Critical care : the official journal of the Critical Care Forum
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Editorial Comment
Risk stratification in critically ill patients: GDF-15 scores in adult respiratory distress syndrome.
Patients with adult respiratory distress syndrome (ARDS) are highly heterogeneous but current therapies are rather uniform and largely supportive. In the previous issue of Critical Care, Clark and colleagues report that the biomarker GDF-15 provides prognostic information in ARDS that is additive to that provided by the APACHE III score. Patients with high levels of growth-differentiation factor 15 (GDF-15) had a higher mortality and more complicated hospital course. Biomarkers such as GDF-15 may help us to identify patients at higher risk who may eventually benefit from more personalized and targeted therapies.
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Editorial Comment
Measuring glomerular filtration rate in the intensive care unit: no substitutes please.
Acute kidney injury (AKI), due to its increasing incidence, associated morbidity and mortality, and potential for development of chronic kidney disease with acceleration to end-stage renal disease, has become of major interest to nephrologists and critical care physicians. The development of biomarkers to diagnose AKI, quantify risk and predict prognosis is receiving considerable attention. Yet techniques to accurately assess functional changes within patients still rely on the use of an insensitive marker (creatinine), creatinine-based estimating equations and unreliable urinary tests. Therefore, it is critical that functional tests be developed and used in combination with biomarkers, thus allowing improved care in AKI and chronic kidney disease patient populations.
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Barriers to the use of selective digestive decontamination include concerns about emergence of resistant organisms, over-estimation of current performance in preventing ventilator-associated pneumonia (VAP), alternative methods of preventing VAP, and misunderstanding of mechanisms of action. A definitive cluster-randomised trial should be undertaken that incorporates practitioner concerns and effect-size preferences.
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Editorial Comment
Candida and severe acute pancreatitis: We won't be fooled again.
Several studies have suggested a role of candida in infected cases of severe acute pancreatitis. This commentary reports high incidence and mortality rates of candida infection in this setting and demonstrates the value of the colonization index to detect patients at risk for fungal infection. These findings indicate the need to review the place of antifungal therapy and prophylaxis.