Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world. Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - <= 50, 51-60, 61-70, 71-80, >80 years. Sepsis was defined as infection plus at least one organ failure. Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (<= 50 = 25.2%: 51-60 = 30.3%; 61-70 = 32.8%; 71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients <= 50 years (493% vs 25.2%, p < .05). The maximum rate of increase in mortality was about 0.75% per year, occurring between the ages of 71 and 77 years. In multilevel analysis, age > 70 years was independently associated with increased risk of dying. Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved.

INTRODUCTION:Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic.METHODS:This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU EPOSS).RESULTS:394 patients were analyzed. Median age at admission was 66 (56- 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19- 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840- 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS ICU length of stay (LOS) was 7 (3- 15) days and median hospital LOS was 13 (8- 28) days. Hospital mortality in our cohort was 35.8%.CONCLUSION:Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.

This study evaluated inflammatory, coagulation and microvascular responses to a continuous 24-h work day in 13 healthy intensive care physicians. Inflammatory markers (interleukin [IL]-2, IL-6, IL-10, tumour necrosis factor-α, matrix metalloproteinase [MMP]-9 and adiponectin), adhesion molecules (vascular cellular adhesion molecule-1 and intercellular adhesion molecule-1 [ICAM-1]), coagulation parameters (thrombin—anti thrombin, von Willebrand factor and tissue factor) and sublingual micro circulation were assessed before and after a 24-h work shift. The 24-h work shift had no effect on inflammatory markers and ICAM-1. Direct visualization of microcirculation did not reveal stress-related perfusion abnormalities. A 24-h work shift in the intensive care unit was associated with significantly increased plasma levels of tissue factor — a potentially important mechanism linking acute job strain, haemostasis and atherosclerosis. The long-term consequences warrant further evaluation.

Hypothermia was shown to attenuate ventilator-induced lung injury due to large tidal volumes. It is unclear if the protective effect of hypothermia is maintained under less injurious mechanical ventilation in animals without previous lung injury. Tracheostomized rats were randomly allocated to non-ventilated group (group C) or ventilated groups of normothermia (group N) and mild hypothermia (group H). After two hours of mechanical ventilation with inspiratory fraction of oxygen 1.0, respiratory rate 60 min(-1), tidal volume 10 ml x kg(-1), positive end-expiratory pressure (PEEP) 2 cm H2O or immediately after tracheostomy in non-ventilated animals inspiratory pressures were recorded, rats were sacrificed, pressure-volume (PV) curve of respiratory system constructed, bronchoalveolar lavage (BAL) fluid and aortic blood samples obtained. Group N animals exhibited a higher rise in peak inspiratory pressures in comparison to group H animals. Shift of the PV curve to right, higher total protein and interleukin-6 levels in BAL fluid were observed in normothermia animals in comparison with hypothermia animals and non-ventilated controls. Tumor necrosis factor-alpha was lower in the hypothermia group in comparison with normothermia and non-ventilated groups. Mild hypothermia attenuated changes in respiratory system mechanics and modified cytokine concentration in bronchoalveolar lavage fluid during low lung volume ventilation in animals without previous lung injury.

Recent recommendations on tight glucose control in general critically ill patients questioned its effect on patient outcome [1,2]. The aim of our work is to determine whether the implementation of tight glucose control to our practice improved our patients' outcome.

Large tidal volumes and transpulmonary pressures play a central role in pathogenesis of ventilator-induced lung injury. Moderate tidal volumes are considered safe in healthy lungs [1]. Recent studies suggested that insults like endotoxin [2] or surgery [3] sensitize the lung to injury by priming for an exaggerated response to a second stimulus. Our aim was to investigate how animals sensitized to lung injury by previous anesthesia and surgery respond to mechanical ventilation (MV).

The purpose of the study was to compare the results of interstitial glucose measurements obtained by the Guardian Real-time system and arterial plasma glucose concentration in mechanically ventilated, critically ill patients. The Guardian Real-time continuous glucose monitoring system is an external device that uses a subcutaneous microsensor that measures the concentrations of glucose in interstitial fluid.

Intermittent positive pressure ventilation (IPPV) may be accompanied by alteration of microcirculation [1,2]; however, the effect of IPPV is not mentioned in the interpretation of the results of studies evaluating microcirculation using orthogonal polarization spectral or sidestream dark-field imaging. This study aimed to evaluate the effect of IPPV on microcirculation in the skeleton muscles and in the serosa of the small intestine in rats.

Hydrogen sulfide is produced endogenously by a variety of enzymes involved in cysteine metabolism.Clinical data indicate that endogenous levels of hydrogen sulfide are diminished in various forms of cardiovascular diseases.The aim of the current study was to investigate the effects of hydrogen sulfide supplementation on cardiac function during reperfusion in a clinically relevant experimental model of cardiopulmonary bypass.Twelve anesthetized dogs underwent hypothermic cardiopulmonary bypass.After 60 minutes of hypothermic cardiac arrest, reperfusion was started after application of either saline vehicle (control, n = 6), or the sodium sulfide infusion (1 mg/kg/hour, n = 6).Biventricular hemodynamic variables were measured by combined pressure-volume-conductance catheters.Coronary and pulmonary blood flow, vasodilator responses to acetylcholine and sodiumnitroprusside and pulmonary function were also determined.Administration of sodium sulfide led to a significantly better recovery of left and right ventricular systolic function (P < 0.05) after 60 minutes of reperfusion.Coronary blood flow was also significantly higher in the sodium sulfide-treated group (P < 0.05).Sodium sulfide treatment improved coronary blood flow, and preserved the acetylcholine-induced increases in coronary and pulmonary blood (P < 0.05).Myocardial ATP levels were markedly improved in the sulfide-treated group.Thus, supplementation of sulfide improves the recovery of myocardial and endothelial function and energetic status after hypothermic cardiac arrest during cardiopulmonary bypass.These beneficial effects occurred without any detectable adverse hemodynamic or cardiovascular effects of sulfide at the dose used in the current study.

Department of Anesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic

1Department of Anesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic

BACKGROUND:End of life decisions have been considered as an important part of making decisions in terminally critically ill patients. Withdrawing mechanical ventilation (terminal weaning) represents one of the procedures limiting life support therapy. The aim of the study was to examine the clinical experiences of limiting ventilatory support at tertiary care hospital ICU in Czech Republic.METHODS AND RESULTS:A retrospective, descriptive study of all patients experienced terminal weaning (TW) in years 1999-2001 was conducted. Diagnosis, length of ICU stay (LOS) in days before decision of TW was made, duration of TW (TW time = time from starting TW to cardiac arrest in minutes), way of TW and difference in TW time between selected patients subgroups were also evaluated. Selected data are presented as mean or median, t-test or Mann-Whitney Rank Sum Test were used, p < 0.05 was considered statistically significant. The TW procedure was employed in 46 patients, stepwise reduction of ventilatory support was performed in 23 patients, ventilator withdrawal procedure in 23 patients. The mean TW time in all patients was 188 minutes. There was shorter TW time in patients with analgosedation comparing to those without (median 17, resp. 161 minutes, p = 0.002). Patients without respiratory activity showed shorter TW time comparing to patients with preserved respiratory activity (median 17, resp. 85 minutes, p = 0.014).CONCLUSIONS:Terminal weaning represents an important part of processes of discontinuing life-sustaining therapies in terminally critically ill patients. There is medical, ethical and legal basis to employ this procedure at intensive care unit.

SOCIETY OF CRITICAL CARE MEDICINE 32ND CRITICAL CARE CONGRESS SAN ANTONIO, TEXAS, USA JANUARY 28-FEBRUARY 2, 2003: ORAL/SANDWICH PRESENTATIONS: Poster Presentation: Clinical Science: Pulmonary Disease Outcomes: PDF Only

A new adjunctive system to obtain higher PaO 2 with nasal cannula or catheter: double trunk mask

Different techniques to determine optimal PEEP setting in patients with ARDS have been suggested. The aim of our study was to evaluate assessment of static compliance of respiratory system in combination with estimated lung recruitment [1] for selection of PEEP setting with minimal Qs/Qt.