Critical care : the official journal of the Critical Care Forum
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In an observational multicenter study, Elseviers and colleagues report that renal replacement therapy (RRT) in acutely ill patients treated for acute kidney injury is an independent risk factor for death. This result may question the benefit of the current practice of early RRT initiation.
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In hypoxemic patients needing fiberoptic bronchoscopy (FOB), noninvasive ventilation (NIV) has been used to prevent gas-exchange deterioration associated with FOB and to compensate for the increase in work of breathing occurring during FOB, thus avoiding endotracheal intubation and its related complications. The application of NIV to allow FOB has been found of particular interest in the diagnosis of pneumonia in patients spontaneously breathing and in those who started NIV to assist FOB. There is less information for patients who were already receiving NIV for acute respiratory failure and who were scheduled to undergo FOB. In the previous issue of Critical Care, the study by Baumann and colleagues adds new information to this specific issue, addressing the feasibility and safety of FOB during NIV in patients with established hypoxemic respiratory failure.
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Severe community-acquired pneumonia is a major cause of admission to intensive care units and its mortality rates remain exceedingly high. In the search for adjunctive therapies, clinicians who were encouraged by available, though limited, evidence prescribed steroids in most patients with severe sepsis or septic shock, including those with community-acquired pneumonia. Current evidence demonstrates that, whereas corticosteroids should not be routinely employed as adjuvant therapy for severe community-acquired pneumonia, there is sufficient equipoise to continue studying the use of corticosteroids.
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The recent advent of consensus definitions for acute kidney injury (AKI) has led to improvement in epidemiology of this complex disease and facilitated the development of new diagnostic makers and new therapies. However, important new challenges are also apparent. ⋯ Progress in this area will require new ideas and thinking outside the conventional box. By confronting some of the most significant controversies in the field of AKI we seek to develop new concepts that will ultimately yield new results.
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ICU-acquired muscle weakness commonly occurs in patients with septic shock and is associated with poor outcome. Although atrophy is known to be involved, it is unclear whether ligands in plasma from these patients are responsible for initiating degradation of muscle proteins. The aim of the present study was to investigate if plasma from septic shock patients induces skeletal muscle atrophy and to examine the time course of plasma-induced muscle atrophy during ICU stay. ⋯ Plasma from patients with septic shock induces loss of myosin and activates key regulators of proteolysis in skeletal myotubes. IL-6 is an important player in sepsis-induced muscle atrophy in this model. The potential to induce atrophy is strongest in plasma obtained during the early phase of human sepsis.