tailieunhanh - Báo cáo y học: "To dose or not to dose: that is the (starch) question"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: To dose or not to dose: that is the (starch) question. | Kaplan Critical Care 2010 14 148 http content 14 3 148 CRITICAL CARE COMMENTARY L__ To dose or not to dose that is the starch question . Lewis J Kaplan See related research by Boussekey etal. http content 14 2 R40 Abstract The present study describes the impact on renal function of a modern starch used for resuscitation in the intensive care unit. The role of starch in renal dysfunction the importance of the definition of acute kidney injury and acute renal failure and hyperoncoticity are reviewed. Hydroxyethyl starch HES has been vilified praised or largely ignored as a resuscitation fluid depending on the setting within which the HES is administered. The most recent HES focus has been on renal injury when HES is administered to patients with severe sepsis or septic shock. Boussekey and colleagues have provided us with a single-center 2-year view of how HES use in the intensive care unit relates to renal function 1 . Several elements of this study merit discussion. First Boussekey and colleagues study is similar to another that provided a snapshot view of fluid resuscitation in a host of European intensive care units 2 . Most notably HES use was not associated with renal injury even when administered to patients with sepsis. This finding reflects a relatively low dose of HES consistent with that used in the current study - quite different from the doses used in studies decrying the use of HES 3-5 . Like the study of Sakr and colleagues 2 HES was only one component of a multimodal approach to fluid management. This critical element underscores the observation that HES does not provide significant free water. Resuscitation with only HES as predominantly occurs in HES trials will therefore establish a hyper-oncotic state and predictably lead to acute kidney injury AKI or acute renal failure ARF 6 . Third the authors are to be congratulated on applying an objective and evidence-based approach to categorizing renally relevant events - .