Journal of critical care
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Journal of critical care · Aug 2014
ReviewFrom data patterns to mechanistic models in acute critical illness.
The complexity of the physiologic and inflammatory response in acute critical illness has stymied the accurate diagnosis and development of therapies. The Society for Complex Acute Illness was formed a decade ago with the goal of leveraging multiple complex systems approaches to address this unmet need. ⋯ We suggest that the next decade holds the potential to merge these approaches, connecting patient diagnosis to treatment via mechanism-based dynamical system modeling and feedback control and allowing extrapolation from physiologic signals to biomarkers to novel drug candidates. As a predicate example, we focus on the role of data-driven and mechanistic models in neuroscience and the impact that merging these modeling approaches can have on general anesthesia.
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Noninvasive ventilation (NIV) has well-recognized benefits in acute exacerbation of chronic obstructive pulmonary disease and pulmonary edema. Its utilization in acute asthma, however, remains controversial. In this review, we describe the physiological basis to justify NIV use in acute asthma and contribute a critical appraisal of the available literature relating to this practice. ⋯ Evidence suggestive of any improvement in mortality, intubation rate, or hospital/intensive care unit length of stay, however, is lacking. Studies to date have been hampered by small numbers and a lack of demonstrable meaningful clinical outcomes. Data relating to mortality, endotracheal intubation rates, and hospital length of stay/admission should be sought in future large clinical trials.
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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
ReviewMeasurement of the glucocorticoid receptor: Relevance to the diagnosis of critical illness-related corticosteroid insufficiency in children.
Diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in children continues to remain difficult and controversial in that no consensus for either exists among pediatric critical care physicians. Critical illness-related corticosteroid insufficiency is defined as a corticosteroid response that is inadequate for the severity of the illness experienced by the patient. ⋯ This article details the role of the GR during critical illness with a focus upon the measurement of the GR, as a potentially important means by which to clinically assess the level of corticosteroid tissue-resistant in patients suspected of CIRCI. Measurement of the GR may be particularly useful as a means by which to determine the judicious administration of steroids, maximizing their therapeutic potential, whereas minimizing the morbidity that can be associated with their use.