Publications

www.clinicaltrials.gov: NCT00511186.

Introduction: Hyperosmotic agents are the mainstay of therapy for intra-cranial hypertension. However, little is known about the cerebral metabolic response to different hyper-osmotic agents. Methods: Pigs (35–45 Kg), anesthetized using a continuous intravenous infusion of midazolam, fentanyl and rocuronium, were managed to achieve normal cardiac output and mean arterial pressure and ventilated to maintain normoxia, normocapnia and normal cerebral perfusion. A balloon catheter was used to increase intracranial pressure (ICP). When ICP reached 30 mmHg, animals were randomized to receive one iso-osmolar load of 255 mOsm/dose of either 20% mannitol (M20%) or 7.45% hypertonic saline (HS 7.45%) as a 30 min bolus through a central vein. The effectiveness of the solution to decrease ICP was arbitrarily defined as an ICP decrease of ≥3 mmHg after the infusion. Measurements of cerebral perfusion (intra-parenchymal pressure, cerebral perfusion pressure, brain oxygen tension, PtO2), systemic perfusion (mean arterial pressure [MAP], cardiac output (CO), serum lactate) and neuronal response (lactate/pyruvate ratio, L/P) were taken at baseline (twice), at ICPs of 15 and 30 mmHg and at T30, T60, T120 and T180 min after the end of the infusion. After 5 hours, the animal was sacrificed. A linear mixed model was used to analyze the time courses of considered variables. Results: All values are express as mean (SD). HS 7.45% administration resulted in lower ICP at T180 min: 27.1 mmHg (11.64) vs. 36.1 mmHg (11.9); mean difference: 9 mmHg ±4.2;p=0.04) and higher PtO2 at T180: 41.0 (14.9) vs. 21.7 (13.1); mean difference: 19.2 mmHg ±7.1 mmHg, p=0.01. We found no significant difference in the L/P ratio at T180 min: 67.5 (31.8) vs. 65.4 (115.41); mean difference: 2.1 ± 34.2, p=0.95, or on MAP, CO or lactate levels between the two groups. Conclusions: In this model, administration of HS 7.45% was more effective than M20% in reducing ICP and increasing PtbO2. These differences were not associated with significant differences in systemic variables or regional metabolism.

This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

ClinicalTrials.gov Identifier: NCT02622724.

In an international scenario, testing frequency for viruses in CAP is very low. The most common cause of viral CAP is Influenza virus. Obesity and need for invasive ventilation represent independent risk factors for viral CAP. Adherence to recommendations for treatment with oseltamivir is poor.