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Báo cáo hóa học: " Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments | Honore et al. Annals of Intensive Care 2011 1 32 http www.annalsofintensivecare.eom content 1 1 32 Ù Annals of Intensive Care a SpringerOpen Journal REVIEW Open Access Septic AKI in ICU patients. diagnosis pathophysiology and treatment type dosing and timing a comprehensive review of recent and future developments 1 1 2 13 1 Patrick M Honore Rita Jacobs Olivier Joannes-Boyau Jouke De Regt Willem Boer Elisabeth De Waele Vincent Collin4 and Herbert D Spapen1 Abstract Evidence is accumulating showing that septic acute kidney injury AKI is different from non-septic AKI. Specifically a large body of research points to apoptotic processes underlying septic AKI. Unravelling the complex and intertwined apoptotic and immuno-inflammatory pathways at the cellular level will undoubtedly create new and exciting perspectives for the future development e.g. caspase inhibition or refinement specific vasopressor use of therapeutic strategies. Shock complicating sepsis may cause more AKI but also will render treatment of this condition in an hemodynamically unstable patient more difficult. Expert opinion along with the aggregated results of two recent large randomized trials favors continuous renal replacement therapy CRRT as preferential treatment for septic AKI hemodynamically unstable . It is suggested that this approach might decrease the need for subsequent chronic dialysis. Large-scale introduction of citrate as an anticoagulant most likely will change CRRT management in intensive care units ICU because it not only significantly increases filter lifespan but also better preserves filter porosity. A possible role of citrate in reducing mortality and morbidity mainly in surgical ICU patients remains to be proven. Also citrate administration in the predilution mode appears to be safe and exempt of relevant side effects yet still requires rigorous monitoring. Current consensus exists about using a CRRT dose of 25 ml kg h in non-septic AKI. However because patients should not be .