Current opinion in critical care
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Curr Opin Crit Care · Dec 2009
ReviewFluid accumulation and acute kidney injury: consequence or cause.
Fluid accumulation and fluid overload are frequent findings in critically ill patients and in those suffering from severe acute kidney injury. This review focuses on the consequences associated with fluid overload in critically ill patients with or without associated acute kidney injury and discusses the potential mechanisms by which acute kidney injury can contribute to fluid overload and whether fluid overload can also contribute to kidney dysfunction. ⋯ Fluid overload is independently associated with increased mortality in patients with acute kidney injury and contributes to worsen outcomes in critically ill patients. Further studies are required to determine the influence of fluid overload on organ function and overall prognosis.
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Care of the injured patient is a dynamic process. Hemorrhage remains the primary cause of preventable death after trauma. Rapid and effective early care can improve survival and outcomes. Emerging therapies to address traumatic hemorrhage will be discussed. ⋯ Given the potential to preserve life with appropriate attention applied to the bleeding trauma victim, it is vitally important to explore the options currently available and continue to make improvements in care.
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Acute kidney injury (AKI) continues to contribute significantly to morbidity and mortality in the ICU setting, especially when associated with distant organ dysfunction. There is increasing evidence that AKI directly contributes to organ dysfunction in lung, brain, liver, heart and other organs. This review will examine our current understanding of the deleterious organ crosstalk in the critically ill, which can provide a framework for developing novel therapeutics. ⋯ There is increasing knowledge of AKI and deleterious interorgan crosstalk that arises, at least in part, due to the imbalance of immune, inflammatory, and soluble mediator metabolism that attends severe insults to the kidney. Further studies can build on these new mechanistic observations to develop strategies to improve outcomes in the critically ill patient.
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Curr Opin Crit Care · Dec 2009
ReviewImpaired blood flow in acute kidney injury: pathophysiology and potential efficacy of intrarenal vasodilator therapy.
Acute kidney injury (AKI) is a common complication of hospitalized patients and associated with significant morbidity and mortality. Numerous studies have documented that acute reductions in glomerular filtration rates are associated with significant in-hospital mortality. Moreover, patients progressing to dialysis-dependent AKI can have mortality rates that exceed 60%. The pathophysiology of AKI is unknown, but marked reductions in corticomedullary blood flow leads to significant reductions in glomerular filtration rate during early phases of the disease. The recognition that hypoperfusion of the outer medulla is common to many forms of AKI and contributes to tubular ischemia has led many investigators to re-examine the use of vasodilators to restore blood flow and stabilize renal function. ⋯ Previous trials utilizing vasodilator therapy to stabilize renal function in AKI have given conflicting results. This study will critically review trial design and dose selection used in previous studies of vasodilator therapy in AKI. Lastly, the potential for high-dose therapy using intrarenal drug delivery systems will be discussed.