Authors: Patel GP, Balk RA Despite over five decades of study and debate, the role of corticosteroid treatment in patients with severe sepsis and septic shock remains controversial. Data supports a beneficial effect on systemic blood pressure in patients with septic shock. However, the ability of corticosteroid therapy to improve mortality in patients with severe sepsis and septic shock remains controversial with contradictory results from recent large multicenter clinical trials. While it appears clear that high dose corticosteroid treatment provides no benefit and possibly harm in septic patients, the experimental design flaws and biases of recent low dose (physiologic) steroid treatment trials limits their ability to provide adequate answers to the important questions of which septi...

Authors: Marini JJ Auto-PEEP and dynamic hyperinflation may affect hemodynamics, predispose to barotrauma, increase work of breathing, cause dyspnea, disrupt patient-ventilator synchrony, confuse monitoring of hemodynamics and respiratory system mechanics, and interfere with the effectiveness of pressure-regulated ventilation. While basic knowledge regarding the clinical physiology and management of auto-PEEP during mechanical ventilation has evolved impressively over the thirty years since DH and auto-PEEP were first brought to clinical attention, novel and clinically relevant characteristics of this complex phenomenon continue to be described. This discussion reviews some of the more important aspects of auto-PEEP that bear on the care of the ventilated patient with critical illness....

Authors: Hoeper MM, Granton J Despite advances in medical therapies, pulmonary arterial hypertension (PAH), continues to cause significant morbidity and mortality. Although the right ventricle can adapt to an increase in afterload, progression of the pulmonary vasculopathy that characterizes PAH causes many patients to develop progressive right ventricular failure. Furthermore acute right ventricular decompensation may develop from disorders that lead to either an acute increase in cardiac demand such as sepsis, or increase in ventricular afterload including interruptions in medical therapy, arrhythmia, or pulmonary embolism. The poor reserve of the right ventricle, RV ischemia and adverse right ventricular influence on left ventricular filling may lead to a global reduction in oxygen ...

CONCLUSIONS: The reported use of gastroesophageal reflux medications is associated with decreased radiologic fibrosis and is an independent predictor of longer survival time in patients with idiopathic pulmonary fibrosis. These findings further support the hypothesis that GER and chronic microaspiration may play important roles in the pathobiology of IPF. PMID: 21700909 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)