]. The cerebral oxygenation goals to be achieved depend on the available resources and the technique employed. Oxygen pressure of the brain parenchyma locally reflects the balance between the supply and consumption of Oand should be maintained at values above 18 mmHg. The venous oxygen saturation obtained from the jugular bulb , globally represents the Othat returns to the general circulation after being consumed by brain cells and should be maintained at values > 55%.
When advanced and specialized technology is available, such as microdialysis or a specific software for the continuous evaluation of the autoregulatory phenomenon, it is recommended to maintain the lactate/pyruvate ratio < 25 and pressure reactivity index or oxygen reactivity index < 0.2. Orx and Prx are the correlation coefficients between CPP and PtiOand ICP, respectively. Both parameters are related to cerebral oxygenation, as high ICP reduces oxygen tolerance.
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Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: a systematic review and meta-analysis - Critical CareBackground Several biomarkers have been proposed to predict the occurrence of acute kidney injury (AKI); however, their efficacy varies between different trials. The aim of this study was to compare the predictive performance of different candidate biomarkers for AKI. Methods In this systematic review, we searched PubMed, Medline, Embase, and the Cochrane Library for papers published up to August 15, 2022. We selected all studies of adults (| 18 years) that reported the predictive performance of damage biomarkers (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP)), inflammatory biomarker (interleukin-18 (IL-18)), and stress biomarker (tissue inhibitor of metalloproteinases-2 × insulin-like growth factor-binding protein-7 (TIMP-2 × IGFBP-7)) for the occurrence of AKI. We performed pairwise meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) individually. Hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the pooled test performance, and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to appraise the quality of evidence. Results We identified 242 published relevant studies from 1,803 screened abstracts, of which 110 studies with 38,725 patients were included in this meta-analysis. Urinary NGAL/creatinine (diagnostic odds ratio [DOR] 16.2, 95% CI 10.1–25.9), urinary NGAL (DOR 13.8, 95% CI 10.2–18.8), and serum NGAL (DOR 12.6, 95% CI 9.3–17.3) had the best diagnostic accuracy for the risk of AKI. In subgroup analyses, urinary NGAL, urinary NGAL/creatinine, and serum NGAL had better diagnostic accuracy for AKI than urinary IL-18 in non-critically ill patients. However, all of the biomarkers had similar diagnostic accuracy in critically ill patients. In the setting of medical and non-sepsis patients, urinary NGAL had better predictive performance than urinary IL-18, urinary L-FAB
Source: BioMedCentral - 🏆 22. / 71 Read more »