Critical care clinics
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Critical care clinics · Apr 2011
ReviewAntimicrobial therapy of sepsis and septic shock--when are two drugs better than one?
In clinical practice, physicians frequently use combination therapy despite the conflicting evidence for its effectiveness. The results of recent studies have contributed to our understanding of this important issue. In this article, we examine the evidence for, or against, the use of combination drug therapy compared with monotherapy in the management of serious infections, sepsis, and septic shock.
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Critical care clinics · Apr 2011
ReviewNeutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for early acute kidney injury.
Based on information to date, although limitations in the accuracy of NGAL in predicting AKI persist, the preponderance of published studies demonstrate that NGAL, when measured in the plasma and in the urine, is a reliable biomarker for the subsequent development of clinically apparent AKI. If very early detection of AKI, via the measurement of plasma or urinary NGAL, can be followed by effective treatment to abort the development or limit the severity of AKI, and therefore decrease the rate of RRT, length of hospitalization stay, and/or mortality risk, NGAL measurement will become a critically important diagnostic tool in critical care medicine, pediatrics, and surgery.
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Critical care clinics · Apr 2011
ReviewPhysiologic parameters as biomarkers: what can we learn from physiologic variables and variation?
Sepsis generates an overwhelming host response characterized by changes in physiologic parameters. Monitoring these parameters can help identify and stratify septic patients. ⋯ Several studies have analyzed the independent physiologic parameters associated with the diagnosis of sepsis or bacteremia, with the development of severe sepsis or septic shock, and with mortality. Physiologic variability of heart rate and body temperature is reduced in sepsis and measuring the variability of these parameters can be useful for the diagnosis and prognosis of sepsis.
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The future application of biomarkers in critical illness will be to select and guide therapy. Specific biomarkers could identify a pathophysiologic perturbation or noxious mediator to counteract or the need to replete a deficient protective protein. ⋯ Genetic expression studies could help differentiate patients with sepsis from those with noninfectious inflammation and could also help to monitor illnesses over time. Expressional and functional proteomics could lead to the identification of new biomarkers and organ-specific therapies.
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Levels of C-reactive protein (CRP), an acute phase protein, are elevated in many inflammatory conditions and are used to detect and follow disease in many fields of medicine, including rheumatology, gastroenterology, and cardiology. CRP concentrations are also used in critically ill patients, notably because they are increased during the inflammatory response to infection, that is, sepsis. However, CRP is not specific for sepsis, and serum CRP concentrations need to be interpreted in the context of a full clinical examination and the presence of other signs and symptoms of sepsis.