Critical care : the official journal of the Critical Care Forum
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The Acute Kidney Injury Network proposed a new classification for acute kidney injury (AKI) distinguishing between three stages. We applied the criteria to a large intensive care unit (ICU) population and evaluated the impact of AKI in the context of other risk factors. ⋯ The proposed AKI classification correlated with ICU outcome but only AKI III was an independent risk factor for ICU mortality. The use of renal replacement therapy as a criterion for AKI III may have a confounding effect on the predictive power of the classification system as a whole.
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Comment
Good night, sleep tight: the time is ripe for critical care providers to wake up and focus on sleep.
The role of sleep during recovery from acute illness has been overlooked for decades. Advances in the support of critically ill patients have been made in mechanical ventilation, specialized nutrition support, highly specific antibiotic therapy, and early rehabilitation. However, the promotion of sleep - a basic tenet for survival - has been actively ignored by critical care providers. Bourne and coworkers recently conducted a small clinical trial that describes improved sleep efficiency with oral melatonin use in critically ill patients.
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Epinephrine remains the drug of choice for cardiopulmonary resuscitation. The aim of the present study is to assess whether the combination of vasopressin and epinephrine, given their different mechanisms of action, provides better results than epinephrine alone in cardiopulmonary resuscitation. ⋯ The administration of vasopressin in combination with epinephrine during cardiopulmonary resuscitation results in a drastic improvement in the hemodynamic parameters necessary for the return of spontaneous circulation.
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Arginine vasopressin (AVP) is increasingly used to restore mean arterial pressure (MAP) in low-pressure shock states unresponsive to conventional inotropes. This is potentially deleterious since AVP is also known to reduce cardiac output by increasing vascular resistance. The effects of AVP on blood flow to vital organs and cardiac performance in a circulation altered by cardiac ischemia are still not sufficiently clarified. We hypothesised that restoring MAP by low dose, therapeutic level AVP would reduce vital organ blood flow in a setting of experimental acute left ventricular dysfunction. ⋯ Low dose AVP induced a pronounced reduction in vital organ blood flow in pigs after transient cardiac ischemia. This indicates a potentially deleterious effect of AVP in patients with heart failure or cardiogenic shock due to impaired coronary perfusion.
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Kolar and colleagues contribute an additional and important incentive for rescuers to utilize end-tidal carbon dioxide tensions as a routine monitor to guide management and decision-making during cardiopulmonary resuscitation. They conclude that below-threshold levels of 14 mmHg (1.5 kPa) measured after 20 minutes of cardiopulmonary resuscitation reliably predict that spontaneous circulation cannot be restored.