Critical care : the official journal of the Critical Care Forum
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Comparative Study
Serum cystatin C concentration as a marker of acute renal dysfunction in critically ill patients.
In critically ill patients sudden changes in glomerular filtration rate (GFR) are not instantly followed by parallel changes in serum creatinine. The aim of the present study was to analyze the utility of serum cystatin C as a marker of renal function in these patients. ⋯ Cystatin C is an accurate marker of subtle changes in GFR, and it may be superior to creatinine when assessing this parameter in clinical practice in critically ill patients.
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Comment Comparative Study
Artificial neural networks as prediction tools in the critically ill.
The past 25 years have witnessed the development of improved tools with which to predict short-term and long-term outcomes after critical illness. The general paradigm for constructing the best known tools has been the logistic regression model. Recently, a variety of alternative tools, such as artificial neural networks, have been proposed, with claims of improved performance over more traditional models in particular settings. However, these newer methods have yet to demonstrate their practicality and usefulness within the context of predicting outcomes in the critically ill.
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Cardiovascular failure is one of the central therapeutic problems in patients with severe infection. Although norepinephrine is a potent and, in most cases, highly effective vasopressor agent, very high dosages leading to significant side effects can be necessary to stabilize advanced shock. As a supplementary vasopressor, arginine vasopressin can reverse hemodynamic failure and significantly decrease norepinephrine dosages. Whether the promising possibility of 'bridging' advanced septic shock when the benefit/risk ratio of catecholamine therapy leaves a clinically tolerable range may improve quantitative and qualitative patient outcome can only be determined by a large, prospective, randomized study.
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Sedation and analgesia are provided by using different agents and techniques in different countries. The goal is to achieve early spontaneous breathing and to obtain an awake and cooperative pain-free patient. It was the aim of this study to conduct a survey of the agents and techniques used for analgesia and sedation in intensive care units in Germany. ⋯ In contrast to the US 'Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult', our survey showed that in Germany different agents, and frequently neuroaxial techniques, were used.