Myocardial reperfusion injury

A review of the mechanism of ischemic-reperfusion injury, proposed interventions to prevent injury, and future directions have been presented to enhance the practitioner's knowledge of this new, exciting concept in myocardial injury. There is increasing evidence in the literature that reperfusion injury may occur in other organ systems and is responsible for some of the more prevalent pathologies seen in critically ill patients. Investigators have indicated that the tissue damage in sepsis, the development of adult respiratory distress syndrome (ARDS), delayed organ recovery in transplanted organs, and delayed ventricular recovery after cardiopulmonary bypass may be attributed to reperfusion injury. The next few years will prove to be exciting as this concept is further investigated and refined. Critical care nurses need to understand the concept of reperfusion injury and may soon begin to apply the results of ongoing research studies to patients undergoing reperfusion.     

Burn injury pain: the continuing challenge.

The development of more effective methods of relieving pain associated with burn injury is a major unmet medical need. Not only is acute burn injury pain a source of immense suffering, but it has been linked to debilitating chronic pain and stress-related disorders. Although pain management guidelines and protocols have been developed and implemented, unrelieved moderate-to-severe pain continues to be reported after burn injury. One reason for this is that the intensity of pain associated with wound care and rehabilitation therapy, the major source of severe pain in this patient population, varies widely over the 3 phases of burn recovery, making it difficult to estimate analgesic requirements. The effects of opioids, the most commonly administered analgesics for burn injury procedural pain, are difficult to gauge over the course of burn recovery because the need for an opioid may change rapidly, resulting in the overmedication or undermedication of burn-injured patients. Understanding the mechanisms that contribute to the intensity and variability of burn injury pain over time is crucial to its proper management. We provide an overview of the types of pain associated with a burn injury, describe how these different types of pain interfere with the phases of burn recovery, and summarize pharmacologic pain management strategies across the continuum of burn care. We conclude with a discussion and suggestions for improvement. Rational management, based on the underlying mechanisms that contribute to the intensity and variability of burn injury pain, is in its infancy. The paucity of information highlights the need for research that explores and advances the identification of mechanisms of acute and chronic burn injury pain. PERSPECTIVE: Researchers continue to report that burn pain is undertreated. This review examines burn injury pain management across the phases of burn recovery, emphasizing 3 types of pain that require separate assessment and management. It provides insights and suggestions for future research directions to address this significant clinical problem.     

Myocardial protection from ischemia/reperfusion injury by endogenous and exogenous HGF

Using a rat model of ischemia/reperfusion injury, we demonstrate here that HGF is cardioprotective due to its antiapoptotic effect on cardiomyocytes. Following transient myocardial ischemia and reperfusion, c-Met/HGF receptor expression rapidly increased in the ischemic myocardium, an event accompanied by a dramatic increase in plasma HGF levels in the infarcted rats. When endogenous HGF was neutralized with a specific antibody, the number of myocyte cell deaths increased markedly, the infarct area expanded, and the mortality increased to 50%, as compared with a control group in which there was no mortality. Plasma from the myocardial infarcted rats had cardioprotective effects on primary cultured cardiomyocytes, but these effects were significantly diminished by neutralizing HGF. In contrast, recombinant HGF administration reduced the size of infarct area and improved cardiac function by suppressing apoptosis in cardiomyocytes. HGF rapidly augmented Bcl-xL expression in injured cardiomyocytes both in vitro and in vivo. As apoptosis of cardiomyocytes is one of the major contributors to the pathogenesis in subjects with ischemia/reperfusion injury, prevention of apoptosis may prove to be a reasonable therapeutic strategy. Supplements of HGF, an endogenous cardioprotective factor, may be found clinically suitable in treating subjects with myocardial infarction.     

Transfusion-related acute lung injury: a clinical challenge.

Transfusion-related acute lung injury is a life-threatening clinical syndrome. In the last 3 years, it has become the leading cause of reported transfusion-related deaths in the United States. This syndrome is characterized by acute hypoxemia and noncardiogenic pulmonary edema directly linked in time to a blood transfusion. All types of blood products have been implicated in transfusion-related acute lung injury, but transfusion of plasma-containing products from multiparous women seems to carry the highest risk. The purpose of this article is to raise awareness of this syndrome for the critical care nurse. This article discusses the widely accepted clinical features of transfusion-related acute lung injury, its pathogenesis, differential diagnosis, and treatment.     

Health care fraud: a critical challenge

Fraud is defined as an international deception or misrepresentation that the individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual, the entity, or some other party. This article focuses on acts committed by health care providers but it is important to note that health care fraud also encompasses those fraudulent acts perpetrated by employer groups, members or insureds, and employees.     

Thirst: a critical care nursing challenge

Thirst is a symptom commonly experienced by critically ill patients. Critical care nurses have the opportunity to prevent and reduce thirst by recognizing the types of thirst, identifying patients at risk, monitoring physiological parameters, and providing comfort measures.     

Cocaine and the critical care challenge

OBJECTIVE: Cocaine, which first made its appearance >1,000 yrs ago, is now widely used throughout the world. The physiologic responses to cocaine may cause severe pathologic effects. This review highlights the many critical care challenges resulting from these effects. DESIGN: Historical vignettes, epidemiologic factors, modes of preparation and delivery, and the physiologic and pharmacologic effects of these agents are presented. SETTING: Cocaine causes intense vasoconstriction, which potentially causes damage to all organ systems. Examples of these toxicities are presented. PATIENTS: The adverse multisystem responses to cocaine exposure produce organ failure, which challenges diagnostic accuracy and therapeutic intervention. Organ system failure involves the brain, heart, lung, kidneys, gastrointestinal tract, musculature, and other organs. These harmful effects are additive to preexisting organ dysfunction. INTERVENTION: Recognition of associated cocaine injury alerts the physician that organ dysfunction is more likely to occur and to be more severe. Such anticipation helps plan for therapy in the critical care setting. RESULTS AND CONCLUSIONS: Cocaine use is an expanding health hazard, despite intense governmental efforts to contain its distribution and use. Recognition of the signs and symptoms of cocaine toxicity help anticipate the subsequent organ dysfunction and implement earlier organ system support.     

The challenge facing critical care nurses in the UK: a personal perspective.

Wide-reaching professional, organisational and technological changes within healthcare have impacted on the role of the critical care nurse over the past decade. The major challenge to critical care nurses is to remain focused on providing quality care, optimistic about what can be achieved and realistic given the finite resources available. Suggestions as to how the future of critical care nursing may look are raised. Strategies to ensure that best practice and innovation continues within critical care are discussed, ensuring that patient and family needs remain a priority.