Critical care : the official journal of the Critical Care Forum
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After numerous negative randomized trials testing drugs for severe sepsis and/or septic shock, the blood purification approach remains one possibility. Many techniques have been proposed, having in common the goal to eliminate blood and/or plasma factors, supposed to play a negative role in outcomes. Among these, high dose of hemofiltration, high volume hemofiltration, high permeability hemofiltration and specific or non-specific hemoperfusion or hemoadsorption have been proposed. ⋯ Because of the potential interaction with mediators and cell capture, Rimmelé and colleagues published the results obtained with an in vitro set up, testing different adsorption cartridges in comparison to hemofiltration. They nicely confirmed the complex impact on mediator levels and cell capture and phenotype. This is certainly a more systematic approach to better understand the action of such adsorbing cartridges, which has to be developed.
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There are limited long-term follow-up data on functional changes in the myocardium after high-voltage electrical injury (HVEI). ⋯ The long-term contractile performance of the myocardium is preserved when patient do not experience left ventricular dysfunction in the early stages after HVEI.
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Epidemiological studies document that males are more prone than females to develop severe sepsis and this is confirmed by Sakr and colleagues in the previous issue of Critical Care. However, the impact of gender on prognosis of severe sepsis is a matter of debate. ⋯ The impact of sexual hormones in older females is less relevant. Treatments aimed at modifying sexual hormone profile are promising but need to be tested in future trials.
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The observational literature suggests that hypernatremia is associated with worse outcomes in patients with traumatic brain injury. In a previous issue of Critical Care, Wells and colleagues add to this literature by failing to show an association between hypernatremia and reduced intracranial pressure. However, we must bear in mind many limitations of observational methods before eliminating hyperosmolar therapy from our armamentarium.
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Editorial Comment
Measuring glomerular filtration rate in the intensive care unit: no substitutes please.
Acute kidney injury (AKI), due to its increasing incidence, associated morbidity and mortality, and potential for development of chronic kidney disease with acceleration to end-stage renal disease, has become of major interest to nephrologists and critical care physicians. The development of biomarkers to diagnose AKI, quantify risk and predict prognosis is receiving considerable attention. Yet techniques to accurately assess functional changes within patients still rely on the use of an insensitive marker (creatinine), creatinine-based estimating equations and unreliable urinary tests. Therefore, it is critical that functional tests be developed and used in combination with biomarkers, thus allowing improved care in AKI and chronic kidney disease patient populations.