About the blog

The blog has been a little dead for the last few months, I really want to revive it but I'm unsure what people that read it come here looking for, would be great to have some feedback dropped on the comments so I can start working on it again. Thanks.

Obesity paradox

Obesity paradox (lower mortality in the obese) documented in other populations is also observed in septic shock. This may be related in part to differences in patient characteristics. However, the true paradox may lie in the variations in the sepsis interventions such as the administration of resuscitation fluids and antimicrobial therapy. Considering the obesity epidemic and its impact on critical care, further studies are warranted to examine whether weight-based approach to common therapeutic interventions in septic shock influences outcome.

Full article 

New biomarkers for AKI

I knew about IL-18, NGAL and KIM-1 already, but these biomarkers are new.

Moderate to severe AKI occurred in 14% of Sapphire subjects. The two top biomarkers from discovery were validated. Urine insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2), both inducers of G1cell cycle arrest, a key mechanism implicated in AKI, together demonstrated an AUC of 0.80 (0.76 and 0.79 alone). Urine [TIMP-2]·[IGFBP7] was significantly superior to all previously described markers of AKI (P <0.002), none of which achieved an AUC >0.72. Furthermore, [TIMP-2]·[IGFBP7] significantly improved risk stratification when added to a nine-variable clinical model when analyzed using Cox proportional hazards model, generalized estimating equation, integrated discrimination improvement or net reclassification improvement. Finally, in sensitivity analyses [TIMP-2]·[IGFBP7] remained significant and superior to all other markers regardless of changes in reference creatinine method.

Full article

Arterial Blood Gases Interpretation

So, one of the things most nurses on ICU like to know is how to correctly interpret arterial blood gases results. Although it may seem a bit complicated sometimes, there are a few step-to-step guides that make the task really easy. I'm sharing this one with you guys, hope you like it.

Interpretation of Arterial Blood Gases 

Acute Kidney Injury VS Acute Renal Failure

During my ICU placement I've noticed most physicians were starting to use the AKI designation instead of Acute Renal Failure, decided to research on it, and here is one of the articles I've come across, that explains why the designation change.

Until recently, no uniform standard existed for diagnosing and classifying acute renal failure. To clarify diagnosis,the Acute Dialysis Quality Initiative group stated its consensus on the need for a clear definition and classification system of renal dysfunction with measurable criteria.Today the term acute kidney injury has replaced the term acute renal failure,with an understanding thatsuch injury is a common clinical problemin critically ill patients and typically is predictive of an increase in morbidity andmortality.Aclassification system, known asRIFLE (risk of injury, injury,failure, loss offunction, and end-stagerenalfailure), includesspecific goalsfor preventing acute kidney injury: adequate hydration,maintenance ofrenal perfusion, limiting exposureto nephrotoxins, drug protectivestrategies, and the use ofrenal replacementtherapiesthatreducerenalinjury.

Full article

New shock classification

The recognition and management of hypovolemic shock still remain an important task during initial trauma assessment. Recently, we have questioned the validity of the Advanced Trauma Life Support (ATLS) classification of hypovolemic shock by demonstrating that the suggested combination of heart rate, systolic blood pressure and Glasgow Coma Scale displays substantial deficits in reflecting clinical reality. The aim of this study was to introduce and validate a new classification of hypovolemic shock based upon base deficit (BD) at emergency department (ED) arrival.

Full Article