To dose or not to dose that is the (starch) question 英文参考文献.docVIP

Kaplan Critical Care 2010,14:148 /content/14/3/148 COMMENTARY To dose or not to dose: that is the (starch) question … Lewis J Kaplan* See related research by Boussekey et al., /content/14/2/R40 trials evaluating renal dysfunction are binary, in that ARF Abstract is present or absent; AKI is often not addressed. More- 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 de?nition of acute kidney injury and acute renal failure, and hyperoncoticity are reviewed. over, the de? nitions used in non-RIFLE trials are often based on a percentage change in creatinine (100%), a creatinine threshold (2.0 mg%), and the need for dialysis regardless of modality without specifying the triggering criteria. Worse still, the HES and diluents used are vastly di? erent between trials. Boussekey and colleagues used a modern low molecular weight and degree of substitution starch, and Hydroxyethyl starch (HES) has been vili? ed, praised, or the diluent was not speci? ed but presumed to be 0.9% largely ignored as a resuscitation ? uid depending on the normal saline solution. Unfortunately, they did not report on the presence of hyperchloremic metabolic acidosis during their trial, a condition that is associated with setting within which the HES is administere e most recent HES focus has been on renal injury when HES is administered to patients with severe sepsis or septic reduced renal blood ? ow and reduced glomerular 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. ? ltration rate. Patients in the study were divided into two groups based on whether HES was or was not adminis- tered at