Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

Supplementary Table 9, column 'Edoxaban', row 'eGFR category', '95 mL/min' (page 15). The cell should be coloured green instead of yellow. It should also read "60 mg"instead of "60 mg (use with caution in 'supranormal' renal function)."In the above-indicated cell, a footnote has also been added to state: "Edoxaban should be used in patients with high creatinine clearance only after a careful evaluation of the individual thromboembolic and bleeding risk."Supplementary Table 9, column 'Edoxaban', row 'Dose reduction in selected patients' (page 16). The cell should read "Edoxaban 60 mg reduced to 30 mg once daily if any of the following: creatinine clearance 15-50 mL/min, body weight <60 kg, concomitant use of dronedarone, erythromycin, ciclosporine or ketokonazole"instead of "Edoxaban 60 mg reduced to 30 mg once daily, and edoxaban 30 mg reduced to 15mg once daily, if any of the following: creatinine clearance of 30-50 mL/min, body weight <60 kg, concomitant us of verapamil or quinidine or dronedarone."

/pdf/2020-esc-guidelines-for-the-diagnosis-and-management-of-38dpic1xu8.pdf

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).

Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.

https://www.easy-immune-health.com/support-files/clin_practice_guidelines_candidiasis.pdf

Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.

Executive Summary Introduction Methodology Used to Prepare the Guideline Epidemiology Incidence Etiology Major Epidemiologic Points Pathogenesis Major Points for Pathogenesis Modifiable Risk Factors Intubation and Mechanical Ventilation Aspiration, Body Position, and Enteral Feeding Modulation of Colonization: Oral Antiseptics and Antibiotics Stress Bleeding Prophylaxis, Transfusion, and Glucose Control Major Points and Recommendations for Modifiable Risk Factors Diagnostic Testing Major Points and Recommendations for Diagnosis Diagnostic Strategies and Approaches Clinical Strategy Bacteriologic Strategy Recommended Diagnostic Strategy Major Points and Recommendations for Comparing Diagnostic Strategies Antibiotic Treatment of Hospital-acquired Pneumonia General Approach Initial Empiric Antibiotic Therapy Appropriate Antibiotic Selection and Adequate Dosing Local Instillation and Aerosolized Antibiotics Combination versus Monotherapy Duration of Therapy Major Points and Recommendations for Optimal Antibiotic Therapy Specific Antibiotic Regimens Antibiotic Heterogeneity and Antibiotic Cycling Response to Therapy Modification of Empiric Antibiotic Regimens Defining the Normal Pattern of Resolution Reasons for Deterioration or Nonresolution Evaluation of the Nonresponding Patient Major Points and Recommendations for Assessing Response to Therapy Suggested Performance Indicators

Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia the official statement of the American Thoracic Society and the Infectious Disease Society of America (特集 救急診療ガイドライン) -- (海外のガイドライン)

BET Bromodomain Inhibition as a Therapeutic Strategy to Target c-Myc

/pdf/a-response-to-letter-to-the-editor-regarding-2s3sengw.pdf

A Response to: Letter to the Editor Regarding “Neurophysiological Assessments During Continuous Sedation Until Death Put Validity of Observational Assessments Into Question: A Prospective Observational Study”

Relatively simple measures of echocardiography and Doppler, as left ventricular end-systolic area and volume, should be taken in consideration when performing a Doppler echocardiographic examination, as they could have both clinical and prognostic value. Echocardiography made an enormous technological evolution from M mode imaging in the sixties, to two-dimensional, colour, pulsed and continuous wave Doppler echocardiography to come to some rather sophisticated items such as myocardial Doppler imaging, colour Doppler analysis of flow velocities and speckle tracking. The prognostic potential of these new techniques has not yet been elucidated, in particular in critically ill patients. In this issue of Critical Care, Sturgess et al. retrospectively analyzed a cohort of intensive care unit patients with respect to outcome [1]. Doppler myocardial imaging is a newer cardiac ultrasound technique in which the Doppler signals are processed following reflection of ultrasound beams originating within the myocardium. With this technique, pulsed Doppler signals are analyzed by performing spectral or power analysis allowing more extensive analysis of diastolic function, when used in conjunction with transmitral and pulmonary venous Doppler flow pattern analysis. Although Isaaz et al. already described pulsed Doppler recordings of myocardial tissue motion using a simple sample volume technique in 1989 [2], little clinical value was awarded to this technique. A single pulsed Doppler myocardial velocity sample volume interrogation inherently permits the analysis of regional wall motions, related to electrical and mechanical cardiac events. Echocardiographs have to allow high amplitude, low velocity information. A few years later however, it became clear that visualization of tissue motion had indeed a potential for clinical use [3]. Colour Doppler myocardial imaging permits accurate measurement of myocardial velocities at a large number of adjacent intramural sites. Doppler myocardial imaging allows estimation of both longitudinal systolic and diastolic function of the ventricles. The present study retrospectively analyzed a series of data in critically ill patients with respect to myocardial Doppler imaging as part of a general echocardiographic examination. Although the decision to perform the echo investigation was taken on a clinical basis in the sickest patients, and therefore contains a considerable selection bias both in terms of patient selection and timing, some remarkable issues were put forward. The most prominent conclusion is the important prognostic value of left ventricular end-systolic volume, related with outcome. From the literature, it is well-known that presence of a dilated cardiomyopathy has a strong inverse relationship with outcome, not only in adults but also in children [4-8]. Also in mitral valve disease, echocardiographic findings of a left ventricular end-systolic diameter above 4.5 cm strongly hampers two-years survival [9]. Therefore, the importance of the presence of a dilated left ventricle in a critically ill patient should not be denied.

/pdf/commentary-myocardial-doppler-velocities-as-a-marker-of-uc2moc2cxn.pdf

Commentary Myocardial Doppler velocities as a marker of prognosis in the

Repetitive neuromuscular monitoring and stimulating electrode fatigue

Transoesophageal echocardiography (TOE) offers real-time diagnosis and monitoring of a variety of structural and functional abnormalities of the heart in critically ill patients. It provides, in particular, useful information on cardiac contractivity, filling status and output, valvular morphology and function and the structure of the ascending and descending aorta. The anaesthetist disposes of the full range of echocardiographic modalities, including M-mode, two-dimensional and colour Doppler echocardiography. This chapter describes how different two-dimensional images can be obtained, presents a summary of the anatomical and functional information available in those images and relates this information to the clinical questions which form the indications to perform TOE.

2 Two-dimensional imaging and related indications

The need to introduce guidelines on neuromuscular monitoring emphasising the use of quantitative techniques that record the train-of-four ratio is now recognised by an increasing number of national anaesthetic societies in the Western world. But the challenge of convincing individual anaesthetists to adopt and use this practice routinely remains. For >10 yr, it has been recognised that all staff in anaesthetic departments need to have regular training in modern neuromuscular monitoring techniques. We discuss a publication in this journal that describes the challenges of setting up multicentre training in Spain to expand the use of quantitative neuromuscular monitoring and their short-term results. 

Jan Poelaert

Papers

A Response to: Letter to the Editor Regarding “Neurophysiological Assessments During Continuous Sedation Until Death Put Validity of Observational Assessments Into Question: A Prospective Observational Study”

Commentary Myocardial Doppler velocities as a marker of prognosis in the

Repetitive neuromuscular monitoring and stimulating electrode fatigue

2 Two-dimensional imaging and related indications

Educating anaesthetists on neuromuscular monitoring: the challenges continue.