Current opinion in critical care
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The aim of this study was to summarize the current evidence around the impact of individualizing patient care following an episode of acute kidney injury (AKI) in the ICU. ⋯ Although large scale evidence-based guidelines are lacking, standardization of post-ICU-AKI is needed.
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The aim of this study was to discuss recent findings related to providing adequate and well tolerated nutrition to the critically ill surgical patient. ⋯ Current evidence suggests early enteral nutrition with protein supplementation in critically ill surgical patients with consideration of early parenteral nutrition in high nutrition risk patients unable to achieve nutrition goals enterally. Despite established guidelines for nutritional therapy, the paucity of data to support these recommendations illustrates the critical need for additional studies.
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Curr Opin Crit Care · Dec 2020
ReviewAssessment and management of agitation, sleep, and mental illness in the surgical ICU.
Increased focus on patient-centered outcomes, mental health, and delirium prevention makes this review timely and relevant for critical care. ⋯ Highlighting new research, such as novel implementation strategies in addition to a lack of research in certain areas like sleep in the ICU may lead to innovation and establishment of evidence-based practices in critical care. Perioperative brain health is multifaceted, and an increase in multidisciplinary interventions may help improve outcomes and decrease morbidity in ICU survivors.
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Curr Opin Crit Care · Dec 2020
ReviewReal-time glomerular filtration rate: improving sensitivity, accuracy and prognostic value in acute kidney injury.
Acute kidney injury (AKI) is common and associated with high patient mortality, and accelerated progression to chronic kidney disease. Our ability to diagnose and stratify patients with AKI is paramount for translational progress. Unfortunately, currently available methods have major pitfalls. Serum creatinine is an insensitive functional biomarker of AKI, slow to register the event and influenced by multiple variables. Cystatin C, a proposed alternative, requires long laboratory processing and also lacks specificity. Other techniques are either very cumbersome (inuline, iohexol) or involve administration of radioactive products, and are therefore, not applicable on a large scale. ⋯ The clinical utility of rapid GFR measurements in AKI patients remains unknown as these disruptive technologies have not been tested in studies exploring clinical outcomes. However, these approaches have the potential to improve our understanding of AKI and clinical care. This overdue technology has the potential to individualize patient care and foster therapeutic success in AKI.
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Curr Opin Crit Care · Dec 2020
ReviewPrevention, diagnosis, and management of venous thromboembolism in the critically ill surgical and trauma patient.
Venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism, is common among trauma patients and critically ill surgical patients admitted to the ICU. Critical care surgical patients are at an extremely high risk for VTE and the related morbidity and mortality associated with it. The present review aims to provide an overview of the importance of identifying risk factors, prescribing effective prohylaxis, accurate diagnosis, and timely appropriate treatment for trauma and critically ill surgical patients with VTE in the ICU. ⋯ Critical care surgical and trauma patients represent a population that are at a heightened risk for VTE and associated complications. Appropriate screening, prevention strategies, accurate diagnosis, and timely administration of appropriate treatment must be utilized to reduce morbidity and mortality.