Critical care : the official journal of the Critical Care Forum
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Comment Comparative Study
Extracorporeal therapies in acute rhabdomyolysis and myoglobin clearance.
Rhabdomyolysis is a pathogenetic cause of acute kidney injury. In such circumstances, not only should therapeutic strategies to replace the failing kidney be implemented, but measures should also be explored to prevent further damage by circulating myoglobin. Volume expansion and forced diuresis have been used, but when a kidney fails, renal replacement therapies are instituted. ⋯ The removal of myoglobin was greater than in than any previous report. Thus, if the removal of myoglobin is desirable, a combination of continuous hemofiltration and hyperpermeable membranes seems to be the most effective. However, care must be exercised to prevent unwanted albumin losses.
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Comparative Study
Increased blood flow prevents intramucosal acidosis in sheep endotoxemia: a controlled study.
Increased intramucosal-arterial carbon dioxide tension (PCO2) difference (DeltaPCO2) is common in experimental endotoxemia. However, its meaning remains controversial because it has been ascribed to hypoperfusion of intestinal villi or to cytopathic hypoxia. Our hypothesis was that increased blood flow could prevent the increase in DeltaPCO2. ⋯ In this model of endotoxemia, intramucosal acidosis was corrected by increased blood flow and so might follow tissue hypoperfusion. In contrast, anion-gap metabolic acidosis was left uncorrected and even worsened with aggressive volume expansion. These results point to different mechanisms generating both alterations.
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Research involving critically ill persons highlights challenging questions surrounding third party authorization. The ethical and legal viability in research involving persons who do not have the capacity to consent to participation is not universally accepted, and inconsistent standards are reflected in research ethics guidelines, law and practice. In order to ensure that research participants who are considered incapable of consenting to research are appropriately protected, and that minimal risk research on illnesses affecting those who are unable to consent is enabled, clear and justifiable parameters must be created and, where they are already established, they must be made more transparent.
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Impaired health-related quality of life after critical illness has been demonstrated in a number of studies. It is not clear exactly how or why critical illness and intensive care lead to impaired health status, but understanding this association is an important step to improving long-term outcomes of the critically ill. ⋯ This commentary examines a recent study and places this study in the context of previous studies suggesting that both amnesia and persisting nightmares of the ICU experience are associated with impaired quality of life. Further research is needed if we are effectively to understand, prevent and treat the negative sequelae of critical illness.