Current opinion in critical care
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Curr Opin Crit Care · Dec 2005
Consensus development in acute renal failure: The Acute Dialysis Quality Initiative.
Although acute renal failure is both common and highly lethal in the intensive care unit, our understanding of the epidemiology and pathophysiology of acute renal failure is limited, and treatment for acute renal failure is extremely variable around the world. The general lack of consensus with regard to definitions, prevention, and treatment of acute renal failure has limited progress in this field. ⋯ Broad consensus in the diagnosis and management of acute renal failure and in the use of blood purification in nonrenal critical illness is achievable. Standardization of definitions, practice, and research methodology is urgently needed, and specific proposals have been made by an international, interdisciplinary group.
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Homeostasis represents a delicate balance between hemostatic and fibrinolytic processes. This balance permits arrest of hemorrhage after mild injury but prevents thrombosis from occurring under normal circumstances. Trauma disturbs the equilibrium between hemostatic and fibrinolytic processes, frequently producing either a hypocoagulable state or a hypercoagulable state depending on the severity of injury, degree of hemorrhage, and the nature of the resuscitation. The purpose of this review is to describe the epidemiology and pathophysiology of coagulopathy after trauma and to discuss novel methods of treating it. ⋯ Changes in coagulation following trauma are characterized by a complex series of events that may result in either a hypocoagulable or a hypercoagulable state. Routinely analyzed coagulation parameters do not adequately describe this state and they are deficient for guiding its therapy. Several promising new agents are available for treating hemorrhage in coagulopathic trauma patients that should result in improved survival.