Abstract
Hyperglycemia and insulin resistance are common in critical illness. Recently, a reduction of morbidity and mortality of patients in a surgical ICU by maintaining normoglycemia with insulin has been demonstrated [1]. Studies on mitochondria in sepsis [2] and other critical illness and on hyperglycemia in diabetes [3] suggested that the effects of this therapy on mitochondrial integrity and oxidative stress state may contribute to the positive results of the treatment. Twenty liver biopsies obtained postmortem from patients randomized to intensive insulin therapy (IIT) or conventional insulin therapy (CIT) were randomly selected for mitochondrial investigation. Studied patients in the CIT and IIT groups were comparable for age and type, severity and duration of critical illness. The mean blood glucose levels were 10.5 ± 0.6 and 5.6 ± 0.4 mmol/l (P < 0.0001) on a median daily insulin dose of 31 and 45 IU (P = 0.3), respectively. Hypertrophic mitochondria with an increased number of abnormal and irregular cristae and reduced electron-density of the matrix were observed by electron microscopy for seven of the nine patients in the CIT group, in contrast to only one of the 11 IIT patients (P = 0.0018). In addition, significantly higher activities of complex III and complex IV of the respiratory chain and a trend for higher activities of complex I, complex II and complex V and glyceraldehyde-3-P dehydrogenase, an enzyme of which the inhibition by superoxide has been linked to hyperglycemic complications in diabetes [3], were found in the IIT as compared with the CIT group. In conclusion, maintenance of normoglycemia with IIT appeared to prevent ultrastructural and functional abnormalities of hepatocytic mitochondria associated with critical illness-induced hyperglycemia. These alterations may have contributed to the benefits of the intervention. Further analyses are needed to link the positive effect of IIT on mitochondrial integrity to an effect on oxidative stress state in critical illness.
Highlights
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today
Summary Our study demonstrated that LS is a good alternative to restore cardiac contractile function when combined with NE
The use of AVP may lead to further deteriorate sepsis-related myocardial dysfunction even when combined with a positive inotropic agent
Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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