Current opinion in critical care
-
Blunt cerebrovascular injuries (BCVI) are a rare but potentially devastating injury with stroke rates up to 50%. Over the past decade, the recognition and subsequent management of these injuries has undergone a marked evolution. This review will focus on the rationale for BCVI screening, imaging options, and treatment modalities. ⋯ Cerebrovascular injuries (CVI) are now diagnosed in approximately 1% of blunt trauma patients. The recognition of a clinically silent period allows for injury screening based upon mechanism of trauma and the patient's injury pattern. Following identification of injuries in asymptomatic patients, prompt initiation of antithrombotic therapy reduces the incidence of stroke.
-
Acute kidney injury (AKI) is a major clinical problem in hospitalized patients. Effective treatment and early diagnosis of this syndrome are not currently available. This review focuses on recent studies examining the biological characteristics and the diagnostic and prognostic value of a novel biomarker--neutrophil gelatinase-associated lipocalin (NGAL)--in the two major patient populations at risk for AKI. ⋯ NGAL appears to fulfill many characteristics of an appropriate 'real-time' biomarker for AKI detection.
-
Curr Opin Crit Care · Dec 2010
ReviewCritical incident monitoring in paediatric and adult critical care: from reporting to improved patient outcomes?
Critical incident reporting alone does not necessarily improve patient safety or even patient outcomes. Substantial improvement has been made by focusing on the further two steps of critical incident monitoring, that is, the analysis of critical incidents and implementation of system changes. The system approach to patient safety had an impact on the view about the patient's role in safety. This review aims to analyse recent advances in the technique of reporting, the analysis of reported incidents, and the implementation of actual system improvements. It also explores how families should be approached about safety issues. ⋯ A persisting high number of reported incidents is anticipated and regarded as continuing good safety culture. However, only the implementation of system changes, based on incident reports, and also involving the expertise of patients and their families, has the potential to improve patient outcome. Hard outcome criteria, such as standardized mortality ratio, have not yet been shown to improve as a result of critical incident monitoring.
-
To summarize the history and current findings for creatinine as a renal biomarker and try to predict its future, looking at new biomarkers for kidneys (neutrophil gelatinase-associated lipocalin and cystatin C) and comparing current development to other diseases (troponins and procalcitonin). ⋯ Unless enough evidence accumulates, considering the history, familiarity, and recent findings related to outcome, creatinine will continue to be used and dominate in clinical practice.
-
Curr Opin Crit Care · Dec 2010
Urinary hepcidin: an inverse biomarker of acute kidney injury after cardiopulmonary bypass?
In this review, we discuss the potential role of urinary hepcidin, a 2.8-kDa hormonal regulator of iron metabolism, as a biomarker of acute kidney injury (AKI) after cardiopulmonary bypass. ⋯ Smaller increases in urinary hepcidin, a central regulator of iron metabolism, may be associated with greater risk of AKI after cardiopulmonary bypass. Further research is required to establish the significance and nature of this association.