Critical care : the official journal of the Critical Care Forum
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Serum creatinine is a late marker of acute kidney injury (AKI). Urine neutrophil gelatinase-associated lipocalin (uNGAL) is an early marker of AKI, where the timing of kidney injury is known. It is unknown whether uNGAL predicts AKI in the general critical care setting. We assessed the ability of uNGAL to predict AKI development and severity in critically ill children. ⋯ We found uNGAL to be a useful early AKI marker that predicted development of severe AKI in a heterogeneous group of patients with unknown timing of kidney injury.
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Comparative Study
Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock.
In seriously ill patients, etomidate gives cardiovascular stability at induction of anaesthesia, but there is concern over possible adrenal suppression. Etomidate could reduce steroid synthesis and increase the need for vasopressor and steroid therapy. The outcome could be worse than in patients given other induction agents. ⋯ Etomidate use for critically ill patients should consider all of these issues and not simply the possibility of adrenal suppression, which may not be important when steroid supplements are used.
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Clinical Trial
Efficacy of and tolerance to mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular cooling system.
We evaluated the efficacy of and tolerance to mild therapeutic hypothermia achieved using an endovascular cooling system, and its ability to reach and maintain a target temperature of 33 degrees C after cardiac arrest. ⋯ The intravascular cooling system is effective, safe and allows a target temperature to be reached fairly rapidly and steadily over a period of 36 hours.
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Assessment of left ventricular diastolic function in the critically ill patient remains a difficult issue in clinical practice. Combined use of routine transmitral and pulmonary venous Doppler patterns in conjunction with tissue Doppler imaging have been claimed to allow bedside diagnosis of diastolic dysfunction. Although in the previous issue of Critical Care it was clearly demonstrated there might be a difference in load dependency of the early myocardial tissue Doppler velocity between lateral and septal placed sample volume, there remain still several unanswered questions, particularly with respect to the preload dependency of these indices.