Undiagnosed Chronic Granulomatous Disease, Burkholderia cepacia complex Pneumonia, and Acquired Hemophagocytic Lymphohistiocytosis: A Deadly Association.

Background. Chronic granulomatous disease is a rare inherited disorder of the phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase. The clinical course of the disease is marked by recurrent infections, including Burkholderia cepacia complex infection.

From bench to bedside.

Because the microcirculation has emerged as an important reanimation target, appropriate methods to monitor the microcirculatory function are crucial. Several teams have now succeeded in crossing this bridge from bench to bedside, but the choice of the tissues of interest remains a debate. The potential accessible vascular beds that doctors could use in reanimation strategies and the relationship of these beds to more relevant microcirculatory ones are important issues to address.

Evaluation of sublingual and gut mucosal microcirculation in sepsis: a quantitative analysis.

Objective: To determine the relationship between sublingual and intestinal mucosal microcirculatory perfusion.

Design: Observational, experimental study.

Setting: University-affiliated large animal laboratory.

Microvascular response to red blood cell transfusion in patients with severe sepsis.

Objectives: Microvascular alterations may play a role in the development of multiple organ failure in severe sepsis. The effects of red blood cell transfusions on microvascular perfusion are not well defined. We investigated the effects of red blood cell transfusion on sublingual microvascular perfusion in patients with sepsis.

Prediction of postoperative complications after urgent laparotomy by intraperitoneal microdialysis: A pilot study.

Objective: The aim of the present study was to investigate the role of intraperitoneal microdialysis (IPM) techniques in monitoring the evolution of postoperative critically ill patients requiring urgent laparotomy.

Summary Background Data: Postoperative intraabdominal sepsis is associated with an important degree of morbidity and mortality in acutely ill patients. Early diagnosis is critical to improve outcomes.

Euglycemic hyperinsulinemia in severe sepsis and septic shock.

Background: Recent studies have suggested that strict glucose control with intensive insulin therapy in critically ill patients may result in better outcomes. Whether this is also true in septic shock has not been determined. In addition, whether it is the insulin administration per se or the glucose control that contributes to the beneficial effects is unclear.

Effects of dexamethasone on macrophage migration inhibitory factor production in sepsis.

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that plays a major role in the pathogenesis of sepsis. Some studies have indicated that glucocorticoids increase MIF production in physiological conditions. The goal of this study was to determine whether glucocorticoid treatment also upregulates MIF production in sepsis.

Beneficial effects of alkaline phosphatase in septic shock.

Objective: Alkaline phosphatase may decrease the harmful effects of lipopolysaccharide by detoxifying lipid A. The aim of this study was to investigate whether administration of alkaline phosphatase is beneficial in a clinically relevant septic shock model.

Design: Interventional laboratory study.

Effects of drotrecogin alfa activated on microcirculatory alterations in patients with severe sepsis.

Objective: Microvascular alterations may play an important role in the development of sepsis-induced organ dysfunction. Drotrecogin alfa activated (DAA) improves outcome in patients with severe sepsis, but its precise mechanism of action is not entirely defined. We investigated whether DAA can influence microcirculatory alterations in patients with severe sepsis.

Skin microcirculation and vasopressin infusion: a laser Doppler study.

Use of arginine vasopressin in the management of refractory vasodilatory shock has been associated with development of ischaemic skin lesions. Because of the increasing popularity of arginine vasopressin, it is important to evaluate its effects on microcirculatory blood flow. Such studies are crucial if we are to appreciate the microcirculatory consequences of our various resuscitation strategies.

The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects.

Objective: To evaluate the effects of dobutamine on microcirculatory blood flow alterations in patients with septic shock.

Design: Prospective, open-label study.

Setting: A 31-bed, medico-surgical intensive care unit of a university hospital.

How monitoring of the microcirculation may help us at the bedside.

Purpose Of Review: Recent technologic developments have allowed the direct visualization of the microcirculation at the bedside. The present review explores how the monitoring of microcirculation can help in clinical practice.

Recent Findings: Using orthogonal polarization spectral (OPS) imaging techniques, various investigators have reported microcirculatory alterations in critically ill patients and especially in patients with severe sepsis and septic shock.

The following is the abstract of the article discussed in the subsequent letter:

Sublingual and intestinal mucosal blood flow and Pco(2) were studied in a canine model of endotoxin-induced circulatory shock and resuscitation. Sublingual Pco(2) (Ps(CO(2))) was measured by using a novel fluorescent optrode-based technique and compared with lingual measurements obtained by using a Stowe-Severinghaus electrode [lingual Pco(2) (Pl(CO(2)))]. Endotoxin caused parallel changes in cardiac output, and in portal, intestinal mucosal, and sublingual blood flow (Q(s)).

15th Annual Congress of the European Society of Intensive Care Medicine, 29 September-2 October 2002, Barcelona, Spain: clinical research to improve outcome.

The 15Annual European Society of Intensive Care Medicine Meeting opened in Barcelona, Spain on September 30, 2002. This report focuses on some highlights of this congress. Preliminary data from the Sepsis Occurrence in the Acutely ill Patient (SOAP) study are presented, as are findings from the Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury (ALVEOLI) study, which compared higher positive end-expiratory pressure (PEEP)/lower fractional inspired oxygen (FiO) with lower PEEP/higher FiOstrategies.