Articles: function.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2014
Review[Echocardiography for hemodynamic monitoring on ICU?].
A goal-directed hemodynamic therapy (GDT) using volume substitution and/or cardiovascular agents in order to increase stroke volume and consecutively tissue oxygenation has been shown to reduce perioperative complications. Previous hemodynamic monitoring devices mostly are only able to detect a restriction in several parameters of cardiovascular function not always diagnostically conclusive to their pathophysiological cause. However, this is mandatory for GDT. ⋯ It is introduced orally in the patient's esophagus and can remain up to 72 hours in situ. First clinical reports/studies were able to demonstrate that a short intensive training programme for physicians unexperienced in echocardiography was sufficient to adequately initiate GDT. However, further studies have to prove the clinical feasibility and the positive effect on patient's outcome.
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Acta Anaesthesiol Scand · Nov 2014
ReviewIndocyanine green plasma disappearance rate as dynamic liver function test in critically ill patients.
Indocyanine green (ICG) is a water-soluble fluorescent dye that is bound to plasma protein when administered intravenously. Removal of ICG from the blood depends on hepatic blood flow, function of the parenchymal cells and biliary excretion. ICG elimination is described as a useful dynamic liver function test. ⋯ In conclusion, measuring ICG-PDR is a valuable method for dynamic assessment of liver function, and is found to be a valuable prognostic tool in predicting survival for septic patients, patients presenting with acute liver failure and critically ill patients.
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The prevalence of chronic kidney disease (CKD) is increasing, which presents challenges for both patients and health-care budgets. Although this phenomenon has been attributed to the growth in diabetes, hypertension, and obesity, sleep apnea and nocturnal hypoxemia may also contribute to the pathogenesis of CKD and its progression to kidney failure. Two pathophysiologic mechanisms responsible for CKD are glomerular hyperfiltration and chronic intrarenal hypoxia, resulting in tubulointerstitial injury, the final common pathway to end-stage kidney disease (ESKD). ⋯ Nevertheless, sleep apnea and nocturnal hypoxemia have been associated with loss of kidney function and kidney injury, suggesting that they contribute to the pathogenesis of continued deterioration in kidney function. There are several pathways through which sleep apnea may achieve this, including a direct effect of intrarenal hypoxia and activation of the systemic and renal renin-angiotensin system. Further research is required to better understand these relationships and determine whether specific interventions in patients with sleep apnea have an impact on clinical outcomes, such as reducing the prevalence of CKD and delaying its progression to ESKD.
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Curr Opin Crit Care · Oct 2014
ReviewFluid removal in acute heart failure: diuretics versus devices.
Fluid removal and relief of congestion are central to treatment of acute heart failure. Diuretics have been the decongestive mainstay but their known limitations have led to the exploration of alternative strategies. This review compares diuretics with ultrafiltration and examines the recent evidence evaluating their use. ⋯ Decongestion remains a major challenge in acute heart failure. Although recent studies provide useful data to guide practice, the relatively poor outcomes point to the continued need to identify better strategies for safe and effective decongestion.
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Fibromyalgia syndrome (FMS) is a common and intriguing condition, manifest by chronic pain and fatigue. Although the pathogenesis of FMS is not yet completely understood, predicting the future development of FMS and chronic pain is a major challenge with great potential advantages, both from an individual as well as an epidemiological standpoint. Current knowledge indicates a genetic underpinning for FMS, and as increasing data are accumulated regarding the genetics involved, the prospect of utilizing these data for prediction becomes ever more attractive. ⋯ Functional neuroimaging may help to elucidate the neural processes involved in central sensitization, and may ultimately also evolve into markers of predictive value. Last but not least, obesity and disturbed sleep are clinical (inter-related) features relevant for this spectrum. Future efforts will aim at integrating genetic, clinical and physiological data in the prediction of FMS and chronic pain.