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The future of critical care medicine will be shaped not only by the evidence-validated foundations of science, but also by innovations based on unproven and, in many cases, untested concepts and thoughtful visions of scientists and clinicians familiar with the complex problems actually faced in clinical practice. Clinical investigations and trials often lag behind collective experience and impressions, in a well-intentioned and necessary quest to determine the fallacy or validity of ongoing practice. Progress made in this way can be painfully slow, and imperfect theory may prove difficult to challenge. On occasion, an innovative paradigm shift fostered by a novel approach can reorient the forces of academic investigation toward generating an evidence base upon which such concepts and interpretations can find scientific justification. This discussion presents a selected set of ideas to improve the future practice of critical care - each having a defensible rationale, but unconfirmed validity.
info:eu-repo/semantics/published
From the currently available published data, it is difficult to determine whether there is a relationship between the age of transfused RBCs and outcome in adult patients, except possibly in trauma patients receiving massive transfusion.
We describe a patient who experienced a prolonged episode of hypoglycemia secondary to an acute voluntary intoxication with diphenylhydantoin 20 g and zopiclone 225 mg. This hypoglycemic episode was presumptively attributed to diphenylhydantoin and might be due either to an escape from the inhibitory effects of diphenylhydantoin on insulin secretion or an increased sensitivity of the tissues to insulin. Zopiclone was considered less likely since zopiclone overdoses have been only exceptionally associated with hyperglycemia.
SCOPUS: le.j
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
Bacterial colonization of the airways can lead to nosocomial respiratory infections. The emergence of Gram-negative bacteria in the upper airways is usual in critical conditions. Antimicrobial therapy and especially bacterial adherence to the airways mucosa have been incriminated in the selection of Gram-negative bacteria becoming ultimately multiresistant. Transmission of bacteria by the hands of the ICU-personnel and aspiration of bacteria represent two important factors in the airway colonization. Bacterial clearance can simultaneously be impaired by debility and altered mental state. Pulmonary infections are especially common in peritonitis or after abdominal surgery. In a series of 30 patients who had a complicated course after abdominal surgery, we observed that in all patients with acute respiratory failure, sputum cultus yielded at least one microorganism also recovered from cultus of the abdominal secretions. Acute respiratory failure was most commonly due to respiratory infection and carried a worse prognosis. Aspiration of bacteria from the gastrointestinal tract appears to represent the most common source of nosocomial bronchopulmonary superinfection in the critically ill.
