Ugeskrift for laeger
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Acute renal failure (ARF) is characterized by a sudden increase in plasma creatinine and a decrease in urine flow. ARF is caused by multiple factors of which the most important are hypovolemia, hypotension, septic mediators and nephrotoxic agents. ARF is observed in 10-23% of critically ill patients. ⋯ If the patient survives, the recovery of renal function is 90-95%. Non-dialytic therapy is early volume resuscitation whereas furosemid may worsen ARF. At the present time the dialytic therapy of choice in ICU patients with ARF is continuous renal replacement therapy (CRRT).
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Critical care research has facilitated the development of clinical guidelines to improve the outcome of critically-ill patients. The high mortality needs to be reduced further, by means of increased research to the benefit of patients, relatives and society. Clinicians, researchers, public officials and politicians at all levels must work together towards this aim.
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Critical illness is characterized by one or more failing organs. Hormonal regulation of metabolism changes during the course of critical illness and is related to the severity of disease. ⋯ Recent large scale insulin infusion studies have demonstrated beneficial effects on both the immune response and coagulation systems. Future research will show whether further hormonal substitution can reveal similar results.
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The neurointensive care unit provides observation and treatment of acute, life-threatening disorders of and injuries to the central and peripheral nervous system. The primary aim of care is the prevention of secondary neuronal damage; this requires a highly multidisciplinary approach, involving neuromonitoring as well as management of systemic comorbidity and complications. This article presents major pathophysiological issues specific to neurointensive care, as well as recent advances in the management of the critically-ill neurosurgical and neurological patient.