Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2017
ReviewPrevention of cardiac surgery-associated acute kidney injury.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequently occurring complication. It carries the risks of increasing mortality and development of chronic kidney disease. The complex pathophysiologic mechanisms still remain unexplained to a large extent. As a result, there is a considerable lack of sufficient therapeutic strategies with renal replacement therapy still representing the cornerstone for the treatment of severe AKI. ⋯ The identification of high-risk patients for AKI and the adherence to the Kidney Disease: Improving Global Outcomes guidelines constitute the mainstays in the management of CSA-AKI. It is of paramount importance to always maintain a sufficient perfusion pressure throughout the perioperative period. In patients at high risk, the use of new biomarkers and remote ischemic preconditioning should be considered.
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The applications for extracorporeal membrane oxygenation for lung support are constantly evolving. This review highlights fundamental concepts in extracorporeal lung support and describes directions for future research. ⋯ Extracorporeal lung support is a safe and an easily implemented intervention for refractory respiratory failure. Recent advances have extended its use beyond acute illnesses and the developments for chronic support will facilitate the development of durable devices and possible artificial lung development.
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Curr Opin Anaesthesiol · Feb 2017
ReviewDoes fluid management affect the occurrence of acute kidney injury?
To describe the potential impact of different fluid management strategies on renal outcomes in critically ill and postoperative patients. ⋯ Although synthetic colloids should be avoided in patients with or at risk of AKI, the renal efficacy of using albumin solutions and/or balanced crystalloids as alternatives to 0.9% sodium chloride in high-risk patients is yet to be confirmed or refuted. Improved goal-directed protocols, which minimize unnecessary fluid administration and reduce potentially harmful effects of fluid overload, need to be developed and tested.
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Curr Opin Anaesthesiol · Feb 2017
ReviewDiagnosis of cardiac surgery-associated acute kidney injury from functional to damage biomarkers.
Acute kidney injury (AKI) occurs in up to 30% after cardiac surgery and is associated with adverse outcome. Currently, cardiac surgery-associated acute kidney injury (CSA-AKI) is diagnosed by Kidney Disease: Improving Global Outcomes criteria based on creatinine and urine output. To detect and treat AKI earlier, various biomarkers have been evaluated. This review addresses the current position of the two damage biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and [TIMP-2] [IGFBP7] in clinical practice. ⋯ NGAL and urinary [TIMP-2] [IGFBP7], in combination with pretest assessment, are promising tools for early detection and treatment in CSA-AKI.
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Ventilator-induced lung injury is a major contributor to perioperative lung injury. The end-expiratory lung volume, regional lung overdistension, and tidal recruitment are known to be the main factors causing subsequent alveolar damage and inflammation. The alveolar-capillary membrane including the endothelial glycocalyx as an integral part of the vascular endothelium seems to play a major role in different kinds of lung injury. ⋯ This review focuses on the involvement of the pulmonary endothelial glycocalyx in the context of perioperative lung injury. The pathophysiological mechanisms and trigger factors of glycocalyx deterioration are discussed, and prevention strategies are taken into consideration.