Novel parameters of extended complete blood cell count under fluorescence flow cytometry in patients with sepsis

BACKGROUND

We first describe a patient who developed urosepsis from an ordinary urinary tract infection. In this case, the new hematological parameters of immature leukocytes, that is, the high-fluorescence lymphocyte cell (HFLC) and immature granulocyte (IG) counts peaked early, whereas the established infection parameters, that is, C-reactive protein (CRP) and total white blood cell count showed less dynamic regarding infection and therapy.

METHODS

To investigate this phenomenon in greater detail, the novel parameters HFLC and IG counts are investigated retrospectively in a cohort of 38 patients who were admitted to the anesthesia intensive care unit. Three groups of patients have been analyzed and compared: patients without signs of infection, patients with limited infections, and patients with sepsis. Data were collected with a Sysmex XE-5000 hematological analyzer.

RESULTS

In patients (n = 22) without any signs of infection, both values are very low. In patients with limited local infections (n = 10), moderate elevations of the IG and HFLC counts are seen. In patients with sepsis (n = 6), the IG and HFLC counts are significantly higher.

CONCLUSION

The total IG count seems to be useful for distinguishing a septic patient from a nonseptic (P < 0.004). Hematological parameters have the advantage of being measured easily during routine blood cell analysis.

[Inhalation of nitric oxide in severe lung failure]

Despite intensive therapeutic efforts, adult respiratory distress syndrome (ARDS) is still associated with a lethality ranging from 50 to 80%. Besides hypoxemia, fatal outcome is caused by myocardial insufficiency due to a progressive decrease in pulmonary vascular conductance. Inhalation of NO can selectively dilate pulmonary vessels in ventilated lung regions, thus increasing mean pulmonary artery conductance and decreasing venous admixture. This study determines the effects of NO inhalation in patients with severe ARDS on pulmonary gas exchange, haemodynamics and mortality. Twenty surgical patients (mean age 50.3 +/- 9.25 years) with severe ARDS (Murray score 3.4 +/- 0.3) were treated with variable concentrations of NO during mechanical ventilation with continuous positive pressure. Pulmonary artery catheters were used to measure pressures, flow and venous admixture. Mortality with NO inhalation was compared with that of previous ARDS patients (n = 20) who had not received NO. Mean duration of NO inhalation was 120.1 +/- 33.12 hours (n = 20) (range 40 to 254 hours). Mean NO concentration during the first hour of delivery was 18.5 +/- 3.88 ppm. Sixteen patients had FiO2 of 1.0 when NO was started. Within the first hour of NO inhalation, the PaO2/FiO2 ratio increased from 82.1 +/- 10.28 to 124.6 +/- 28.18. Eighteen patients were responders. Mean ventilatory pressure was lowered. Oxygenation improvement was most marked during the first 36 hours and then gradually declined. Despite the significant increase in NO related oxygenation, pulmonary artery pressures did not consistently decrease. Sixteen patients in the NO group died. In the group without NO 15 patients died. Compared with ARDS patients of similar severity not receiving NO, the NO-treated patients had the same lethality. In severe ARDS, oxygenation significantly improves with the initiation of NO inhalation, but this effect declines over time. With NO, FiO2 and ventilatory pressures can be lowered. Whether the theoretically reduced oxygen toxicity and the reduced invasiveness of mechanical ventilation with NO reduces patient mortality must be determined in larger patient groups.

Nitric oxide inhalation in acute pulmonary hypertension after cardiac surgery reduces oxygen concentration and improves mechanical ventilation but not mortality

Impaired right-ventricular function may benefit from afterload reduction. Inhalation of nitric oxide (NO) reduces pulmonary hypertension without systemic circulatory depression. Influence of NO inhalation on oxygenation, ventilation, and hemodynamic parameters in 10 patients with acute pulmonary hypertension after cardiac surgery was examined in this study. Ten patients without NO treatment served as a control group. NO patients showed significantly improved oxygenation and recovery of right-ventricular function. Pulmonary artery pressure (12.8%), inspiratory oxygen demand (34.7%), PEEP (13.2%), and inspiration time (18.8%) decreased significantly during inhalation of nitric oxide. Mortality in both groups was identical. We therefore conclude that NO, by improving oxygenation and right-ventricular function, temporarily reduces invasiveness of mechanical ventilation. Reduction of invasiveness of ventilation did not influence mortality as compared with patients who did not receive NO. To finally estimate the benefit of NO inhalation, larger patient groups need to be examined.