Critical care : the official journal of the Critical Care Forum
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Editorial Comment Comparative Study
Circuit lifespan during continuous renal replacement therapy: children and adults are not equal.
In the field of continuous renal replacement therapy (CRRT), session length, downtime and dose require detailed research, which will provide information important in relation to prescription, anticoagulation and circuit material choice (membrane type and size, vascular access site and size). In particular, it appears that many of the data currently existing in the literature and accepted regarding CRRT prescription and delivery in critically ill adult patients are not strictly applicable to the paediatric setting. Furthermore, many of the available paediatric studies are small, retrospective or underpowered. In paediatric CRRT, epidemiological investigations and prospective trials to investigate practical aspects of extracorporeal therapies are welcome and urgently needed.
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Comparative Study
Inflammatory and transcriptional roles of poly (ADP-ribose) polymerase in ventilator-induced lung injury.
Poly (ADP-ribose) polymerase (PARP) participates in inflammation by cellular necrosis and the nuclear factor-kappa-B (NF-kappaB)-dependent transcription. The purpose of this study was to examine the roles of PARP in ventilator-induced lung injury (VILI) in normal mice lung. ⋯ Overactivation of PARP plays an important role in the inflammatory and transcriptional pathogenesis of VILI, and PARP inhibition has potentially beneficial effects on the prevention and treatment of VILI.
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Adrenal insufficiency is common in critically ill patients and affects their prognosis, but little is known about how adrenal function changes during prolonged critical illness. This study was conducted to investigate dynamic changes in cortisol levels in patients with critical illness who do not improve after treatment. ⋯ The majority of acutely ill patients who remained in a critical condition had decreased serum cortisol levels. Depressed cortisol levels at follow up may lead to worse clinical outcomes. We propose that repeated adrenal function testing be conducted in patients with prolonged critical illness.
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The Acute Kidney Injury Network proposed a new classification for acute kidney injury (AKI) distinguishing between three stages. We applied the criteria to a large intensive care unit (ICU) population and evaluated the impact of AKI in the context of other risk factors. ⋯ The proposed AKI classification correlated with ICU outcome but only AKI III was an independent risk factor for ICU mortality. The use of renal replacement therapy as a criterion for AKI III may have a confounding effect on the predictive power of the classification system as a whole.
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Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) remain important causes of morbidity and mortality in the critically ill patient, with far-reaching short-term and long-term implications for individual patients and for healthcare providers. It is well accepted that mechanical ventilation can worsen lung injury, potentially worsening systemic organ function, and can thus impact on mortality in acute lung injury (ALI)/ARDS. ⋯ The authors also report hypothesis-generating data on the implications of statin use in this population. The present commentary reviews aspects of this work, with particular attention to the implementation of low-tidal-volume/lung-protective ventilatory strategies in ALI/ARDS.