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Acute renal failure critically ill

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https://read.qxmd.com/read/30746220/effect-of-high-versus-low-volume-saline-administration-on-acute-kidney-injury-after-cardiac-surgery
#1
Ju Yong Lim, Pil Je Kang, Sung Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee, Joon Bum Kim
Background: Fluid resuscitation is critical to perioperative maintenance of adequate preload and cardiac output after cardiac surgery. Liberal use of saline, however, is reportedly associated with an increased risk of acute kidney injury (AKI) in critically ill patients. This study examined the effects of high- versus low-volume saline administration on AKI after cardiac surgery. Methods: In this retrospective study, we evaluated 1,740 consecutive patients who underwent cardiac surgery over a 2-year period...
December 2018: Journal of Thoracic Disease
https://read.qxmd.com/read/30712038/endogenous-erythropoietin-and-hepatic-dysfunction-in-acute-kidney-injury-requiring-renal-replacement-therapy
#2
Ryo Matsuura, Kent Doi, Yohei Komaru, Yoshihisa Miyamoto, Teruhiko Yoshida, Takuya Isegawa, Kohei Yoshimoto, Tetsushi Yamashita, Eisei Noiri, Masaomi Nangaku
Backgrounds/Objectives: Elevated erythropoietin (EPO) is observed in human acute kidney injury (AKI). Whether blood EPO level is associated with mortality or other organ dysfunction in critically ill patients is unknown. METHODS: A prospective observational cohort study of 162 AKI patients requiring renal replacement therapy (RRT) was conducted in our intensive care unit (ICU) during October 2013 through October 2016. We evaluated the relation with plasma EPO at RRT initiation and 90-day mortality, hemoglobin, urine output, and sequential organ failure assessment (SOFA) score until day 7 or discharge from the ICU...
February 1, 2019: Nephron
https://read.qxmd.com/read/30672747/midazolam-dose-optimization-in-critically-ill-pediatric-patients-with-acute-respiratory-failure-a-population-pharmacokinetic-pharmacogenomic-study
#3
Athena F Zuppa, Daniela J Conrado, Nicole R Zane, Martha A Q Curley, Jonathan Bradfield, Hakon Hakonarson, Madeleine S Gastonguay, Ganesh Moorthy, Janice Prodell, Marc R Gastonguay
OBJECTIVES: To develop a pharmacokinetic-pharmacogenomic population model of midazolam in critically ill children with primary respiratory failure. DESIGN: Prospective pharmacokinetic-pharmacogenomic observational study. SETTING: Thirteen PICUs across the United States. PATIENTS: Pediatric subjects mechanically ventilated for acute respiratory failure, weight greater than or equal to 7 kg, receiving morphine and/or midazolam continuous infusions...
January 21, 2019: Critical Care Medicine
https://read.qxmd.com/read/30658667/vascular-endothelial-cadherin-shedding-is-more-severe-in-sepsis-patients-with-severe-acute-kidney-injury
#4
Wen-Kuang Yu, J Brennan McNeil, Nancy E Wickersham, Ciara M Shaver, Julie A Bastarache, Lorraine B Ware
BACKGROUND: Vascular endothelial cadherin (VE-cadherin) is a membrane protein that is the major component of adherens junctions between endothelial cells. It is crucial for regulating vascular integrity, endothelial permeability, and angiogenesis. During inflammatory processes, VE-cadherin is shed into circulation (sVE-cadherin). Plasma sVE-cadherin is elevated in sepsis, malignancy, autoimmune diseases, and coronary atherosclerosis. However, the relationship between specific organ failures, especially severe acute kidney injury (AKI) defined by requirement for renal replacement therapy (AKI-RRT), and plasma sVE-cadherin levels in severe sepsis has not been well studied...
January 18, 2019: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/30585829/effects-of-baseline-thrombocytopenia-and-platelet-decrease-following-renal-replacement-therapy-initiation-in-patients-with-severe-acute-kidney-injury
#5
Benjamin R Griffin, Anna Jovanovich, Zhiying You, Paul Palevsky, Sarah Faubel, Diana Jalal
OBJECTIVES: Thrombocytopenia is common in critically ill patients with severe acute kidney injury and may be worsened by the use of renal replacement therapy. In this study, we evaluate the effects of renal replacement therapy on subsequent platelet values, the prognostic significance of a decrease in platelets, and potential risk factors for platelet decreases. DESIGN: Post hoc analysis of the Acute Renal Failure Trial Network Study. SETTING: The Acute Renal Failure Trial Network study was a multicenter, prospective, randomized, parallel-group trial of two strategies for renal replacement therapy in critically ill patients with acute kidney injury conducted between November 2003 and July 2007 at 27 Veterans Affairs and university-affiliated medical centers...
December 21, 2018: Critical Care Medicine
https://read.qxmd.com/read/30574566/factors-associated-with-mortality-in-patients-with-a-solid-malignancy-admitted-to-the-intensive-care-unit-a-prospective-observational-study
#6
Pascal Kingah, Nasser Alzubaidi, Jihane Zaza Dit Yafawi, Emad Shehada, Khaled Alshabani, Ayman O Soubani
Purpose: Several studies show conflicting results regarding the prognosis and predictors of the outcome of critically ill patients with a solid malignancy. This study aims to determine the outcome of critically ill patients, admitted to a hospital, with a solid malignancy and the factors associated with the outcomes. Methods and Materials: All patients with a solid malignancy admitted to an intensive care unit (ICU) at a tertiary academic medical center were enrolled...
October 2018: Journal of Critical Care Medicine
https://read.qxmd.com/read/30525838/-relationship-between-the-nutric-nutritional-risk-scale-and-protein-hypercatabolism-in-critically-ventilated-patients
#7
Dino Moretti, Melisa D Ré, Nicolás S Rocchetti, Daniel Horacio Bagilet, Claudio Jesus Settecase, Martin Gonzalo Buncuga, Marta Quaglino
INTRODUCTION: the Nutrition Risk in Critically Ill (NUTRIC) score does not include a variable that objectively estimates protein hypercatabolism (PHC), one of the main metabolic changes experienced by critical patients. OBJECTIVE: to evaluate the correlation of the NUTRIC score with PHC in critically ventilated patients. MATERIALS AND METHODS: prospective, observational study. Mixed ICU. It included ventilated patients ≥ 18 years old, without anuria or chronic renal failure...
October 17, 2018: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://read.qxmd.com/read/30523563/when-kidneys-and-lungs-suffer-together
#8
REVIEW
Sorino Claudio, Scichilone Nicola, Pedone Claudio, Negri Stefano, Visca Dina, Spanevello Antonio
A significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one. Subjects suffering from COPD may have systemic inflammation, hypoxemia, endothelial dysfunction, increased sympathetic activation and increased aortic stiffness. As well as the exposure to nicotine, all the foresaid factors can induce a microvascular damage, albuminuria, and a worsening of renal function...
December 6, 2018: Journal of Nephrology
https://read.qxmd.com/read/30505345/intensive-care-unit-physician-delivered-point-of-care-renal-tract-ultrasound-in-acute-kidney-injury-is-feasible
#9
Prashant Parulekar, Ed Neil-Gallacher, Alex Harrison
Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine...
November 2018: Journal of the Intensive Care Society
https://read.qxmd.com/read/30485886/kidney-injury-and-electrolyte-abnormalities-in-liver-failure
#10
Anthony Bonavia, Kai Singbartl
The liver and kidney are key organs of metabolic homeostasis in the body and display complex interactions. Liver diseases often have direct and immediate effects on renal physiology and function. Conversely, acute kidney injury (AKI) is a common problem in patients with both acute and chronic liver diseases. AKI in patients with acute liver failure is usually multifactorial and involves insults similar to those seen in the general AKI population. Liver cirrhosis affects and is directly affected by aberrations in systemic and renal hemodynamics, inflammatory response, renal handling of sodium and free water excretion, and additional nonvasomotor mechanisms...
October 2018: Seminars in Respiratory and Critical Care Medicine
https://read.qxmd.com/read/30390876/higher-bmi-is-associated-with-reduced-mortality-but-longer-hospital-stays-following-icu-discharge-in-critically-ill-asian-patients
#11
Amartya Mukhopadhyay, Yanika Kowitlawakul, Jeyakumar Henry, Venetia Ong, Claudia Shu-Fen Leong, Bee Choo Tai
BACKGROUND & AIMS: Asians with similar body mass index (BMI) as the Caucasians are at higher health risk as compared to their counterparts. Although the mean weight of patients admitted to the intensive care unit (ICU) is increasing but the relation between BMI with 28-day mortality and length of stay (LOS) following ICU discharge in Asian patients is not well studied. METHODS: We included all adult patients admitted to the ICU of a tertiary hospital who received mechanical ventilation (MV) for at least 48 hours between October 2013 and September 2014...
December 2018: Clinical Nutrition ESPEN
https://read.qxmd.com/read/30374606/augmented-renal-clearance-in-pediatric-intensive-care-are-we-undertreating-our-sickest-patients
#12
Evelyn Dhont, Tatjana Van Der Heggen, Annick De Jaeger, Johan Vande Walle, Peter De Paepe, Pieter A De Cock
Many critically ill patients display a supraphysiological renal function with enhanced renal perfusion and glomerular hyperfiltration. This phenomenon described as augmented renal clearance (ARC) may result in enhanced drug elimination through renal excretion mechanisms. Augmented renal clearance seems to be triggered by systemic inflammation and therapeutic interventions in intensive care. There is growing evidence that ARC is not restricted to the adult intensive care population, but is also prevalent in critically ill children...
October 29, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://read.qxmd.com/read/30352414/vitamin-d-and-critical-illness-what-endocrinology-can-learn-from-intensive-care-and-vice-versa
#13
REVIEW
Karin Amrein, Alja Papinutti, Erwin Mathew, Greisa Vila, Dhruv Parekh
The prevalence of vitamin D deficiency in intensive care units ranges typically between 40 and 70 %. There are many reasons for being or becoming deficient in the ICU. Hepatic, parathyroid and renal dysfunction aditionally increase the risk for developing vitamin D deficiency. Moreover, therapeutic interventions like fluid resuscitation, dialysis, surgery, extracorporeal membrane oxygenation, cardiopulmonary bypass and plasma exchange may significantly reduce vitamin D levels. Many observational studies have consistently shown an association between low vitamin D levels and poor clinical outcomes in critically ill adults and children, including excess mortality and morbidity such as acute kidney injury, acute respiratory failure, duration of mechanical ventilation and sepsis...
October 1, 2018: Endocrine Connections
https://read.qxmd.com/read/30342418/creation-of-an-empiric-tool-to-predict-ecmo-deployment-in-pediatric-respiratory-or-cardiac-failure
#14
Punkaj Gupta, Jeffrey M Gossett, Danny Kofos, Mallikarjuna Rettiganti
PURPOSE: To create a real-time prediction tool to predict probability of ECMO deployment in children with cardiac or pulmonary failure. MATERIALS AND METHODS: Patients ≤18 years old admitted to an ICU that participated in the Virtual Pediatric Systems database (2009-2015) were included. Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with ECMO use. RESULTS: A total of 538,202 ICU patients from 140 ICUs qualified for inclusion...
February 2019: Journal of Critical Care
https://read.qxmd.com/read/30337758/-individualized-vancomycin-dosing-for-a-patient-diagnosed-as-severe-acute-pancreatitis-with-concurrent-extracorporeal-membrane-oxygenation-and-continuous-veno-venous-hemofiltration-therapy-a-case-report
#15
N He, Y Y Yan, Y Q Ying, M Yi, G Q Yao, Q G Ge, S D Zhai
Pharmacokinetic parameters can be significantly altered for acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO) and continuous veno-venous hemofiltration therapy (CVVH). Here we reported a case of individualized vancomycin dosing for a patient diagnosed as severe acute pancreatitis treated with concurrent ECMO and CVVH. A 65 kg 32-year-old woman was admitted to hospital presented with severe acute pancreatitis (SAP), respiratory failure, metabotropic acidosis and hyperkalemia. She was admitted to intensive care unit (ICU) on hospital day 1 and was initiated on CVVH...
October 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://read.qxmd.com/read/30322739/prediction-of-major-adverse-kidney-events-in-critically-ill-burn-patients
#16
François Dépret, Louis Boutin, Jiří Jarkovský, Maité Chaussard, Sabri Soussi, Aurélien Bataille, Haikel Oueslati, Nabila Moreno, Christian de Tymowski, Jiří Parenica, Klára Benešová, Thomas Vauchel, Axelle Ferry, Mourad Benyamina, Alexandru Cupaciu, Maxime Coutrot, Jean-Pierre Garnier, Kevin Serror, Marc Chaouat, Alexandre Mebazaa, Matthieu Legrand
OBJECTIVE: We aimed at assessing the predictive value of plasmatic Neutrophil Gelatinase Associated Lipocalin (pNGAL) at admission and severity scores to predict major adverse kidney events (MAKE, defined as death and/or need for renal replacement therapy (RRT) and/or non-renal recovery at day 90) in critically ill burn patients. MATERIAL AND METHODS: Single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients (total burned body surface >20%) from January 2012 until January 2015 with a pNGAL dosage at admission...
October 12, 2018: Burns: Journal of the International Society for Burn Injuries
https://read.qxmd.com/read/30293927/outcome-and-prognostic-factors-of-patients-treated-in-the-intensive-care-unit-for-carbon-monoxide-poisoning
#17
Wei-Chih Liao, Wen-Chien Cheng, Biing-Ru Wu, Wei-Chun Chen, Chih-Yu Chen, Chia-Hung Chen, Chih-Yen Tu, Te-Chun Hsia
BACKGROUND: Carbon monoxide (CO), a colorless and odorless gas, is one of the common causes of poisoning-related deaths worldwide. CO poisoning can result in hypoxic brain damage and death, but intensive care can improve the likely outcome for critically ill patients. However, there is a paucity of clinical data regarding the prognostic factors and association between organ dysfunction and clinical outcome of patients treated for CO poisoning in the intensive care unit (ICU). METHODS: We performed a retrospective study of patients admitted to a university affiliated hospital ICU between July 2001 and December 2010 following CO poisoning...
October 5, 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://read.qxmd.com/read/30238174/renal-failure-in-critically-ill-patients-beware-of-applying-central-venous-pressure-on-the-kidney
#18
REVIEW
Xiukai Chen, Xiaoting Wang, Patrick M Honore, Herbert D Spapen, Dawei Liu
The central venous pressure (CVP) is traditionally used as a surrogate of intravascular volume. CVP measurements therefore are often applied at the bedside to guide fluid administration in postoperative and critically ill patients. Pursuing high CVP levels has recently been challenged. A high CVP might impede venous return to the heart and disturb microcirculatory blood flow which may cause tissue congestion and organ failure. By imposing an increased "afterload" on the kidney, an elevated CVP will particularly harm kidney hemodynamics and promote acute kidney injury (AKI) even in the absence of volume overload...
September 20, 2018: Annals of Intensive Care
https://read.qxmd.com/read/30180125/consensus-recommendations-for-rbc-transfusion-practice-in-critically-ill-children-from-the-pediatric-critical-care-transfusion-and-anemia-expertise-initiative
#19
Stacey L Valentine, Melania M Bembea, Jennifer A Muszynski, Jill M Cholette, Allan Doctor, Phillip C Spinella, Marie E Steiner, Marisa Tucci, Nabil E Hassan, Robert I Parker, Jacques Lacroix, Andrew Argent, Jeffrey L Carson, Kenneth E Remy, Pierre Demaret, Guillaume Emeriaud, Martin C J Kneyber, Nina Guzzetta, Mark W Hall, Duncan Macrae, Oliver Karam, Robert T Russell, Paul A Stricker, Adam M Vogel, Robert C Tasker, Alexis F Turgeon, Steven M Schwartz, Ariane Willems, Cassandra D Josephson, Naomi L C Luban, Leslie E Lehmann, Simon J Stanworth, Nicole D Zantek, Timothy E Bunchman, Ira M Cheifetz, James D Fortenberry, Meghan Delaney, Leo van de Watering, Karen A Robinson, Sara Malone, Katherine M Steffen, Scot T Bateman
OBJECTIVES: To date, there are no published guidelines to direct RBC transfusion decision-making specifically for critically ill children. We present the recommendations from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN: Consensus conference series of multidisciplinary, international experts in RBC transfusion management of critically ill children. SETTING: Not applicable. INTERVENTION: None...
September 2018: Pediatric Critical Care Medicine
https://read.qxmd.com/read/30116993/management-of-acute-on-chronic-liver-failure-an-algorithmic-approach
#20
Shiv Kumar Sarin, Ashok Choudhury
Acute-on-chronic liver failure (ACLF) is a distinct syndrome of liver failure in a patient with chronic liver disease presenting with jaundice, coagulopathy and ascites and/or hepatic encephalopathy, developing following an acute hepatic insult and associated with high 28-day mortality. The definition though lacks global consensus, excludes patients with known distinct entities such as acute liver failure and those with end-stage liver disease. The initial Systemic Inflammatory Response Syndrome (SIRS) because of cytokine storm in relation to acute insult and/or subsequent development of sepsis due to immunoparalysis leads to extrahepatic organ failure...
September 2018: Hepatology International
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