Current opinion in critical care
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The current narrative review discusses practical applications of stress and damage biomarkers for the management of acute kidney injury (AKI) based on clinical trials and real-world evaluations. ⋯ Stress and damage biomarker-based approaches to patient care seem to be promising for identifying patients at high risk for developing AKI and thus offers an opportunity for early management to prevent and ameliorate AKI and drug-associated AKI.
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Curr Opin Crit Care · Dec 2020
ReviewRefractory cardiac arrest: where extracorporeal cardiopulmonary resuscitation fits.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a powerful technique increasingly used to care for patients with refractory cardiac arrest. This review will detail where ECPR fits in the current care of cardiac arrest patients, including the key aspects of ECPR deployment and patient selection shown to maximize its benefit. ⋯ ECPR is a system of resuscitation care that must be optimized at every level to successfully treat patients with refractory cardiac arrest.
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Curr Opin Crit Care · Dec 2020
ReviewArtificial intelligence to guide management of acute kidney injury in the ICU: a narrative review.
Acute kidney injury (AKI) frequently complicates hospital admission, especially in the ICU or after major surgery, and is associated with high morbidity and mortality. The risk of developing AKI depends on the presence of preexisting comorbidities and the cause of the current disease. Besides, many other parameters affect the kidney function, such as the state of other vital organs, the host response, and the initiated treatment. Advancements in the field of informatics have led to the opportunity to store and utilize the patient-related data to train and validate models to detect specific patterns and, as such, predict disease states or outcomes. ⋯ In this article, we provide an overview of the machine-learning prediction models for AKI and its outcomes in critically ill patients and individuals undergoing major surgery. We also discuss the pitfalls and the opportunities related to the implementation of these models in clinical practices.
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Curr Opin Crit Care · Dec 2020
ReviewUses and pitfalls of measurement of end-tidal carbon dioxide during cardiac arrest.
To discuss recent studies relevant to the utility of measuring end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) and its correlation with outcome in adults experiencing cardiac arrest. ⋯ Higher values of ETCO2 during resuscitation from cardiac arrest are generally associated with a greater likelihood of ROSC. However, timing of measurements and cut-off values used show significant variability across different studies, making it hard to draw any conclusions about the utility of any particular reading for prognostication. Future studies might aim to develop an accepted standard for the timing and cut-off value of ETCO2 used, to enable comparison of the parameter across different studies.
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AKI is a complex clinical syndrome with many causes and there is a broad range of clinical presentations that vary according to duration, severity and context. Established consensus definitions of AKI are nonspecific and limited to kidney function. This reduces treatment options to generic approaches rather than individualized, cause-based strategies that have limited both understanding and management of AKI. ⋯ Appropriate intervention requires refinement of the nomenclature of AKI to identify subphenotypes that facilitate correctly timed and selectively targeted intervention.