Critical care : the official journal of the Critical Care Forum
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We summarize original research in the field of critical care nephrology accepted or published in 2009 in Critical Care or, when considered relevant or directly linked to this research, in other journals. Four main topics have been identified for a rapid overview: (a) post-surgical acute kidney injury (AKI); (b) timing of renal replacement therapy (RRT): different authors examined this critical issue of RRT in different settings (post-surgical patients, burned patients, and intensive care unit patients); (c) DoReMi (Dose Response Multicentre International) and other important surveys on dialysis dose and management; and (d) pediatric AKI and RRT: interest in this last topic is increasing, and studies on biomarkers, complications of pediatric dialysis, and application of RRT to extracorporeal membrane oxygenation are discussed.
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Comparative Study
Copeptin and risk stratification in patients with acute dyspnea.
The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of Copeptin, the C-terminal part of the vasopressin prohormone alone and combined to N-terminal pro B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea. ⋯ Copeptin is a new promising prognostic marker for short-term mortality independently and additive to natriuretic peptide levels in patients with acute dyspnea.
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Comment Review
Preventing severe hypoxia during emergent intubation: is nasopharyngeal oxygenation the answer?
Critically ill patients requiring emergent endotracheal intubation are at risk for life-threatening hypoxemia during the intubation procedure, particularly when the patient is apneic and not receiving any supplemental oxygen. In a current study, Engström and colleagues investigated the effect of nasopharyngeal oxygenation in eight anesthetized pigs with induced acute lung injury. The investigators confirmed, even in this model, that pharyngeal oxygenation significantly prolonged the time to desaturation during periods of apnea. Recognizing the limitations of directly extrapolating these experimental results to critically ill human subjects, the findings do support the contention that, until proven otherwise, nasopharyngeal oxygenation should at least be considered as one technique to diminish hypoxemic complications in very sick patients, particularly those with underlying pulmonary impairment.
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Traumatic brain injury remains a major cause of death and severe disability throughout the world. Traumatic brain injury leads to 1,000,000 hospital admissions per annum throughout the European Union. It causes the majority of the 50,000 deaths from road traffic accidents and leaves 10,000 patients severely handicapped: three quarters of these victims are young people. ⋯ There is an absence of evidence for the five commonly used treatments for raised ICP and all are potential 'double-edged swords' with significant disadvantages. The use of hypothermia in patients with traumatic brain injury may have beneficial effects in both ICP reduction and possible neuro-protection. This review will focus on the bench-to-bedside evidence that has supported the development of the Eurotherm3235Trial protocol.
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Comparative Study
Regulation and prognostic relevance of serum ghrelin concentrations in critical illness and sepsis.
Ghrelin has been recently identified as a mediator of various beneficial effects in animal models of sepsis. At present, no data are available concerning specific properties of ghrelin in critically ill patients from large cohorts. In order to identify possible pathogenic functions of ghrelin in critically ill patients and human sepsis from a clinical point of view, we aimed at analyzing ghrelin serum concentrations in a large cohort of well characterized patients with critical illness. ⋯ Ghrelin serum concentrations are elevated in all circumstances of critical disease, including sepsis and non-sepsis patients. High ghrelin levels are a positive predictor of ICU-survival in sepsis patients, matching previous results from animal models. Future experimental and clinical studies are needed to evaluate ghrelin as a novel prognostic tool in ICU patients and its potential therapeutic use in sepsis.