Search

Dysphagia is a major risk factor for morbidity and mortality in critically ill patients treated in intensive care units (ICUs). Structured otorhinolaryngological data on dysphagia in ICU survivors with severe sepsis are missing. In a prospective study, 30 ICU patients with severe sepsis and thirty without sepsis as control group were examined using bedside fiberoptic endoscopic evaluation of swallowing after 14 days in the ICU (T1) and 4 months after onset of critical illness (T2). Swallowing dysfunction was assessed using the Penetration-Aspiration Scale (PAS). The Functional Oral Intake Scale was applied to evaluate the diet needed. Primary endpoint was the burden of dysphagia defined as PAS score >5. At T1, 19 of 30 severe sepsis patients showed aspiration with a PAS score >5, compared to 7 of 30 in critically ill patients without severe sepsis (p = 0.002). Severe sepsis and tracheostomy were independent risk factors for severe dysphagia with aspiration (PAS > 5) at T1 (p = 0.042 and 0.006, respectively). 4-month mortality (T2) was 57 % in severe sepsis patients compared to 20 % in patients without severe sepsis (p = 0.006). At T2, more severe sepsis survivors were tracheostomy-dependent and needed more often tube or parenteral feeding (p = 0.014 and p = 0.040, respectively). Multivariate analysis revealed tracheostomy at T1 as independent risk factor for severe dysphagia at T2 (p = 0.030). Severe sepsis appears to be a relevant risk factor for long-term dysphagia. An otorhinolaryngological evaluation of dysphagia at ICU discharge is mandatory for survivors of severe critical illness to plan specific swallowing rehabilitation programs.

Introduction: Muscle ultrasound is emerging as a promising tool in the diagnosis of neuromuscular diseases. The current observational study evaluates the usefulness of muscle ultrasound in patients with severe sepsis for assessment of critical illness polyneuropathy and myopathy (CINM) in the intensive care unit., Methods: 28 patients with either septic shock or severe sepsis underwent clinical neurological examinations, muscle ultrasound, and nerve conduction studies on days 4 and 14 after onset of sepsis. 26 healthy controls of comparable age underwent clinical neurological evaluation and muscle ultrasound only., Results: 26 of the 28 patients exhibited classic electrophysiological characteristics of CINM, and all showed typical clinical signs. Ultrasonic echogenicity of muscles was graded semiquantitatively and fasciculations were evaluated in muscles of proximal and distal arms and legs. 75% of patients showed a mean echotexture greater than 1.5, which was the maximal value found in the control group. A significant difference in mean muscle echotexture between patients and controls was found at day 4 and day 14 (both p < 0.001). In addition, from day 4 to day 14, the mean grades of muscle echotexture increased in the patient group, although the values did not reach significance levels (p = 0.085). Controls revealed the lowest number of fasciculations. In the patients group, fasciculations were detected in more muscular regions (lower and upper arm and leg) in comparison to controls (p = 0.08 at day 4 and p = 0.002 at day 14)., Conclusions: Muscle ultrasound represents an easily applicable, non-invasive diagnostic tool which adds to neurophysiological testing information regarding morphological changes of muscles early in the course of sepsis. Muscle ultrasound could be useful for screening purposes prior to subjecting patients to more invasive techniques such as electromyography and/or muscle biopsy., Trial Registration: German Clinical Trials Register, DRKS-ID: DRKS00000642.

Incubation of normal human peripheral blood lymphoid cells in fetal calf serum-supplemented media initiates blastogenic and nonspecific cytotoxic responses. A panel of lymphocytes from 13 normal donors exhibited increased [3H]thymidine incorporation from 2 to 40 times that of control lymphocytes incubated in pooled human AB-supplemented media. Fetal calf serum-sensitized human lymphoid cells were active in cytotoxicity assays against a wide variety of cultured human tumor and normal target cells. Cytotoxicity continued to increase from 3 to 9 days of incubation in fetal calf serum-supplemented media, while blastogenic response peaked at 6 days of incubation. Cytotoxic and blastogenic responses increased with higher concentrations of fetal calf serum. Once stimulated with fetal calf serum, the lymphocytes did not require the continued presence of fetal calf serum to mediate a cytotoxic reaction.

The culture of human peripheral blood lymphocytes (PBL) in fetal bovine serum (FBS) supplemented media results in the activation of an amplifier activity for mitogen or antigen induced proliferative responses. T cells are required for the generation of amplifier cells. In addition, this amplifier activity was shown to require a cell with Fc receptors for IgG but lacked Fc receptors for IgM. Therefore, it appears that the FBS induced amplifier cells have the same characteristics as the FBS culture induced NK-like cytotoxic and proliferating cells, i.e. these cells are of T cell origin, Fc gamma positive, and Fc mu negative. These FBS-cultured PBL may be a useful model for studying cell interactions and regulatory phenomena in human lymphoid cells.

Human peripheral blood lymphocytes (PBL) were found to be highly cytotoxic to a human malignant melanoma target cell line after the PBL were cultured in medium supplemented with 20% fetal bovine serum (FBS). The effector cells had surface markers similar to those of non-cultured NK effectors against melanoma targets. Both NK (without culture) and the culture-induced cytotoxic effectors had Fc gamma receptors, lacked Fc mu receptors and were either heterogeneous for E receptors or had low-affinity E receptors. Cells required to generate the FBS response were sensitive to anti-T serum plus complement, passed through a nylon-fiber column, formed E rosettes, but lacked detectable receptors for the Fc portions of either IgG or IgM. These results suggest that events causing activation of T cells such as culture of PBL in FBS-containing medium, result in the augmentation of NK activity.