Changes in Plasma Free Fatty Acid Levels in Septic Patients Are Associated With Cardiac Damage and Reduction in Heart Rate Variability

Abstract

Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.

Pathophysiology of Sepsis-Related Cardiac Dysfunction: Driven by Inflammation, Energy Mismanagement, or Both?

“…Sepsis is associated with altered lipoprotein metabolism characterized by elevated plasma triglyceride and free fatty acid levels [21, 99–101] and suppression of energy production in several organs, including the heart [20, 21, 22•] (Fig. 2).…”

Dyslipidemia: a prospective controlled randomized trial of intensive glycemic control in sepsis

“…In studies of patients with sepsis or septic shock, our group has previously demonstrated that, on the first and sixth day of sepsis, nonsurvivors present higher serum levels of FFAs than do survivors [19,34]. We have also shown that FFA levels are elevated in patients with cardiac mitochondrial damage and changes in heart rate variability [19,34], as well as that oxidative stress activates poly(adenosine diphosphate-ribose) polymerase in the hearts of nonsurvivors of sepsis [34].…”

“…To detect a 20% reduction in FFA and oxLDL levels [19], with a 5% level of significance (two-tailed) and a power of 80%, the required sample size (given an anticipated dropout rate of 10%) was 24 patients per group.…”

“…These effects seem to be associated with oxidative stress because they can be partially prevented by antioxidants, such as tocopherol [15][16][17][18]. It has been shown that serum FFAs play a role in heart rate variability [19,20]. Elevated serum levels of FFAs can disrupt the structure and function of the cardiac plasma membrane, as well as increasing the concentration of intracellular calcium, thereby affecting cardiac activity [21,22].…”

Oleic acid inhibits lung Na/K-ATPase in mice and induces injury with lipid body formation in leukocytes and eicosanoid production

“…As a corollary, patients with high levels of plasma OA have a higher risk of developing ARDS [19] or showing deleterious effects on their heart muscle [40]. Therefore, we can suggest that lowering OA plasma levels could help in the prevention of the high mortality and morbidity of ARDS.…”