Serum melatonin levels during the first seven days of severe sepsis diagnosis are associated with sepsis severity and mortality / Los niveles séricos de melatonina durante los primeros 7 días del diagnóstico de la sepsis grave están asociados con la gravedad y mortalidad

OBJECTIVE: Higher serum melatonin levels have previously been found in patients with severe sepsis who died within 30 days of diagnosis than in survivors. The objective of our study were to determine whether serum melatonin levels during the first seven days of severe sepsis diagnosis could be associated with sepsis severity and mortality. METHODS: Multicentre study in eight Spanish Intensive Care Units which enrolled 308 patients with severe sepsis. We determined serum levels of melatonin, malondialdehyde (as biomarker of lipid peroxidation) and tumor necrosis factor-alpha at days 1, 4 and 8 of severe sepsis diagnosis. The study's primary endpoint was 30-day mortality. RESULTS: A total of 103 patients had died and 205 survived at 30 days of severe sepsis diagnosis, with the non-survivors presenting higher serum melatonin levels at days 1 (p < 0.001), 4 (p < 0.001) and 8 (p < 0.001) of severe sepsis diagnosis than the survivor patient group. The multiple logistic regression analysis found that serum melatonin levels at days 1, 4 and 8 of severe sepsis diagnosis (p < 0.001, p = 0.01 and p = 0.001, respectively) were associated with mortality adjusted for age, serum lactic acid, SOFA score and diabetes mellitus. CONCLUSIONS: The novel and more interesting findings of our study were that serum melatonin levels during the first seven days of severe sepsis diagnosis are associated with sepsis severity and mortality

OBJETIVO: Previamente se han encontrado mayores niveles séricos de melatonina en pacientes con sepsis grave que fallecían en los primeros 30 días del diagnóstico de la sepsis grave en comparación con los supervivientes. Los objetivos de nuestro estudio fueron determinar si los niveles séricos de melatonina durante la primera semana del diagnóstico de la sepsis grave están asociados con la gravedad y mortalidad de la sepsis. MÉTODOS: Estudio multicéntrico en 8 Unidades de Cuidados Intensivos españolas con 308 pacientes con sepsis grave. Se determinaron niveles séricos de melatonina, malondialdehído (como biomarcador de peroxidación lipídica) y factor de necrosis tumoral-alfa en los días 1, 4 y 8 del diagnóstico de la sepsis grave. Consideramos la mortalidad a 30 días como la variable resultado principal del estudio. RESULTADOS: Un total de 103 pacientes estaban fallecidos y 205 vivos a los 30 días del diagnóstico de la sepsis grave, y los fallecidos presentaron superiores niveles séricos de melatonina en los días 1 (p < 0.001), 4 (p < 0.001), y 8 (p < 0.001) del diagnóstico de la sepsis grave que los supervivientes. En el análisis de regresión logística múltiple encontramos que los niveles séricos de melatonina en los días 1, 4 y 8 del diagnóstico de la sepsis grave (p < 0.001, p = 0.01 and p = 0.001, respectively) estaban asociados con la mortalidad controlando por la edad, niveles séricos de ácido lactico, SOFA score y diabetes mellitus. CONCLUSIONES: Los nuevos y más interesantes hallazgos de nuestro estudio son que los niveles séricos de melatonina durante la primera semana del diagnóstico de la sepsis grave están asociados con la gravedad y la mortalidad de la sepsis

Serum melatonin levels during the first seven days of severe sepsis diagnosis are associated with sepsis severity and mortality.

OBJECTIVE: Higher serum melatonin levels have previously been found in patients with severe sepsis who died within 30 days of diagnosis than in survivors. The objective of our study were to determine whether serum melatonin levels during the first seven days of severe sepsis diagnosis could be associated with sepsis severity and mortality. METHODS: Multicentre study in eight Spanish Intensive Care Units which enrolled 308 patients with severe sepsis. We determined serum levels of melatonin, malondialdehyde (as biomarker of lipid peroxidation) and tumor necrosis factor-alpha at days 1, 4 and 8 of severe sepsis diagnosis. The study's primary endpoint was 30-day mortality. RESULTS: A total of 103 patients had died and 205 survived at 30 days of severe sepsis diagnosis, with the non-survivors presenting higher serum melatonin levels at days 1 (p<0.001), 4 (p<0.001) and 8 (p<0.001) of severe sepsis diagnosis than the survivor patient group. The multiple logistic regression analysis found that serum melatonin levels at days 1, 4 and 8 of severe sepsis diagnosis (p<0.001, p=0.01 and p=0.001, respectively) were associated with mortality adjusted for age, serum lactic acid, SOFA score and diabetes mellitus. CONCLUSIONS: The novel and more interesting findings of our study were that serum melatonin levels during the first seven days of severe sepsis diagnosis are associated with sepsis severity and mortality.

Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia.

INTRODUCTION: The use of a system for continuous control of endotracheal tube cuff pressure reduced the incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial (RCT) with 112 patients but not in another RCT with 142 patients. In several guidelines on the prevention of VAP, the use of a system for continuous or intermittent control of endotracheal cuff pressure is not reviewed. The objective of this study was to compare the incidence of VAP in a large sample of patients (n = 284) treated with either continuous or intermittent control of endotracheal tube cuff pressure. METHODS: We performed a prospective observational study of patients undergoing mechanical ventilation during more than 48 hours in an intensive care unit (ICU) using either continuous or intermittent endotracheal tube cuff pressure control. Multivariate logistic regression analysis (MLRA) and Cox proportional hazard regression analysis were used to predict VAP. The magnitude of the effect was expressed as odds ratio (OR) or hazard ratio (HR), respectively, and 95% confidence interval (CI). RESULTS: We found a lower incidence of VAP with the continuous (n = 150) than with the intermittent (n = 134) pressure control system (22.0% versus 11.2%; p = 0.02). MLRA showed that the continuous pressure control system (OR = 0.45; 95% CI = 0.22-0.89; p = 0.02) and the use of an endotracheal tube incorporating a lumen for subglottic secretion drainage (SSD) (OR = 0.39; 95% CI = 0.19-0.84; p = 0.02) were protective factors against VAP. Cox regression analysis showed that the continuous pressure control system (HR = 0.45; 95% CI = 0.24-0.84; p = 0.01) and the use of an endotracheal tube incorporating a lumen for SSD (HR = 0.29; 95% CI = 0.15-0.56; p < 0.001) were protective factors against VAP. However, the interaction between type of endotracheal cuff pressure control system (continuous or intermittent) and endotracheal tube (with or without SSD) was not statistically significant in MLRA (OR = 0.41; 95% CI = 0.07-2.37; p = 0.32) or in Cox analysis (HR = 0.35; 95% CI = 0.06-1.84; p = 0.21). CONCLUSIONS: The use of a continuous endotracheal cuff pressure control system and/or an endotracheal tube with a lumen for SSD could help to prevent VAP in patients requiring more than 48 hours of mechanical ventilation.