/min to more than 1500 ml/min, and the membrane surface areas range from 0.35 to 1.3 m(2). The present study in an animal model with similar CO2 production as an adult patient was aimed at determining the optimal membrane lung surface area and technical requirements for successful vv-ECCO2R. METHODS: Four different membrane lungs, with varying lung surface areas of 0...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28702940/heart-rate-variability-in-critical-care-medicine-a-systematic-review
#19
Shamir N Karmali, Alberto Sciusco, Shaun M May, Gareth L Ackland
BACKGROUND: Heart rate variability (HRV) has been used to assess cardiac autonomic activity in critically ill patients, driven by translational and biomarker research agendas. Several clinical and technical factors can interfere with the measurement and/or interpretation of HRV. We systematically evaluated how HRV parameters are acquired/processed in critical care medicine. METHODS: PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (1996-2016) were searched for cohort or case-control clinical studies of adult (>18 years) critically ill patients using heart variability analysis...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28699088/sepsis-prediction-in-critically-ill-patients-by-platelet-activation-markers-on-icu-admission-a-prospective-pilot-study
#20
Nathalie Layios, Céline Delierneux, Alexandre Hego, Justine Huart, Christian Gosset, Christelle Lecut, Nathalie Maes, Pierre Geurts, Arnaud Joly, Patrizio Lancellotti, Adelin Albert, Pierre Damas, André Gothot, Cécile Oury
BACKGROUND: Platelets have been involved in both immune surveillance and host defense against severe infection. To date, whether platelet phenotype or other hemostasis components could be associated with predisposition to sepsis in critical illness remains unknown. The aim of this work was to identify platelet markers that could predict sepsis occurrence in critically ill injured patients. METHODS: This single-center, prospective, observational, 7-month study was based on a cohort of 99 non-infected adult patients admitted to ICUs for elective cardiac surgery, trauma, acute brain injury, and post-operative prolonged ventilation and followed up during ICU stay...
December 2017: Intensive Care Medicine Experimental
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