Cardiopulmonary interactions and volume status assessment.

Assessment of the hemodynamics and volume status is an important daily task for physicians caring for critically ill patients. There is growing consensus in the critical care community that the "traditional" methods-e.g.

Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU.

Background: Patients undergoing alcohol withdrawal in the intensive care unit (ICU) often require escalating doses of benzodiazepines and not uncommonly require intubation and mechanical ventilation for airway protection. This may lead to complications and prolonged ICU stays. Experimental studies and single case reports suggest the α2-agonist dexmedetomidine is effective in managing the autonomic symptoms seen with alcohol withdrawal.

An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: an international consensus conference in intensive care medicine.

Objectives: To address the issues of Prevention and Management of Acute Renal Failure in the ICU Patient, using the format of an International Consensus Conference.

Methods And Questions: Five main questions formulated by scientific advisors were addressed by experts during a 2-day symposium and a Jury summarized the available evidence: (1) Identification and definition of acute kidney insufficiency (AKI), this terminology being selected by the Jury; (2) Prevention of AKI during routine ICU Care; (3) Prevention in specific diseases, including liver failure, lung Injury, cardiac surgery, tumor lysis syndrome, rhabdomyolysis and elevated intraabdominal pressure; (4) Management of AKI, including nutrition, anticoagulation, and dialysate composition; (5) Impact of renal replacement therapy on mortality and recovery.

Results And Conclusions: The Jury recommended the use of newly described definitions.

Interactions between respiration and systemic hemodynamics. Part I: basic concepts.

The topic of cardiorespiratory interactions is of extreme importance to the practicing intensivist. It also has a reputation for being intellectually challenging, due in part to the enormous volume of relevant, at times contradictory literature. Another source of difficulty is the need to simultaneously consider the interrelated functioning of several organ systems (not necessarily limited to the heart and lung), in other words, to adopt a systemic (as opposed to analytic) point of view.

Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care.

In Part I of this review, we have covered basic concepts regarding cardiorespiratory interactions. Here, we put this theoretical framework to practical use. We describe mechanisms underlying Kussmaul's sign and pulsus paradoxus.

Modulating cofactors of acute lung injury 2005-2006: any closer to 'prime time'?

Purpose Of Review: Considerable progress has recently been made in understanding the modulation of acute lung injury by cofactors that are not traditionally considered 'pulmonary' in nature. We will review findings regarding some of these extrapulmonary cofactors, focusing on those most readily manipulated in the current clinical setting.

Recent Findings: Recent studies have demonstrated that limiting fluid administration in the setting of acute lung injury might improve surrogate outcomes; that hypercapnea and induced hypothermia might protect against or attenuate acute lung injury; that corticosteroids can improve mechanics but not mortality in acute respiratory distress syndrome; a potential role for concomitant administration of colloid and diuretic in acute lung injury; and the potential benefits of inhaled beta agonists in acute lung injury.

An agent-based and spatially explicit model of pathogen dissemination in the intensive care unit.

Objective: To develop and disseminate a spatially explicit model of contact transmission of pathogens in the intensive care unit.

Design: A model simulating the spread of a pathogen transmitted by direct contact (such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus) was constructed. The modulation of pathogen dissemination attending changes in clinically relevant pathogen- and institution-specific factors was then systematically examined.

Transient hemodynamic effects of recruitment maneuvers in three experimental models of acute lung injury.

Objective: Elevated lung volumes and increased pleural pressures associated with recruitment maneuvers (RM) may adversely affect pulmonary vascular resistance and cardiac filling or performance. We investigated the hemodynamic consequences of three RM techniques after inducing acute lung injury.

Design: Prospective, randomized, controlled experimental study.

Intercomparison of recruitment maneuver efficacy in three models of acute lung injury.

Objective: To compare the relative efficacy of three forms of recruitment maneuvers in diverse models of acute lung injury characterized by differing pathoanatomy.

Design: We compared three recruiting maneuver (RM) techniques at three levels of post-RM positive end-expiratory pressure in three distinct porcine models of acute lung injury: oleic acid injury; injury induced purely by the mechanical stress of high-tidal airway pressures; and pneumococcal pneumonia.

Setting: Laboratory in a clinical research facility.

Effects of L-NAME and inhaled nitric oxide on ventilator-induced lung injury in isolated, perfused rabbit lungs.

Objective: To determine whether nitric oxide (NO) might modulate ventilator-induced lung injury.

Design: Randomized prospective animal study.

Setting: Animal research laboratory in a university hospital.

Bench-to-bedside review: microvascular and airspace linkage in ventilator-induced lung injury.

Experimental and clinical evidence point strongly toward the potential for microvascular stresses to influence the severity and expression of ventilator associated lung injury. Intense microvascular stresses not only influence edema but predispose to structural failure of the gas-blood barrier, possibly with adverse consequences for the lung and for extrapulmonary organs. Taking measures to lower vascular stress may offer a logical, but as yet unproven, extension of a lung-protective strategy for life support in ARDS.

Relapsing acute respiratory failure induced by minocycline.

The antibiotic minocycline, which is used in the treatment of acne, has been associated with various pulmonary complications such as pulmonary lupus and hypersensitivity pneumonitis. We now report a particularly severe case of minocycline-related pulmonary toxicity that was characterized by a relapsing form of hypersensitivity eosinophilic pneumonia complicated by acute respiratory failure.

Impact of low pulmonary vascular pressure on ventilator-induced lung injury.

Objective: To study the impact of low pulmonary vascular pressure on ventilator-induced lung injury.

Design: Randomized prospective animal study.

Subjects: Isolated perfused rabbit heart-lung preparation.