Using Pupillary Pain Index to Assess Nociception in Sedated Critically Ill Patients.

Background: Pupillary reflex dilation is a reliable indicator of response to noxious stimulation. In a proof of concept study, we investigated the performance of pupillary pain index, a new score derived from pupillary reflex dilation measurements, to predict nociceptive response to endotracheal suctioning in sedated critically ill patients.

Methods: Twenty brain-injured and 20 non-brain-injured patients were studied within 48 hours of admission (T1) in the intensive care unit and at 48-72 hours later (T2).

Which Protocol for Milrinone to Treat Cerebral Vasospasm Associated With Subarachnoid Hemorrhage?

Background: Milrinone has emerged as an option to treat delayed cerebral ischemia after subarachnoid hemorrhage. However, substantial variation exists in the administration of this drug. We retrospectively assessed the effectiveness of 2 protocols in patients with angiographically proven cerebral vasospasm.

Capillary lactate concentration on admission of normotensive trauma patients: a prospective study.

Background: Elevated serum blood lactate is an indicator of on-going bleeding in severe trauma patients. Point-of-care (POC) capillary lactate measurement devices may be useful to rapidly assess lactate concentration at the bedside. The aim of this study was to test the diagnostic performance of capillary lactate to predict significant transfusion in normotensive trauma patients.

Pupillometry to detect pain response during general anaesthesia following unilateral popliteal sciatic nerve block: a prospective, observational study.

Context: Pupillary reflex dilation appears to be a reliable indicator of response to noxious stimulation even under general anaesthesia. The ability of pupillometry to detect the effects of extremity blocks during continuous infusion of opioids remains unknown.

Objective: To explore the performance of pupillometry to detect differences in pupillary reflex dilation response to a standardised noxious stimulus applied to each leg following unilateral popliteal sciatic nerve block during continuous infusion of remifentanil.

[Pulmonary resection and ECMO: A salvage therapy for penetrating lung trauma].

The majority of chest penetrating trauma patients are successfully managed with tube thoracostomy and general supportive measures. Pulmonary resection for hemorrhagic shock is rarely required after trauma to control bleeding. Both pulmonary injury and massive blood transfusion can lead to acute respiratory distress syndrome (ARDS).

[Pupillometry in anesthesia and critical care].

Pupil size reflects the balance between sympathetic and parasympathetic systems. Due to technological advances, accurate and repeated pupil size measurements are possible using infrared, video-recorded pupillometers. Two pupil size reflexes are assessed: the pupillary reflex dilation during noxious stimulation, and the pupil light reflex when the pupil is exposed to the light.

Corticosteroid after etomidate in critically ill patients: a randomized controlled trial.

Objective: To investigate the effects of moderate-dose hydrocortisone on hemodynamic status in critically ill patients throughout the period of etomidate-related adrenal insufficiency.

Design: : Randomized, controlled, double-blind trial (NCT00862381).

Setting: University hospital emergency department and three intensive care units.

[Should etomidate still be used?].

Etomidate blocks the cortisol synthesis by specifically inhibiting the activity of 11 beta-hydroxylase, resulting in a primary adrenal insufficiency. Therefore, a serum accumulation of 11 beta-deoxycortisol and a low secretion of serum cortisol must be required as diagnostic criteria to assign that adrenal impairment to the drug. These requirements have been rarely fulfilled in studies exploring the contribution of etomidate to the adrenal insufficiency despite numerous causes of adrenal derangement.

Duration of adrenal inhibition following a single dose of etomidate in critically ill patients.

Objective: To determine the incidence and duration of adrenal inhibition induced by a single dose of etomidate in critically ill patients.

Design: Prospective, observational cohort study.

Setting: Three intensive care units in a university hospital.