Annual Update in Intensive Care and Emergency Medicine 2011

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506 M. Bassetti, F. Ginocchio, and M. Mikulska XII against ESBL-producing strains. Moreover, their combined use with carbapenems, makes the latter active against MBL-producing strains. Although the results of studies on the clinical usefulness of new β-lactam inhibitors are not yet available, they seem particularly promising as therapeutic agents. Details of new β-lactam inhibitors are outlined in Table 2. Inhibitors with a �-lactam Structure Imidazole-substituted 6-methylidene-penem molecules The unique structure of these compounds (they contain byciclic or triciclic substituents connected by a methydilene linkage to the 6 position of the β-lactam ring) imparts potent activity against class A and C β-lactamases, such as the AmpC enzyme, which is not observed with the currently used inhibitors. Several novel compounds demonstrated excellent in vitro inhibition of the TEM-1 enzyme (class A β-lactamases) and AmpC enzyme with significantly higher activity compared with tazobactam [22]. In vitro tests showed synergistic activity of these compounds when combined with piperacillin with susceptibility of 90 % of the tested organisms; animal models confirmed the synergistic effect with piperacillin [22, 23]. Among these agents, BLI-489 is the compound with the most promising clinical data. It has shown activity against molecular class A, C and D enzymes, including ESBL as well as class C β-lactamases; some strains that were class C or ESBL producers, classified as non-susceptible to piperacillin/tazobactam, were found to be susceptible to piperacillin/BLI-489 [24]. 2�-alkenyl penam sulfones 2β-alkenyl penam sulfones, another group of inhibitors with β-lactam structure, inhibit most of the common types of β-lactamases, with a level of activity depending strongly on the nature of the substituent in the 2β-alkenyl group. Richter et al. demonstrated that Ro 48-1220, the most active inhibitor from this class of compounds, enhanced the action of ceftriaxone against a broad selection of organism producing β-lactamases, including strains of cephalosporinase-producing Enterobacteriaceae [25]. In a different study, Ro 48-1220 was at least 15 times more effective than tazobactam against the class C enzymes and reduced the MIC values of ceftriaxone and ceftazidime against the class A plasmid-mediated β-lactamases; less potency was exerted towards SHV-type β-lactamases [26]. 4-phenyl cyclic phosphate 4-phenyl cyclic phosphate is a monocyclic acyl phosphonate. It has an irreversible reaction with E. Cloacae P99 β-lactamase (Class C). This compound also bound TEM-2 and P99 β-lactamases non-covalently. Similar to other novel inhibitors, it is effective against class A and class C enzymes [27]. C3-modified penicillin sulfones Buynak et al. reported that C3-methylene-group penicillin sulfones were 10-fold more active against class C β-lactamases compared to sulbactam [28]. Monobactam-based structure compounds BAL 30376 is a β-lactamase inhibitor and is a combination of BAL 0019764 (a siderophore monobactam), BAL 0029880 (a bridged monobactam which is a class C inhibitor), and clavulanic acid [24]. Page et al. [29] demonstrated the in vitro
activity of BAL 30376 against various Gram-negative bacteria. MICs were observed in a range of e 0.06–4 mg/l, including most carbapenem-resistant strains. Higher MICs were observed for a few strains of Acinetobacter spp., Enterobacter spp. and P. aeruginosa. Tricyclic carbapenem inhibitors LK-157 is a tricyclic carbapenem inhibitor of serine β-lactamases [24]. LK-157 decreased the MICs of aztreonam, ceftazidime, and cefuroxime for B. fragilis and awiderangeofβ-lactamases-producing Enterobacteriaceae members. However, LK-157 did not affect the MICs of aztreonam, ceftazidime or cefuroxime against CTX-M producing members of Enterobacteriaceae [24]. Oxapenems Four β-lactamase inhibitors, members of the oxapenems, are being developed (AM-112 – AM-115) and express activity against class A, C, and D enzymes [30]. AM-114 and AM-115 displayed the most potent activity against class A enzymes, comparable to that of clavulanic acid. Activity against class C and class D enzymes was similar to that of AM-112 and AM-113 and was superior to that of clavulanic acid. A synergistic activity of ceftazidime with the oxapenems was demonstrated against SHV- and TEM-producing E. coli. Enhancedactivityof oxapenems in combination with ceftazidime was also noted against Pseudomonas strains and MRSA [31]. Inhibitors with no �-lactam Structure NXL104 NXL104 is a non-β-lactam compound which inhibits β-lactamases through the formation of a stable covalent carbamoyl linkage. In combination with ceftazidime and cefotaxime against Enetrobacteriaceae producing CTX-M ESBLs, it showed a 4 to 8000-fold potentiation of the cephalosporins, with MIC values e 1 for all organisms irrespective of CTX-M type [24]. Against P99, NXL104 showed a stronger inhibition than tazobactam, whereas clavulanic acid was inactive. Another study showed that combination with NXL104 restored the activity of ceftazidime and cefotaxime against isolates producing class A carbapenemases [24]. NXL104/ceftazidime combination is currently undergoing Phase II clinical trials in patients admitted for complicated intra-abdominal and complicated urinary tract infections [32]. Maleic acid derivates ME1071, previously known as CP3242, is a metallo β-lactamase inhibitor that competitively inhibits IMP-1 and VIM-2. It significantly lowered the MICs of biapenem in a concentration-dependent manner against MBL-producing P. aeruginosa. MIC lowering by ME1071 was also shown for IMP- or VIM-producing E. coli, S. marcescens, A. baumanii and K. pneumoniae [24]. New Cephalosporins New Treatment Options against Gram-negative Organisms 507 New cephalosporins are very resistant to penicillinases and two of them have demonstrated anti-methicillin resistant S. aureus (MRSA) activity in animal mod- XII
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Annual Update in Intensive Care and
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The series Annual Update in Intensi
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VI Table of Contents IV Endotrachea
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VIII Table of Contents XI Periopera
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List of Contributors Abroug F Inten
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Cecconi M Department of General Int
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Garcia X Department of Critical Car
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Jog S Department of Intensive Care
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Murias G Intensive Care Unit Clinic
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Reuter DA Department of Anesthesiol
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Sobol J Department of Anesthesiolog
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Wunsch H Department of Anesthesiolo
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Section I 1 I Mechanisms of Sepsis
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4 M.A.D. van Zoelen, A. Achouiti, a
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10 M.A.D. van Zoelen, A. Achouiti,
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16 I The Endocannabinoid System: A
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18 C. Lehmann, V. Cerny, and M. Mat
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26 I Remote Ischemic Conditioning a
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28 P. Meybohm and B. Bein I Remote
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30 P. Meybohm and B. Bein I other i
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32 P. Meybohm and B. Bein I determi
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34 P. Meybohm and B. Bein I to enco
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36 P. Meybohm and B. Bein I 39. Wal
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38 S.N. Heyman, S. Rosen, and C. Ro
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Section II 49 II Coagulation System
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52 X. Delabranche, F. Toti, and F.
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62 II The Inflammatory Potential of
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64 C. Jennewein, N. Tran, and K. Za
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70 II Iron Deficiency in Critically
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72 N.Heming,P.Montravers,andS.Lasoc
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80 II Heparin-induced Thrombocytope
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82 Y. Sakr II increase the risk of
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84 Y. Sakr II Thrombotic Complicati
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86 Y. Sakr II used. The agglutinati
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88 Y. Sakr II In30%ofpatientswhoare
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90 Y. Sakr II The Challenge of Diag
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92 Y. Sakr II tures of heparin-indu
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Section III 95 III Acute Respirator
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98 N.J. Meyer and J.D. Christie III
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100 N.J. Meyer and J.D. Christie II
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110 F. Dachraoui, L. Ouanes-Besbes,
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118 I. Galvin and N.D. Ferguson III
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Rapid Sequence Intubation: Overview
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Pre-hospital Rapid Sequence Intubat
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ecommend its use in the setting of
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Table 1. Hypnotic agents Agent Dose
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Conclusion Rapid sequence intubatio
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Alterations in Oral Microbial Ecolo
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pharynx is deemed to play an import
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Table 1. The BRUSHED Assessment Mod
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Research Priorities in Oral Care fo
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Conclusion Research Priorities in O
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Research Priorities in Oral Care fo
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Pros and Cons of Assisted Mechanica
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NoisyPSVhasanadvantageoverotherassi
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improvement in lung elastance, with
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controlled mechanical ventilation [
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References Pros and Cons of Assiste
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Can ’Permissive’ Hypercapnia Mo
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However, concerns persist, particul
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NAVA: Why, When, Who? 189 Restricte
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Table 1. Summary of recent human ph
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Essentially, neural (EAdi) monitori
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NAVA: Why, When, Who? 195 16. Girar
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Therapeutic Aerosols in Mechanicall
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a) Jet nebulizer b) Ultrasonic nebu
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References Therapeutic Aerosols in
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Section VI 207 VI Cardiac Crises VI
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210 S. Scolletta, B. Biagioli, and
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220 VI Evolving Rationale for Minim
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222 J.G. Wigginton, A.H. Idris, and
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Hypoalbuminemia as a Risk Factor fo
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Microcirculation Possibly, at least
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Tubular Function Tubular concentrat
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injury, failure, need for renal rep
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Developing Biological Markers 247 a
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Conclusion The discovery of several
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Biomarkers of Acute Kidney Injury i
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and acute tubular necrosis is unpro
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utility (Breathing Not Properly stu
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NGAL, in various other complexes wi
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tantly, a positive association with
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References Biomarkers of Acute Kidn
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Cardio-renal Syndromes: A Complex S
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�� Cardio-renal Syndro
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Blood Purification in Sepsis and Ac
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The Lymphatic Vasculature as a Part
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FormationofLymph The Lymphatic Vasc
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The Interstitium and Lymphatics hav
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Fluid is a Drug that can be Overdos
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Table 1. Fluid overload and outcome
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Conclusion The studies discussed ab
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Crystalloid or Colloid Fluids: A Ma
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More Saline than Colloid Needed? Cr
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The Cyclic Effects of Mechanical Ve
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PracticalUseofPPVinPatientswithARDS
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Meaning of Pulse Pressure Variation
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References Meaning of Pulse Pressur
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Meaning of Pulse Pressure Variation
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however, an overall assessment of t
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Fig. 2. Varying response to stoke v
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Table 1. An example of a safety pro
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References The Fluid Challenge 339
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Facing the Challenge: A Rational St
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Section IX 353 IX The Microcirculat
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356 M.A. Puskarich and A.E. Jones I
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366 IX How Can We Use Tissue Carbon
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368 E. Futier, J.-L. Teboul, and B.
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376 X.Garcia,F.X.Guyette,andM.R.Pin
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378 X.Garcia,F.X.Guyette,andM.R.Pin
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380 IX The Microcirculation of the
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382 A.P.C. Top, R.C. Tasker, and C.
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384 A.P.C.Top,R.C.Tasker,andC.Ince
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Heart Rate as Prognostic Marker and
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Fig. 3. Effects of baseline heart r
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heart rate 140 120 100 80 60 40 20
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in conjunction with cardiogenic sho
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Table 1. Summary of different hemod
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Hemodynamic Monitoring in Cardiogen
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variations of the left sided time-v
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Non-Invasive Estimation of Left Ven
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Fig. 1. Original theory by Otto Fra
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Hemodynamics from the Periphery 427
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Totally Non-invasive Continuous Car
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There are some limitations to the u
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Cardiac Output Monitoring: An Integ
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occurring signal variation with dif
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Table 2. (continued) Additional var
Page 463 and 464: Fig. 2. Integrative concept for the
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Page 467 and 468: Section XI 457 XI Perioperative Med
Page 469 and 470: 460 N. Brienza, L. Dalfino, and M.T
Page 481 and 482: 472 S.G. De Hert and P.F. Wouters X
Page 489 and 490: A New Approach to Ventilator-associ
Page 491 and 492: Underlying Diseases A New Approach
Page 497 and 498: organisms in acute respiratory infe
Page 501 and 502: Selective Decontamination of the Di
Page 503 and 504: SDD/SOD and Antibiotic Resistance A
Page 505 and 506: study the effects of SDD and SOD on
Page 507 and 508: Selective Decontamination of the Di
Page 509 and 510: New Treatment Options against Gram-
Page 511 and 512: Table 1. Classification schemes for
Page 513: are currently no antibacterials in
Page 519 and 520: Panipenem/betamipron New Treatment
Page 521 and 522: References New Treatment Options ag
Page 525 and 526: The ‘Bug’ In order to ensure ou
Page 527 and 528: tum [38].Allthreecompoundsarefungic
Page 529 and 530: Antifungal Therapy in The ICU: The
Page 533 and 534: Renal Dysfunction Antifungal Therap
Page 535 and 536: For fusariosis, voriconazole, posac
Page 539 and 540: Mycobacterial Sepsis and Multiorgan
Page 541 and 542: Other Systems Seeding of every orga
Page 545 and 546: mediuminthepresenceandabsenceofanti
Page 547 and 548: Table 1. Suggested treatment regime
Page 551 and 552: Pentraxin 3 (PTX3): Possible Role i
Page 553 and 554: patients, anti-PTX3 antibodies are
Page 555 and 556: Fig. 2. Pentraxin 3 (PTX3) in septi
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Page 559 and 560: The Role of IgM- and IgA-enriched I
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Spontaneous Bacterial Peritonitis i
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of the splanchnic sympathetic nervo
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concomitant malignancy or traumatic
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These criteria seem to be very sens
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Prognosis When SBP was initially de
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significant effect on the probabili
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Fig. 1. The ‘critical mass’ con
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Acute-on-chronic Liver Failure: An
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Fig. 4. Representative scheme of th
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Survival benefit with MARS in patie
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Section XIV 589 XIV Trauma and Emer
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XIV 592 J.E. Hollander and A.M. Cha
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XIV 600 C. Hommers and J. Nolan sys
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XIV 602 C. Hommers and J. Nolan 97-
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XIV 604 C. Hommers and J. Nolan exp
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XIV 606 C. Hommers and J. Nolan per
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XIV 608 C. Hommers and J. Nolan 4.
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XIV 610 C. Hommers and J. Nolan 49.
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XIV 612 H. Schoechl, W. Voelckel, a
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XIV 620 H.Schoechl,W.Voelckel,andC.
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Section XV 629 XV Neurological Aspe
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632 S. Legriel, F. Pico, and E. Azo
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654 XV Prediction of Neurological O
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656 C. Sandroni, F. Cavallaro, and
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664 XV Neuroprotection in Sepsis by
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666 F. Esen XV leading to further n
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668 F. Esen XV can activate complem
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670 F. Esen XV tested the neuroprot
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672 F. Esen XV In sepsis, the use o
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674 F. Esen XV 41. Mocco J, Mack WJ
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676 A. Demertzi, S. Laureys, and M.
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Metformin and Lactic Acidosis S. Ve
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note, lactic acidosis may develop e
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unexplained lactic acidosis and hav
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17 ± 5 mmol/l. In one fatal case,
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Metformin and Lactic Acidosis 693 2
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Determination of Energy Goals Indir
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acy rates (defined as < 15 % error
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Energy Goals in the Critically Ill
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ing. Hence, while a brief period of
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lipogenesis, hepatic steatosis, inc
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educed metabolic demands of adipose
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Energy Goals in the Critically Ill
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Frailty: A New Conceptual Framework
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Although the concept of frailty has
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tion in the development of acquired
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digm that includes those processes
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Frailty: A New Conceptual Framework
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In the last decade, the UK reduced
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Access Block and Emergency Departme
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Potential Solutions Access Block an
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Access Block and Emergency Departme
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Triage of High-risk Surgical Patien
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is another system calculated from s
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ICU Admission Guidelines Triage of
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Transportation of the Critically Il
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sum of several smaller - seemingly
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shown that intra-hospital transport
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is stationary, the external ventric
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Should We Still Order Chest X-rays
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Table 1. Item wording of the Delphi
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on-demand approach, such as increas
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Fig. 2. Assessment of intragastricp
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Fig. 4. Assessment of lung sliding
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Conclusion We have convincingly sho
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Should We Still Order Chest X-rays
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tor cells of rods (low-level light)
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Box 1. Examples of immune effects a
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The Effect of Light on Critical Ill
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Box 2. Some beneficial health effec
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still many nebulous aspects, and wi
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Context Information in Critical Car
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Fig. 2. Alternative medical problem
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of intensivist specialty expertise
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Fig. 3. XML file for context inform
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Context Information in Critical Car
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Ambient Intelligence in the Intensi
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cognitive networks, likely without
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Conclusion The application of rules
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Simulation in Critical Care Medicin
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Engineering a Better Simulation Exp
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skills development before any patie
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decade has to be about reaching out
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seriously we take the safety of our
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Intensive Care Medicine: Where We A
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direction and orientation of a prim
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Subject Index Abdominal compartment
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C-reactive protein (CRP) 57, 268, 5
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Information 781 Injury severity sco
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Phenytoin 648 Phorbol myristate ace
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Vagal activity 398 - stimulation 74
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