Critical care : the official journal of the Critical Care Forum
-
Hepatobiliary elimination of endo- and xenobiotics is affected by different variables including hepatic perfusion, hepatocellular energy state and functional integrity of transporter proteins, all of which are altered during sepsis. A particular impairment of hepatocellular transport at the canalicular pole resulting in an accumulation of potentially hepatotoxic compounds would have major implications for critical care pharmacology and diagnostics. ⋯ Hepatocytes accumulate organic anions under conditions of sepsis-associated organ dysfunction. These results have potential implications for monitoring liver function, critical care pharmacology and the understanding of drug-induced liver injury in the critically ill.
-
Fever is prevalent in the majority of patients after aneurysmal subarachnoid hemorrhage and is associated with worse outcome. Treatment of fever is highly recommended, but with low-grade evidence in current guidelines. The analysis by Schiefecker and colleagues reveals that the situation may be more complicated than at first glance and careless treatment may introduce further harm. The importance of this study lies in analyzing real-world multimodal neuromonitoring data, showing a pitfall in incautiously applied treatment paradigms.