Airway management with orotracheal intubation is one of the basic skills of a critical care practitioner. The oral route is the most common and easily mastered approach for tracheal intubation. Routinely, this technique involves visualization of the glottis, the use of a laryngoscope, and passage of the endotracheal tube into the trachea under direct vision. In many instances, this technique cannot be accomplished and the clinician needs to access the airway utilizing a variety of techniques.

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Background: Previous reports about the effect of dexamethasone on LPS-induced expression of TF on endothelial cells obtained conflicting results. It was also unclear if dexamethasone could influence LPSinduced expression of TM and PS on endothelial cells. Objective: We re-examined the effects of dexamethasone on LPS-induced expression of TF, TM and PS on HUVEC. Methods: Human umbilical vein endothelial cells in their first to fifth passage were incubated with LPS in serum free medium with or without DEX. After incubation for indicated time, the cells were lysed.

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Noninvasive Positive Pressure Ventilation (NIMV) has significantly changed the approach to respiratory failure in the last two decades. NIMV has found increasing applications and widespread acceptability. It has proven value in reducing the intubation rate, mortality and length of hospital stay in acute decompensations in patients of chronic obstructive pulmonary disease (COPD). NIMV has been applied for respiratory failure in a wide variety of acute and chronic respiratory conditions where its beneficial effects are yet to be established.

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Singapore was the fifth most severely SARS (severe acute respiratory syndrome) afflicted country with 238 cases after China (5327), Hong Kong (1755), Taiwan (346) and Canada (251) [1]. On 31 May 2003, Singapore was declared SARS free by World Health Organization (WHO). The last SARS patient was discharged on 13 Jul 2003. The case fatality rate in Singapore was 13.9% (33/238), which was comparable to Canada 17.1%, Hong Kong 17.0%, Vietnam 12.7%, Taiwan 10.7% and China 6.6%. The global case fatality rate was 9.6% (774/8098).

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There has been considerable interest in the use of steroids in sepsis and septic shock from the 1970s. Early clinical trials with short term, high dose steroids showed either no benefit or increased mortality. Current evidence suggests that relative adrenal insufficiency is common in sepsis. This has led to renewed interest in the use of low, physiological doses of corticosteroids in septic shock. Small randomized controlled trials have shown earlier reversal of shock, reduced organ failures and a trend towards reduced mortality.

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There is emerging evidence on the effectiveness and safety of high-frequency oscillatory ventilation in patients with acute respiratory distress syndrome. We described two patients with severe acute respiratory distress syndrome in whom low tidal volume ventilation with conventional mechanical ventilator failed to achieve physiological improvement. The initiation of high-frequency oscillatory ventilation as rescue therapy in these patients resulted in remarkable improvement in oxygenation and hypercapnia.

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Vasopressin is a hormone from posterior pituitary. It is an octapeptide referred often as arginine vasopressin and antidiuretic hormone. It is emerging as an important advance in the treatment of variety of shock states. The current interest is for the use of ventricular fibrillation, sepsis and cardio pulmonary bypass. The pressor actions are complex and not understood completely. It has unique action in reversing some of the pathophysiological vasodilatation processes that occur in advanced shock, which are refractory to catecholamine vasopressors.

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Purpose: Inhibition of surfactant activities by the protein in pulmonary edematous fluid plays a role in the occurrence of respiratory failure in acute respiratory distress syndrome (ARDS). Polymorphonuclear (PMN) elastase may be involved in surfactant-mediated damage. Accordingly, the concentrations of surfactant protein-D (SP-D) and PMN elastase were determined in patients with sepsis, and the associations of these two factors with the occurrence of ARDS and prognosis were examined. Methods: Blood samples from 33 patients with sepsis and with or without ARDS were assayed.

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