Low incidence of delirium in patients followed by physiotherapists in the ICU

Critical Care 2013, Volume 17 Suppl 3 http://ccforum.com/supplements/17/S3 M E E T I N G A B S T R AC T S Seventh International Symposium on Intensive Care and Emergency Medicine for Latin America São Paulo, Brazil. 19–22 June 2013 Published: 19 June 2013 Basic Science P1 Bone morphogenetic protein-2 and leptin but not endothelin-1 induce osteochondrogenesis through increasing oxidative stress in vascular smooth muscle cells LS do Carmo, MCC de Andrade, D de Castro Fernandes, M Liberman Albert Einstein Research and Education Institute, Morumbi, São Paulo, SP, Brazil Critical Care 2013, 17(Suppl 3):P1 (doi: 10.1186/cc12617) Introduction Vascular calcification is a regulated process, which associates with coronary artery disease (CAD) and occurs through an increase in transcription factor expression such as RUNX2, MSX2 and alkaline phosphatase (ALP), then inducing calcium deposition. Bone morphogenetic protein-2 (BMP2) is a potent osteochondrogenic mediator, which is expressed in CAD. Endothelin-1 (ET1) and leptin have a role in regulating inflammation and CAD. We hypothesized that BMP2, leptin or both increase ROS formation in C57BL/6 vascular smooth muscle cells (SMC), stimulating osteochondrogenic differentiation. We also investigated the effect of ET1 in SMC osteochondrogenesis. Our objectives were: to investigate ROS production in SMC after BMP2 (50 ng/ml) and/or leptin (10 ng/ml) incubation for 6 hours; and to assess osteochondrogenic gene expression and calcification of SMC stimulated with BMP2, leptin or ET1 (10 nM). Methods We assessed 2-hydroxyethidium, more specific for superoxide, and ethidium which reflects hydrogen peroxide through HPLC analysis in SMC after stimulation. SMC cells were incubated with these stimuli for 48 to 96 hours and RUNX2, MSX2, ALP mRNA and protein expression were assessed using qPCR and western blotting. We quantified SMC calcification after 14 days of stimulation through Alizarin Red staining. Results The results are shown as mean ± SD and were statistically significant when pHydrogen peroxide and superoxide production increased both in BMP2 and in leptin-incubated SMC (3.77 ± 0.32 and 3.26 ± 0.26) versus control (n = 6); pBMP2 and leptin alone increased SMC calcification (1.25 ± 0.08 and 1.28 ± 0.14) versus control after 14 days (n = 6); pET1 alone did not stimulate osteocondrogenic mRNA expression vs. control. Conclusion We showed that BMP2 and leptin increased ROS formation in SMC, which stimulated osteocondrogenic mRNA/protein expression to induce SMC calcification. ET1 alone did not increase osteochondrogenesis in SMC. P2 Effects of rapid repetition of a vascular occlusion test on near-infrared spectroscopy-derived variables in healthy subjects and in critically ill patients DO Cortes, F Puflea, K Donadello, D de Backer, J-L Vincent, J Creteur Erasme Hospital, Universite Libre de Bruxelles, Anderlecht, Bruxelles, Belgium Critical Care 2013, 17(Suppl 3):P2 (doi: 10.1186/cc12618) Introduction Transient ischemia modifies cellular metabolism and microvascular physiology in order to limit damage from future hypoxic © 2010 BioMed Central Ltd © 2013 BioMed Central Ltd episodes, a phenomenon called preconditioning. Near-infrared spectroscopy (NIRS) is a non-invasive technique that, when coupled to a vascular occlusion test (VOT), provides an indirect measurement of muscle oxygen consumption (VO2) and microvascular reactivity. We hypothesized that: rapid repetition of a VOT may alter VOTinduced NIRS-derived variables and these changes could reflect preconditioning; and these alterations would be different in healthy volunteers and critically ill patients. Methods Continuous non-invasive measurements of thenar tissue oxygen saturation (StO2) were performed using NIRS technology (InSpectra 650; Hutchinson, USA). VOTs were performed by inflating a cuff to 50 mmHg above the systolic pressure for 3 minutes. In a group of healthy volunteers, the VOT was repeated after 5 minutes on day 1, after 15 minutes on day 2 and after 30 minutes on day 3. In a group of critically ill patients, the VOT was repeated after 5 minutes. For each VOT, we calculated the StO2 desaturation slope (DescSlope), StO2 resaturation slope (AscSlope) and the NIRS VO2 as the DescSlope×mean total hemoglobin index over the occlusion time. All statistical analyses were performed using SPSS 19.0 (IBM, USA). Results Twenty-one healthy volunteers (age 29 ± 6 years, heart rate 71 ± 6 bpm, mean arterial pressure 82 ± 6 mmHg) and 18 critically ill patients (age 59 ± 14 years, APACHE II score 21 ± 9, norepinephrine use in 10/18, ICU mortality 22%) were included. In the healthy volunteers, repetition of the VOT was associated with a decrease in the DescSlope and in NIRS VO2. This effect was not observed in the critically ill patients (Tables 1 and 2). Table 1 (abstract P2). Effects of a repeat VOT on VOT-induced NIRS-derived variables in healthy volunteers Interval Variable First Second P value 5 minutes AscSlope 4.2 (3.4 to 4.9) 4 (3.3 to 5) 0.298 15 minutes 30 minutes DescSlope 12 (9.2 to 14.5) 9.8 (8.3 to 10.8) >0.001 NIRS VO2 151 (132 to 171) 131 (118 to 146) 0.001 AscSlope 4 (3.2 to 5.2) 4.1 (3.4 to 5) 0.676 DescSlope 10.3 (9.6 to 11.3) 9.4 (8.3 to 10.2) 0.003 NIRS VO2 153 (141 to 165) 141 (120 to 146) 0.005 AscSlope 4.2 (3.6 to 5.3) 3.4 (3.1 to 4.8) 0.006 DescSlope 10.9 (9.5 to 12.6) 9.4 (7.4 to 10.4) >0.001 NIRS VO2 157 (122 to 171) 132 (112 to 152) >0.001 Table 2 (abstract P2). Effects of a repeat VOT on VOT-induced NIRS-derived variables in critically ill patients Interval Variable First Second P value 5 minutes AscSlope 3.6 (2.7 to 4) 3.4 (2.8 to 4.6) 0.065 DescSlope 10 (8.4 to 11.6) 10.5 (8 to 11.8) 0.774 NIRS VO2 103 (74 to 156) 108 (73 to 140) 0.442 Critical Care 2013, Volume 17 Suppl 3 http://ccforum.com/supplements/17/S3 Conclusion Rapid repetition of a VOT alters VOT-induced NIRS-derived variables in healthy volunteers but not in critically ill patients. If these alterations reflect preconditioning, our results suggest that this phenomenon may be altered in critically ill patients. P3 Low incidence of delirium in patients followed by physiotherapists in the ICU KT Timenetsky, D Carnieli-Cazati, CS Azevedo, RC Eid Hospital Israelita Albert Einstein, Morumbi, Sao Paulo, SP, Brazil Critical Care 2013, 17(Suppl 3):P3 (doi: 10.1186/cc12619) Introduction Delirium is an acute temporary and fluctuating mentalorganic syndrome, characterized by a global impairment of cognitive function, reduced level of consciousness, attentional deficits and altered sleep–wake cycle, and changes in arousal (hyperactive, hypoactive, or mixed). The Confusion Assessment Method (CAM and CAM ICU) [1] is a diagnostic assessment instrument for delirium and can lead physiotherapeutic treatment, aiming to optimize patient’s recovery, reinforce the importance of preventive and therapeutic measures, and appraise the multidisciplinary t (...truncated)