Measurements of cTnI reveal a higher incidence of myocardial injury than predicted by CK-MB in aneurysmal SAH, and elevations of cTnI are associated with a higher incidence of myocardial dysfunction. Thus, cTnI is a highly sensitive and specific indicator of myocardial dysfunction in aneurysmal SAH.

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60-1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14-1.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.

Intramedullary reamed nailing causes elevation in intramedullary pressure and extravazation of intramedullary contents into the venous blood system. This study investigated the effect of an intramedullary suction system, recently developed in our laboratory, on the pressure and fat extravazation in isolated bovine bone and a sheep model. During reaming, the pressure with and without suction was recorded at each step of the procedure. Hemodynamic parameters of mean arterial blood pressure, pulmonary artery pressure, pulmonary arterial CO 2 (PaCO 2 ), heart rate, and oxygen saturation were monitored. Blood and lung tissue samples were collected for the examination of medullary fat intravazation. The increases of intramedullary pressure were dramatically reduced in the suction group (p < 0.05) in both in vitro and in vivo experiments. PaCO 2 was significantly lower in the suction group than nonsuction group (32 vs. 40 mmHg, respectively, p ¼ 0.02), while oxygen saturation was higher in the suction group (99 vs. 91 mmHg, respectively, p ¼ 0.009). Histological data revealed a significant higher count of fat emboli in sheep lung tissue in the nonsuction group. Total lipids in lung specimens was lower in the suction group (7.6 mg/g tissue) than in the nonsuction group (13.6 mg/g, p ¼ 0.04). The suction system appears to control the surge in intramedullary pressure and therefore prevent fat embolism. ß

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