What's new in Shock, May 2008?

摘要

As the snow lies peacefully on the ground in New England, good and gentle reader, it is time to review the science in the May issue of Shock. There are 16 articles in this month's issue covering a range of interesting topics. There are two clinical articles that explore issues in cardiorespiratory failure and cardiac arrest. The article by Jakob et al.. (1) examined gastric tonometry in more than 100 patients after acute respiratory or circulatory failure. Gastric PCO_2 was measured and used to calculate a PCO_2 gradient. One of the interesting aspects of the study was the finding that an increase in the Pc_2 gradient was associated with a 10-fold increase in mortality. In a similar manner, a low mucosal pH (<7.32) was associated with a doubling of mortality. The increase in the PCO_2 gradient in the early resuscitation period suggests poor tissue perfusion. Hayakawa et al. (2) evaluated the presence of neutrophil elastase and urinary trypsin inhibitor (UTI) after cardiac arrest. The name UTI suggests that it was measured in the urine, but in this study, it was measured in the plasma. Patients were divided into those where the return of spontaneous circulation occurred within 30 min and those with a delay of greater than 30 min. There was a significant association between an increase in the plasma levels of neutrophil elastase and decreased levels of UTI and the length of cardiac arrest.