LOW STRONG ION DIFFERENCE AS A PROGNOSTIC INDICATOR IN CRITICALLY ILL PATIENTS

2002 ◽  
Vol 30 (Supplement) ◽  
pp. A134
Author(s):  
Flavio E Nacul ◽  
Emanuela Moraes ◽  
Fabio Gomes ◽  
Luciana Portela
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Indicator ◽  
Strong Ion Difference

Crystalloids in critical illness

2016 ◽  
Author(s):  
Karthik Raghunathan ◽  
Andrew Shaw
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Endothelial Glycocalyx ◽  
Strong Ion Difference ◽  
Negative Consequences ◽  
Negative Effects ◽  
Randomized Controlled Studies ◽  
Preload Responsiveness ◽  
Saline Solutions

‘Crystalloid’ refers to solutions of crystalline substances that can pass through a semipermeable membrane and are distributed widely in body fluid compartments. The conventional Starling model predicts transvascular exchange based on the net balance of opposing hydrostatic and oncotic forces. Based on this model, colloids might be considered superior resuscitative fluids. However, observations of fluid behaviour during critical illness are not consistent with such predictions. Large randomized controlled studies have consistently found that colloids offer no survival advantage relative to crystalloids in critically-ill patients. A revised Starling model describes a central role for the endothelial glycocalyx in determining fluid disposition. This model supports crystalloid utilization in most critical care settings where the endothelial surface layer is disrupted and lower capillary pressures (hypovolaemia) make volume expansion with crystalloids effective, since transvascular filtration decreases, intravascular retention increases and clearance is significantly reduced. There are important negative consequences of both inadequate and excessive crystalloid resuscitation. Precise dosing may be titrated based on functional measures of preload responsiveness like pulse pressure variation or responses to manoeuvres such as passive leg raising. Crystalloids have variable electrolyte concentrations, volumes of distribution, and, consequently variable effects on plasma pH. Choosing balanced crystalloid solutions for resuscitation may be potentially advantageous versus ‘normal’ (isotonic, 0.9%) saline solutions. When used as the primary fluid for resuscitation, saline solutions may have adverse effects in critically-ill patients secondary to a reduction in the strong ion difference and hyperchloraemic, metabolic acidosis. Significant negative effects on immune and renal function may result as well.

The use of sodium-chloride difference and chloride-sodium ratio as strong ion difference surrogates in the evaluation of metabolic acidosis in critically ill patients

2010 ◽  
Vol 25 (3) ◽  
pp. 525-531 ◽  
Author(s):  
Danielle Nagaoka ◽  
Antonio Paulo Nassar Junior ◽  
Alexandre Toledo Maciel ◽  
Leandro Utino Taniguchi ◽  
Danilo Teixeira Noritomi ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Sodium Chloride ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Strong Ion Difference

scholarly journals Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation

2014 ◽  
Vol 71 (10) ◽  
pp. 936-941 ◽  
Author(s):  
Milos Novovic ◽  
Jasna Jevdjic
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Strong Ion Difference ◽  
Acid Base ◽  
Prediction Of Mortality

Background/Aim. Acid-base disorders are common within critically ill patients. Physicochemical approach described by Stewart and modified by Figge gives precise quantification method of metabolic acidosis and insight into its main mechanisms, as well as influence of unmeasured anion on metabolic acidosis. The aims of this study were to determine whether the conventional acid-base variables are connected with survival rate of critically ill patients at Intensive care unit; whether strong ion difference/strong ion gap (SID/SIG) is a better predictor of mortality rate comparing to conventional acid-base variables; to determine all significant predictable parameters for the 28-day mortality rate at intensive care units. Methods. This retrospective observational analytic study included 142 adult patients requiring mechanical ventilation, survivors (n = 68) and nonsurvivors (n = 74). Apparent strong ion difference (SIDapp), effective strong ion difference (SIDeff) and SIG values were calculated with the Stewart-Figge?s quantitative biophysical method. Descriptive and analytical statistical methods were used in the study [t-test, Mann-Whitney U test, ?2-test, binary logistic regression, Reciever operating characteristic (ROC) curves, calibration]. Results. Age, Na+, acute physiology and chronic health evaluation (APACHE II), Cl-, albumin, SIG, SID app, SIDeff, and aninon gap (AG) were statistically significant predictors. AG represented a model with imprecise calibration, i.e. a model with little predictive power. APACHE II had p-value more than 0.05 if it was near it, and therefore it could be considered potentially unreliable for outcome prediction. SIDeff and SIG represented models with well-defined calibration. ROC analysis results showed that APACHE II, Cl-, albumin, SIDeff, SIG i AG had the largest area bellow the curve. By creation of logistic models with calibration methods, we found that outcome depends on SIG and APACHE II score. Conclusion. Based on our data, unmeasured anions provide prediction of mortality of critically ill patients on mechanical ventilation, unlike the traditional acid-base variables which are not accurate predictors of the 28-day mortality rate.

scholarly journals Study of troponin-t elevation in critically ill patients-incidence and outcome

2017 ◽  
Vol 4 (4) ◽  
pp. 974
Author(s):  
Augustine Sabu ◽  
S. Madhu ◽  
Shilpa Avarebeel ◽  
Sruthy Velangupara ◽  
Mohan Goudar
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Myocardial Injury ◽  
Troponin T ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Prognostic Indicator ◽  
Care Hospital ◽  
Exclusion Criteria ◽  
Diagnostic Categories

Background: Besides cardiac disease, critical illness patients are often subjected to myocardial injury. Hence, the goal of present study was to analyze the incidence of elevated cardiac troponin levels in critically ill patients and its outcome which in turn can act as a prognostic marker.Methods: The settings were the ICU’s of a tertiary care hospital in south India. A sample of 54 was identified using purposive sampling technique. Serial monitoring of troponin T was done on day 1, 3 and 5. A performa was used to collect the baseline data of who met the inclusion and exclusion criteria. The collected data was analyzed by using descriptive and inferential statistics.Results: Among 54 patients 17 (31.5%) of them expired. It was found that patients with mean APACHE score were significantly greater among mortality group (P<0.001). When analyzing the outcome in relation to the troponin T levels, it can be concluded that troponin levels were higher among patients who died but it was not statistically significant. (p=0.56, 0.84 and 0.67 on day 1, 3 and 5 respectively). Among the 54 patients it is inferred from the findings that most of the critically ill patients do have high troponin T levels.Conclusions: The study illustrated the incidence of high troponin T levels in critically ill patients which is an informative prognostic indicator. The relation couldn’t be proved due to less sample size and other imposing factors in critically ill such as broad diagnostic categories.  

scholarly journals Relevance of Serum Leptin and Leptin-Receptor Concentrations in Critically Ill Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Alexander Koch ◽  
Ralf Weiskirchen ◽  
Henning W. Zimmermann ◽  
Edouard Sanson ◽  
Christian Trautwein ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Leptin Receptor ◽  
Prognostic Indicator ◽  
Severe Illness ◽  
Serum Leptin ◽  
Metabolic Alterations ◽  
Obesity And Diabetes ◽  
The Impact

The adipocyte-derived cytokine leptin was implicated to link inflammation and metabolic alterations. We investigated the potential role of leptin components in critically ill patients, because systemic inflammation, insulin resistance, and hyperglycemia are common features of critical illness. Upon admission to Medical Intensive Care Unit (ICU), free leptin and soluble leptin-receptor serum concentrations were determined in 137 critically ill patients (95 with sepsis, 42 without sepsis) and 26 healthy controls. Serum leptin or leptin-receptor did not differ between patients or controls and were independent of sepsis. However, serum leptin was closely associated with obesity and diabetes and clearly correlated with markers of metabolism and liver function. Leptin-receptor was an unfavourable prognostic indicator, associated with mortality during three years follow-up. Our study indicates a functional role of leptin in the pathogenesis of severe illness and emphasizes the impact of complex metabolic alterations on the clinical outcome of critically ill patients.

Sign in / Sign up

Export Citation Format

Share Document