Early fluid overload is associated with acute kidney injury and PICU mortality in critically ill children

2015 ◽  
Vol 175 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Yanhong Li ◽  
Jian Wang ◽  
Zhenjiang Bai ◽  
Jiao Chen ◽  
Xueqin Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Early Fluid

THE IMPACT OF FIXED CONCENTRATIONS SEDATION INFUSIONS ON FLUID OVERLOAD IN CRITICALLY ILL CHILDREN

2016 ◽  
Vol 101 (9) ◽  
pp. e2.43-e2 ◽  
Author(s):  
Adam Sutherland ◽  
Elizabeth Jemmett ◽  
Stephen Playfor
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Fluid Resuscitation ◽  
Representative Sample ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Intravenous Drugs ◽  
The Impact ◽  
Weight Groups

IntroductionFluid overload of 10% at 48 hrs (100 ml/kg additional fluid) is strongly associated with morbidity in critically ill children.1 Contributors include fluid resuscitation, acute kidney injury, and administration of intravenous drugs. Acute Kidney Injury has been observed to be more prevalent in infants.2 Drug infusions are historically prepared according to bodyweight to run at large volumes to facilitate end-of-bed calculation and administration. We report the impact of using standardised concentrations on fluid overload in critically ill children in a tertiary general PICU.MethodsAdministration of sedation infusions was prospectively documented using purposive sampling until a population-representative sample for age and weight was obtained. Infusion volumes were calculated in ml/kg/day for different weight groups – 0–5 kg, 5–20 kg and <20 kg – and compared with equivalent volumes for weight-based infusions.Results33 patients received sedation infusions over a 5 week period. Overall drug volumes were reduced by 50.3%(41.3 to 58.7%) from 5.19 ml/kg to 2.65 ml/kg. Greatest reduction was seen in the smallest patients (total reduction 68% (16.72 ml/kg vs 5.36 ml/kg). Midazolam volumes in patients >20 kg was observed to increase (0.75 ml/kg vs. 0.95 ml/kg) but this did not have an impact on overall fluid burden.ConclusionsWeight based sedation infusions may contribute to fluid overload related morbidity, especially in infants. An infant on morphine and midazolam at standard doses (20 mcg/kg/hr and 90 mcg/kg/hr respectively) will receive 16.7 ml/kg/day (33.4% of critical fluid overload at 48 hrs) when using weight-based infusions. Using standard concentrations reduces this volume to 5.36 ml/kg/day (10.7% of critical fluid overload at 48 hrs).

scholarly journals Assessment of the Independent and Synergistic Effects of Fluid Overload and Acute Kidney Injury on Outcomes of Critically Ill Children*

2020 ◽  
Vol 21 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Katja M. Gist ◽  
David T. Selewski ◽  
John Brinton ◽  
Shina Menon ◽  
Stuart L. Goldstein ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Fluid Overload ◽  
Synergistic Effects ◽  
Kidney Injury ◽  
Critically Ill Children

scholarly journals Renal angina index predicts fluid overload in critically ill children: an observational cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Stephen M. Gorga ◽  
Erin F. Carlton ◽  
Joseph G. Kohne ◽  
Ryan P. Barbaro ◽  
Rajit K. Basu
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Fluid Overload ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Poor Outcomes ◽  
Renal Angina Index ◽  
Renal Angina

Abstract Background Fluid overload and acute kidney injury are common and associated with poor outcomes among critically ill children. The prodrome of renal angina stratifies patients by risk for severe acute kidney injury, but the predictive discrimination for fluid overload is unknown. Methods Post-hoc analysis of patients admitted to a tertiary care pediatric intensive care unit (PICU). The primary outcome was the performance of renal angina fulfillment on day of ICU admission to predict fluid overload ≥15% on Day 3. Results 77/139 children (55%) fulfilled renal angina (RA+). After adjusting for covariates, RA+ was associated with increased odds of fluid overload on Day 3 (adjusted odds ratio (aOR) 5.1, 95% CI 1.23–21.2, p = 0.025, versus RA-). RA- resulted in a 90% negative predictive value for fluid overload on Day 3. Median fluid overload was significantly higher in RA+ patients with severe acute kidney injury compared to RA+ patients without severe acute kidney injury (% fluid overload on Day 3: 8.8% vs. 0.73%, p = 0.002). Conclusion Among critically ill children, fulfillment of renal angina was associated with increased odds of fluid overload versus the absence of renal angina and a higher fluid overload among patients who developed acute kidney injury. Renal angina directed risk classification may identify patients at highest risk for fluid accumulation. Expanded study in larger populations is warranted.

OR007: Nutrition Support Guidelines in Critically Ill Children with Acute Kidney Injury

2015 ◽  
Vol 34 ◽  
pp. S2
Author(s):  
J.C. Silva ◽  
U.G. Kyle ◽  
M. Treviño ◽  
J.L. Lusk ◽  
G. Dardon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Nutrition Support ◽  
Critically Ill Children ◽  
Support Guidelines

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

scholarly journals Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

2019 ◽  
Vol 3 (2) ◽  
pp. 093-099 ◽  
Author(s):  
Ali Mohammed Abu Zeid ◽  
Doaa Youssef Mohammed* ◽  
Amal Saeed AbdAlazeem ◽  
Anas Saad Elsayed Mohammed Seddeeq ◽  
Ashraf Mohamed Elnaany
Keyword(s):  
Acute Kidney Injury ◽  
Early Detection ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Urinary Ngal ◽  
Renal Angina Index ◽  
Renal Angina

Risk Factors of Acute Kidney Injury in Critically Ill Children*

2016 ◽  
Vol 17 (9) ◽  
pp. e391-e398 ◽  
Author(s):  
Morgan B. Slater ◽  
Andrea Gruneir ◽  
Paula A. Rochon ◽  
Andrew W. Howard ◽  
Gideon Koren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children
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