Critical care : the official journal of the Critical Care Forum
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Data obtained from net organ balance studies of glucose production lead to the classic view according to which glucose homeostasis is mainly ensured by the liver, and renal glucose production only plays a significant role during acidosis and prolonged starvation. Renal glucose release and uptake, as well as the participation of gluconeogenic substrates in renal gluconeogenesis, were recently re-evaluated using systemic and renal arteriovenous balance of substrates in combination with deuterated glucose dilution. Data obtained using these methods lead one to reconsider the magnitude of renal glucose production as well as its role in various physiological and pathological circumstances. These findings now conduce one to consider that renal gluconeogenesis substantially participates in postabsorptive glucose production, and that its role in glucose homeostasis is of first importance.
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Despite decades of resuscitating patients with intravenous fluids in intensive care units, it is somewhat surprising that very little consensus exists regarding the type of fluid physicians should choose. Factors that influence decisions are often local culture or politics, hospital administrators, history (i.e. 'I've always done it this way') and budgets, as opposed to strong evidence. ⋯ As such, in the future, clinicians will need to consider other factors when making their decision. In addition, large-scale quality randomised studies are desperately needed to guide clinicians.
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A growing body of evidence indicates that survivors of intensive care have an impaired quality of life. It is not entirely clear from the available literature whether this impairment is a complication of critical illness or a complication of therapy. There is little evidence to guide physicians to treatments in the intensive care unit that will minimize the effects of critical illness on these sequelae. Although the study by Rublee and colleagues in this issue of Critical Care provides little clinically useful information about the effects of antithrombin III on quality of life, it provides some insight into the challenges that investigators will encounter as we try to incorporate these outcomes into studies of critical illness.