Recently published papers: Delivery, volume and outcome – what is best for our patient?

Many studies have demonstrated that prompt appropriate treatment for the critically ill patient improves outcome. Moving patients to the best place for instituting care, however, is not always associated with improved outcome. Recent studies on delivering patients to the best place for treatment as well as further work on the effects of volume are discussed. Finally, a large retrospective cohort study comparing outcomes of patients treated with continuous venovenous haemofiltration or intermittent haemodialysis is outlined

Recently published papers: Heavyweight problems in the intensive care unit?

The management of the obese patient in intensive care is fraught with difficulty, or so conventional wisdom would have us believe. Two recent studies add to the growing evidence that the obese patient is not significantly disadvantaged in terms of outcome following intensive care admission. Another study highlights the increasing burden of end-stage renal disease on intensive care unit resources with some interesting results. And there is more on citrate, the new anticoagulant

Clinical review: Timing of renal replacement therapy

Acute kidney injury is common in intensive care patients and continuous renal replacement therapy is the preferred treatment for this in most centres. Although these techniques have been adopted internationally, there remains significant variation with regard to their clinical application. This is particularly pertinent when one considers that the fundamental questions regarding any treatment, such as initiation, dose and length of treatment, remain a source of debate and have not as yet all been fully answered. In this narrative review we consider the timing of renal replacement therapy, highlighting the relative paucity of high quality data regarding this fundamental question. We examine the role of the usual biochemical criteria as well as conventional clinical indications for commencing renal replacement therapy together with the application of recent classification systems, namely RIFLE and AKIN. We discuss the potential role of biomarkers for acute kidney injury as predictors for the need for renal support and discuss commencing therapy for indications other than acute kidney injury