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Articles by David Brealey
A randomized, placebo-controlled trial of 13-valent pneumococcal conjugate vaccination to accelerate immune recovery after sepsis
Editor’s summary Abstract INTRODUCTION RESULTS DISCUSSION MATERIALS AND METHODS Acknowledgments Supplementary Materials REFERENCES AND NOTES Information & Authors Metrics & Citations View Options References Figures Tables Media Share Editor’s summary Adults who survive sepsis can suffer from persistent inflammation and immune cell dysfunction that might be modified by vaccines, but vaccine immunogenicity has not been studied in this population.
Experimental sepsis causes SERCA2 expression in white adipose tissue but not classical browning
Abstract Sepsis causes muscle wasting and cachexia but mechanisms remain unclear. Cachexia in cancer and burn injury is partly attributed to ‘browning’; where white adipose tissue (WAT) develops a catabolic, thermogenic brown adipose tissue-like phenotype. We hypothesised that sepsis-induced muscle wasting is caused by browning. 58 male Wistar rats were randomised to sham (n = 17) or experimental sepsis induced by intraperitoneal zymosan (n = 41).
Preoperative activation of the Renin-Angiotensin system and myocardial injury in noncardiac surgery: Post Hoc Analysis of the SPACE randomised controlled Trial. | medRxiv
The authors have declared no competing interest. ISRCTN17251494). From 07/31/2017 to 10/01/2021, the Stopping Perioperative ACE-inhibitors/ARBs (SPACE) phase 2a trial (EudraCT:2016-004141-90) https://www.qmul.ac.uk/ccpmg/sops--saps/statistical-analysis-plans-saps G.L.A. was supported by the National Institute for Academic Anaesthesia (British Oxygen Company research chair grant); NIHR Advanced Fellowship [NIHR300097], and a British Heart Foundation Programme grants (RG/14/4/30736; RG/19/5/34463).
Lessons and risks of medical device deployment in a global pandemic
COVID-19 has challenged health-care systems in an unprecedented manner. As recorded deaths exceed 2 million worldwide, countries continue to grapple with policies that balance health care and economic stresses. Strategic international coordination and cooperation remain haphazard. Here we reflect on our experiences in delivering a non-invasive respiratory support device that highlights the need for a more responsive, harmonised approach.
High oxygen flow rates with the UCL Ventura CPAP device - Authors' reply
We thank Stephen Kempley and colleagues for highlighting the potential for high oxygen flow rates if the University College London (UCL) Ventura continuous positive airway pressure (CPAP) device is either disconnected from a patient or there is a mask leak. On a bench test, they measured an outflow of 116 L/min when the device was delivering 97% oxygen with fully opened valves.
Organisms causing secondary pneumonias in COVID-19 patients at 5 UK ICUs as detected with the FilmArray test
Abstract ABSTRACT Introduction. Several viral respiratory infections - notably influenza - are associated with secondary bacterial infection and additional pathology. The extent to which this applies for COVID-19 is unknown. Accordingly, we aimed to define the bacteria causing secondary pneumonias in COVID-19 ICU patients using the FilmArray Pneumonia Panel, and to determine this tests potential in COVID-19 management. Methods.
Use of non-invasive ventilation for patients with COVID-19: a cause for concern?
The potential for transmission of coronavirus disease 2019 (COVID-19) from patients to health-care workers has caused concern, particularly among patients requiring advanced respiratory support, high flow rates of oxygen, or aerosol-generating procedures.
Optimising organ perfusion in the high-risk surgical and critical care patient: a narrative review
• Tissue hypoxia is a major determinant of outcome in surgical and critical care patients. • Current strategies including goal-directed fluid therapy aimed to detect and correct tissue hypoxia by resuscitating to predefined physiological targets, thought to imply adequate perfusion. • Prompt recognition of tissue hypoxia presents a diagnostic challenge. Thus, an accurate tissue oxygenation monitor would prove invaluable.
Evidence for chemokine synergy during neutrophil migration in ARDS
Background Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterised by pulmonary oedema, respiratory failure and severe inflammation. ARDS is further characterised by the recruitment of neutrophils into the lung interstitium and alveolar space. Objectives The factors that regulate neutrophil infiltration into the inflamed lung and our understanding of the pathomechanisms in ARDS remain incomplete.
Evidence for chemokine synergy during neutrophil migration in ARDS
Results CCL2 and CCL7 were significantly elevated in BAL fluid recovered from LPS-challenged volunteers and patients with ARDS. BAL fluid from patients with ARDS was highly chemotactic for human neutrophils and neutralising either CCL2 or CCL7 attenuated the neutrophil chemotactic response. Moreover, CCL2 and CCL7 synergised with CXCL8 to promote neutrophil migration.
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