Current opinion in critical care
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Curr Opin Crit Care · Dec 2013
ReviewMeasuring renal function in critically ill patients: tools and strategies for assessing glomerular filtration rate.
Alterations in kidney function are common in critically ill patients and are generally assessed by changes in serum creatinine (sCr) or urine output, which are considered surrogates for glomerular filtration rate (GFR) but do not reflect the overall kidney function. There is a great need for more reliable measurements of glomerular filtration in order to guide diagnosis and therapy for acute kidney injury. In this review, we will focus on recent advances to measure GFR that could help to better evaluate kidney function and improve patient care. ⋯ Standardized assays for sCr measurements, the use of a more precise scale with more frequent measurements, and the interpretation of the results based on patient's characteristics can increase the clinical value of sCr. New endogenous and exogenous markers will provide a more precise estimation. Imaging techniques are being developed and will probably be available in the near future. New gold standards for glomerular filtration will help in the development and improvement in the use of new biomarkers of kidney injury.
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Curr Opin Crit Care · Dec 2013
ReviewTherapeutic targeting of the mitochondrial dysfunction in septic acute kidney injury.
Acute kidney injury (AKI) is a common and serious complication of severe sepsis. No targeted therapies exist for sepsis-associated AKI, suggesting a pressing need for elucidation of the underlying pathogenic mechanisms. ⋯ Recent findings from human and experimental septic AKI studies strongly implicate the mitochondrion as an important target for sublethal kidney injury. Stimulating the natural pathways through which mitochondrial function is normally recovered following sepsis represents a promising strategy for the development of novel therapies.
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Curr Opin Crit Care · Dec 2013
ReviewMilitary trauma system in Afghanistan: lessons for civil systems?
This review focuses on development and maturation of the tactical evacuation and en route care capabilities of the military trauma system in Afghanistan and discusses hard-learned lessons that may have enduring relevance to civilian trauma systems. ⋯ Transfer of the lessons learned in the military trauma system operating in Afghanistan to civilian trauma systems with a comparable burden of prolonged evacuation times may be realized in improved patient outcomes in these systems.
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Although early acute traumatic coagulopathy has received much recent attention, the procoagulopathy that often follows appears less appreciated. Thromboembolic disease following trauma is common and lethal, but very effective prophylactic strategies are available. These strategies are variably implemented because of the difficulty in quantifying the magnitude of procoagulopathy in individual patients. ⋯ The logical next step following from the improved pathophysiological understanding of the procoagulopathy of trauma should be a simultaneous clinical trial of procoagulopathy diagnosis and thromboembolic prophylaxis.
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Curr Opin Crit Care · Dec 2013
ReviewEvolving practices in critical care and their influence on acute kidney injury.
This review highlights the principal advances in critical care over the past year, and discusses the impact of these advances on the diagnosis and management of acute kidney injury (AKI). ⋯ The incidence of AKI appears to be increasing, and despite advances in the provision of critical care and renal replacement therapies, there has been little improvement in its associated morbidity and mortality. Nonetheless, recent advances in critical care will impact the diagnosis and management of AKI, as well as shape the future research agenda. Continued work in the fields of critical care and nephrology will undoubtedly be centered on improved biomarkers for the detection of AKI, specific therapies to mitigate or reverse AKI, and techniques to prevent the development of AKI in the critically ill population.