Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation

Long pentraxin PTX3 deficiency worsens LPS-induced acute lung injury

“…It has been pointed out that LPS should be considered as an exploratory rather than a clinically relevant model [36]. However, because LPS is a ligand of Toll-like receptor 4 and has a well-defined signaling pathway, it has been commonly used to explore the mechanisms of acute inflammatory responses.…”

The Effects of Low and High Tidal Volume and Pentoxifylline on Intestinal Blood Flow and Leukocyte-Endothelial Interactions in Mechanically Ventilated Rats

“…29,30 Several studies have shown an association between mechanical ventilation and exacerbated pulmonary inflammatory response and increased alveolar capillary permeability. [1][2][3]31 Other studies have found protective effects from PEEP and low V T in patients with injured lungs 1,3,32-34 and non-injured lungs. 35 Recently, Dos Santos et al 32 reported a 20 -40% deterioration of pulmonary compliance in rats ventilated with a high V T (12 mL/kg), versus low V T (6 mL/kg), after 2-4 hours of mechanical ventilation.…”

“…The combination of high PEEP and low tidal volume (V T ) during mechanical ventilation is a protective strategy that decreases the risk of pulmonary overdistention, damage due to cyclic opening and closing of the alveoli, and inflammatory responses that can lead to multiple-organ dysfunction. [1][2][3] However, PEEP increases intrathoracic pressure, which can reduce venous return and cardiac output, and redistribute blood flow away from the splanchnic vasculature. [4][5][6] Hypoperfusion and ischemia in the gastrointestinal tract are associated with loss of tract barrier and systemic inflammation, 7 which may play a pivotal role in the pathogenesis of several complications associated with mechanical ventilation, [8][9][10] including multiple-organ failure in patients with severe sepsis and cardiac failure, a situation that usually has a very poor outcome.…”

Surgical intensive care unit—the trauma surgery perspective

“…Endpoints of successful ventilator support are good oxygenation, a conscious patient, uncompromised airways, sufficient respiratory parameters (tidal volume, vital capacity and inspiration force), effective couch and adverse-effects reflex, finally allowing uneventful extubation of the patient. However, extubation failure has been shown to be associated with increased morbidity and mortality [48]. Corticosteroid significantly reducing laryngeal edema is one approach for decreasing the reintubation rate (≤50%).…”

“…Extracorporeal gas exchange by a capillary membrane oxygenator for oxygenation and decarboxylation, such as ECMO, ECLA and pumpless interventional lung assist (iLA) can help in such conditions to reduce the inspiratory plateau pressure, PaCO 2, improve the oxygenation and survival of the patients (Fig. 1) [48].…”