Current opinion in critical care
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Curr Opin Crit Care · Dec 2018
ReviewCorticosteroids administration to improve outcome in high-risk surgical patients.
Intraoperative corticosteroids may decrease postoperative complications, including infection, after major surgery.
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The present article reviews the recent literature on the main aspects of perioperative acute kidney injury (AKI). ⋯ AKI remains a frequent and severe postoperative complication. A personalizedmulticomponent approach might help reducing the risk of AKI and improving patients' outcomes.
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Intravenous fluid administration is a fundamental therapy in critical care, yet key questions remain unanswered regarding optimal fluid composition and dose. This review evaluates recent evidence regarding the effects of fluid resuscitation on pathophysiology, organ function, and clinical outcomes for critically ill patients. ⋯ As evidence on fluid resuscitation evolves, a reasonable approach would be to use primarily balanced crystalloids, consider 2-3 l for initial fluid resuscitation of hypovolemic or distributive shock, and use measures of anticipated hemodynamic response to guide further fluid administration.
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Curr Opin Crit Care · Dec 2018
ReviewOptimizing continuous renal replacement therapy in the ICU: a team strategy.
The consideration of acute kidney injury, its incidence and its impact on the outcome of patients has grown continuously in recent years, leading to an increase in the use of renal replacement therapy (RRT) techniques. However, the successful conduct of RRT depends on the effectiveness of the entire team, doctors and nurses. It is therefore important to know the essential elements to be implemented in the ICU to ensure optimal RRT. ⋯ We now have a better understanding of the measures to be deployed to optimize RRT. Organization, training, evaluation and protocols are the key points of the team's efficiency for a safe and effective implementation of RRT.
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Curr Opin Crit Care · Dec 2018
ReviewDialysis catheters in the ICU: selection, insertion and maintenance.
Choosing the best catheter for renal replacement therapy (RRT) is not an easy task. Beyond catheter length, many of its properties can influence effectiveness of the RRT session. Maintenance between sessions, particularly the locking solution, also impacts catheter lifespan and infection rates. ⋯ Although studies conducted in the specific context of the ICU are still scarce, some conclusions can be drawn. Catheter length must be adapted to the insertion site to reach an area of high blood flow. Kidney-shape lumens appear to be less thrombogenic and seem to prevent catheter dysfunction. Catheter tip and lumen holes also affect catheter function. For catheter locking, 4% citrate appears nowadays as one of the best options, but taurolidine-based solutions are also interesting.