BACKGROUND: Previous studies have reported increased levels of inflammatory mediators in patients with obstructive sleep apnea (OSA), but their relation with the severity of OSA is controversial. OBJECTIVE: To address potential relationships between OSA-related inflammatory markers, namely, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and fibrinogen, with different oxygenation parameters and with BMI. METHODS: All eligible patients with suspected OSA newly referred to the Sleep Medicine Research Center at King Abdulaziz University Hospital, Jeddah, were evaluated demographically and anthropometrically, and underwent overnight polysomnography. Fasting morning blood samples were collected to measure serum levels of CRP, fibrinogen, TNF-α, and IL-6. Potential correlations between these inflammatory mediators and severity measures of OSA and body mass index (BMI) were explored. RESULTS: Sixty-four patients completed the study (40 with OSA and 24 without OSA). Significantly increased levels of CRP, fibrinogen, IL-6, and TNF-α emerged in patients with OSA compared to non-OSA. Significant associations between log CRP and log fibrinogen levels emerged with increasing BMI. However, there was no significant association between any of the inflammatory markers and the severity of OSA based on the apnea/hypopnea index or oxyhemoglobin saturation-derived parameters. CONCLUSIONS: OSA patients exhibit increased levels of inflammatory mediators that do not appear to be associated with polysomnographic measures, but exhibit positive correlation with the degree of adiposity.

reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. carbon dioxide 30 [27][28][29][30][31][32][33][34][35] mmHg and median temperature 37.1 [36.8-37.3]°C. After removal of artefacts, the mean monitoring time was 22 h08 (8 h54). All patients had impaired cerebral autoregulation during their monitoring time. The mean IAR index was 17 (9.5) %. During H 0 H 6 and H 18 H 24 , the majority of our patients; respectively 53 and 71 % had an IAR index > 10 %. Conclusion According to our data, patients with septic shock had impaired cerebral autoregulation within the first 24 hours of their admission in the ICU. In our patients, we described a variability of distribution of impaired autoregulation according to time. ReferencesSchramm P, Klein KU, Falkenberg L, et al. Impaired cerebrovascular autoregulation in patients with severe sepsis and sepsis-associated delirium. Crit Care 2012; 16: R181. Aries MJH, Czosnyka M, Budohoski KP, et al. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit. Care Med. 2012.

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PURPOSE: Corticosteroids are commonly administered in critically ill patients for a variety of reasons. They were estimated to be used in about 26% of critically ill patients. Controversies have always surrounded their outcomes in the ICU. While they have been shown to increase death in Intensive Care Unit-acquired pneumonia, they have been proposed to prevent hospital acquired pneumonia in intubated patients with multiple trauma. In the Society of Critical Care Medicine guidelines, it was recommended to consider hydrocortisone treatment for patients with septic shock with no mortality benefit. Herein, we present a sample of an ongoing analysis of the use of hydrocortisone and the risk of Ventilator Associated Events compared to other steroids in our university hospital. Ventilator Asscoiated Events (VAE) defined by the CDC National Healthcare Safety Network developed in 2013. METHODS: The dataset consisted of a sample of 858 mechanically-ventilated patients. According to hospital surveillance records, 152 patients met CDC-defined criteria for a VAE. Dexamethasone, methylprednisolone, prednisone, and hydrocortisone usage during the intubation period was also collected among each group. The data was analyzed using Chi-square statistics and an alpha level of 0.05 was considered statistically significant. RESULTS: Of the total 858 patients, 706 where in the non-VAE group. Of those, 62 (8.8%) patients received dexamethasone, 133(18.8%) where treated with methylprednisolone, 72 (10.2%) with prednisone and 68 (9.6%) patients with hydrocortisone. In the VAE group (N¼152), the numbers where as follows: 14 for dexamethasone (9.2%), 39 for methylprednisolone (25.7%), 16 for prednisone (10.5%) and 41 for hydrocortisone (27%). Only hydrocortisone treated group showed a significant relationship in regards to the development of VAE (X 2 ¼ 33.9, P < 0.001). No statistical significance was noted with the other steroids. The was no difference in the SOFA score or the pressor use among all steroid groups including hydrocortisone group. CONCLUSIONS: Postulations behind the lack of favor of hydrocortisone could include the weaker anti-inflammatory of this steroid when compared to others. Also, patients who need hydrocortisone therapy would be generally more critically ill so the need of hydrocortisone therapy could implement a negative prognostic factor for the development of VAE. However, in our analysis the SOFA score and vasopressor use were similar among all groups. CLINICAL IMPLICATIONS: In our study we found that the use of hydrocortisone was significantly higher in the VAP population. This can be related to hydrocortisone being the steroid of choice in septic & adrenally insuffecient patients. Albeit hydrocortisone's immunosuppressive potency is lower compared to its peer steroids, this doesn't seem to play a major role when it comes to VAE in our population.

PURPOSE:Establishing whether there is a correlation or not between volume overload and ventilator associated events (VAE). The least layer in the spectrum of VAE is Ventilator Associated Condition (VAC). VAC needs one of two criteria; either an increase in Fraction of Inspired Oxygen (FiO2) or Positive End Exipratory Pressure (PEEP) for two days. We suspected prior to gathering the data that some patients qualify for VAC due to volume overload resulting in hypoxia. This study investigated if VAE patients had a higher CVP than match controls.