La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 12 avril 2016
The respiratory system is key to the management of patients with respiratory, as well as haemodynamic, compromise and should be monitored. The ventilator is more than just a machine that delivers gas; it is a true respiratory system monitoring device, allowing the measurement of airway pressures and intrinsic positive end-expiratory pressure and the plotting of pressure/volume curves. For effective and reliable monitoring, it is necessary to keep in mind the physiology, such as the alveolar gas equation, heart-lung interactions, the equation of movement, etc. Monitoring the respiratory system enables adaptation of not only respiratory management, but also haemodynamic management.
We believe severity of illness scores are poor surrogates for risk stratification and should not be used as a criterion for patient enrollment into clinical trials or as the basis for individual treatment decisions.
Dept. of Anesthesiology and Intensive Care, Friedrich Schiller University, Jena, Germany (Sakr, Reinhart, Vincent) Dept. of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium (Gerlach)
Introduction Septic patients frequently develop critical illness myopathies (CIMs) that may represent a crucial factor for prolonged intensive care unit treatment and for ventilator weaning delay. Experimental fi ndings have identifi ed that oxidative stress plays a role in causing muscle depletion in chronic pathological states like sepsis. It is well documented that regular moderate physical exercise can decreased oxidative stress and enhance antioxidant functions. Objective To investigate whether exercise training reduces oxidative damage in septic rats induced by cecal ligation and perforation (CLP). Methods Wistar rats were randomly assigned to three groups: Sham (submitted to a fake surgery), CLP, and CLP that was previously trained (CLPT). The exercise training protocol consisted of 8 weeks of running on a treadmill, 5 days/week, for 60 minutes at 60% of the maximal running speed obtained on the graded treadmill test. Rats were subjected to CLP surgery; after 120 hours of surgical procedure they were killed by decapitation. Oxidative damage of lipids (thiobarbituric acid reactive species (TBARS)) and proteins (carbonyl groups) were analyzed in Soleus (type I fi ber) and plantaris (type II fi ber) muscles. Results See Table
Nosocomial infections are common in many hospital departments, but particularly so on the intensive care unit, where they affect some 20 to 30% of patients. While early diagnosis and appropriate treatment are, of course, important, perhaps the greatest challenge is in the application of techniques to limit the development of such infections. This review will briefly discuss some of the background pathophysiology and epidemiology of nosocomial infection, and then focus on general and infection-specific preventative strategies individually and as part of broader infection-control programs with infection surveillance.
