A prospective randomised controlled trial of the LMA Supreme vs cuffed tracheal tube as the airway device during percutaneous tracheostomy

We studied the performance of the LMA Supreme against a cuffed tracheal tube, our standard method of airway control during percutaneous tracheostomy, in 50 consecutive patients from three general critical care units. The primary outcome measure was adequacy of ventilation calculated as the difference in arterial carbon dioxide tension before and after tracheostomy. On an intention-to-treat analysis, there was no difference in the increase in arterial carbon dioxide tension between groups, with a median (IQR [range]) for the LMA Supreme of 0.9 (0.3-1.6 [0-2.8]) kPa, and for the tracheal tube of 0.8 (0.4-1.2 [0-2.5]) kPa, p = 0.82. Eight patients out of 25 (32%) crossed over from the LMA Supreme group to the tracheal tube group before commencement of tracheostomy due to airway or ventilation problems, compared with none out of 25 in the tracheal tube group, p = 0.01, and tracheostomy was postponed in two patients in the LMA Supreme group due to poor oxygenation. There were more clinically important complications in the LMA Supreme group compared with the tracheal tube group.

Emergency tracheal intubation without drugs: outcome and one-year survival of medical patients not in cardiac arrest

Non-medicine-assisted tracheal intubation in prehospital trauma is associated with a dismal prognosis. We wished to study the outcome of medical patients who underwent non-medicine-assisted tracheal intubation. This retrospective study of patients attending our university hospital emergency department was conducted over seven years. The tracheal intubation database was analysed to identify medical patients not in cardiac arrest undergoing tracheal intubation without medicines. Intensive care unit, hospital, 12-month mortality and patients' residence at 12 months were recorded. Eighty patients were identified who met inclusion criteria. The most common reason for intubation was definite airway compromise due to decreased conscious level (62.5%), then respiratory failure (26.3%) and finally potentially compromised airway due to a decreased conscious level (11.2%). Eighty-eight percent of patients with a definitely compromised airway were successfully intubated at first attempt compared with 66.7% of patients with a potentially compromised airway or respiratory failure (P= 0.03). Of 75 patients with complete data, 30 (40%) were survivors at 12 months, with all but two (6.7%) living at home. Non-medicine-assisted laryngoscopy leads to an increased first time tracheal intubation failure rate in patients with intact airway reflexes and, therefore, cannot be recommended as best practice.

Regulation of the lipidation of beta-secretase by statins

Statins inhibit the dimerization of beta-secretase [BACE (beta-site amyloid precursor protein-cleaving enzyme)] by inhibiting the lipidation of BACE and associated proteins. Our studies have demonstrated a clearly defined temporal sequence for these reactions in the assembly of the BACE complex, which may provide targets for the treatment of Alzheimer's disease.

Tissue factor and tissue factor pathway inhibitor

The classical 'cascade/waterfall' hypothesis formulated to explain in vitro coagulation organised the amplification processes into the intrinsic and extrinsic pathways. Recent molecular biology and clinical data indicate that tissue factor/factor-VII interaction is the primary cellular initiator of coagulation in vivo. The process of blood coagulation is divided into an initiation phase followed by a propagation phase. The discovery of tissue factor pathway inhibitor further supports the revised theory of coagulation. Tissue factor is also a signalling receptor. Recent evidence has shown that blood-borne tissue factor has an important procoagulant function in sepsis, atherosclerosis and cancer, and other functions beyond haemostasis such as immune function and metastases.