Current opinion in critical care
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This review will summarize the recent advances in our understanding of the relationship between liver and kidney function. It will outline the new concepts of the pathophysiology of renal dysfunction in chronic liver disease and examine novel renal biomarkers to detect acute kidney injury (AKI) in cirrhosis and following liver transplantation. We will further review new treatments for hepatorenal syndrome (HRS) and approaches to kidney dysfunction in liver transplantation recipients. ⋯ Greater knowledge of the physiologic relationship between kidney and liver may open avenues for specific therapies of liver and kidney injury. Renal biomarkers may allow early diagnosis and targeted treatment of AKI, and improved management of kidney disease in the preliver and postliver transplantation setting will be crucial to improving long-term outcomes in these patients.
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Curr Opin Crit Care · Feb 2013
ReviewExtracorporeal membrane oxygenation in adults with acute respiratory distress syndrome.
To evaluate the last 2 years' publications for evidence supporting use of extracorporeal membrane oxygenation (ECMO) for critically ill adults with acute respiratory distress syndrome (ARDS). ⋯ Intensivists may have increased their utilization of ECMO. Credible evidence for mortality benefit of ECMO is lacking. A prospective randomized controlled trial designed to evaluate the efficacy of ECMO for ARDS is overdue.
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Curr Opin Crit Care · Feb 2013
ReviewThe new definition for acute lung injury and acute respiratory distress syndrome: is there room for improvement?
To review the new (Berlin) definition of the acute respiratory distress syndrome (ARDS) and to propose potential improvements. ⋯ The Berlin definition brought improvement and simplification over the previous definitions. The use of data over the first 24 h to reclassify the severity of the disease and the use of compliance to stratify each oxygenation category might further improve the definition.