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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Author: Signavitae (Page 1 of 89)

Intensive Care Week Croatia

June, 16th – 23rd, 2018
Brijuni, Croatia

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The management of ARDS: what is really evidence-based? 

Introduction

Acute respiratory distress syndrome (ARDS) is the result of a diffuse inflammatory lung injury, which leads to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue. (1) The causes of ARDS are multiple and include sepsis –the most common–, pneumonia, aspiration, and severe trauma. The Berlin criteria (1) define ARDS according to four key features: timing (within 1 week of a known clinical insult or new or worsening respiratory symptoms); chest imaging (presence of bilateral opacities that cannot be fully explained by effusions, lobar/lung collapse, or nodules); edema due to primary respiratory failure and not cardiac failure or fluid overload; the PaO2/FIO2 ratio. This latter feature is used to define the severity of ARDS as mild, moderate or severe. In a large observational study of 29,144 patients admitted to 459 intensive care units (ICUs) in 50 countries, 10% had ARDS. The overall mortality rate was 40%, increasing from 35% in patients with mild ARDS, to 40% in moderate and 46% in severe ARDS. (2) Although several studies have suggested a trend towards lower mortality rates over time (3-7), hospital mortality rates remain high (1, 2) and long-term morbidity is considerable. (8-10)

Many potential pharmacological agents, both inhaled (11) and systemic, have been assessed for use in patients with ARDS (table 1), but none has consistently been shown to improve mortality. As such, management essentially relies on treatment of the underlying cause, especially sepsis and limiting further lung injury by providing appropriate protective lung ventilation and avoiding highly positive fluid balances. (12) Here we will briefly consider the evidence base (or lack of) for these approaches and for some of the other therapeutic approaches that have been proposed.

Dr Vincent has no conflicts of interest to declare regarding this manuscript

Key words: acute respiratory distress syndrome

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The functional renal reserve: the key to unlocking the role of biomarkers of AKI?

Introduction

The Normal Glomerular Filtration Rate (GFR):

There is considerable variation between normal individuals with regard to renal size and the overall nephron mass which are determined by not only genetic predisposition but nutritional factors and indeed perinatal exposures. (1) Clearly these factors will influence the measured baseline renal characteristics. The most widely used measure of kidney function is the GFR. The glomerular filtration rate describes the volume of fluid filtered from the glomerular capillaries into the Bowman’s capsule per unit time. This is maintained by the difference in tone of the afferent and efferent hence the filtration rate is dependent on this pressure differential created through vasoconstriction of the input or afferent arteriole versus the lower blood pressure created by vasodilation of the output or efferent arteriole. It follows that when any solute is freely filtered and neither reabsorbed nor secreted by the kidneys then the GFR will equal the clearance rate of that solute. The GFR is calculated from the quantity of the substance in the urine that originated from a calculable volume of blood over unit time. Where the serum creatinine is measured this is expressed simply as:

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Severe brain injuries in children

Abstract

Injury is the leading cause of death or permanent disability in children up to 19 years of age and is one of the primary reasons for hospital treatment. Blunt injuries due to traffic accidents or falls and especially blunt head injuries are the most frequent child injuries.

Appropriate care and correct treatment of the injured child require multidisciplinary teamwork (medical emergency team, surgeons, radiologists, paediatric intensive care physicians and other specialists).

Key words: child, injury, treatment, intensive therapy

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Update on the duration of dual antiplatelet therapy (DAPT)

Introduction

While the necessity of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) with coronary stenting is undisputed, the optimal duration of DAPT remains a major topic of discussion. Research data supports both prolonged and shortened duration of DAPT in certain situations. The present paper aims to summarize current evidence and give an overview of contemporary treatment options for patients in need of dual antiplatelet therapy.

Key words: dual antiplatelet therapy, acute coronary syndrome

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