Effects of descending positive end-expiratory pressure on lung mechanics and aeration in healthy anaesthetized piglets

Introduction  

Atelectasis and distal airway closure are common clinical entities of general anaesthesia. These two phenomena are expected to reduce the ventilation of dependent lung regions and represent major causes of arterial oxygenation impairment in anaesthetic conditions. The behaviour of the elastance of the respiratory system (E _rs), as well as the lung aeration assessed by computed tomography (CT) scan, was evaluated during a descendent positive end-expiratory pressure (PEEP) titration. This work sought to evaluate the potential usefulness of E _rs monitoring to set the PEEP in order to prevent tidal recruitment and hyperinflation of healthy lungs under general anaesthesia.     

Congenital pericardial defect associated with atrial and ventricular septal defects

Congenital pericardial defects are rare anomalies but in recent years improved diagnostic techniques have often led to a pre-operative diagnosis. The present communication describes a case of a partial pericardial defect with herniation of the lung into the pericardium associated with a lung cyst which is extremely rare. The sternum showed some deficiency in its lower portion. Atrial and ventricular septal defects with a small pericardio-peritoneal foramen were also present.     

Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia

Clin Microbiol Infect 2012; 18: 1040-1048 ABSTRACT: The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with a mean age of 42 (±16.1)?years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2?±?43.2 points, the CURB-65 score was 1.7?±?1.1 points and the PIRO-CAP score was 3.2?±?1.5 points. None of the scores had a good predictive ability: area under the ROC for PSI, 0.72 (95% CI, 0.65-0.78); CURB-65, 0.67 (95% CI, 0.59-0.74); and PIRO-CAP, 0.64 (95% CI, 0.56-0.71). The PSI score (OR, 1.022 (1.009-1.034), p 0.001) was independently associated with ICU mortality; however, none of the three scores, when used at ICU admission, were able to reliably detect a low-risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I-III) or CURB65 (<2). Observed mortality was 13.7%, 13.5% and 19.4%, respectively. Pneumonia-specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.     

Culturally Competent Care Complements Interactions with People with Disabilities

This article describes the concept of disability as a culture, discusses key components of cross‐cultural communication with people with disabilities, and identifies the key elements of providing culturally competent care to people with disabilities. To gain an understanding of cultural competence, it is important to understand the concepts and definitions of culture, disability, and competence. The World Health Organization classification of functioning, disability, and health will be used as the theoretical model in the discussion on disability. J. Campinha‐Bacote's Cultural Competent Model of Care is used as the theoretical model for the discussion on cultural competence.     

Implication of intercellular adhesion molecule-1 (ICAM-1) and serum N(G)-hydroxy-L-arginine (L-NHA) in the pathogenesis of systemic sclerosis

In a trial to throw light on the implication of intercellular adhesion molecule-1 (ICAM-1) and N(G)-hydroxy-L-arginine (L-NHA) in the pathogenesis of systemic sclerosis or Scleroderma, (SSc), their serum levels were estimated in twenty SSc patients using ELISA and high performance liquid chromatography respectively. In situ "local" expression of ICAM-1 in lesional skin of these patients was also assessed using biotinstreptavidin amplified detection system. Patients were divided into 3 groups according to the cutaneous extension of sclerosis (Grades I; II & III). A significant (P < 0.001) difference was found between patients (n = 20) and controls (n = 10) regarding soluble ICAM-1 (s ICAM-1) and L-NHA levels. Among patients, a significant difference (P < 0.001, 0.05 respectively) in sICAM-1 & L-NHA serum levels was found between patients who had musculoskeletal manifestations and those who had not. A significant (P < 0.001) difference in L-NHA level was found between patients with grade I, II, III. Among patients, there was a negative correlation (r = -0.413) between serum sICAM-1 and the duration of the disease, and a positive correlation (r = +0.514) between sICAM-1 and L-NHA serum levels. 4 patients (23.6%) showed mild immunostaining, 8 patients (47%) showed moderate staining, and 5 patients (29.4%) showed intense staining, while control specimens showed negative immunostaining. In conclusion, ICAM-1 and serum L-NHA are probably implicated in the pathogenesis of SSc. Elevated sICAM-1 and L-NHA serum could be used as a quantitative marker of tissue sclerosis, allowing better follow up of patients.     

The Incremental Value of Right Ventricular Size and Strain in the Risk Assessment of Right Heart Failure Post - Left Ventricular Assist Device Implantation

Background

Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with high morbidity and mortality. Existing risk scores include semiquantitative evaluation of right ventricular (RV) dysfunction. This study aimed to determine whether quantitative evaluation of both RV size and function improve risk stratification for RHF after LVAD implantation beyond validated scores.