Rinaldo Bellomo

..The administration of N-acetylcysteine to protect the kidney from oxidative stress is not recommended. There is marked lack of randomised controlled trials in this field...

..The aim of this article is to assess the data on clinical outcomes for critically ill patients admitted to Australian and New Zealand intensive care units in comparison to information available for similar patients in other counties..

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..The aim of this study was to study the characteristics and outcome of patients with severe (RIFLE-F) AKI who did not receive RRT...

..Acute kidney injury (AKI) is a common and serious complication of cardiopulmonary bypass (CPB) surgery. Hepcidin, a peptide hormone that regulates iron homeostasis, is a potential biomarker of AKI following CPB...

..During cardiopulmonary bypass (CPB) surgery, modifiable factors may contribute to post-operative AKI. Their avoidance might be a potential target for nephroprotection...

..To compare two approaches to the statistical analysis of the relationship between the baseline incidence of adverse events and the effect of medical emergency teams (METs)...

..The primary analysis will be intention-to-treat. Planned recruitment will be complete by June 2011 and results available by December 2011. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00978354...

..Citrate can, however, with inadequate use cause metabolic derangements. Full advantages of citrate can only be realized if its risks are well controlled. These observations suggest a greater role for citrate...

..To estimate the incidence of intensive care unit (ICU)-acquired bloodstream infection (BSI) and its independent effect on hospital mortality...

..Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients...

..Finally, the review examines the potential intensive care unit practice implications of a better understanding of chloride...

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..Further evaluation and validation of the approach are required...

..The purpose of the present study was to assess the effect of the MET and other variables on long-term mortality in this patient population...

..However, unlike other vasopressors, its systemic, regional blood flow and renal functional effects in hypotensive hyperdynamic sepsis have not been investigated...

..Multicentre randomized controlled trials focusing on clinical rather than physiological outcomes are needed...

..There is limited information on whether the incidence of acute kidney injury (AKI) in critically ill patients has changed over time and there is controversy on whether its outcome has improved...

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..Furthermore, they have allowed improved analysis and characterization of 'at-risk' patients and their needs. Four years later, we remain glad we MET...

..The aim of this study was to estimate the cost difference between CRRT and IRRT in the intensive care unit (ICU)...

..Our findings show sustainability and suggest that, for every 17 MET calls, one cardiac arrest might be prevented...

..It appears likely that the accumulation of evidence from different settings and situations, though methodologically imperfect, will increase the rationale and logic of RRS. A conclusive randomised controlled trial is unlikely to occur...

..We tested the hypothesis that relative hyperlactatemia is independently associated with an increased risk of hospital death...

..These aspects of study design impact upon the evaluation of complex interventions in critical care. Clinicians should also consider these specific issues when implementing new complex interventions into their practice...

..Clinicians need to be aware of this controversy when considering the application of intensive insulin therapy and interpreting future trials...

..We performed a systematic review to describe the effect in septic patients of direct hemoperfusion with PMX-F on outcomes of blood pressure, use of vasoactive drugs, oxygenation, and mortality reported in published studies...

..We proposed that hyperlactatemia is not the sole cause of cardiac arrest acidosis and that other factors participate significantly in its development...

..CONCLUSIONS: SHF hemofiltration achieved a much greater clearance of myoglobin than conventional hemofiltration, and it may provide a potential modality for the treatment of myoglobinuric acute renal failure...

..Future studies may best be targeted at understanding the effect of pursuing different fluid balance regimens rather than monitoring techniques per se...

..Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and dexmedetomidine in facilitating extubation...

..To assess multicentre, randomised, controlled trials (MC-RCTs) of systemic inflammatory response syndrome (SIRS) and sepsis conducted in Japan, published in Japanese and not available to English-language medical databases...

..While these findings need to be confirmed, they challenge established paradigms and offer a new conceptual framework of reference for further investigation and intervention in man...

..Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies...

..To determine the effect on cardiac arrests and overall hospital mortality of an intensive care-based medical emergency team...

..Important steps are being taken toward improving the outcome of these patients. Critical care physicians need to understand and participate in this process...

..Their role in the management of SIRS/Sepsis remains controversial...

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..This editorial aims to summarize and interpret recent findings concerning the application of the RIFLE criteria to the assessment of the epidemiology and the prediction of the outcome of ARF...

..Data from the mid 1970s relating to the clinical features, pathogenesis, treatment and outcome of patients affected by acute renal failure were compared with data reported in the literature in 2005...

..Accordingly, we argue for more reflection, definition and consensus on these aspects of the evaluation of evidence...

..The results of these two studies should be available in 2008. Before making any major changes to practice, it seems prudent to wait for the publication of the findings of these two pivotal trials...

..Whether it is superior to noradrenaline in this setting remains uncertain, and more studies are needed before recommendations can be made...

..Until such studies are completed, basing international treatment guidelines on a single centre study performed in what may turn out to be a highly atypical environment would seem premature...

..Hyperoxia has recently been reported as an independent risk factor for mortality in patients resuscitated from cardiac arrest. We examined the independent relationship between hyperoxia and outcomes in such patients...

..We hypothesised that most stools in critically ill patients are not formed and that both diarrhoea and non-defecation are common...

..abstract:..

..These observations imply that changes in the vasoconstrictor tone of both the afferent and efferent arterioles are an important component of the pathogenesis of septic AKI...

..As yet in Australia, there is no systematic provision of reliable guidance for practitioners...

..Finally, there is a growing appreciation that acute renal failure may identify patients who are at increased risk of subsequent chronic renal dysfunction and mortality, opening the way to post-ICU interventional trials...

..During critical illness, oliguria is often used as a biomarker of acute kidney injury (AKI). However, its relationship with the subsequent development of AKI has not been prospectively evaluated...

..Such findings suggest caution with excessive transfusion after cardiac surgery and the need for a large randomised controlled trial...

..To explore whether fluid resuscitation with normal saline or 4% albumin is associated with differential changes in routine clinical coagulation tests...

..The combination of diuretic therapy and/or ultrafiltration can achieve volume control in essentially all patients with heart failure...

..Thus, accurate assessment of fluid status and careful definition of targets are needed to improve clinical outcomes. Controlled studies of conservative versus liberal fluid management in patients with AKI or CRS seem justified...

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..Fluid resuscitation with saline in severe sepsis is controversial. Hypertonic (3%) saline (HTS) may be superior to normal (0.9%) saline (NS)...

..Pulse pressure variation (PPV) is an accepted measure of intravascular filling. It can now be estimated automatically. However, there is limited knowledge of the epidemiology and associations of such estimates in cardiac surgery patients...

..We tested whether the degree of preexisting hyperglycemia would modulate the association between glycemia and outcome during critical illness in patients with diabetes mellitus...

..Patients with septic AKI had an increased risk for death and longer duration of hospitalization yet showed trends toward greater renal recovery and independence from RRT...

..The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes...

..To compare the value of novel with conventional serum biomarkers in the prediction of acute kidney injury (AKI) in adult cardiac surgical patients according to preoperative renal function...

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..To assess the association of abnormalities of ionized calcium levels with mortality in a heterogeneous cohort of critically ill patients...

..To assess the effect of a Medical Emergency Team (MET) service on patient mortality in the 4 years since its introduction into a teaching hospital...

..The primary objective was to evaluate the rate, characteristics and outcomes of very old (age >or= 80 years) patients admitted to intensive care units (ICUs)...

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..To study the impact of diabetes mellitus on the relationship between glycemia and mortality in critically ill patients...

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..A large, multiple-center database might be needed to improve the discrimination and calibration of acute renal failure scoring system...

..To describe the quality of postoperative documentation of vital signs and of medical and nursing review and to identify the patient and hospital factors associated with incomplete documentation...

..To measure renal blood flow (RBF) and renal function during recovery from experimental septic acute kidney injury (AKI)...

..Little information is available regarding current practice in continuous renal replacement therapy (CRRT) for the treatment of acute renal failure (ARF) and the possible clinical effect of practice variation...

..CONCLUSIONS: Small solute SC and mass transfer during isovolaemic HVHF are significantly affected by the proportion of replacement fluid administered pre-filter. Isovolaemic HVHF is neither isonatraemic nor isochloraemic...

..To determine whether mild or moderate hypoglycemia that occurs in critically ill patients is independently associated with an increased risk of death...

..There was little correlation between the changes in RSNA and renal blood flow, suggesting that the renal vasodilatation was mediated mainly by other mechanisms...

..To evaluate the impact of Rapid Response System (RRS) maturation on delayed Medical Emergency Team (MET) activation and patient characteristics and outcomes...

..In summary, this study identifies COMT LL homozygosity as an independent risk factor for shock, AKI, and hospital stay after cardiac surgery. (ClinicalTrials.gov number, NCT00334009)...

..However, standard hemodialysis membranes achieve only little diffusive removal of circulating cytokines. Modified membranes may enable both successful IHD treatment and simultaneous diffusive cytokine removal...

..To assess the effect of high-dose N-acetylcysteine on renal function in cardiac surgery patients at higher risk of postoperative renal failure...

..Severity scores could be used to predict the hospital outcome for these patients. Their mortality, when treated with CRRT, was similar to that of diagnosis- and severity-score-matched patients with acute renal failure...

..We conclude that cytokine dialysis is achievable through a membrane with a high cut-off point with negligible albumin loss. These findings support the technical feasibility of this new approach to blood purification in sepsis...

..However, NIV is sometimes used by the Medical Emergency Team (MET) as respiratory support for ward patients...

..To compare the time course of organ dysfunction/failure, mortality and cause of death in patients with severe sepsis (SS) and patients with severe non-infectious systemic inflammatory response syndrome (SNISIRS)...

..To describe the characteristics and outcomes of patients receiving a medical emergency team (MET) review for the MET syndromes of respiratory distress or hypotension and to assess the effect of delayed MET activation on their outcomes...

..However, it has been suggested that NAC may lower plasma creatinine levels independent of any effects on glomerular filtration rate (GFR)...

..However, overall differences between the types of fluid are minor, whereas the volume of fluid administered is a much stronger predictor of such changes, which are also influenced by illness severity and the passage of time...

..To measure the extended renal hemodynamic changes induced by intravenous radiocontrast...

..When unknown, current recommendations are to estimate a baseline SCr by the MDRD equation. However, the MDRD approach assumes a glomerular filtration rate of approximately 75 mL/min/1.73 m(2). This method has not been validated...

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..To identify factors that predict outcome in patients receiving a Medical Emergency Team review...

..The choice of definition of acute kidney injury (AKI) might, at least in part, account for such variability...

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..Further, we proposed that differences between indirect and direct chloride assays might be explained by interference from other plasma constituents, particularly bicarbonate, and possibly albumin...

..4 vs. 9.7%/ day, p = 0.78). CONCLUSIONS: Post-dilution was associated with reduced filter life without any beneficial effect on daily changes in urea and creatinine levels. Pre-dilution appears a preferable technical approach to CVVH...

..Decreasing the variability of blood glucose concentration might be an important aspect of glucose management...

..To determine whether there was a difference between epinephrine and norepinephrine in achieving a mean arterial pressure (MAP) goal in intensive care (ICU) patients...

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