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Abstract: Acute respiratory distress syndrome (ARDS) is associated with a high mortality linked primarily to co-morbidities (sepsis, cardiac failure, multiple organ failure, etc.). When the lung is the single failing organ, quick resolution of ARDS should skip some complications arising from a prolonged stay in the critical care unit. In severe ARDS (PaO2/FIO2 =P/F<100 with positive end-expiratory pressure (PEEP)⩾5cm H2O), current recommendations are to intubate the trachea of the patient and use mechanical ventilation, low tidal volume, high PEEP, prone positioning and possibly neuromuscular blockade in association with intravenous sedation. Another strategy is possible. Firstly, spontaneous ventilation (SV) coupled with pressure support (PS) ventilation and high PEEP is possible from tracheal intubation onwards, with the possible exception of the short period following immediately tracheal intubation. Secondly, using alpha-2 adrenergic agonists (e.g. clonidine, dexmedetomidine) can provide first-line sedation from the beginning of mechanical ventilation, as they preserve respiratory drive, lower oxygen consumption and pulmonary hypertension and increase diuresis. Alpha-2 agonists are to be supplemented, if appropriate, by drugs devoid of effect on respiratory drive (neuroleptics, etc.). The expected benefits would be to prevent acquired diaphragmatic weakness, accumulation of sedation, cognitive dysfunction, and presumably improved outcome. This hypothesis should be tested in a double blind randomized controlled trial. [Copyright &y& Elsevier]

Abstract: Alpha-2 adrenergic agonists (“alpha-2 agonists”) present multiple pharmacodynamic effects: rousable sedation, decreased incidence of delirium in the setting of critical care, preservation of respiratory drive, decreased whole body oxygen consumption, decreased systemic and pulmonary arterial impedance, improved left ventricular systolic and diastolic function, preserved vascular reactivity to exogenous catecholamines, preserved vasomotor baroreflex with lowered set point, preserved kidney function, decreased protein catabolism. These pharmacodynamic effects explain the interest for these drugs in the critical care setting. However, their exact role for sedation in critically ill-patients remains open for further studies. Given the few double-blind randomized multicentric trials available, the present non exhaustive analysis of the literature aims at presenting the utilization of alpha-2 agonists as potential first-line sedative agents, in the critical care setting. Suggestions regarding the use of alpha-2 agonists as sedatives are detailed. [Copyright &y& Elsevier]

Summary: One of the unsolved problems of septic shock is the poor responsiveness, or reduced vascular reactivity, to vasopressors used to increase blood pressure (BP). Attempts to restore vascular reactivity with NO inhibitors or low dose steroids have met with little success. Low vascular reactivity, which may lead to refractory shock and death, is linked to desensitization or down-regulation of alpha-1 adrenergic receptors. Our working hypothesis is that the use of alpha-2 agonists (e.g. clonidine or dexmedetomidine) in septic shock, in addition to the state-of-the-art treatment (including volume load and vasopressors), will reduce the vasopressor requirements needed to restore adequate BP. This counter-intuitive proposal is based on the fact that alpha-2 agonists will reduce the massive release of endogenous catecholamines. A decrease in plasma endogenous catecholamine concentrations will be followed by reduced down-regulation of alpha-1 receptors and/or a gradual re-sensitization of alpha-1 adrenergic receptors. In turn, this will lead to lowered vasopressor requirement, with respect to dose and duration. Our hypothesis, based on a reverse “denervation hypersensitivity”, is at variance with accepted treatments, which rest only on volume load and vasopressors and emphasizes restoration of blood pressure per se. Several observations in the cardiology and anesthesia setting have shown increased vascular reactivity following alpha-2 agonist administration. Our preliminary observations in the setting of septic shock again suggest such increased vascular reactivity. Improved outcome was also observed. Rigorous work is warranted to verify reduced vasopressor requirement and improved outcome, when an alpha-2 agonist is combined with state-of -the-art treatment of septic shock. [ABSTRACT FROM AUTHOR]

Abstract: Due to their outstanding properties, surface-functionalized polymer latexes proved to offer suitable colloidal supports in many biotechnological applications. At first, numerous polymerization methods in heterogeneous media, especially in aqueous medium, allow to synthesise a wide variety of polymer particles upon varying particle size, composition and morphology. Secondly, a broad selection of functionalities can be installed to the particle interface due to both the availability of a large amount of functional molecular and macromolecular species and versatility of manufacturing protocols. Surface functionalization with appropriate reactive groups has now become a prerequisite in the handling of polymer particles for biotechnological applications. The immobilization of a hydrophilic and sometimes stimuli-responsive hairy layer as well as the possibility of coating particles with specific ligands (saccharide moieties, lipids, biomolecules) open very attractive potentialities. More elaborated surface-functionalized (nano)particles can take much advantage of novel controlled radical polymerization techniques as well as the immobilization of complex organic or inorganic structures allowing an improved specificity in relevant applications. [Copyright &y& Elsevier]

A male patient presented with bronchospasm and acute respiratory distress. The patient had presented 2 previous episodes of severe bronchospasm following abdominal surgery, leading twice to intubation, mechanical ventilation, and conventional sedation. As the patient positively rejected a third episode of intubation + mechanical ventilation, noninvasive ventilation (pressure support = 8 cm H20, positive endexpiratory pressure=10 cmH20), inhaled therapy, and clonidine orally (≈4 µg/kg)were combined. Over 1 to 2 hours, the acute respiratory distress disappeared. Noninvasive ventilation was discontinued on the next morning (day 2). The patient was discharged from the critical care unit on day 3 on good condition but died at a later interval from iterative bronchospasm. Evidence-based documentation of the effects of alpha-2 agonists in the setting of acute bronchospasmin the emergency department or status asthmaticus in the critical care unit is awaited. [ABSTRACT FROM AUTHOR]

The preparation of well-defined (o/w) magnetic emulsions from an organic ferrofluid is reported. The ferrofluid synthesis is first described and a complete characterization is achieved by using numerous techniques. The ferrofluid is found to be composed of superparamagnetic maghemite nanoparticles, with a diameter below 10 nm, stabilized in octane by a surrounding oleic acid layer. This magnetic fluid is then emulsified in aqueous media in order to obtain stable ferrofluid droplets. The use of a couette mixer and a size sorting step under magnetic field allowed to produce magnetic emulsion with a narrow size distribution. Morphology and chemical composition of the magnetic emulsion are investigated. Magnetic properties of both ferrofluid and magnetic emulsion are also compared and discussed. In particular, it is showed that the superparamagnetic behavior is still observed after the emulsification process. [Copyright &y& Elsevier]