Critical care : the official journal of the Critical Care Forum
-
Acute kidney injury (AKI) research in the past decade has mostly focused upon development of a standard AKI definition, validation of early novel biomarkers to predict AKI prior to serum creatinine rise and predict AKI severity, and assessment of aspects of renal replacement therapies and their impact on survival. Given the independent association between AKI and mortality in the acute phase, such focus makes imminent sense. More recently, the recognition that AKI is associated with subsequent development of chronic kidney disease and end-stage renal disease, with the attendant increase in mortality, has led to interest in the clinical epidemiology and the mechanistic understanding of renal recovery after an AKI episode in critically ill patients. We review the current knowledge surrounding renal recovery after an AKI episode, including renal replacement therapy initiation timing and modality impact, biomarker assessment and mechanistic targets to guide potential future clinical trials.
-
Patients with distributive shock still have a high mortality rate and remain an important issue for intensivists. Management of catecholamine-resistant shock in these patients poses a challenging problem. ⋯ The authors demonstrate that, in case of distributive shock, angiotensin II is an effective vasopressor therapy. Its impact on outcome and adverse effects still needs to be further explored.
-
Sepsis is one of the oldest and most elusive syndromes in medicine. Every effort should be made to treat these patients with the best available evidence. As a milestone, empiric antimicrobial therapy is essential in order to reduce morbidity and mortality of septic patients. As a sticking point, the use of broad-spectrum antimicrobial agents may be associated with induction of resistance among common pathogens.
-
Comment
TEG®- or ROTEM®-based individualized goal-directed coagulation algorithms: don't wait - act now!
In trauma patients, TEG® and ROTEM® allow prediction of massive transfusion requirement and mortality, and creation of goal-directed, individualized coagulation algorithms that may improve patient outcome. This outcome benefit has been shown for cardiac surgery in prospective randomized trials. For trauma, only non-randomized studies have been performed. Nevertheless, TEG® and ROTEM® are highly promising monitoring techniques to guide coagulation management in all types of major bleeding, including trauma.