Critical care : the official journal of the Critical Care Forum
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Case Reports Comparative Study
Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report.
To test the ability of a novel super high-flux (SHF) membrane with a larger pore size to clear myoglobin from serum. ⋯ SHF hemofiltration achieved a much greater clearance of myoglobin than conventional hemofiltration, and it may provide a potential modality for the treatment of myoglobinuric acute renal failure.
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Comparative Study
Initial distribution volume of glucose can be approximated using a conventional glucose analyzer in the intensive care unit.
We previously reported that initial distribution volume of glucose (IDVG) reflects central extracellular fluid volume, and that IDVG may represent an indirect measure of cardiac preload that is independent of the plasma glucose values present before glucose injection or infusion of insulin and/or vasoactive drugs. The original IDVG measurement requires an accurate glucose analyzer and repeated arterial blood sampling over a period of 7 min after glucose injection. The purpose of the present study was to compare approximated IDVG, derived from just two blood samples, versus original IDVG, and to test whether approximated IDVG is an acceptable alternative measure of IDVG in the intensive care unit. ⋯ Our findings demonstrate that there was good correlation between each approximated IDVG and original IDVG, although the two measures are not interchangeable. This suggests that approximated IDVG is clinically acceptable as an alternative calculation of IDVG, although approximated and original IDVGs are not equivalent; plasma rather than whole blood measurements are preferable.
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Comparative Study
Intensive care unit-acquired urinary tract infections in a regional critical care system.
Few studies have evaluated urinary tract infections (UTIs) specifically acquired within intensive care units (ICUs), and the effect of such infections on patient outcome is unclear. The objectives of this study were to describe the occurrence, microbiology, and risk factors for acquiring UTIs in the ICU and to determine whether these infections independently increase mortality. ⋯ Development of an ICU-acquired UTI is common in critically ill patients. Although a marker of increased morbidity associated with critical illness, it is not a significant attributable cause of mortality.
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Comment Comparative Study
Extracorporeal therapies in acute rhabdomyolysis and myoglobin clearance.
Rhabdomyolysis is a pathogenetic cause of acute kidney injury. In such circumstances, not only should therapeutic strategies to replace the failing kidney be implemented, but measures should also be explored to prevent further damage by circulating myoglobin. Volume expansion and forced diuresis have been used, but when a kidney fails, renal replacement therapies are instituted. ⋯ The removal of myoglobin was greater than in than any previous report. Thus, if the removal of myoglobin is desirable, a combination of continuous hemofiltration and hyperpermeable membranes seems to be the most effective. However, care must be exercised to prevent unwanted albumin losses.