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By Juan Carlos Luis Navarro Anesthesiologist in Virgen del Rocio University Hospital.
https://www.readbyqxmd.com/read/28470347/fluid-management-in-acute-kidney-injury
#1
REVIEW
Anders Perner, John Prowle, Michael Joannidis, Paul Young, Peter B Hjortrup, Ville Pettilä
Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration of fluid and brought attention to the delicate balance between benefits and harms of different aspects of fluid management in critically ill patients, in particular those with AKI. This narrative review addresses various aspects of fluid management in AKI outlining physiological aspects, the effects of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI...
May 3, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28320439/mechanical-ventilation-in-obese-icu-patients-from-intubation-to-extubation
#2
REVIEW
Audrey De Jong, Gerald Chanques, Samir Jaber
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2017. Other selected articles can be found online at http://ccforum.com/series/annualupdate2017 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .
March 21, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28364303/acute-kidney-injury-in-sepsis
#3
REVIEW
Rinaldo Bellomo, John A Kellum, Claudio Ronco, Ron Wald, Johan Martensson, Matthew Maiden, Sean M Bagshaw, Neil J Glassford, Yugeesh Lankadeva, Suvi T Vaara, Antoine Schneider
Acute kidney injury (AKI) and sepsis carry consensus definitions. The simultaneous presence of both identifies septic AKI. Septic AKI is the most common AKI syndrome in ICU and accounts for approximately half of all such AKI. Its pathophysiology remains poorly understood, but animal models and lack of histological changes suggest that, at least initially, septic AKI may be a functional phenomenon with combined microvascular shunting and tubular cell stress. The diagnosis remains based on clinical assessment and measurement of urinary output and serum creatinine...
March 31, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28267435/the-right-ventricle-in-ards
#4
REVIEW
Vasileios Zochios, Ken Parhar, William Tunnicliffe, Andrew Roscoe, Fang Gao
ARDS is associated with poor clinical outcomes, with a pooled mortality rate of approximately 40% despite best standards of care. Current therapeutic strategies are based on improving oxygenation and pulmonary compliance while minimizing ventilator-induced lung injury. It has been demonstrated that relative hypoxemia can be well tolerated, and improvements in oxygenation do not necessarily translate into survival benefit. Cardiac failure, in particular right ventricular dysfunction (RVD), is commonly encountered in moderate to severe ARDS and is reported to be one of the major determinants of mortality...
July 2017: Chest
https://www.readbyqxmd.com/read/27748729/effects-of-passive-leg-raising-on-microvascular-venous-compartment-in-critically-ill-patients
#5
Roberto A DE Blasi, Roberto Arcioni, Domitilla Brancadoro, Monica Rocco
BACKGROUND: Even though fluid loading is thought to improve organ perfusion, the way in which it does so remains unclear. We assessed how the microvascular bed in skeletal muscle reacts to passive leg raising in patients with and without sepsis or septic shock. METHODS: We studied 40 critically ill patients (group A) and 30 healthy controls (group B). The forearm microvascular bed was assessed using near-infrared spectroscopy before and after passive leg raising...
October 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28257335/serial-procalcitonin-predicts-mortality-in-severe-sepsis-patients-results-from-the-multicenter-procalcitonin-monitoring-sepsis-moses-study
#6
MULTICENTER STUDY
Philipp Schuetz, Robert Birkhahn, Robert Sherwin, Alan E Jones, Adam Singer, Jeffrey A Kline, Michael S Runyon, Wesley H Self, D Mark Courtney, Richard M Nowak, David F Gaieski, Stefan Ebmeyer, Sascha Johannes, Jan C Wiemer, Andrej Schwabe, Nathan I Shapiro
OBJECTIVES: To prospectively validate that the inability to decrease procalcitonin levels by more than 80% between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. DESIGN: Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-approved protocol. SETTING: Thirteen U.S.-based emergency departments and ICUs...
May 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28257336/preadmission-oral-corticosteroids-are-associated-with-reduced-risk-of-acute-respiratory-distress-syndrome-in-critically-ill-adults-with-sepsis
#7
Andrew C McKown, Erin M McGuinn, Lorraine B Ware, Li Wang, David R Janz, Todd W Rice, Matthew W Semler
OBJECTIVES: To determine the association between preadmission oral corticosteroid receipt and the development of acute respiratory distress syndrome in critically ill patients with sepsis. DESIGN: Retrospective observational study. SETTING: Medical, surgical, trauma, and cardiovascular ICUs of an academic medical center. PATIENTS: A total of 1,080 critically ill patients with sepsis. INTERVENTIONS: None...
May 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28114931/procalcitonin-guided-diagnosis-and-antibiotic-stewardship-revisited
#8
REVIEW
Ramon Sager, Alexander Kutz, Beat Mueller, Philipp Schuetz
Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i...
January 24, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28233565/prophylactic-hydration-to-protect-renal-function-from-intravascular-iodinated-contrast-material-in-patients-at-high-risk-of-contrast-induced-nephropathy-amacing-a-prospective-randomised-phase-3-controlled-open-label-non-inferiority-trial
#9
Estelle C Nijssen, Roger J Rennenberg, Patty J Nelemans, Brigitte A Essers, Marga M Janssen, Marja A Vermeeren, Vincent van Ommen, Joachim E Wildberger
BACKGROUND: Intravenous saline is recommended in clinical practice guidelines as the cornerstone for preventing contrast-induced nephropathy in patients with compromised renal function. However, clinical-effectiveness and cost-effectiveness of this prophylactic hydration treatment in protecting renal function has not been adequately studied in the population targeted by the guidelines, against a group receiving no prophylaxis. This was the aim of the AMACING trial. METHODS: AMACING is a prospective, randomised, phase 3, parallel-group, open-label, non-inferiority trial of patients at risk of contrast-induced nephropathy according to current guidelines...
April 1, 2017: Lancet
https://www.readbyqxmd.com/read/28181941/sodium-bicarbonate-versus-sodium-chloride-for-preventing-contrast-associated-acute-kidney-injury-in-critically-ill-patients-a-randomized-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Xavier Valette, Isabelle Desmeulles, Benoit Savary, Romain Masson, Amélie Seguin, Bertrand Sauneuf, Jennifer Brunet, Pierre Verrier, Véronique Pottier, Marie Orabona, Désiré Samba, Gérald Viquesnel, Mathilde Lermuzeaux, Pascal Hazera, Jean-Jacques Dutheil, Jean-Luc Hanouz, Jean-Jacques Parienti, Damien du Cheyron
OBJECTIVES: To test whether hydration with bicarbonate rather than isotonic sodium chloride reduces the risk of contrast-associated acute kidney injury in critically ill patients. DESIGN: Prospective, double-blind, multicenter, randomized controlled study. SETTING: Three French ICUs. PATIENTS: Critically ill patients with stable renal function (n = 307) who received intravascular contrast media. INTERVENTIONS: Hydration with 0...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28107224/abdominal-sepsis
#11
Quirine J J Boldingh, Fleur E E de Vries, Marja A Boermeester
PURPOSE OF REVIEW: To summarize the recent evidence on the treatment of abdominal sepsis with a specific emphasis on the surgical treatment. RECENT FINDINGS: A multitude of surgical approaches towards abdominal sepsis are practised. Recent evidence shows that immediate closure of the abdomen has a better outcome. A short course of antibiotics has a similar effect as a long course of antibiotics in patients with intra-abdominal infection without severe sepsis. SUMMARY: Management of abdominal sepsis requires a multidisciplinary approach...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28169856/postinterventional-critical-care-management-of-aneurysmal-subarachnoid-hemorrhage
#12
Sudhir Datar, Alejandro A Rabinstein
PURPOSE OF REVIEW: Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28203777/2017-infectious-diseases-society-of-america-s-clinical-practice-guidelines-for-healthcare-associated-ventriculitis-and-meningitis
#13
Allan R Tunkel, Rodrigo Hasbun, Adarsh Bhimraj, Karin Byers, Sheldon L Kaplan, W Michael Scheld, Diederik van de Beek, Thomas P Bleck, Hugh J L Garton, Joseph R Zunt
The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society)...
February 14, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/27998289/effects-of-low-doses-of-esmolol-on-cardiac-and-vascular-function-in-experimental-septic-shock
#14
Chaojie Wei, Huguette Louis, Margaux Schmitt, Eliane Albuisson, Sophie Orlowski, Bruno Levy, Antoine Kimmoun
BACKGROUND: Administration of a selective β1-blocker, such as esmolol, in human septic shock has demonstrated cardiovascular protective effects related to heart rate reduction. Certain experimental data also indicate that esmolol exerts systemic anti-inflammatory and beneficial effects on vascular tone. Thus, the present study aimed to determine whether a non-chronotropic dose of esmolol maintains its protective cardiovascular and anti-inflammatory effects in experimental septic shock...
December 21, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28050897/fluid-resuscitation-in-human-sepsis-time-to-rewrite-history
#15
REVIEW
Liam Byrne, Frank Van Haren
Fluid resuscitation continues to be recommended as the first-line resuscitative therapy for all patients with severe sepsis and septic shock. The current acceptance of the therapy is based in part on long history and familiarity with its use in the resuscitation of other forms of shock, as well as on an incomplete and incorrect understanding of the pathophysiology of sepsis. Recently, the safety of intravenous fluids in patients with sepsis has been called into question with both prospective and observational data suggesting improved outcomes with less fluid or no fluid...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/27522622/lactic-acidosis-an-update
#16
REVIEW
Jansen Seheult, Gerard Fitzpatrick, Gerard Boran
Lactate is one of the most crucial intermediates in carbohydrate and nonessential amino acid metabolism. The complexity of cellular interactions and metabolism means that lactate can be considered a waste product for one cell but a useful substrate for another. The presence of elevated lactate levels in critically ill patients has important implications for morbidity and mortality. In this review, we provide a brief outline of the metabolism of lactate, the pathophysiology of lactic acidosis, the clinical significance of D-lactate, the role of lactate measurement in acutely ill patients, the methods used to measure lactate in blood or plasma and some of the methodological issues related to interferences in these assays, especially in the case of ethylene glycol poisoning...
March 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28149560/glucose-insulin-potassium-correlates-with-hemodynamic-improvement-in-patients-with-septic-myocardial-dysfunction
#17
Won-Young Kim, Moon Seong Baek, Young Shin Kim, Jarim Seo, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
BACKGROUND: Glucose-insulin-potassium (GIK) demonstrates a cardioprotective effect by providing metabolic support and anti-inflammatory action, and may be useful in septic myocardial depression. The aim of this study was to examine the relationship between GIK and hemodynamic outcomes in septic shock patients with myocardial depression. METHODS: Between October 2012 and March 2014, 45 patients in the intensive care unit who fulfilled the criteria for severe sepsis/septic shock and were treated with GIK were recruited...
December 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28122469/dexmedetomidine-for-refractory-intracranial-hypertension
#18
Kendra J Schomer, Christian M Sebat, Jason Y Adams, Jeremiah J Duby, Kiarash Shahlaie, Erin L Louie
Dexmedetomidine (DEX) is a selective α2 adrenergic agonist that is commonly used for sedation in the intensive care unit (ICU). The role of DEX for adjunctive treatment of refractory intracranial hypertension is poorly defined. The primary objective of this study was to determine the effect of DEX on the need for rescue therapy (ie, hyperosmolar boluses, extraventricular drain [EVD] drainages) for refractory intracranial hypertension. Secondary objectives included the number of intracranial pressure (ICP) excursions, bradycardic, hypotensive, and compromised cerebral perfusion pressure episodes...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27007094/clinical-practice-guideline-management-of-acute-pancreatitis
#19
REVIEW
Joshua A Greenberg, Jonathan Hsu, Mohammad Bawazeer, John Marshall, Jan O Friedrich, Avery Nathens, Natalie Coburn, Gary R May, Emily Pearsall, Robin S McLeod
There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis...
April 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/26679628/clinical-practice-guideline-for-the-management-of-candidiasis-2016-update-by-the-infectious-diseases-society-of-america
#20
Peter G Pappas, Carol A Kauffman, David R Andes, Cornelius J Clancy, Kieren A Marr, Luis Ostrosky-Zeichner, Annette C Reboli, Mindy G Schuster, Jose A Vazquez, Thomas J Walsh, Theoklis E Zaoutis, Jack D Sobel
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
February 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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