A Consecutive Case Series of Rescue Intubations With the Articulating Total Control Introducer for Precision Tracheal Access.

Effective rescue after failed intubation is important to limit the number of attempts and patient risk. Nothing is known about the Total Control Introducer's (TCI) effectiveness as an intubation rescue device. A single system's airway management database was studied. The TCI was used for rescue in 34 cases. Overall success was 33 of 34 (97%). First-pass success was 32 of 33 (97%). First-pass rescue was successful in 12 of 12 (100%) after video and direct laryngoscopy had failed. In this case series, the TCI was found to be a highly effective rescue technique after failed direct and video laryngoscopy.

Should Early Mobilization Be Routine in Mechanically Ventilated Patients?

ICU-acquired weakness is a major complication of critical illness requiring mechanical ventilation. Early mobilization has been shown to decrease the negative consequences of ICU-acquired weakness. However, early mobilization might entail risks to the patient. Additional staffing needs might have a negative financial impact. This review examines whether early mobilization should be routinely performed in mechanically ventilated patients.

Increased glucose disposal and AMP-dependent kinase signaling in a mouse model of hemochromatosis.

Hereditary hemochromatosis is an inherited disorder of increased iron absorption that can result in cirrhosis, diabetes, and other morbidities. We have investigated the mechanisms underlying supranormal glucose tolerance despite decreased insulin secretion in a mouse model of hemochromatosis with deletion of the hemochromatosis gene (Hfe(-/-)). Hfe(-/-) mice on 129Sv or C57BL/6J backgrounds have decreased glucose excursions after challenge compared with controls. In the C57BL/6J/ Hfe(-/-), for example, incremental area under the glucose curve is reduced 52% (p < 0.001) despite decreased serum insulin, and homeostasis model assessment insulin resistance is decreased 50% (p < 0.05). When studied by the euglycemic clamp technique 129Sv/Hfe(-/-) mice exhibit a 20% increase in glucose disposal (p < 0.05) at submaximal insulin but no increase at maximal insulin compared with wild types. [1,2-(13)C]D-glucose clearance from plasma is significantly increased in Hfe(-/-) mice (19%, p < 0.05), and lactate derived from glycolysis is elevated 5.1-fold in Hfe(-/-) mice (p < 0.0001). Basal but not insulin-stimulated glucose uptake is elevated in isolated soleus muscle from Hfe(-/-) mice (p < 0.03). Compared with controls Hfe(-/-) mice exhibit no differences in serum lipid, insulin, glucagon, or thyroid hormone levels; adiponectin levels are elevated 41% (p < 0.05), and the adiponectin message in adipocytes is increased 83% (p = 0.04). Insulin action measured by phosphorylation of Akt is not enhanced in muscle, but phosphorylation of AMP-dependent kinase is increased. We conclude that supranormal glucose tolerance in iron overload is characterized by increased glucose disposal that does not result from increased insulin action. Instead, the Hfe(-/-) mice demonstrate increased adiponectin levels and activation of AMP-dependent kinase.