Acute kidney injury (AKI), diagnosed by elevated serum creatinine and decreased urine output, is a syndrome with a broad spectrum of diseases. The new concept of AKI was proposed nearly 20 years ago for better describing critically ill patients with acute renal dysfunction in ICUs. The medium- to long-term prognosis of AKI has recently been investigated in regards of transition to chronic kidney disease (CKD), and prolonged AKI has been recognized as acute kidney diseases and disorders (AKD). Composite outcome of major adverse kidney event (MAKE) is widely used. As CKD is the strongest risk factor for developing AKI, and AKI is a major risk for developing CKD, i.e., AKI and CKD form a vicious cycle that acts as risk factors for each other. Therefore, AKI may better be recognized as a temporary, sudden worsening phase of prolonged and progressive renal impairment rather than being a reversible, short-term disease condition.

The importance of nutrition monitoring for critically ill patients has been recognized as a method to ensure adequate provision of nutrition for critically ill patients, while accounting for the complex metabolic dynamics in the early phase of the critical illness. During the acute phase of a critical illness, metabolism can be significantly enhanced or suppressed due to the high degree of stress and can change dramatically depending on the type and severity of the illness, therapeutic intervention, progression of the disease state, and development of complications. Feeding according to the measured energy expenditure by indirect calorimetry is recommended to avoid over- and underfeeding by adapting to the metabolic characteristics of the individual patient. The relationship between consumption and requirement is not as clear for protein as it is for energy, and the requirement can be only be evaluated in relative terms based on the assessment of protein loss by nitrogen balance and changes in the muscle mass by body composition analyses. Monitoring should be implemented with a thorough understanding of its mechanisms and limitations. Further optimization of nutrition therapy for critically ill patients can be achieved by developing methods to recognize the optimal timing to start feeding and to determine the complete profile of the required nutrients.

Long-term sedation in pediatric patients can lead to drug tolerance and iatrogenic withdrawal syndrome (IWS). The patient was a 14-year-old male. He was diagnosed with fulminant myocarditis and a left ventricular assist device was implanted. Midazolam, fentanyl, and dexmedetomidine were intravenously administered, and the amounts of each sedative were increased due to drug tolerance. For extubation, it was necessary to slowly taper the amount of each drug to prevent IWS, and we needed to maintain the level of sedation until extubation for safe management. We tapered the amount of midazolam and fentanyl by 5% every 12 hr. Ketamine, isoflurane, and propofol were administered as off-label drugs to maintain the target level of sedation. The patient woke up immediately after propofol discontinuation and was successfully extubated. After the discontinuation of midazolam and fentanyl, dexmedetomidine was tapered and discontinued. During the course, there were no findings that suggested propofol infusion syndrome, IWS, or malignant hyperthermia.

Pericardial decompression syndrome is a rare complication that causes sudden cardiogenic shock relatively early after pericardial drainage (PD), which is a life-saving procedure for patients with cardiac tamponade. A 41-year-old man developed pericardial decompression syndrome after PD (fluid volume, 475 mL) and was successfully treated with the immediate application of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pumping (IABP). When hemodynamic failure occurs after PD, pericardial decompression syndrome should be kept in mind, as early diagnosis. The immediate supportive care until circulatory recovery and the immediate implementation of ECMO or other adjuvant circulatory support may contribute to improvement in survival of this complication.