Current opinion in critical care
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To review recent advances in the definitions and diagnostic criteria for acute renal failure and acute kidney injury. To explore how these changes impact the epidemiology and clinical implications for patients in the intensive care unit. ⋯ Small changes in kidney function in hospitalized patients are important and impact on outcome. RIFLE criteria provide a uniform definition of acute kidney injury and are increasingly used in literature.
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Curr Opin Crit Care · Dec 2006
ReviewMeasurement of acid-base resuscitation endpoints: lactate, base deficit, bicarbonate or what?
Inadequate oxygen delivery to the tissues frequently results in significant metabolic acidosis. The resultant cellular and organ dysfunction can increase morbidity, mortality and hospital stay. Early diagnosis of shock can lead to early resuscitation efforts that can prevent ongoing tissue injury. This review focuses on the metabolic, hemodynamic and regional perfusion endpoints utilized in the diagnosis of metabolic acidosis resulting from shock. Resuscitation strategies aimed at supranormal oxygen delivery will be discussed. ⋯ Despite the large number of endpoints available to the clinician, none are universally applicable and none have independently demonstrated improved survival when guiding resuscitation. Patients who respond well to initial resuscitation efforts demonstrate a survival advantage over nonresponders.
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Research priorities in critical care are increasingly focusing on long-term outcomes and prognosis for survivors of critical illness. This review will focus on long-term outcomes after acute renal failure. ⋯ The long-term survival after acute renal failure is poor. Yet, most survivors recover sufficient function to become independent from renal replacement therapy. While perceived health-related quality of life is good, survivors have a lower health-related quality of life compared with the general population. Further research is needed to explore the relationship between survival, markers of morbidity and costs after acute renal failure.
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Curr Opin Crit Care · Dec 2006
ReviewThe impact of endogenous triggers on trauma-associated inflammation.
Inflammation immediately starting after trauma is a consequence of an efficient host defense system that is not only capable of sensing exogenous and pathogen-derived danger signals, but also endogenous, multifunctional alarm signals, which both can initiate an inflammatory response. ⋯ In addition to improved insights into the regulation of traumatic inflammation and the etiology of the systemic inflammatory response syndrome, some endogenous immune triggers seem to have the potential to serve as novel biomarkers in predicting post-traumatic complications.
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Transfusion of red blood cells in the trauma patient can be lifesaving. The question is how much and when? It is important to weigh the risks and benefits of red blood cell transfusions, as well alternatives to transfusion as these products are not benign. ⋯ Optimal transfusion practice and use of alternatives in trauma is a rapidly expanding and important area of research. Strong clinical evidence derived by future randomized controlled trials in the area of transfusion triggers as well as transfusion alternatives is required to determine their roles in clinical practice.