Journal of critical care
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Journal of critical care · Oct 2012
Integrating lung ultrasound in the hemodynamic evaluation of acute circulatory failure (the fluid administration limited by lung sonography protocol).
In circulatory failure, fluid administration limited by lung sonography protocol uses lung ultrasound artifacts and makes sequential diagnosis of obstructive, cardiogenic, hypovolemic, and septic shock. Lung ultrasound is used along with simple cardiac and vena cava analysis. Whenever echocardiography cannot be performed, fluid administration limited by lung sonography protocol is favored because of its simplicity and could prove contributive. ⋯ Whenever noninvasive hemodynamic measures are inconclusive, in a deteriorating patient, a pulmonary artery catheter may be placed. Ultrasound is not a therapy but a guide for treatment, and physicians should aim to treat underlying pathologies. Despite its limitations, general chest ultrasound (lung and cardiac ultrasound) is a powerful diagnostic and monitoring tool reflecting an era of genuine "visual" medicine.
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Journal of critical care · Oct 2012
A risk, injury, failure, loss, and end-stage renal failure score-based trigger for renal replacement therapy and survival after cardiac surgery.
It is controversial whether all critically ill patients with risk, injury, failure, loss, and end-stage renal failure (RIFLE) F class acute kidney injury (AKI) should receive renal replacement therapy (RRT). We reviewed the outcome of open heart surgery patients with severe RIFLE-F AKI who did not receive RRT. ⋯ After cardiac surgery, RRT was typically applied to patients with the most severe clinical presentation irrespective of creatinine levels. A RIFLE score-based trigger for RRT is unlikely to improve patient survival.