Critical care clinics
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Critical care clinics · Oct 2015
ReviewDrug-Induced Acute Kidney Injury: A Focus on Risk Assessment for Prevention.
Drugs are the third to fifth leading cause of acute kidney injury (AKI) in critically ill patients following sepsis and hypotension. Susceptibilities and exposures for development of AKI have been identified, and some are modifiable allowing for the possibility of AKI prevention or mitigation of AKI severity. Using drug therapies for prevention of AKI has been attempted but with little success in human studies, so we must rely on risk-assessment strategies for prevention. The purpose of this article is to review the risk factors, risk-assessment strategies, prevention, and management of drug-induced AKI with emphasis on risk assessment.
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Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality, which cannot solely be explained by loss of organ function. Renal replacement therapy allows rapid correction of most acute changes associated with AKI, indicating that additional pathogenetic factors play a major role in AKI. ⋯ AKI seems to compromise the function of the innate immune system. AKI is an acute systemic disease with serious distant organ effects.
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Restless legs syndrome is a common sensorimotor disorder characterized by an urge to move, and associated with uncomfortable sensations in the legs (limbs). Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Brain iron deficiency and dopaminergic neurotransmission abnormalities play a central role in the pathogenesis of this disorder, along with other nondopaminergic systems, although the exact mechanisms are still. Intensive care unit patients are especially vulnerable to have unmasking or exacerbation of restless legs syndrome because of sleep deprivation, circadian rhythm disturbance, immobilization, iron deficiency, and use of multiple medications that can antagonize dopamine.
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Critical care clinics · Jul 2015
ReviewNeuromuscular Disorders and Sleep in Critically Ill Patients.
Sleep-disordered breathing (SDB) is a frequent presenting manifestation of neuromuscular disorders and can lead to significant morbidity and mortality. If not recognized and addressed early in the clinical course, SDB can lead to clinical deterioration with respiratory failure. The pathophysiologic basis of SDB in neuromuscular disorders, clinical features encountered in specific neuromuscular diseases, and diagnostic and management strategies for SDB in neuromuscular patients in the critical care setting are reviewed. Noninvasive positive pressure ventilation has been a crucial advance in critical care management, improving sleep quality and often preventing or delaying mechanical ventilation and improving survival in neuromuscular patients.