Current opinion in critical care
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The present article will review the current state of our understanding of nephrotoxic medication-associated acute kidney injury (AKI) and provide strategies to reduce its impact. ⋯ Recent work on understanding specific combinations, thresholds for nephrotoxic burden and systematic kidney function assessment had mitigated, and even in some cases reduced, nephrotoxic AKI rates and severity. Current initiatives are underway to further refine specific nephrotoxic medication AKI risk via novel urinary biomarkers and genetic susceptibility.
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The benefits of palliative care for critically ill patients are well recognized, yet acceptance into surgical culture is lagging. With the increasing proportion of geriatric trauma patients, integration of palliative medicine within daily intensive care services to facilitate goal-concordant care is imperative. ⋯ Shifting our quality focus from 30-day mortality rates to measurements of symptom control and achievement of patient treatment preferences will prioritize patient beneficence and autonomy. Ownership of surgical palliative care as a service provided by acute care surgeons will ensure that our patients with incurable injury and illness will receive optimal patient-centered care.
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Curr Opin Crit Care · Dec 2016
ReviewFluid resuscitation for acute kidney injury: an empty promise.
The past decade has seen more advances in our understanding of fluid therapy than the preceding decades combined. What was once thought to be a relatively benign panacea is increasingly being recognized as a potent pharmacological and physiological intervention that may pose as much harm as benefit. ⋯ The practice of giving more fluid early and often is being replaced with new conceptual models of fluid resuscitation that suggest fluid therapy be 'personalized' to individual patient pathophysiology.
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To describe recent advances in the understanding of the role of fluid composition in renal outcomes in critically ill patients. ⋯ Recent evidence suggests that crystalloid fluid composition matters and can influence renal outcomes in critically ill patients. Further studies should assess the impact and cost-efficiency of balanced solutions in the context of high-risk scenarios.
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Curr Opin Crit Care · Dec 2016
ReviewBlood products and procoagulants in traumatic bleeding: use and evidence.
Death from uncontrolled haemorrhage is one of the leading causes of trauma-related mortality and is potentially preventable. Advances in understanding the mechanisms of trauma-induced coagulopathy (TIC) have focused attention on the role of blood products and procoagulants in mitigating the sequelae of TIC and how these therapies can be improved. ⋯ There are promising results from ex-vivo studies in manufacturing and storage of blood products to optimize haemostatic activity and availability, particularly with alternative plasma and platelet products and whole blood. There is an urgent need for these products needs to be tested prospectively.