Critical care : the official journal of the Critical Care Forum
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Editorial Comment
Long-term risk of sepsis among survivors of acute kidney injury.
Many prior studies have shown that, in critically ill patients, acute kidney injury (AKI) commonly occurs in association with sepsis and its presence portends an increased likelihood of poor outcomes. In contrast, few studies have focused specifically on the influence of AKI on the long-term risk of developing sepsis. ⋯ Further mechanistic and clinical studies are required to more precisely define the extent and duration of any increased risk of severe sepsis beyond which a need for ongoing renal replacement therapy following AKI might be associated. Nonetheless, this novel study by Lai and colleagues could lead to a number of important new avenues for clinical inquiry, such as whether it might be possible to identify those most susceptible to severe sepsis after AKI and, ultimately, whether such episodes might be preventable.
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We used contrast-enhanced ultrasound (CEUS) to estimate the effect of an increase in mean arterial pressure (MAP) induced by noradrenaline infusion on renal microvascular cortical perfusion in critically ill patients. ⋯ A noradrenaline-induced increase in MAP was not associated with an overall increase in renal cortical perfusion as estimated by CEUS. However, at individual level, such response was heterogeneous and unpredictable suggesting great variability in pressure responsiveness within a cohort with a similar clinical phenotype.
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Editorial Comment
The role of thoracic epidural anesthesia in severe acute pancreatitis.
In animal studies of severe acute pancreatitis, thoracic epidural anesthesia appears to enhance the splanchnic circulation, improve end-organ perfusion, and favorably influence mortality. The application of thoracic epidurals in the critically ill human patient is less clear. Methodological difficulties in reliably assessing mesenteric flow have hampered progress, and clinical concerns surrounding this potentially attractive therapeutic modality remain unanswered. Future research needs to focus on the impact of epidural anesthesia on basic human physiological parameters to help direct further randomized studies in human disease.
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Several aspects of ventilator-associated tracheobronchitis (VAT)-including diagnostic criteria, overlap with ventilator-associated pneumonia (VAP), and appropriate treatment regimens-remain poorly defined. The objectives of this study were to survey reported practices in the clinical and microbiological diagnosis of VAT and to evaluate perceptions of the impact of VAT on patient outcomes. ⋯ Given the possible high incidence of VAT and the perception of its importance as a risk factor for VAP and mortality, a large multicenter international prospective study would be helpful to validate a consensual definition of VAT, determine its incidence, and delineate its impact on subsequent VAP occurrence.
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Comparative Study
Bench-test comparison of 26 emergency and transport ventilators.
Numerous emergency and transport ventilators are commercialized and new generations arise constantly. The aim of this study was to evaluate a large panel of ventilators to allow clinicians to choose a device, taking into account their specificities of use. ⋯ Major differences were observed between devices and categories, either in terms of general characteristics or technical reliability, across the spectrum of operation. Huge variability of tidal volume delivery with some devices in response to modifications in respiratory mechanics and FIO2 should make clinicians question their use in the clinical setting.