Automated sedation outperforms manual administration of propofol and remifentanil in critically ill patients with deep sedation: a randomized phase II trial.

Purpose: To compare automated administration of propofol and remifentanil guided by the Bispectral index (BIS) versus manual administration of short-acting drugs in critical care patients requiring deep sedation. The primary outcome was the percentage of BIS values between 40 and 60 (BIS(40-60)).

Methods: This randomized controlled phase II trial in the intensive care unit (ICU) was conducted in adults with multiorgan failure.

Mechanisms of brain signaling during sepsis.

Brain signaling is a crucial event for the body to mount an appropriate response to invading microorganisms. Pro-inflammatory cytokines are released from infected tissues and reach key structures in the brain via the circumventricular organs, areas of damaged blood brain barrier or they cross actively the blood brain barrier using specific carriers. Alternately, cytokines may activate brain endothelial cells or microglial to produce prostaglandins which then diffuse into the brain to activate neurons.

Long-term outcome of iatrogenic gas embolism.

Objective: To establish the incidence and long-term prognosis of iatrogenic gas embolism.

Methods: This was a prospective inception cohort. We included all consecutive adults with proven iatrogenic gas embolism admitted to the sole referral academic hyperbaric center in Paris.

Sepsis-associated delirium: the pro and con of C5a blockade.

The intimate mechanisms of sepsis-induced delirium are unknown. Among the potential contributing factors, the breakdown of the blood-brain barrier is considered a key determinant of brain dysfunction. The complement activation is paramount to an appropriate activation of the central nervous system during stress.