Current opinion in critical care
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Curr Opin Crit Care · Dec 2021
ReviewControversies in paediatric acute kidney injury and continuous renal replacement therapy: can paediatric care lead the way to precision acute kidney injury medicine?
Paediatric patients represent a unique challenge for providers managing acute kidney injury (AKI). Critical care for these children requires a precise approach to assessment, diagnostics and management. ⋯ In this review, we will summarize the past, present and future of AKI care in children, discussing the ongoing work and future goals of a personalized approach to AKI medicine.
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Curr Opin Crit Care · Dec 2021
ReviewPostoperative blood pressure management in patients treated in the ICU after noncardiac surgery.
Blood pressure management is a cornerstone of hemodynamic management in patients treated in the ICU after noncardiac surgery. Postoperative blood pressure management is challenging, because blood pressure alterations after surgery can be profound and have numerous causes. ⋯ Future research on postoperative blood pressure management in patients treated in the ICU after noncardiac surgery needs to assess whether the prevention or treatment of postoperative blood pressure alterations - especially postoperative hypotension - reduces the incidence of postoperative adverse outcomes.
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To describe current developed regional blocks, their indications and clinical use. Furthermore, describe new local anesthetics recently introduced and the new agents in pipeline. ⋯ New regional block techniques and new local anesthetics have been introduced recently. However, the efficacy/safety and comparison to conventional techniques and local anesthetics are still needed. Future studies must focus on prolonging analgesia with least invasive regional technique and compare new local anesthetics with current ones.
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Acute kidney injury (AKI) is a common but underestimated syndrome in the perioperative setting. AKI can be induced by different causes and is associated with increased morbidity and mortality. Unfortunately, no specific treatment options are available at the moment. ⋯ Good evidence exists for the use of biomarkers to identify individual patients at risk for AKI and for the implementation of haemodynamic optimization, abdication of nephrotoxins, adequate fluid administration using balanced crystalloid solutions and glycaemic control. The data for using colloids or the degree of nephrotoxicity of contrast media still remain inconclusive.
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Most patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Knowledge about the optimal strategy for treating these patients is evolving rapidly. This review will summarize the evidence on key aspects of postarrest care and prognostication, with a focus on actionable parameters that may impact patient survival and neurologic outcomes. ⋯ Clinical guidelines for postresuscitation care have recently been updated and incorporate all the available science supporting the treatment of postcardiac arrests. At a minimum, fever should be strictly avoided in comatose postcardiac patients. Prognostication must involve multiple modalities and should not be attempted until assessment confounders have been sufficiently excluded.