Critical care : the official journal of the Critical Care Forum
-
Substantial basic and translational research has been directed to detect earlier and more sensitive acute kidney injury (AKI) biomarkers over the past decade. Much of the seminal AKI biomarker validation research has been performed in children undergoing cardiopulmonary bypass since they represent an ideal clinical model for AKI biomarker study: the timing of the injury is known and children do not have many of the co-morbidities seen in adult patient populations, which can confound the clinical situation. ⋯ They demonstrate that fenoldopam administration led to decreased postoperative urine NGAL and urine cystatin C concentrations, suggesting a renoprotective effect. Given the high sensitivity of NGAL for AKI post cardiopulmonary bypass, this study provides a model to use novel AKI biomarkers in a novel manner.
-
The study by Yang and colleagues examined 81 patients with septic shock due to pneumonia, along with 20 patients with pneumonia without organ dysfunction. Their major findings were that circulating levels of soluble vascular endothelial cell growth factor receptor-1 (sVEGFR-1) and urokinase-type plasminogen activator (uPA) were associated with organ dysfunction and mortality, whereas vascular endothelial cell growth factor (VEGF) levels had no such predictive power. Yang and colleagues are to be complimented for a well-conducted study of a reasonably (and helpfully!) homogeneous population of patients with sepsis that carefully and comprehensively analyzed the relationship between sVEGFR-1, uPA, VEGF and clinical outcome. The study serves not only to provide evidence in support of new diagnostic biomarker targets in sepsis, but also to augment the growing evidence of an important role of the endothelium in sepsis in general, and the VEGF signaling axis in particular.
-
Observational Study
High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients.
The aim of this study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels. We also sought to define whether fluid responsiveness would be less likely in the presence of a high SvO2 (>70%). ⋯ The response of septic patients to a fluid challenge is independent of baseline SvO2. The presence of a high SvO2 does not necessarily exclude the need for further fluid administration.
-
Understanding the nature and biological basis of gender-determined differences in risk of and outcome from infection might identify new therapeutic targets, allow more individualised treatment, and facilitate better risk prediction and application of healthcare resources. Gender differences in behaviours, comorbidities, access to healthcare and biology may result in differences in acquiring infection, or in response to infection once acquired. ⋯ Studying sufficient patient numbers to explore this entire continuum while accounting for heterogeneity in type of infection and comorbidity is difficult because of the number of patients required. However, if true gender effects can be identified, examination of their biological or psychosocial causes will be warranted.