Administration of LY315920Na/S-5920 had an acceptable safety profile in patients with severe sepsis. There was no overall survival benefit associated with the use of LY315920Na/S-5920 in this study. However, prospectively planned secondary analyses suggested that treatment with LY315920Na/S-5920 was associated with an improvement in survival in patients treated within 18 hrs of the first sepsis-induced organ failure.

Pulmonary function data, including diffusing capacity, were evaluated in 56 patients with chronic severe cardiomyopathy before heart transplantation. Cardiac catheterization data were used to describe the relationship between cardiac and pulmonary function. Of 56 patients 44 had some abnormality in pulmonary function. The majority, 30 of 56, had a restrictive impairment alone. Of 28 patients in whom diffusing capacity was measured, 64% had a diffusion impairment. There was no association of pulmonary function impairment with type of cardiomyopathy or smoking history. Pulmonary capillary wedge pressure correlated positively with DLCO, but not with FVC or TLC. Cardiac index and ejection fraction did not correlate with diffusing capacity. This precardiac transplantation cardiomyopathy patient group demonstrated frequent pulmonary function abnormalities not previously recognized.

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Platelets are currently thought to play a role in tissue injury and inflammatory states both directly and indirectly through their action on neutrophils (PMNs). Both stimulation and inhibition of PMN superoxide anion (O2-) production by platelets has been reported. To clarify these discrepant observations, we investigated the effects of wide ranges of platelet to PMN ratios as well as concentrations of ATP and ADP on human PMN O2- production. Platelets, at low platelet-to-PMN ratios (1:1 and 5:1), primed PMNs which were stimulated with either FMLP or PMA. However, at higher platelet-to-PMN ratios (25:1, 50:1, and 100:1), inhibition of O2- production was seen. ATP also had a biphasic effect on O2-production: low concentrations of ATP (1 x 10(-6) to 3.2 x 10(-4) M) increased O2-production and high concentrations of ATP (6.4 x 10(-4) M and above) inhibited O2-production. ADP, when added to stimulatory concentrations at ATP, also caused inhibition of O2- production. The incubation time for platelet-neutrophil interactions in vitro was also crucial. Short incubation periods lead to priming, whereas longer periods (greater than 5 min) lead to inhibition. We believe that these studies help to resolve the controversy over the effects of platelets upon the production of O2- by human PMNs and lend further support to the notion that platelets may modulate injury resulting from neutrophil activation.

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Background Postoperative critical care management is an integral part of cardiac surgery that contributes directly to clinical outcomes. In the United States there remains considerable variability in the critical care infrastructure for cardiac surgical programs. There is little published data investigating the impact of a dedicated cardiac surgical intensive care service. Methods A retrospective study examining postoperative outcomes in cardiac surgical patients before and after the implementation of a dedicated cardiac surgical intensive care service at a single academic institution. An institutional Society of Thoracic Surgeons database was queried for study variables. Primary endpoints were the postoperative length of stay, intensive care unit length of stay, and mechanical ventilation time. Secondary endpoints included mortality, readmission rates, and postoperative complications. The effect on outcomes based on procedure type was also analyzed. Results A total of 1703 patients were included in this study—914 in the control group (before dedicated intensive care service) and 789 in the study group (after dedicated intensive care service). Baseline demographics were similar between groups. Length of stay, mechanical ventilation hours, and renal failure rate were significantly reduced in the study group. Coronary artery bypass grafting patients observed the greatest improvement in outcomes. Conclusions Implementation of a dedicated cardiac surgical intensive care service leads to significant improvements in clinical outcomes. The greatest benefit is seen in patients undergoing coronary artery bypass, the most common cardiac surgical operation in the United States. Thus, developing a cardiac surgical intensive care service may be a worthwhile initiative for any cardiac surgical program.

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