Journal of critical care
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Journal of critical care · Aug 2014
ReviewObesity and perioperative acute kidney injury: A focused review.
Obesity has reached epidemic proportions in the developed world today. Obesity is a significant risk factor for cardiovascular disease, hypertension, diabetes mellitus, and chronic kidney disease. There has been renewed interest in the role of perioperative renal dysfunction with the establishment of new diagnostic criteria for kidney dysfunction such as the Acute Kidney Injury Network criteria and the Risk-Injury-Failure-Loss End-stage kidney disease criteria. ⋯ Furthermore, the traditional methods of quantifying obesity such as body mass index are increasing being questioned because they may not accurately reflect true visceral obesity and may skew epidemiologic classification of metabolically healthy patients. Recent epidemiologic studies suggest the existence of an obesity paradox wherein obese patients seem to have superior perioperative outcomes compared with patients with normal and low body mass index. We seek to review the epidemiologic and pathophysiologic aspects of obesity, especially with respect to structural and functional changes in kidney function and their impact on perioperative outcomes.
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Journal of critical care · Aug 2014
Multicenter Study Observational StudyPulse pressure variations to guide fluid therapy in donors: A multicentric echocardiographic observational study.
Preload responsiveness parameters could be useful in the hemodynamic management of septic shock. ⋯ A ΔPP threshold of 13% is insufficient to guide volume expansion in donors. The best threshold is 20%. Fluid responsiveness monitoring could enhance organ harvesting.
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Journal of critical care · Aug 2014
The ability of current scoring systems in differentiating transient and persistent organ failure in patients with acute pancreatitis.
The purpose of this study is to investigate the accuracy of currently used scoring systems in differentiating transient and persistent organ failure in patients with acute pancreatitis (AP). ⋯ Current scoring systems are not accurate enough in differentiating transient and persistent organ failure in patients with AP.
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Journal of critical care · Aug 2014
The cost-effectiveness ratio of a managed protocol for severe sepsis.
Severe sepsis is a time-dependent disease, and implementation of early treatment has been associated with mortality rate reduction. However, the literature is controversial regarding cost-effectiveness analysis of this intervention. The aim was to assess the cost-effectiveness of a managed protocol for the treatment of severe sepsis. ⋯ Given that the incremental cost was lower than or equal to zero, the effectiveness of the protocol was justified by the significant increase in the life-years saved and the reduced mortality.
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Journal of critical care · Aug 2014
Hyperglycemia, hypoglycemia, and glycemic complexity are associated with worse outcomes after surgery.
The purpose of this study was to determine if glycemic complexity, along with hypoglycemia and hyperglycemia, was associated with worse outcomes after cardiac surgery. ⋯ We found that hypoglycemia (glucose<71 mg/dL) and hyperglycemia (glucose>140 mg/dL) were associated with increased risk of complications, whereas greater complexity of the glucose time series was associated with mortality.