Critical care medicine
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Critical care medicine · Nov 2008
Modulation of aquaporin-2/vasopressin2 receptor kidney expression and tubular injury after endotoxin (lipopolysaccharide) challenge.
Sepsis-induced organ dysfunctions remain prevalent and account for >50% of intensive care unit admissions for acute renal failure with a mortality rate nearing 75%. In addition to the fact that the mechanisms underlying the pathophysiology of sepsis-related acute renal failure are unclear, the impact on septic-induced acute renal failure of either norepinephrine, a gold-standard vasopressor, and arginine vasopressin, a candidate alternative, are not well understood. ⋯ In this endotoxic model, dose-targeted arginine vasopressin infusion increased lipopolysaccharide-induced renal dysfunction without affecting renal blood flow and glomerular function, but with particular disruption of aquaporin-2/V2 receptor networking, consecutive decreased salt and water handling ability. This is in clear contrast with norepinephrine infusion and suggests specific arginine vasopressin-induced "tubular epithelial dysfunction."
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Critical care medicine · Nov 2008
Cardioprotective effects of erythropoietin on postresuscitation myocardial dysfunction in appropriate therapeutic windows.
Erythropoietin has been noted for its cardioprotective effects. The objective of the study is to investigate its effects on postresuscitation myocardial dysfunction and therapeutic windows. ⋯ Erythropoietin has the potential to improve postresuscitation myocardial dysfunction and short-term survival in appropriate therapeutic windows.
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Critical care medicine · Nov 2008
The use of regional citrate anticoagulation for continuous venovenous hemodiafiltration in acute kidney injury.
Continuous renal replacement therapy is commonly used in the treatment of acute kidney injury. Although the optimal anticoagulation system is not well defined, citrate has emerged as the most promising method. We evaluated the data of 143 patients with acute kidney injury subjected to citrate-based continuous venovenous hemodiafiltration. ⋯ Besides a trend toward higher mortality rate observed in the group with liver failure, we found that citrate-based continuous venovenous hemodiafiltration allowed an effective dialysis dose and reasonable filter patency.
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Critical care medicine · Nov 2008
Glycemic variability: a strong independent predictor of mortality in critically ill patients.
To determine the effect of glycemic variability, assessed by the standard deviation of each patient's mean glucose level, on mortality in a population of critically ill adult patients. ⋯ This study demonstrates that increasing glycemic variability conferred a strong independent risk of mortality in this heterogeneous population of critically ill patients. Previously published interventional studies of glycemic control may be reinterpreted using the metric of glycemic variability. Measures to ensure a low degree of glycemic variability may improve outcomes in intensive care unit's implementing glycemic control. Finally, ongoing and future investigations should consider including this new metric in their study design.
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Critical care medicine · Nov 2008
Intravenous infusion of bone marrow mesenchymal stem cells improves brain function after resuscitation from cardiac arrest.
Allogeneic bone marrow mesenchymal stem cells were previously shown to improve myocardial function when administered intravenously after resuscitation from cardiac arrest in rats. Coincidental evidence of improved brain function prompted the present study. ⋯ Mesenchymal stem cells injected into the right atrium of rats after resuscitation from cardiac arrest were identified in brains harvested 35 days later. Brain function was significantly improved. Accordingly, venous injection of mesenchymal stem cells after cardiopulmonary resuscitation has promise of minimizing the severity of postresuscitation neurologic impairment.