RELATIONSHIP OF CREATININE CLEARANCE, URINE OUTPUT, AND FLUID BALANCE AND SURVIVAL IN CRITICALLY ILL PATIENTS

Abstract Introduction: Elevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%. Aim: The aim of this study was to observe if a link between increased intraabdominal pressure and modification in renal function exists (NGAL, creatinine clearance). Material and Method: The study enrolled 30 critically ill patients admitted in the Intensive Care Unit of SCJU Tîrgu Mures between November 2015 and August 2016. The study enrolled adult, hemodynamically stable patients admitted in intensive critical care - defined by a normal blood pressure maintained without any vasopressor or inotropic support, invasive monitoring using PICCO device and abdominal pressure monitoring. Results: The patients were divided into two groups based on the intraabdominal pressure values: normal intraabdominal pressure group= 52 values and increased intraabdominal group= 35 values. We compared the groups in the light of NGAL values, 24 hours diuresis, GFR and creatinine clearance. The groups are significantly different when compared in the light of NGAL values and GFR values. We obtained a statistically significant correlation between NGAL value and 24 hour diuresis. No other significant correlations were encountered between the studied items. Conclusions: NGAL values are increased in patients with high intraabdominal pressure which may suggest its utility as a cut off marker for patients with increased intraabdominal pressure. There is a significant decreased GFR in patient with elevated intraabdominal pressure, observation which can help in early detection of renal injury in patients due to high intraabdominal pressure. No correlation was found between creatinine clearance and increased intraabdominal pressure.

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Relationship of energy and protein adequacy with 60-day mortality in mechanically ventilated critically ill patients: A prospective observational study

Clinical Nutrition ◽

10.1016/j.clnu.2017.05.013 ◽

2018 ◽

Vol 37 (4) ◽

pp. 1264-1270 ◽

Cited By ~ 16

Author(s):

Zheng-Yii Lee ◽

Ibrahim Noor Airini ◽

Mohd-Yusof Barakatun-Nisak

Keyword(s):

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Mechanically Ventilated ◽

Relationship Of

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Association Between Urine Output and Mortality in Critically Ill Patients

Critical Care Medicine ◽

10.1097/ccm.0000000000005310 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Aaron J. Heffernan ◽

Stephanie Judge ◽

Stephen M. Petrie ◽

Rakshitha Godahewa ◽

Christoph Bergmeir ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Urine Output

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Influence of Mechanical Ventilation on the Pharmacokinetics of Vancomycin Administered by Continuous Infusion in Critically Ill Patients

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01249-17 ◽

2017 ◽

Vol 61 (12) ◽

Cited By ~ 9

Author(s):

Susanna Edith Medellín-Garibay ◽

Silvia Romano-Moreno ◽

Pilar Tejedor-Prado ◽

Noelia Rubio-Álvaro ◽

Aida Rueda-Naharro ◽

...

Keyword(s):

Mechanical Ventilation ◽

Creatinine Clearance ◽

Continuous Infusion ◽

Critically Ill ◽

Critically Ill Patients ◽

Population Pharmacokinetic Model ◽

Pharmacokinetic Model ◽

Volume Of Distribution ◽

Stochastic Simulations ◽

Population Pharmacokinetic

ABSTRACT Pathophysiological changes involved in drug disposition in critically ill patients should be considered in order to optimize the dosing of vancomycin administered by continuous infusion, and certain strategies must be applied to reach therapeutic targets on the first day of treatment. The aim of this study was to develop a population pharmacokinetic model of vancomycin to determine clinical covariates, including mechanical ventilation, that influence the wide variability of this antimicrobial. Plasma vancomycin concentrations from 54 critically ill patients were analyzed simultaneously by a population pharmacokinetic approach. A nomogram for dosing recommendations was developed and was internally evaluated through stochastic simulations. The plasma vancomycin concentration-versus-time data were best described by a one-compartment open model with exponential interindividual variability associated with vancomycin clearance and the volume of distribution. Residual error followed a homoscedastic trend. Creatinine clearance and body weight significantly dropped the objective function value, showing their influence on vancomycin clearance and the volume of distribution, respectively. Characterization based on the presence of mechanical ventilation demonstrated a 20% decrease in vancomycin clearance. External validation (n = 18) was performed to evaluate the predictive ability of the model; median bias and precision values were 0.7 mg/liter (95% confidence interval [CI], −0.4, 1.7) and 5.9 mg/liter (95% CI, 5.4, 6.4), respectively. A population pharmacokinetic model was developed for the administration of vancomycin by continuous infusion to critically ill patients, demonstrating the influence of creatinine clearance and mechanical ventilation on vancomycin clearance, as well as the implications for targeting dosing rates to reach the therapeutic range (20 to 30 mg/liter).

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Mid-regional pro-adrenomedullin (MR-proADM), a marker of positive fluid balance in critically ill patients: results of the ENVOL study

Critical Care ◽

10.1186/s13054-016-1540-x ◽

2016 ◽

Vol 20 (1) ◽

Cited By ~ 8

Author(s):

Bernard Vigué ◽

Pierre-Etienne Leblanc ◽

Frédérique Moati ◽

Eric Pussard ◽

Hussam Foufa ◽

...

Keyword(s):

Critically Ill ◽

Fluid Balance ◽

Critically Ill Patients ◽

Positive Fluid Balance

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Relation between fluid balance and incidence of morbidity and mortality rates in critically ill patients prospective observational study

QJM ◽

10.1093/qjmed/hcaa039.002 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M G A Gerges ◽

H M M Elazzazi ◽

M H S A Elsersi ◽

S A R Mustafa ◽

M A Saeed

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Critically Ill ◽

Fluid Balance ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Mortality Rates ◽

Morbidity And Mortality ◽

University Hospitals ◽

Cumulative Fluid Balance

Abstract Background While administration of fluid can be lifesaving, it has been suggested that the fluid accumulation after initial resuscitation and hemodynamic stabilization can contribute to potentially avoidable adverse effects and less favorable outcomes. Objective The aim of this study is to assess whether positive fluid balance in comparison with negative or even fluid balance is associated with increased morbidity and mortality rates in critically ill patients. Patients and Methods This prospective observational study was performed on 145 Patients older than 18 years admitted to intensive care units at Helwan university hospitals and Ain shams university hospitals during the period from November 2017 till May 2018. Results A total of 145 patients with an ICU mortality rate of 14.5% were enrolled. The median cumulative fluid balance of the 124 patients who survive was -110 ml (IQR -2.1-2.2 L) after the fourth day following randomization while the median cumulative fluid balance of the 21 patients who not survive was 3800 ml (IQR 1.7-5.2 L) after the fourth day in ICU. In our study critically ill patients with fluid balance more than 1.2 litres per day had higher ICU complications: increased risk of AKI, longer ICU and hospital stays, and mechanical ventilation, and fluid balance was independently associated with mortality. Conclusion In the view of this study, we concluded that:Zero fluid balance and negative fluid balance independently associated with decrease mortality and morbidity rates in critically ill patients after 4 days from admission in ICU.There was higher cumulative fluid balance in non survivors compared to survivors. Cumulative fluid balance after 4 days from admission was independently predictive of mortality in a heterogeneous group of critically ill patients.96 hour negative fluid balance in critically ill patients was associated with less length of stay at ICU and less mechanical ventilation duration.Positive fluid balance, mechanical ventilation, vasopressors, and high admission SAPS II, SOFA, APACHE II and KIDGO were significantly associated with high mortality.

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