Critical care : the official journal of the Critical Care Forum
-
This article focuses on the incidence, predictors, classification, impact on prognosis, and management of bleeding associated with the treatment of acute coronary syndrome. The issue of bleeding complications is related to the continual improvement of ischemic heart disease treatment, which involves mainly (a) the widespread use of coronary angiography, (b) developments in percutaneous coronary interventions, and (c) the introduction of new antithrombotics. ⋯ Bleeding significantly influences both the short- and long-term prognoses. If a group of patients at higher risk of bleeding complications can be identified according to known risk factors and a risk scoring system can be developed, we may focus more on preventive measures that should help us to reduce the incidence of bleeding.
-
Editorial Comment
The needle in the haystack: searching for biomarkers in acute respiratory distress syndrome.
The acute respiratory distress syndrome commonly accompanies critical illness and is associated with significant morbidity and mortality. The implementation of life saving therapies is dependent on accurately identifying patients with this syndrome; however, beyond clinical definitions, we lack ancillary tests aimed at this specific diagnosis. This commentary discusses recent advances in the use of biomarkers to fill this diagnostic void.
-
Editorial Comment
Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy.
Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen concentrate or cryoprecipitate should be considered a clinical priority in major trauma hemorrhage.
-
Review Meta Analysis Comparative Study
Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis.
Ultrasonography is being increasingly utilized in acute care settings with expanding applications. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. In this review, we provide a comprehensive analysis of the current literature comparing ultrasonography and chest radiography for the diagnosis of pneumothorax. ⋯ Our study indicates that ultrasonography is more accurate than chest radiography for detection of pneumothorax. The results support the previous investigations in this field, add new valuable information obtained from subgroup analysis, and provide accurate estimates for the performance parameters of both bedside ultrasonography and chest radiography for pneumothorax evaluation.
-
Multicenter Study
Development and standardization of a furosemide stress test to predict the severity of acute kidney injury.
In the setting of early acute kidney injury (AKI), no test has been shown to definitively predict the progression to more severe stages. ⋯ The FST in subjects with early AKI serves as a novel assessment of tubular function with robust predictive capacity to identify those patients with severe and progressive AKI. Future studies to validate these findings are warranted.