Auditory event-related potentials, bispectral index, and entropy for the discrimination of different levels of sedation in intensive care unit patients

BACKGROUND: Sedation protocols, including the use of sedation scales and regular sedation stops, help to reduce the length of mechanical ventilation and intensive care unit stay. Because clinical assessment of depth of sedation is labor-intensive, performed only intermittently, and interferes with sedation and sleep, processed electrophysiological signals from the brain have gained interest as surrogates. We hypothesized that auditory event-related potentials (ERPs), Bispectral Index (BIS), and Entropy can discriminate among clinically relevant sedation levels. METHODS: We studied 10 patients after elective thoracic or abdominal surgery with general anesthesia. Electroencephalogram, BIS, state entropy (SE), response entropy (RE), and ERPs were recorded immediately after surgery in the intensive care unit at Richmond Agitation-Sedation Scale (RASS) scores of -5 (very deep sedation), -4 (deep sedation), -3 to -1 (moderate sedation), and 0 (awake) during decreasing target-controlled sedation with propofol and remifentanil. Reference measurements for baseline levels were performed before or several days after the operation. RESULTS: At baseline, RASS -5, RASS -4, RASS -3 to -1, and RASS 0, BIS was 94 [4] (median, IQR), 47 [15], 68 [9], 75 [10], and 88 [6]; SE was 87 [3], 46 [10], 60 [22], 74 [21], and 87 [5]; and RE was 97 [4], 48 [9], 71 [25], 81 [18], and 96 [3], respectively (all P < 0.05, Friedman Test). Both BIS and Entropy had high variabilities. When ERP N100 amplitudes were considered alone, ERPs did not differ significantly among sedation levels. Nevertheless, discriminant ERP analysis including two parameters of principal component analysis revealed a prediction probability PK value of 0.89 for differentiating deep sedation, moderate sedation, and awake state. The corresponding PK for RE, SE, and BIS was 0.88, 0.89, and 0.85, respectively. CONCLUSIONS: Neither ERPs nor BIS or Entropy can replace clinical sedation assessment with standard scoring systems. Discrimination among very deep, deep to moderate, and no sedation after general anesthesia can be provided by ERPs and processed electroencephalograms, with similar P(K)s. The high inter- and intraindividual variability of Entropy and BIS precludes defining a target range of values to predict the sedation level in critically ill patients using these parameters. The variability of ERPs is unknown.

Mammary epithelial-specific knockout of the ephrin-B2 gene leads to precocious epithelial cell death at lactation

The family of Eph receptor tyrosine kinases and their membrane bound ligands, the ephrins, are involved in a wide variety of morphogenic processes during embryonic development and adult tissue homeostasis. Receptor-ligand interaction requires direct cell-cell contact and results in forward and reverse signaling originating from the receptor and ligand, respectively. We have previously shown that EphB4 and ephrinB2 are differentially expressed during the development of the adult mammary parenchyma. Overexpression of EphB4 in the mammary epithelium of transgenic mice leads to perturbations in mammary epithelial morphology, motility and growth. To investigate the role of ephrinB2 signaling in mammary gland biology, we have established transgenic mice exhibiting conditional ephrinB2 knockout in the mammary epithelium. In homozygote double transgenic CreLox mice, specific knockout of ephrinB2 occurred in the mammary epithelium during the first pregnancy-lactating period. Abolishing ephrinB2 function led to severe interference with the architecture and functioning of the mammary gland at lactation. The morphology of the transgenic lactating glands resembled that of involuting controls, with decreased epithelial cell number and collapsed lobulo-alveolar structures. Accordingly, massive epithelial cell death and expression of involution-specific genes were observed. Interestingly, in parallel to cell death, significant cell proliferation was apparent, suggestive of tissue regeneration.

Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC

Purpose We hypothesized that reduced arousability (Richmond Agitation Sedation Scale, RASS, scores −2 to −3) for any reason during delirium assessment increases the apparent prevalence of delirium in intensive care patients. To test this hypothesis, we assessed delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in intensive care patients during sedation stops, and related the findings to the level of sedation, as assessed with RASS score. Methods We assessed delirium in 80 patients with ICU stay longer than 48 h using CAM-ICU and ICDSC during daily sedation stops. Sedation was assessed using RASS. The effect of including patients with a RASS of −2 and −3 during sedation stop (“light to moderate sedation”, eye contact less than 10 s or not at all, respectively) on prevalence of delirium was analyzed. Results A total of 467 patient days were assessed. The proportion of CAM-ICU-positive evaluations decreased from 53 to 31 % (p < 0.001) if assessments from patients at RASS −2/−3 (22 % of all assessments) were excluded. Similarly, the number of positive ICDSC results decreased from 51 to 29 % (p < 0.001). Conclusions Sedation per se can result in positive items of both CAM-ICU and ICDSC, and therefore in a diagnosis of delirium. Consequently, apparent prevalence of delirium is dependent on how a depressed level of consciousness after sedation stop is interpreted (delirium vs persisting sedation). We suggest that any reports on delirium using these assessment tools should be stratified for a sedation score during the assessment.

Ms. Ff. Mus. 1406 - Am 10 post Trinit. : Und als er nahe hinzu kam, sahe er die Stadt an ; pp. C. A. T. B., 2 violini, 2 oboe se piace, viola, violoncello et organo

von Telemann. [Text: Gottfried Simonis]

Hilvanando opuestos. Lecturas identitarias a partir de la conformación de una comunidad mapuche en Lago Puelo, Provincia de Chubut. En: Avá, nº 10

El incremento de los negocios inmobiliarios que se viene dando en Patagonia en forma sostenida desde los '90 impacta fuertemente en Lago Puelo sobre los reclamos de tenencia de la tierra de descendientes de antiguos pobladores llegados a la región a fines del S. XIX. El siguiente artículo se propone analizar desde una perspectiva turneriana, y a partir de la reciente conformación de una Comunidad Mapuche en la localidad, como se relacionan las luchas por la tenencia de la tierra, la identidad étnico - nacional de los actores en pugna y el rol jugado por el Estado provincial y local vía su política territorial. Analizar dichos sucesos en clave de "drama social" nos permitirá no sólo comprender las diferentes etapas que se vienen dando en esta lucha ya entenaria, sino proveer de un marco desde el cual repensar, a partir del análisis de esta pequeña localidad, la historia "oficial" de las identidades de los pueblos cordilleranos.

El voley va a la escuela

El objetivo de esta ponencia es presentar el "El Vóley va a la Escuela". El mismo es un programa desarrollado por la Federación Metropolitana de Voleibol, muy divertido y capaz de aunar en el patio de una escuela al deporte con la educación. Este evento conecta exitosamente al deporte con todas las escuelas de la ciudad de Buenos Aires. Desde la Federación Metropolitana de Voleibol, esta actividad ha sido ideada para que todos los chicos y las chicas puedan conocer de manera didáctica al Vóley, y a su vez, para consolidar el crecimiento de este deporte en el seno de nuestra sociedad

Si esta tierra da pa lo do... : Entrevista vía email a Néstor Rodríguez

Fil: Basile, Teresa. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

En la encrucijada : ¿Hacia donde va la cuestión policial ecuatoriana?

Los procesos de reforma policial en América Latina han sido impulsados por el interés de estandarizar las buenas prácticas policiales, en sociedades de baja gobernabilidad, democracias endebles propensas al autoritarismo. Se cuenta con un extenso bagaje de conocimientos, modelos y manuales, pero las recomendaciones caen en el "deber ser". Hay aspectos que se ignora: procesos institucionales internos; las reformas se imponen desde "afuera"; el peso de los aspectos ideológicos de los "reformadores" y en general las pugnas de poder entre tendencias. El artículo enfoca las reformas policiales en curso en el Ecuador desde 2007. Queda la impresión de que lo que está en juego es el Control por sí mismo y no la Seguridad.