Michael Bauer

Anemia and blood transfusion in a surgical intensive care unit

IntroductionStudies in intensive care unit (ICU) patients have suggested that anemia and blood transfusions can influence outcomes, but these effects have not been widely investigated specifically in surgical ICU patients.MethodsWe retrospectively analyzed the prospectively collected data from all adult patients (>18 years old) admitted to a 50-bed surgical ICU between 1st March 2004 and 30th July 2006.ResultsOf the 5925 patients admitted during the study period, 1833 (30.9%) received a blood transfusion in the ICU. Hemoglobin concentrations were < 9 g/dl on at least one occasion in 57.6% of patients. Lower hemoglobin concentrations were associated with a higher Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score, greater mortality rates, and longer ICU and hospital lengths of stay. Transfused patients had higher ICU (12.5 vs. 3.2%) and hospital (18.3 vs. 6.5%) mortality rates (both p < 0.001) than non-transfused patients. However, ICU and in-hospital mortality rates were similar among transfused and non-transfused matched pairs according to a propensity score (n = 1184 pairs), and after adjustment for possible confounders in a multivariable analysis, higher hemoglobin concentrations (RR 0.97[0.95-0.98], per 1 g/dl, p < 0.001) and blood transfusions (RR 0.96[0.92-0.99], p = 0.031) were independently associated with a lower risk of in-hospital death, especially in patients aged from 66 to 80 years, in patients admitted to the ICU after non-cardiovascular surgery, in patients with higher severity scores, and in patients with severe sepsis.ConclusionsIn this group of surgical ICU patients, anemia was common and was associated with higher morbidity and mortality. Higher hemoglobin concentrations and receipt of a blood transfusion were independently associated with a lower risk of in-hospital death. Randomized control studies are warranted to confirm the potential benefit of blood transfusions in these subpopulations.

The heme oxygenase – carbon monoxide system: regulation and role in stress response and organ failure

Heme oxygenase (HO) breaks down heme, the iron-containing, oxygen-carrying constituent of red blood cells, yielding biliverdin, iron (II) ions, and carbon monoxide (CO). Among the isoenzymes cloned to date, only HO-1 can be induced by axa0panoply of stimuli linked by their ability to provoke oxidative stress. HO-1 induction protects against cell death in experimental models associated with ischemia/reperfusion or inflammation, making the gene axa0promising target for critical care medicine. Induction of HO-1 may confer protection by controlling intracellular levels of toxic heme, or by anti-inflammatory, anti-apoptotic, and blood flow-maintaining effects of its by-products biliverdin and CO. Although protective effects of upregulation of HO-1 have been reported for axa0variety of cells and tissues, evidence suggests that the protective action may be restricted to axa0rather narrow threshold of overexpression. In addition, there is substantial variation in gene expression depending on transcriptional control mechanisms such as axa0microsatellite length polymorphism. Genetic variability and the required use of cytotoxic inducers are hurdles for purposeful targeting of HO-1 gene expression in critical care, while administration of by-products of the pathway seems feasible at present.

Effects of 15-deoxy-Δ12,14-prostaglandin-J2 during hyperdynamic porcine endotoxemia

AbstractObjectiveTo investigate the hemodynamic and metabolic effects of nthe peroxisome proliferator-activated receptor (PPAR)-γ ligand and nnuclear-factor (NF)-κ B inhibitor 15-deoxy-Δ12,14-prostaglandin-J2 (15d-PGJ2) during long-term, hyperdynamic nporcine endotoxemia.DesignProspective, randomized, controlled nexperimental study with repeated measures.SettingInvestigational animal laboratory.Subjects19 anesthetized, mechanically ventilated and instrumented pigs.InterventionsAt 12u202fh of continuous intravenous nendotoxin and hydroxyethylstarch to keep mean arterial pressure (MAP) n>u202f60u202fmmHg, swine randomly received vehicle (control group, nu202f=u202f10) or n15-deoxy-Δ12,14-prostaglandin-J2 (15d-PGJ2 group, nu202f=u202f9; n1u202fμgu202fkg−1u202fmin−1loading dose during 1u202fh; thereafter,0.25u202fμgu202fkg−1u202fmin−1 for 11u202fh).Measurements and resultsHemodynamic, metabolic and organ function parameters were assessed together nwith parameters of nitric oxide production and oxidative stress. n15d-PGJ2 prevented the endotoxin-induced progressive hypotension, due nto axa0positive inotropic effect, which resulted in axa0significantly higher nblood pressure during the treatment phase and prevented the rise in hepatic nvein alanine-aminotransferase activity. It did not affect, however, any nother parameter of organ function nor of nitric oxide production, nproinflammatory cytokine release or lipid peroxidation (8-isoprostane).Conclusions15d-PGJ2 stabilized systemic hemodynamics, due to improved nmyocardial performance, and resulted in an only transient effect on nalanine-aminotransferase activity, without further beneficial effect on nendotoxin-induced metabolic and organ function derangements. Low tissue n15d-PGJ2 concentrations and/or the delayed drug administration may nexplain these findings.

Increased lipogenesis in spite of upregulated hepatic 5'AMP-activated protein kinase in human non-alcoholic fatty liver.

Molecular adaptations in human non‐alcoholic fatty liver disease (NAFLD) are incompletely understood. This study investigated the main gene categories related to hepatic de novo lipogenesis and lipid oxidation capacity.

Schock und Multiorganversagen

Eine 50-jahrige Patientin wird nach einem Sturz aus 8 m Hohe in den Schockraum gebracht. Sie war am Unfallort hypoton (Blutdruck 90/50 mmHg), tachykard (130/min), der GCS betrug 12 Punkte. Sie wurde vom Notarzt intubiert und beatmet und hat bei einem Pneumothorax eine Thoraxdrainage erhalten. Die Patientin wird wahrend der Ubergabe reanimationspflichtig. Unter forcierter Volumentherapie, u. a. mit 250 ml HyperHAES und mehreren ungekreuzten Erythrozytenkonzentraten der Blutgruppe Null Rhesus negativ, kann der Kreislauf wiederhergestellt werden. Im Spiral-CT zeigt sich folgendes Verletzungsmuster: kleine traumatische Subarachnoidalblutung, Thoraxtrauma mit Rippenserienfraktur, Pneumothorax und erheblichen Lungenkontusionen, Leberruptur, Lendenwirbelkorperfraktur sowie komplexe Beckenringfraktur. Die Patientin wird direkt operativ versorgt; das Becken wird stabilisiert und bei erheblicher Blutung mit Bauchtuchern gepackt; ebenfalls erfolgt ein Packing im Bereich der Leber. Bis zu diesem Zeitpunkt hat die Patientin 12 EK, 400 ml maschinelles Autotransfusionsblut, 10 FFP, 2 TK, 5 g Fibrinogen sowie 2 g Tranexamsaure erhalten und wird auf die Intensivstation gebracht. Trotz kontinuierlicher Volumentherapie ist die Patientin hoch katecholaminpflichtig; es besteht eine ausgepragte metabolische Azidose (pH-Wert < 7,1) und Hyperlaktatamie, sodass eine Pufferung mit Natriumbikarbonat und TRIS-Puffer erfolgt. Innerhalb einer weiteren Stunde werden weitere 10 EK, 10 FFP und 4 TK sowie 8 g Fibrinogen gegeben. Bei zunehmender Oxygenierungsstorung (paO70 mmHg bei FiO0,8) wird sie in ein Bett zur kontinuierlichen lateralen Rotationstherapie gelagert.

Additional file 3: of Chemerin in peritoneal sepsis and its associations with glucose metabolism and prognosis: a translational cross-sectional study

Figure S2. Correlation of fasting and intra-operative glucose levels with circulating chemerin in controls. a Correlation of circulating chemerin levels with fasting glucose levels (ru2009=u20090.216, pu2009=u20090.034, nu2009=u200917). b Correlation of circulating chemerin levels with OP glucose (ru2009=u20090.549, pu2009=u20090.023, nu2009=u200917). (PDF 44 kb)