Remote ischemic preconditioning in human coronary artery bypass surgery: from promise to disappointment?

Background: We assessed whether remote ischemic preconditioning (RIPC) improves myocardial, renal, and lung protection after on-pump coronary surgery.

Methods And Results: This was a single-center, prospective, randomized (1:1), placebo-controlled trial. Patients, investigators, anesthetists, surgeons, and critical care teams were blinded to group allocation.

Mechanisms of the anti-inflammatory effects of hydroxyethyl starch demonstrated in a flow-based model of neutrophil recruitment by endothelial cells.

Objective: To determine whether plasma volume expander hydroxyethyl starch (HES) may protect against reperfusion injury through an ability to reduce neutrophil recruitment.

Design: An in vitro study using paired comparisons of adhesion of flowing neutrophils.

Setting: A collaboration between clinical and basic science departments in a university hospital.

Microalbuminuria in the intensive care unit: Clinical correlates and association with outcomes in 431 patients.

Objective: Comparison of urine albumin within 6 hrs of intensive care unit (ICU) admission with demography, clinical classification, outcome, inotrope/vasopressor requirement, clinical assessment of mortality risk, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores.

Design: Urine albumin-creatinine ratio (ACR) was measured on ICU admission (ACR 1) and after 4-6 hrs (ACR 2).

Setting: A 17-bed general ICU in a university teaching hospital.

Pulmonary and renal function following cardiopulmonary bypass is associated with systemic capillary leak.

Objective: The purpose of this study was to compare perioperative capillary permeability during cardiac surgery with subsequent pulmonary and renal function.

Design: An observational prospective comparison of capillary permeability (microalbuminuria) during and after cardiopulmonary bypass (CPB), with postoperative pulmonary and renal function.

Setting: A university teaching hospital.

Mortality prediction at admission to intensive care: a comparison of microalbuminuria with acute physiology scores after 24 hours.

Objective: To compare low level albumin excretion (microalbuminuria), a marker of systemic capillary permeability, with mortality, Acute Physiologic And Chronic Health Evaluation (APACHE II) score, the Simplified Acute Physiologic (SAP II) score, and their derived mortality probabilities in patients admitted to a general intensive care unit.

Design: Prospective observational study.

Setting: A 14-bed intensive care unit in a university teaching hospital.