American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Case Reports
Levels of neutrophil gelatinase-associated lipocalin in 2 patients with crush syndrome after a mudslide.
Neutrophil gelatinase-associated lipocalin is one of the most promising biomarkers for the diagnosis of acute kidney injury. An increase in the level of neutrophil gelatinase-associated lipocalin is a good predictor of acute kidney injury and is associated with an increase in the serum level of creatinine. ⋯ The development of acute kidney injury is the second most common cause of death after large earthquakes and other natural disasters, but at the same time, crush-related acute kidney injury is one of the few life-threatening complications of crush injuries that can be reversed if diagnosed early and treated. In this case, measuring the level of neutrophil gelatinase-associated lipocalin enabled early diagnosis of acute kidney injury and anticipation of the changes in levels of conventional markers such as creatinine.
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Ventilator-associated pneumonia is a complication of mechanical ventilation that is associated with increased length of stay, morbidity, mortality, and costs. Evidence-based guidelines to reduce the risk of ventilator-associated pneumonia recommend use of 30º to 45º backrest elevation. Despite recommendations, patients continue to be cared for in positions with a lower backrest elevation. Hemodynamic stability may be a factor in the lack of adherence, yet few data exist to confirm this hypothesis. ⋯ That backrest elevation is associated with lower mean blood pressure and vasopressor use suggests that nurses are not adhering to recommended levels of backrest elevation so as to maintain hemodynamic stability. Further studies are needed to elucidate reasons for lack of adherence to recommended levels of backrest elevation.
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Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available. ⋯ Current risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.