Distinction between induction and maintenance dosing in continuous renal replacement therapy

10.1186/cc10137Critical Care152419CRCA

Clinical review: mechanical circulatory support for cardiogenic shock complicating acute myocardial infarction

Acute myocardial infarction is one of the 10 leading reasons for admission to adult critical care units. In-hospital mortality for this condition has remained static in recent years, and this is related primarily to the development of cardiogenic shock. Recent advances in reperfusion therapies have had little impact on the mortality of cardiogenic shock. This may be attributable to the underutilization of life support technology that may assist or completely supplant the patient's own cardiac output until adequate myocardial recovery is established or long-term therapy can be initiated. Clinicians working in the intensive care environment are increasingly likely to be exposed to these technologies. The purpose of this review is to outline the various techniques of mechanical circulatory support and discuss the latest evidence for their use in cardiogenic shock complicating acute myocardial infarction

ECPR for out-of-hospital cardiac arrest: more evidence is needed

No abstract was provided by the editors of this work

ECLS in Pediatric Cardiac Patients

Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children. In this review, we will present the "state of art" of ECMO in neonate and children with heart failure. ECMO is commonly used in a variety of settings to provide support to critically ill patients with cardiac disease. However, a strict selection of patients and timing of intervention should be performed to avoid the increase in mortality and morbidity of these patients. Therefore, every attempt should be done to start ECLS "urgently" rather than "emergently," before the presence of dysfunction of end organs or circulatory collapse. Even though exciting progress is being made in the development of VADs for long-term mechanical support in children, ECMO remains the mainstay of mechanical circulatory support in children with complex anatomy, particularly those needing rapid resuscitation and those with a functionally univentricular circulation. With the increase in familiarity with ECMO, new indications have been added, such as extracorporeal cardiopulmonary resuscitation (ECPR). The literature supporting ECPR is increasing in children. Reasonable survival rates have been achieved after initiation of support during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS have reduced in the last 5 years and many centers support patients with functionally univentricular circulations. Improved results have been recently achieved in this complex subset of patients

Optimising the timing of renal replacement therapy in acute kidney injury

The optimal timing of renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI) has been much debated. Over the past five years several studies have provided new guidance for evidence-based decision-making. High-quality evidence now supports an approach of expectant management in critically ill patients with AKI, where RRT may be deferred up to 72 h unless a life-threatening indication develops. Nevertheless, physicians’ judgment still plays a central role in identifying appropriate patients for expectant management

Letter to the editor regarding Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

10.1186/s13054-021-03702-6CRITICAL CARE25

Muscle glycogen utilisation during Rugby match play: Effects of pre-game carbohydrate

Objectives: Although the physical demands of Rugby League (RL) match-play are well-known, the fuel sources supporting energy-production are poorly understood. We therefore assessed muscle glycogen utilisation and plasma metabolite responses to RL match-play after a relatively high (HCHO) or relatively low CHO (LCHO) diet. Design: Sixteen (mean ± SD age; 18 ± 1 years, body-mass; 88 ± 12 kg, height 180 ± 8 cm) professional players completed a RL match after 36-h consuming a non-isocaloric high carbohydrate (n = 8; 6 g kg day−1) or low carbohydrate (n = 8; 3 g kg day−1) diet. Methods: Muscle biopsies and blood samples were obtained pre- and post-match, alongside external and internal loads quantified using Global Positioning System technology and heart rate, respectively. Data were analysed using effects sizes ±90% CI and magnitude-based inferences. Results: Differences in pre-match muscle glycogen between high and low carbohydrate conditions (449 ± 51 and 444 ± 81 mmol kg−1 d.w.) were unclear. High (243 ± 43 mmol kg−1 d.w.) and low carbohydrate groups (298 ± 130 mmol kg−1 d.w.) were most and very likely reduced post-match, respectively. For both groups, differences in pre-match NEFA and glycerol were unclear, with a most likely increase in NEFA and glycerol post-match. NEFA was likely lower in the high compared with low carbohydrate group post-match (0.95 ± 0.39 mmol l−1 and 1.45 ± 0.51 mmol l−1, respectively), whereas differences between the 2 groups for glycerol were unclear (98.1 ± 33.6 mmol l−1 and 123.1 ± 39.6 mmol l−1) in the high and low carbohydrate groups, respectively. Conclusions: Professional RL players can utilise ∼40% of their muscle glycogen during a competitive match regardless of their carbohydrate consumption in the preceding 36-h