Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing a comprehensive review of recent and future developments 英文参考文献.docVIP

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Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing a comprehensive review of recent and future developments 英文参考文献.doc

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Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing a comprehensive review of recent and future developments 英文参考文献

Honoreetal.AnnalsofIntensiveCare2011,1:32 /content/1/1/32 REVIEW OpenAccess SepticAKIinICUpatients.diagnosis, pathophysiology,andtreatmenttype,dosing, andtiming:acomprehensivereviewofrecent andfuturedevelopments PatrickMHonore1*,RitaJacobs1,OlivierJoannes-Boyau2,JoukeDeRegt1,WillemBoer3,ElisabethDeWaele1, VincentCollin4andHerbertDSpapen1 Abstract Evidenceisaccumulatingshowingthatsepticacutekidneyinjury(AKI)isdifferentfromnon-septicAKI.Specifically, alargebodyofresearchpointstoapoptoticprocessesunderlyingsepticAKI.Unravellingthecomplexand intertwinedapoptoticandimmuno-inflammatorypathwaysatthecellularlevelwillundoubtedlycreatenewand excitingperspectivesforthefuturedevelopment(e.g.,caspaseinhibition)orrefinement(specificvasopressoruse) oftherapeuticstrategies.ShockcomplicatingsepsismaycausemoreAKIbutalsowillrendertreatmentofthis conditioninanhemodynamicallyunstablepatientmoredifficult.Expertopinion,alongwiththeaggregatedresults oftworecentlargerandomizedtrials,favorscontinuousrenalreplacementtherapy(CRRT)aspreferentialtreatment forsepticAKI(hemodynamicallyunstable).Itissuggestedthatthisapproachmightdecreasetheneedfor subsequentchronicdialysis.Large-scaleintroductionofcitrateasananticoagulantmostlikelywillchangeCRRT managementinintensivecareunits(ICU),becauseitnotonlysignificantlyincreasesfilterlifespanbutalsobetter preservesfilterporosity.Apossibleroleofcitrateinreducingmortalityandmorbidity,mainlyinsurgicalICU patients,remainstobeproven.Also,citrateadministrationinthepredilutionmodeappearstobesafeandexempt ofrelevantsideeffects,yetstillrequiresrigorousmonitoring.CurrentconsensusexistsaboutusingaCRRTdoseof 25ml/kg/hinnon-septicAKI.However,becausepatientsshouldnotbeundertreated,thisimpliesthatdosesas highas30to35ml/kg/hmustbeprescribedtoaccountforeventualtreatmentinterruptions.Awaitingresults fromlarge,ongoingtrials,35ml/kg/hshouldremainthestandarddoseinsepticAKI,particularlywhenshockis present.Todate,exacttimingofCRRTisnotwelldefined.Awidelyacceptedcompositedefiniti