Current opinion in critical care
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Curr Opin Crit Care · Dec 2016
ReviewComputer decision support for acute kidney injury: current and future.
Growing awareness regarding the impact of acute kidney injury (AKI) as a grave consequence of critical illnesses resulted in the expansion of the need for early detection and appropriate management strategies. Clinical decision support systems (CDSS) can generate information to improve the care of AKI patients by providing point-of-care accurate patient-specific information and recommendations. Our objective is to describe the characteristics of CDSS and review the current knowledge regarding the impact of CDSS on patients in the acute care settings, and specifically for AKI. ⋯ The heterogeneity of these studies in their size, design, and conduct has produced controversial findings; hence, this has left the field completely open for further investigations.
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Curr Opin Crit Care · Dec 2016
ReviewResuscitative endovascular balloon occlusion of the aorta: promise, practice, and progress?
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive damage control procedure for life-threatening abdominal or pelvic haemorrhage. The purpose of this review is to summarize the current understanding and experience with REBOA, outline potential future applications of this technology, and highlight priority areas for further research. ⋯ Noncompressible torso haemorrhage is the leading cause of preventable trauma deaths. The majority of these deaths occur soon after injury, often before any opportunity for definitive haemorrhage control. For a meaningful reduction in trauma mortality, novel methods of rapid haemorrhage control are required.
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The present article will review the current state of our understanding of nephrotoxic medication-associated acute kidney injury (AKI) and provide strategies to reduce its impact. ⋯ Recent work on understanding specific combinations, thresholds for nephrotoxic burden and systematic kidney function assessment had mitigated, and even in some cases reduced, nephrotoxic AKI rates and severity. Current initiatives are underway to further refine specific nephrotoxic medication AKI risk via novel urinary biomarkers and genetic susceptibility.
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Curr Opin Crit Care · Dec 2016
ReviewBlood products and procoagulants in traumatic bleeding: use and evidence.
Death from uncontrolled haemorrhage is one of the leading causes of trauma-related mortality and is potentially preventable. Advances in understanding the mechanisms of trauma-induced coagulopathy (TIC) have focused attention on the role of blood products and procoagulants in mitigating the sequelae of TIC and how these therapies can be improved. ⋯ There are promising results from ex-vivo studies in manufacturing and storage of blood products to optimize haemostatic activity and availability, particularly with alternative plasma and platelet products and whole blood. There is an urgent need for these products needs to be tested prospectively.