Intensive Care Medicine Experimental最新文献

{"title":"Multiomic biomarkers after cardiac arrest.","authors":"Victoria Stopa, Gabriele Lileikyte, Anahita Bakochi, Prasoon Agarwal, Rasmus Beske, Pascal Stammet, Christian Hassager, Filip Årman, Niklas Nielsen, Yvan Devaux","doi":"10.1186/s40635-024-00675-y","DOIUrl":"https://doi.org/10.1186/s40635-024-00675-y","url":null,"abstract":"<p><p>Cardiac arrest is a sudden cessation of heart function, leading to an abrupt loss of blood flow and oxygen to vital organs. This life-threatening emergency requires immediate medical intervention and can lead to severe neurological injury or death. Methods and biomarkers to predict neurological outcome are available but lack accuracy. Such methods would allow personalizing healthcare and help clinical decisions. Extensive research has been conducted to identify prognostic omic biomarkers of cardiac arrest. With the emergence of technologies allowing to combine different levels of omics data, and with the help of artificial intelligence and machine learning, there is a potential to use multiomic signatures as prognostic biomarkers after cardiac arrest. This review article delves into the current knowledge of cardiac arrest biomarkers across various omic fields and suggests directions for future research aiming to integrate multiple omics data layers to improve outcome prediction and cardiac arrest patient's care.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"12 1","pages":"83"},"PeriodicalIF":2.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the transpulmonary pressure on right ventricle impairment incidence during acute respiratory distress syndrome: a pilot study in adults and children.","authors":"Meryl Vedrenne-Cloquet, Matthieu Petit, Sonia Khirani, Cyril Charron, Diala Khraiche, Elena Panaioli, Mustafa Habib, Sylvain Renolleau, Brigitte Fauroux, Antoine Vieillard-Baron","doi":"10.1186/s40635-024-00671-2","DOIUrl":"https://doi.org/10.1186/s40635-024-00671-2","url":null,"abstract":"<p><strong>Background: </strong>Right ventricle impairment (RVI) is common during acute respiratory distress syndrome (ARDS) in adults and children, possibly mediated by the level of transpulmonary pressure (P_L). We sought to investigate the impact of the level of P_L on ARDS-associated right ventricle impairment (RVI).</p><p><strong>Methods: </strong>Adults and children (> 72 h of life) were included in this two centers prospective study if they were ventilated for a new-onset ARDS or pediatric ARDS, without spontaneous breathing and contra-indication to esophageal catheter. Serial measures of static lung, chest wall, and respiratory mechanics were coupled to critical care echocardiography (CCE) for 3 days. Mixed-effect logistic regression models tested the impact of lung stress (ΔP_L) along with age, lung injury severity, and carbon dioxide partial pressure, on RVI using two definitions: acute cor pulmonale (ACP), and RV dysfunction (RVD). ACP was defined as a dilated RV with septal dyskinesia; RVD was defined as a composite criterion using tricuspid annular plane systolic excursion, S wave velocity, and fractional area change.</p><p><strong>Results: </strong>46 patients were included (16 children, 30 adults) with 106 CCE (median of 2 CCE/patient). At day one, 19% of adults and 4/7 children > 1 year exhibited ACP, while 59% of adults and 44% of children exhibited RVD. In the entire population, ACP was present on 17/75 (23%) CCE. ACP was associated with an increased lung stress (mean ΔP_L of 16.2 ± 6.6 cmH₂O in ACP vs 11.3 ± 3.6 cmH₂O, adjusted OR of 1.33, CI95% [1.11-1.59], p = 0.002) and being a child. RVD was present in 59/102 (58%) CCE and associated with lung stress. In children > 1 year, PEEP was significantly lower in case of ACP (9.3 [8.6; 10.0] cmH₂O in ACP vs 15.0 [11.9; 16.3] cmH₂O, p = 0.03).</p><p><strong>Conclusion: </strong>Lung stress was associated with RVI in adults and children with ARDS, children being particularly susceptible to RVI. Trial registration Clinical trials identifier: NCT0418467.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"12 1","pages":"84"},"PeriodicalIF":2.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in understanding the mechanisms of lung–kidney crosstalk","authors":"Renata de Souza Mendes, Pedro Leme Silva, Chiara Robba, Denise Battaglini, Miquéias Lopes-Pacheco, Celso Caruso-Neves, Patricia R. M. Rocco","doi":"10.1186/s40635-024-00672-1","DOIUrl":"https://doi.org/10.1186/s40635-024-00672-1","url":null,"abstract":"This narrative review delves into the intricate interplay between the lungs and the kidneys, with a focus on elucidating the pathogenesis of diseases influenced by immunological factors, acid–base regulation, and blood gas disturbances, as well as assessing the effects of various therapeutic modalities on these interactions. Key disorders, such as anti-glomerular basement membrane (anti-GBM) disease, the syndrome of inappropriate antidiuretic hormone secretion (SIADH), and Anti-neutrophil Cytoplasmic Antibodies (ANCA) associated vasculitis (AAV), are also examined to shed light on their underlying mechanisms. This review also explores the relationship between acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), emphasizing how inflammatory mediators can lead to systemic damage and impact multiple organs. In ARDS, fluid overload exacerbates pulmonary edema, while imbalances in blood volume, such as hypovolemia or hypervolemia, can precipitate renal dysfunction. The review highlights how mechanical ventilation strategies can compromise renal blood flow, trigger systemic inflammation, and induce hemodynamic and neurohormonal alterations, all contributing to lung and kidney damage. The impact of extracorporeal membrane oxygenation (ECMO) on lung–kidney interactions is evaluated, highlighting its role in severe respiratory failure and its renal implications. Emerging therapies, such as mesenchymal stem cells and extracellular vesicles, are discussed as promising avenues to mitigate organ damage and enhance outcomes in critically ill patients. Overall, this review offers a nuanced exploration of lung–kidney dynamics, bridging historical insights with contemporary perspectives. It underscores the clinical significance of these interactions in critically ill patients and advocates for integrated management approaches to optimize patient outcomes.","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"5 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal cardiopulmonary resuscitation: a comparison of two experimental approaches and systematic review of experimental models","authors":"Anthony Moreau, Fuhong Su, Filippo Annoni, Fabio Silvio Taccone","doi":"10.1186/s40635-024-00664-1","DOIUrl":"https://doi.org/10.1186/s40635-024-00664-1","url":null,"abstract":"In patients requiring extracorporeal cardiopulmonary resuscitation (ECPR), there is a need for studies to assess the potential benefits of therapeutic interventions to improve survival and reduce hypoxic-ischemic brain injuries. However, conducting human studies may be challenging. This study aimed to describe two experimental models developed in our laboratory and to conduct a systematic review of existing animal models of ECPR reported in the literature. In our experiments, pigs were subjected to 12 min (model 1) or 5 min (model 2) of untreated ventricular fibrillation, followed by 18 min (model 1) or 25 min (model 2) of conventional cardiopulmonary resuscitation. Results showed severe distributive shock, decreased brain oxygen pressure and increased intracranial pressure, with model 1 displaying more pronounced brain perfusion impairment. A systematic review of 52 studies, mostly conducted on pigs, revealed heterogeneity in cardiac arrest induction methods, cardiopulmonary resuscitation strategies, and evaluated outcomes. This review emphasizes the significant impact of no-flow and low-flow durations on brain injury severity following ECPR. However, the diversity in experimental models hinders direct comparisons, urging the standardization of ECPR models to enhance consistency and comparability across studies.","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"85 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142211809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Mechanical power ratio threshold for ventilator-induced lung injury","authors":"Rosanna D’Albo, Tommaso Pozzi, Rosmery V. Nicolardi, Mauro Galizia, Giulia Catozzi, Valentina Ghidoni, Beatrice Donati, Federica Romitti, Peter Herrmann, Mattia Busana, Simone Gattarello, Francesca Collino, Aurelio Sonzogni, Luigi Camporota, John J. Marini, Onnen Moerer, Konrad Meissner, Luciano Gattinoni","doi":"10.1186/s40635-024-00666-z","DOIUrl":"https://doi.org/10.1186/s40635-024-00666-z","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Correction: Intensive Care Medicine Experimental (2024) 12:65&lt;/b&gt; &lt;b&gt;https://doi.org/10.1186/s40635-024-00649-0&lt;/b&gt;&lt;/p&gt;&lt;p&gt;Following publication of the original article, the following two concerns were brought to the attention of the journal: the author affiliations were incorrectly detailed in the PDF version of the article; in Additional file 1, the paragraph regarding the expected mechanical power formula was missing. The published article [1] has since been corrected to address these issues.&lt;/p&gt;&lt;ol data-track-component=\"outbound reference\" data-track-context=\"references section\"&gt;&lt;li data-counter=\"1.\"&gt;&lt;p&gt;D’Albo R, Pozzi T, Nicolardi RV, Galizia M, Catozzi G, Ghidoni V, Donati B, Romitti F, Herrmann P, Busana M, Gattarello S, Collino F, Sonzogni A, Camporota L, Marini JJ, Moerer O, Meissner K, Gattinoni L (2024) Mechanical power ratio threshold for ventilator-induced lung injury. Intensive Care Med Exp 12:65. https://doi.org/10.1186/s40635-024-00649-0&lt;/p&gt;&lt;p&gt;Article PubMed PubMed Central Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;p&gt;Download references&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/p&gt;&lt;span&gt;Author notes&lt;/span&gt;&lt;ol&gt;&lt;li&gt;&lt;p&gt;Rosanna D’Albo and Tommaso Pozzi contributed equally to this work.&lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;h3&gt;Authors and Affiliations&lt;/h3&gt;&lt;ol&gt;&lt;li&gt;&lt;p&gt;Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany&lt;/p&gt;&lt;p&gt;Rosanna D’Albo, Tommaso Pozzi, Rosmery V. Nicolardi, Mauro Galizia, Giulia Catozzi, Valentina Ghidoni, Beatrice Donati, Federica Romitti, Peter Herrmann, Mattia Busana, Simone Gattarello, Onnen Moerer, Konrad Meissner &amp; Luciano Gattinoni&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy&lt;/p&gt;&lt;p&gt;Rosanna D’Albo&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Department of Health Sciences, University of Milan, Milan, Italy&lt;/p&gt;&lt;p&gt;Tommaso Pozzi, Mauro Galizia, Giulia Catozzi &amp; Beatrice Donati&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;IRCCS San Raffaele Scientific Institute, Milan, Italy&lt;/p&gt;&lt;p&gt;Rosmery V. Nicolardi &amp; Simone Gattarello&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence, Florence, Italy&lt;/p&gt;&lt;p&gt;Valentina Ghidoni&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Department of Anesthesia, Intensive Care and Emergency, “City of Health and Science” Hospital, Turin, Italy&lt;/p&gt;&lt;p&gt;Francesca Collino&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Department of Pathology, ASST Bergamo Est, Seriate, Italy&lt;/p&gt;&lt;p&gt;Aurelio Sonzogni&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Department of Adult Critical Care, Health Centre for Human and Applied Physiological Sciences, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK&lt;/p&gt;&lt;p&gt;Luigi Camporota&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Department of Pulmonary and Critical Care Medicine, University of Minnesota and Regions Hospital, St. Paul, MN, USA&lt;/p&gt;&lt;p&gt;John J. Marini&lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;span&gt;Authors&lt;/span&gt;&lt;ol&gt;&lt;li&gt;&lt;span&gt;Rosanna D’Albo&lt;/span&gt;View author publications&lt;p&gt;You","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"18 6 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142211828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lactated Ringers, albumin and mannitol as priming during cardiopulmonary bypass reduces pulmonary edema in rats compared with hydroxyethyl starch.","authors":"Anne M Beukers, Anoek L I van Leeuwen, Roselique Ibelings, Anita M Tuip-de Boer, Carolien S E Bulte, Susanne Eberl, Charissa E van den Brom","doi":"10.1186/s40635-024-00661-4","DOIUrl":"10.1186/s40635-024-00661-4","url":null,"abstract":"<p><strong>Background: </strong>Endothelial disorders with edema formation and microcirculatory perfusion disturbances are common in cardiac surgery with cardiopulmonary bypass (CPB) and contribute to disturbed tissue oxygenation resulting in organ dysfunction. Albumin is protective for the endothelium and could be a useful additive to CPB circuit priming. Therefore, this study aimed to compare organ edema and microcirculatory perfusion in rats on CPB primed with lactated Ringers, albumin and mannitol (LR/albumin/mannitol) compared to 6% hydroxyethyl starch (HES).</p><p><strong>Results: </strong>Male rats were subjected to 75 min of CPB primed with either LR/albumin/mannitol or with 6% HES. Renal and lung edema were determined by wet/dry weight ratio. Pulmonary wet/dry weight ratio was lower in rats on CPB primed with LR/albumin/mannitol compared to HES (4.77 [4.44-5.25] vs. 5.33 [5.06-6.33], p = 0.032), whereas renal wet/dry weight ratio did not differ between groups (4.57 [4.41-4.75] vs. 4.51 [4.47-4.73], p = 0.813). Cremaster microcirculatory perfusion was assessed before, during and after CPB with intravital microscopy. CPB immediately impaired microcirculatory perfusion compared to baseline (LR/albumin/mannitol: 2 [1-7] vs. 14 [12-16] vessels per recording, p = 0.008; HES: 4 [2-6] vs. 12 [10-13] vessels per recording, p = 0.037), which persisted after weaning from CPB without differences between groups (LR/albumin/mannitol: 5 [1-9] vs. HES: 1 [0-4], p = 0.926). In addition, rats on CPB primed with LR/albumin/mannitol required less fluids to reach sufficient flow rates (0.5 [0.0-5.0] mL vs. 9 [4.5-10.0], p < 0.001) and phenylephrine (20 [0-40] µg vs. 90 [40-200], p = 0.004). Circulating markers for inflammation (interleukin 6 and 10), adhesion (ICAM-1), glycocalyx shedding (syndecan-1) and renal injury (NGAL) were determined by ELISA or Luminex. Circulating interleukin-6 (16 [13-25] vs. 33 [24-51] ng/mL, p = 0.006), interleukin-10 (434 [295-782] vs. 2120 [1309-3408] pg/ml, p < 0.0001), syndecan-1 (5 [3-7] vs. 15 [11-16] ng/mL, p < 0.001) and NGAL (555 [375-1078] vs. 2200 [835-3671] ng/mL, p = 0.008) were lower in rats on CPB primed with LR/albumin/mannitol compared to HES.</p><p><strong>Conclusion: </strong>CPB priming with LR, albumin and mannitol resulted in less pulmonary edema, renal injury, inflammation and glycocalyx degradation compared to 6% HES. Furthermore, it enhanced hemodynamic stability compared with HES. Further research is needed to explore the specific role of albumin as a beneficial additive in CPB priming.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"12 1","pages":"78"},"PeriodicalIF":2.8,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional distribution of mechanical strain and macrophage-associated lung inflammation after ventilator-induced lung injury: an experimental study.","authors":"Francesco Liggieri, Elena Chiodaroli, Mariangela Pellegrini, Emmi Puuvuori, Jonathan Sigfridsson, Irina Velikyan, Davide Chiumello, Lorenzo Ball, Paolo Pelosi, Sebastiano Stramaglia, Gunnar Antoni, Olof Eriksson, Gaetano Perchiazzi","doi":"10.1186/s40635-024-00663-2","DOIUrl":"10.1186/s40635-024-00663-2","url":null,"abstract":"<p><strong>Background: </strong>Alveolar macrophages activation to the pro-inflammatory phenotype M1 is pivotal in the pathophysiology of Ventilator-Induced Lung Injury (VILI). Increased lung strain is a known determinant of VILI, but a direct correspondence between regional lung strain and macrophagic activation remains unestablished. [⁶⁸Ga]Ga-DOTA-TATE is a Positron Emission Tomography (PET) radiopharmaceutical with a high affinity for somatostatin receptor subtype 2 (SSTR2), which is overexpressed by pro-inflammatory-activated macrophages. Aim of the study was to determine, in a porcine model of VILI, whether mechanical strain correlates topographically with distribution of activated macrophages detected by [⁶⁸Ga]Ga-DOTA-TATE uptake.</p><p><strong>Methods: </strong>Seven anesthetized pigs underwent VILI, while three served as control. Lung CT scans were acquired at incremental tidal volumes, simultaneously recording lung mechanics. [⁶⁸Ga]Ga-DOTA-TATE was administered, followed by dynamic PET scans. Custom MatLab scripts generated voxel-by-voxel gas volume and strain maps from CT slices at para-diaphragmatic (Para-D) and mid-thoracic (Mid-T) levels. Analysis of regional Voxel-associated Normal Strain (VoStrain) and [⁶⁸Ga]Ga-DOTA-TATE uptake was performed and a measure of the statistical correlation between these two variables was quantified using the linear mutual information (LMI) method.</p><p><strong>Results: </strong>Compared to controls, the VILI group exhibited statistically significant higher VoStrain and Standardized Uptake Value Ratios (SUVR) both at Para-D and Mid-T levels. Both VoStrain and SUVR increased along the gravitational axis with an increment described by statistically different regression lines between VILI and healthy controls and reaching the peak in the dependent regions of the lung (for strain in VILI vs. control was at Para-D: 760 ± 210 vs. 449 ± 106; at Mid-T level 497 ± 373 vs. 193 ± 160; for SUVR, in VILI vs. control was at Para-D: 2.2 ± 1.3 vs. 1.3 ± 0.1; at Mid-T level 1.3 ± 1.0 vs. 0.6 ± 0.03). LMI in both Para-D and Mid-T was statistically significantly higher in VILI than in controls.</p><p><strong>Conclusions: </strong>In this porcine model of VILI, we found a topographical correlation between lung strain and [⁶⁸Ga]Ga-DOTA-TATE uptake at voxel level, suggesting that mechanical alteration and specific activation of inflammatory cells are strongly linked in VILI. This study represents the first voxel-by-voxel examination of this relationship in a multi-modal imaging analysis.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"12 1","pages":"77"},"PeriodicalIF":2.8,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11371987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nitroglycerin challenge identifies microcirculatory target for improved resuscitation in patients with circulatory shock.","authors":"Massimiliano Bertacchi, Pedro D Wendel-Garcia, Anisa Hana, Can Ince, Marco Maggiorini, Matthias P Hilty","doi":"10.1186/s40635-024-00662-3","DOIUrl":"10.1186/s40635-024-00662-3","url":null,"abstract":"<p><strong>Background: </strong>Circulatory shock and multi-organ failure remain major contributors to morbidity and mortality in critically ill patients and are associated with insufficient oxygen availability in the tissue. Intrinsic mechanisms to improve tissue perfusion, such as up-regulation of functional capillary density (FCD) and red blood cell velocity (RBCv), have been identified as maneuvers to improve oxygen extraction by the tissues; however, their role in circulatory shock and potential use as resuscitation targets remains unknown. To fill this gap, we examined the baseline and maximum recruitable FCD and RBCv in response to a topical nitroglycerin stimulus (FCD_NG, RBCv_NG) in patients with and without circulatory shock to test whether this may be a method to identify the presence and magnitude of a microcirculatory reserve capacity important for identifying a resuscitation target.</p><p><strong>Methods: </strong>Sublingual handheld vital microscopy was performed after initial resuscitation in mechanically ventilated patients consecutively admitted to a tertiary medical ICU. FCD and RBCv were quantified using an automated computer vision algorithm (MicroTools). Patients with circulatory shock were retrospectively identified via standardized hemodynamic and clinical criteria and compared to patients without circulatory shock.</p><p><strong>Results: </strong>54 patients (57 ± 14y, BMI 26.3 ± 4.9 kg/m², SAPS 56 ± 19, 65% male) were included, 13 of whom presented with circulatory shock. Both groups had similar cardiac index, mean arterial pressure, RBCv, and RBCv_NG. Heart rate (p < 0.001), central venous pressure (p = 0.02), lactate (p < 0.001), capillary refill time (p < 0.01), and Mottling score (p < 0.001) were higher in circulatory shock after initial resuscitation, while FCD and FCD_NG were 10% lower (16.9 ± 4.2 and 18.9 ± 3.2, p < 0.01; 19.3 ± 3.1 and 21.3 ± 2.9, p = 0.03). Nitroglycerin response was similar in both groups, and circulatory shock patients reached FCD_NG similar to baseline FCD found in patients without shock.</p><p><strong>Conclusion: </strong>Critically ill patients suffering from circulatory shock were found to present with a lower sublingual FCD. The preserved nitroglycerin response suggests a dysfunction of intrinsic regulation mechanisms to increase the microcirculatory oxygen extraction capacity associated with circulatory shock and identifies a potential resuscitation target. These differences in microcirculatory hemodynamic function between patients with and without circulatory shock were not reflected in blood pressure or cardiac index.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"12 1","pages":"76"},"PeriodicalIF":2.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated level of extracellular vimentin is associated with an increased fibrin formation potential in sepsis: ex vivo swine study.","authors":"Marina Martinez-Vargas, Arun Saini, Subhashree Pradhan, Luis Gardea, Barbara Stoll, Inka C Didelija, K Vinod Vijayan, Trung C Nguyen, Miguel A Cruz","doi":"10.1186/s40635-024-00660-5","DOIUrl":"10.1186/s40635-024-00660-5","url":null,"abstract":"<p><strong>Background: </strong>Sepsis can lead to coagulopathy and microvascular thrombosis. Prior studies, including ours, reported an increased level of extracellular vimentin in blood derived from septic patients. Moreover, we identified the contribution of extracellular vimentin to fibrin formation and to the fibrin clot structure ex vivo in plasma from septic patients. Here, we tested the status of plasma vimentin and its impact on fibrin clots using our recently described swine model of methicillin-resistant Staphylococcus aureus (MRSA) sepsis-induced coagulopathy.</p><p><strong>Results: </strong>We employed ELISA, size-exclusion chromatography, vimentin antibodies, confocal microscopy, and turbidity assays on piglet plasma obtained at pre- and post-MRSA inoculation. Plasma vimentin level at 70 h post-MRSA inoculation was on average twofold higher compared to pre-infection (0 h) level in the same animal. Anti-vimentin antibody effectively reduced fibrin formation ex vivo and increased porosity in the fibrin clot structure generated from septic piglet plasma. In contrast to plasma at 0 h, the size-exclusion chromatography revealed that phosphorylated vimentin was in-complex with fibrinogen in septic piglet plasma.</p><p><strong>Conclusions: </strong>Thus, our swine model of sepsis-induced coagulopathy, reproduced increased extracellular circulating vimentin and subsequent potentiation of fibrin formation, often observed in septic patient. These outcomes validate the use of large animal models to investigate the dysregulated host immune response to infection leading to coagulopathy, and to develop new therapies for sepsis-induced disseminated microvascular thrombosis.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"12 1","pages":"75"},"PeriodicalIF":2.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving oxygenation in severe ARDS treated with VV-ECMO: comparative efficacy of moderate hypothermia and landiolol in a swine ARDS model.","authors":"Maud Vincendeau, Thomas Klein, Frederique Groubatch, N'Guyen Tran, Antoine Kimmoun, Bruno Levy","doi":"10.1186/s40635-024-00655-2","DOIUrl":"10.1186/s40635-024-00655-2","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory distress syndrome (ARDS) remains a significant challenge in critical care, with high mortality rates despite advancements in treatment. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is employed as salvage therapy for refractory cases. However, some patients may continue to experience persistent severe hypoxemia despite being treated with VV-ECMO. To achieve this, moderate hypothermia and short-acting selective β1-blockers have been proposed.</p><p><strong>Methods: </strong>Using a swine model of severe ARDS treated with VV-ECMO, this study investigated the efficacy of moderate hypothermia or β-blockade in improving arterial oxygen saturation (SaO₂) three hours after VV-ECMO initiation. Primary endpoints included the ratio of VV-ECMO flow to cardiac output and arterial oxygen saturation before VV-ECMO start (H0) and three hours after ECMO start (H3). Secondary safety criteria encompassed hemodynamics and oxygenation parameters.</p><p><strong>Results: </strong>Twenty-two male pigs were randomized into three groups: control (n = 6), hypothermia (n = 9) and β-blockade (n = 7). At H0, all groups demonstrated similar hemodynamic and respiratory parameters. Both moderate hypothermia and β-blockade groups exhibited a significant increase in the ratio of VV-ECMO flow to cardiac output at H3, resulting in improved SaO₂. At H3, despite a decrease in oxygen delivery and consumption in the intervention groups compared to the control group, oxygen extraction ratios across groups remained unchanged and lactate levels were normal.</p><p><strong>Conclusions: </strong>In a swine model of severe ARDS treated with VV-ECMO, both moderate hypothermia and β-blockade led to an increase in the ratio of VV-ECMO flow to cardiac output resulting in improved arterial oxygen saturation without any impact on tissue perfusion.</p>","PeriodicalId":13750,"journal":{"name":"Intensive Care Medicine Experimental","volume":"12 1","pages":"74"},"PeriodicalIF":2.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}