scholarly journals Optimal Role of the Nephrologist in the Intensive Care Unit

2016 ◽  
Vol 43 (1-3) ◽  
pp. 68-77 ◽  
Author(s):  
D.J. Askenazi ◽  
Michael Heung ◽  
Michael J. Connor Jr. ◽  
Rajit K. Basu ◽  
Jorge Cerdá ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Health Care Team ◽  
Quality Initiatives ◽  
Team Members ◽  
Delivery Of Care ◽  
Multi Disciplinary Team

As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU. Multidisciplinary programs to support these changes have been stablished in some hospitals to maximize the delivery of care, while other programs have continue to struggle in their ability to acquire the necessary resources to maximize outcomes, educate their staff, and develop quality initiatives to evaluate and drive improvements. Clearly, the role of the nephrologist in the ICU has evolved, and varies widely among institutions. This special article will provide insights that will hopefully optimize the role of the nephrologist as the leader of the acute care nephrology program, as clinician for critically ill patients, and as teacher for all members of the health care team.

scholarly journals Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients

2008 ◽  
Vol 126 (4) ◽  
pp. 215-219 ◽  
Author(s):  
Antonio Paulo Nassar Junior ◽  
Ruy Camargo Pires Neto ◽  
Walquiria Barcelos de Figueiredo ◽  
Marcelo Park
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Interrater Reliability ◽  
Weighted Kappa ◽  
Care Physician ◽  
University Hospital ◽  
Validity And Reliability ◽  
Sedation Scale ◽  
Team Members

CONTEXT AND OBJECTIVE: Sedation scales are used to guide sedation protocols in intensive care units (ICUs). However, no sedation scale in Portuguese has ever been evaluated. The aim of this study was to evaluate the validity and reliability of Portuguese translations of four sedation-agitation scales, among critically ill patients: Glasgow Coma Score, Ramsay, Richmond Agitation-Sedation Scale (RASS) and Sedation-Agitation Scale (SAS). DESIGN AND SETTING: Validation study in two mixed ICUs of a university hospital. METHODS: All scales were applied to 29 patients by four different critical care team members (nurse, physiotherapist, senior critical care physician and critical care resident). We tested each scale for interrater reliability and for validity, by correlations between them. Interrater agreement was measured using weighted kappa (k) and correlations used Spearman's test. RESULTS: 136 observations were made on 29 patients. All scales had at least substantial agreement (weighted k 0.68-0.90). RASS (weighted k 0.82-0.87) and SAS (weighted k 0.83-0.90) had the best agreement. All scales had a good and significant correlation with each other. CONCLUSIONS: All scales demonstrated good interrater reliability and were comparable. RASS and SAS showed the best correlations and the best agreement results in all professional categories. All these characteristics make RASS and SAS good scales for use at the bedside, to evaluate sedation-agitation among critically ill patients in terms of validity, reliability and applicability.

Recombinant Human Erythropoietin Use in Intensive Care

2002 ◽  
Vol 36 (6) ◽  
pp. 1068-1074 ◽  
Author(s):  
Martin Darveau ◽  
Éric Notebaert ◽  
André Y Denault ◽  
Sylvain Bélisle
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Recombinant Human Erythropoietin ◽  
Cochrane Library ◽  
Optimal Dosage ◽  
Human Erythropoietin ◽  
The Impact

OBJECTIVE: To review the literature concerning the role of recombinant human erythropoietin (rHuEPO) in reducing the need for transfusion in critically ill patients. DATA SOURCES: Articles were obtained through searches of the MEDLINE database (from 1990 to June 2001) using the key words erythropoietin, epoetin alfa, anemia, reticulocytes, hemoglobin, critical care, intensive care, critical illness, and blood transfusion. Additional references were found in the bibliographies of the articles cited. The Cochrane library was also consulted. STUDY SELECTION AND DATA EXTRACTION: Controlled, prospective, and randomized studies on the use of rHuEPO in critically ill adults were selected. DATA SYNTHESIS: Anemia is a common complication in patients requiring intensive care. It is caused, in part, by abnormally low concentrations of endogenous erythropoietin and is mainly seen in patients with sepsis and multiple organ dysfunction syndrome, in whom inflammation mediator concentrations are often elevated. High doses of rHuEPO produce a rapid response in these patients, despite elevated cytokine concentrations. There have been 3 studies on rHuEPO administration in intensive care and 1 trial in acutely burned patients. Only 2 of these studies looked at the impact of rHuEPO administration on the need for transfusion. CONCLUSIONS: Few randomized, controlled trials explore the role of rHuEPO in critical care. Only 1 was a large, randomized clinical trial, but it presents many limitations. Future outcome and safety studies comparing rHuEPO with placebo must include clinical endpoints such as end-organ morbidity, mortality, transfusion criteria, and pharmacoeconomic analysis. rHuEPO appears to provide an erythropoietic response. Optimal dosage and the real impact of rHuEPO on the need for transfusion in intensive care remain to be determined. Currently, based on the evidence available from the literature, rHuEPO cannot be recommended to reduce the need for red blood cell transfusions in anemic, critically ill patients.

scholarly journals The effect of opioids on gastrointestinal function in the ICU

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Yun Yan ◽  
Yu Chen ◽  
Xijing Zhang
Keyword(s):  
Critical Care ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Potential Risk ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Gastrointestinal Function ◽  
Opioid Antagonists

AbstractGastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.

scholarly journals Survey of U.S. Critical Care Practitioners on Net Ultrafiltration Prescription and Practice Among Critically Ill Patients Receiving Kidney Replacement Therapy

2021 ◽  
Vol 7 (4) ◽  
pp. 272-282
Author(s):  
Huiwen Chen ◽  
Raghavan Murugan
Keyword(s):  
Critical Care ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Advanced Practice ◽  
Fluid Removal ◽  
Kidney Replacement Therapy ◽  
The U.S

Abstract Introduction The current prescription and practice of net ultrafiltration among critically ill patients receiving kidney replacement therapy in the U.S. are unclear. Aim of the study To assess the attitudes of U.S. critical care practitioners on net ultrafiltration (UFNET) prescription and practice among critically ill patients with acute kidney injury treated with kidney replacement therapy. Methods A secondary analysis was conducted of a multinational survey of intensivists, nephrologists, advanced practice providers, and ICU and dialysis nurses practising in the U.S. Results Of 1,569 respondents, 465 (29.6%) practitioners were from the U.S. Mainly were nurses and advanced practice providers (58%) and intensivists (38.2%). The median duration of practice was 8.7 (IQR, 4.2-19.4) years. Practitioners reported using continuous kidney replacement therapy (as the first modality in 60% (IQR 20%-90%) for UFNET. It was found that there was a significant variation in assessment of prescribed-to-delivered dose of UFNET, use of continuous kidney replacement therapy for UFNET, methods used to achieve UFNET, and assessment of net fluid balance during continuous kidney replacement therapy. There was also variation in interventions performed for managing hemodynamic instability, perceived barriers to UFNET, belief that early and protocol-based fluid removal is beneficial, and willingness to enroll patients in a clinical trial. Conclusions There was considerable practice variation in UFNET among critical care practitioners in the U.S., reflecting the need to generate evidence-based practice guidelines for UFNET.

scholarly journals Renal Resistive Index as a Predictor of Acute Kidney Injury and Mortality in COVID-19 Critically Ill Patients

2021 ◽  
pp. 1-8
Author(s):  
Edgar Garcia Cruz ◽  
Blanca Estela Broca Garcia ◽  
Daniel Manzur Sandoval ◽  
Rodrigo Gopar-Nieto ◽  
Francisco Javier Gonzalez Ruiz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Model ◽  
Resistive Index ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Renal Resistive Index ◽  
Bedside Method

<b><i>Background:</i></b> Acute kidney injury (AKI) in patients with COVID-19 can be caused by multiple mechanisms. Renal resistive index (RRI) is a noninvasive instrument to evaluate kidney hemodynamics, and it is obtained by analysis of intrarenal arterial waves using Doppler ultrasound. This study aimed to determine the role of RRI in predicting AKI and adverse outcomes in critically ill patients with COVID-19. <b><i>Methods:</i></b> This cross-sectional study included 65 patients with confirmed SARS-CoV-2 pneumonia admitted to the critical care unit from April 1, 2020, to June 20, 2020. Informed consent was obtained from all individual participants included in the study. Cardiac, pulmonary, and kidney ultrasonographic evaluations were performed in a protocolized way. <b><i>Results:</i></b> In this cohort, 65 patients were included, mean age was 53.4 years, 79% were male, and 35% were diabetic. Thirty-four percent of patients developed AKI, 12% required RRT, and 35% died. Of the patients who developed AKI, 68% had RRI ≥ 0.7. Also, 75% of the patients who required RRT had RRI ≥ 0.7. In the adjusted Cox model, the RRI ≥ 0.7 was associated with higher mortality (HR 2.86, 95% CI: 1.19–6.82, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> Critical care ultrasonography is a noninvasive, reproducible, and accurate bedside method that has proven its usefulness. An elevated RRI may have a role in predicting AKI, RRT initiation, and mortality in patients with severe SARS-CoV-2 pneumonia.

scholarly journals LPS removal reduces CD80-mediated albuminuria in critically ill patients with Gram-negative sepsis

2019 ◽  
Vol 316 (4) ◽  
pp. F723-F731 ◽  
Author(s):  
Giuseppe Stefano Netti ◽  
Fabio Sangregorio ◽  
Federica Spadaccino ◽  
Francesco Staffieri ◽  
Antonio Crovace ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Swine Model ◽  
Gram Negative ◽  
Reactive Protein ◽  
Increased Risk ◽  
Plasma Filtration ◽  
Set Up

LPS-induced sepsis is a leading cause of acute kidney injury (AKI) in critically ill patients. LPS may induce CD80 expression in podocytes with subsequent onset of proteinuria, a risk factor for progressive chronic kidney disease (CKD) frequently observed after AKI. This study aimed to investigate the therapeutic efficacy of LPS removal in decreasing albuminuria through the reduction of podocyte CD80 expression. Between January 2015 and December 2017, 70 consecutive patients with Gram-negative sepsis-induced AKI were randomized to either have coupled plasma filtration and adsorption (CPFA) added to the standard care ( n = 35) or not ( n = 35). To elucidate the possible relationship between LPS-induced renal damage, proteinuria, and CD80 expression in Gram sepsis, a swine model of LPS-induced AKI was set up. Three hours after LPS infusion, animals were treated or not with CPFA for 6 h. Treatment with CPFA significantly reduced serum cytokines, C-reactive protein, procalcitonin, and endotoxin levels in patients with Gram-negative sepsis-induced AKI. CPFA significantly lowered also proteinuria and CD80 urinary excretion. In the swine model of LPS-induced AKI, CD80 glomerular expression, which was undetectable in control pigs, was markedly increased at the podocyte level in LPS-exposed animals. CPFA significantly reduced LPS-induced proteinuria and podocyte CD80 expression in septic pigs. Our data indicate that LPS induces albuminuria via podocyte expression of CD80 and suggest a possible role of timely LPS removal in preventing the maladaptive repair of the podocytes and the consequent increased risk of CKD in sepsis-induced AKI.

scholarly journals Prediction models for acute kidney injury in critically ill patients: a protocol for systematic review and critical appraisal

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046274
Author(s):  
Danqiong Wang ◽  
Weiwen Zhang ◽  
Jian Luo ◽  
Honglong Fang ◽  
Shanshan Jing ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Appraisal ◽  
Prediction Models ◽  
External Validation ◽  
Kidney Injury ◽  
Risk Of Bias

IntroductionAcute kidney injury (AKI) has high morbidity and mortality in intensive care units, which can lead to chronic kidney disease, more costs and longer hospital stay. Early identification of AKI is crucial for clinical intervention. Although various risk prediction models have been developed to identify AKI, the overall predictive performance varies widely across studies. Owing to the different disease scenarios and the small number of externally validated cohorts in different prediction models, the stability and applicability of these models for AKI in critically ill patients are controversial. Moreover, there are no current risk-classification tools that are standardised for prediction of AKI in critically ill patients. The purpose of this systematic review is to map and assess prediction models for AKI in critically ill patients based on a comprehensive literature review.Methods and analysisA systematic review with meta-analysis is designed and will be conducted according to the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). Three databases including PubMed, Cochrane Library and EMBASE from inception through October 2020 will be searched to identify all studies describing development and/or external validation of original multivariable models for predicting AKI in critically ill patients. Random-effects meta-analyses for external validation studies will be performed to estimate the performance of each model. The restricted maximum likelihood estimation and the Hartung-Knapp-Sidik-Jonkman method under a random-effects model will be applied to estimate the summary C statistic and 95% CI. 95% prediction interval integrating the heterogeneity will also be calculated to pool C-statistics to predict a possible range of C-statistics of future validation studies. Two investigators will extract data independently using the CHARMS checklist. Study quality or risk of bias will be assessed using the Prediction Model Risk of Bias Assessment Tool.Ethics and disseminationEthical approval and patient informed consent are not required because all information will be abstracted from published literatures. We plan to share our results with clinicians and publish them in a general or critical care medicine peer-reviewed journal. We also plan to present our results at critical care international conferences.OSF registration number10.17605/OSF.IO/X25AT.

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