Critical care : the official journal of the Critical Care Forum
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Editorial Comment
Risk stratification in critically ill patients: GDF-15 scores in adult respiratory distress syndrome.
Patients with adult respiratory distress syndrome (ARDS) are highly heterogeneous but current therapies are rather uniform and largely supportive. In the previous issue of Critical Care, Clark and colleagues report that the biomarker GDF-15 provides prognostic information in ARDS that is additive to that provided by the APACHE III score. Patients with high levels of growth-differentiation factor 15 (GDF-15) had a higher mortality and more complicated hospital course. Biomarkers such as GDF-15 may help us to identify patients at higher risk who may eventually benefit from more personalized and targeted therapies.
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Nasojejunal tube feeding is considered the current standard of care in patients with severe and critical acute pancreatitis. However, it is not known whether enteral nutrition is best delivered into the jejunum. This Commentary discusses recent clinical studies that have shown that tube feeding into the stomach is safe and well tolerated in the vast majority of patients with acute pancreatitis, thus overthrowing the notion of putting the pancreas at rest. Development of a new conceptual framework is warranted to further advance nutritional management of patients with acute pancreatitis.
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Editorial Comment
Comparative effectiveness of helicopter emergency medical services compared to ground emergency medical services.
The use of helicopter emergency medical services (HEMS) for the transportation and treatment of trauma patients, while commonplace in most developed nations, remains controversial. The purported beneficial effects of HEMS compared to ground emergency medical services is likely to be some combination of speed, crew expertise, and the fact that HEMS is part of an organized trauma system. ⋯ Future HEMS research must rely on robust observational study designs and assessments of a variety of patient outcomes. Questions about the role of speed, distance, and other potentially beneficial elements of HEMS remain.