Stress response during early sedation with dexmedetomidine compared with usual-care in ventilated critically ill patients.

Background: Sedative agents may variably impact the stress response. Dexmedetomidine is a sympatholytic alpha-adrenergic agonist mainly used as a second-line sedative agent in mechanically ventilated patients. We hypothesised that early sedation with dexmedetomidine as the primary agent would result in a reduced stress response compared to usual sedatives in critically ill ventilated adults.

Allostasis and sedation practices in intensive care evaluation: an observational pilot study.

Background: A dysregulated stress response has been implicated in the pathogenesis of critical illness. Sedative agents utilised in the critically unwell patient may impact upon the stress response with a downstream negative effect on multiple organ systems. This study was designed to assess the feasibility of investigating components of the stress response as a sub-study of the current SPICE-III study (NCT01728558).

Outside the box: extra-pericardial tamponade due to acute recurrence of hiatus hernia.

Cardiac tamponade is defined as a life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, thrombus or gas as a result of effusion, trauma, or myocardial rupture. We describe the case of a lady who developed classic signs of cardiac tamponade immediately after an open hiatus hernia repair. Computed tomographic imaging revealed extrapericardial hernia recurrence causing cardiac compression.