Current opinion in critical care
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Curr Opin Crit Care · Dec 2008
ReviewPhysiological basis for the use of erythropoietin in critically ill patients at risk for acute kidney injury.
Acute kidney injury (AKI) frequently occurs in critically ill patients and is an independent risk factor for poor outcome. The prevention of kidney injury in intensive care remains a great challenge as specific nephroprotective therapies are still lacking. The present review summarizes recent evidence for the use of erythropoietin as a promising candidate to provide protection from AKI. ⋯ Animal studies revealed a physiological basis for the use of erythropoietin in AKI, which may be clinically applicable to prevent AKI in critically ill patients, but clinical studies are still lacking.
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Curr Opin Crit Care · Dec 2008
ReviewImproving quality and safety in the ICU: a challenge for the next years.
The objective of this review is to focus on recent developments in ICU quality improvement. ⋯ Changes described above have impacted the whole practice of intensive care. Quality improvement and offering a safer healthcare will promote deep changes in management and leadership.
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Curr Opin Crit Care · Dec 2008
ReviewThe timing of spinal stabilization in polytrauma and in patients with spinal cord injury.
Despite improved care of multiple injured patients, controversial data about the best time point for decompression and stabilization of spine fractures and spinal cord injuries are published. Some studies even question the value of surgical management. ⋯ Most studies support the hypothesis that early decompression and stabilization of spine injuries is beneficial in terms of reducing length of stay at the ICU, as well as improving neurological and overall outcome. Good prospective clinical trials are still missing, thus the level of evidence remains low.
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Curr Opin Crit Care · Dec 2008
ReviewPostinjury immune monitoring: can multiple organ failure be predicted?
Multiple organ failure is the main cause of late morbidity and mortality after severe injury. This disease state is driven by a dysfunctional immune system. Prediction of multiple organ failure on the basis of clinical parameters appears to be insufficient. A better understanding of immunological pathogenesis underlying multiple organ failure may lead to better prediction and innovation in treatment strategy in order to increase the survival of trauma patients. ⋯ General markers of inflammation including cytokines are correlated with posttraumatic complications with a low sensitivity and specificity and are, therefore, of little use as prognostic markers. Current findings regarding the functionality of immune cells are promising and might be of prognostic value in the near future.
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Curr Opin Crit Care · Dec 2008
ReviewAntimicrobial dosing strategies in critically ill patients with acute kidney injury and high-dose continuous veno-venous hemofiltration.
Delivery of appropriate antimicrobial therapy is a great challenge during continuous veno-venous hemofiltration (CVVH), particularly if the recommended higher doses are applied. The present contribution discusses the principles of drug dosing during CVVH and compares the various proposed dosing strategies. ⋯ The delivery of appropriate antimicrobial therapy during CVVH leaves us with uncertainty and presents a great challenge. To ensure efficacy and prevent toxicity, therapeutic drug monitoring is highly recommended. In the absence of therapeutic drug monitoring, adequate concentrations can only be inferred from clinical response. For nontoxic antibiotics overdosing is preferred to underdosing because the danger of underdosing is far greater than that of overdosing.