Critical care : the official journal of the Critical Care Forum
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Earlier initiation of dialysis may have a beneficial impact on survival of critically ill patients with acute kidney injury (AKI). A retrospective analysis in the previous issue of Critical Care showed that early initiation of renal replacement therapy (RRT), as defined by RIFLE criteria, was not associated with a reduction in hospital mortality. The retrospective character of many studies describing the results of early RRT initiation and the validity of RIFLE criteria to determine the need for dialysis can be questioned, in particular when urinary output is not considered. Initiating dialysis in AKI should be based on clinical criteria and not on serum creatinine or another serum/urine-based biomarker.
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Editorial Comment
The desperate need for good-quality clinical trials to evaluate the optimal source and dose of fibrinogen in managing bleeding.
Recent interest in transfusion management of trauma patients has heightened expectation in the role of blood component therapy in improving patient outcome. Optimal transfusion support in supplementation with fibrinogen has not been defined by high-quality evidence. ⋯ Studies of cost-effectiveness have not been considered in research. An international move to supplement fibrinogen more 'aggressively' without direct clinical evaluation beforehand represents a failed opportunity to improve our very limited understanding of optimal transfusion practice.
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The prognosis of patients hospitalized with acute heart failure (AHF) is poor and risk stratification may help clinicians guide care. The objectives of the Acute Heart Failure Database (AHEAD) registry are to assess patient characteristics, etiology, treatment and outcome of AHF. ⋯ The AHEAD Main registry provides up-to-date information on the etiology, treatment and hospital outcomes of patients hospitalized with AHF. The results highlight the highest risk patients.
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Recent publications suggest potential benefits from statins as a preventive or adjuvant therapy in sepsis. Whether ongoing statin therapy should be continued or discontinued in patients admitted in the intensive care unit (ICU) for sepsis is open to question. ⋯ Continuing statin therapy in ICU septic patients was not associated with reduction in the severity of organ failure after matching and adjustment. In addition, the very high plasma concentrations achieved during continuation of statin treatment advocates some caution.
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Several studies have demonstrated that perioperative hemodynamic optimization has the ability to improve postoperative outcome in high-risk surgical patients. All of these studies aimed at optimizing cardiac output and/or oxygen delivery in the perioperative period. We conducted a survey with the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA) to assess current hemodynamic management practices in patients undergoing high-risk surgery in Europe and in the United States. ⋯ In conclusion, these results point to a considerable gap between the accumulating evidence about the benefits of perioperative hemodynamic optimization and the available technologies that may facilitate its clinical implementation, and clinical practices in both Europe and the United States.