scholarly journals Descriptive study of differences in acute kidney injury progression patterns in General and Cardiac Intensive Care Units

2018 ◽  
Vol 20 (3) ◽  
pp. 216-222 ◽  
Author(s):  
Marcin A Pachucki ◽  
Erina Ghosh ◽  
Larry Eshelman ◽  
Krishnamoorthy Palanisamy ◽  
Timothy Gould ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Intensive Care Units ◽  
Kidney Injury ◽  
General Intensive Care Unit ◽  
Cardiac Intensive Care Unit ◽  
Acute Kidney Injury Stage ◽  
Cardiac Intensive Care

Background Acute kidney injury is common in critically ill patients with detrimental effects on mortality, length of stay and post-discharge outcomes. The Acute Kidney Injury Network developed guidelines based on urine output and serum creatinine to classify patients into stages of acute kidney injury. Methods In this analysis we utilize the Acute Kidney Injury Network guidelines to evaluate the acute kidney injury stage in patients admitted to general and cardiac intensive care units over a period of 18 months. Acute kidney injury stage was calculated in real time hourly based on the guidelines and using these temporal stage scores calculated for the population; the prevalence and progression of acute kidney injury stage was compared between the two units. We hypothesized that the prevalence and progression of acute kidney injury stage between the two units may be different. Results More cardiac intensive care unit patients had no acute kidney injury (stage <1) during their intensive care unit stay but more cardiac intensive care unit patients developed acute kidney injury (stage >1), compared to the General Intensive Care Unit. Both at intensive care unit admission and discharge, more General Intensive Care Unit patients had acute kidney injury; however, the number of cardiac intensive care unit patients with acute kidney injury was three times higher at discharge than admission. Acute kidney injury developed in a different pattern in the two intensive care units over five days of intensive care unit stay. In the General Intensive Care Unit, acute kidney injury was most prevalent on second day of intensive care unit stay and in cardiac intensive care unit acute kidney injury was most prevalent on the third day of intensive care unit stay. We observed the biggest increase in new acute kidney injury in the first day of General Intensive Care Unit and second day of the cardiac intensive care unit stay. Conclusions The study demonstrates the different trends of acute kidney injury pattern in general and cardiac intensive care unit patient populations highlighting the earlier development of acute kidney injury on General Intensive Care Unit and more prevalence of acute kidney injury on discharge from cardiac intensive care unit.

EPIDEMIOLOGY AND OUTCOMES OF ACUTE KIDNEY INJURY IN UNSELECTED CARDIAC INTENSIVE CARE UNIT PATIENTS

2020 ◽  
Vol 75 (11) ◽  
pp. 869
Author(s):  
Thomas Breen ◽  
Jacob Colin Jentzer ◽  
Mandeep S. Sidhu ◽  
Gregory W. Barsness ◽  
Kianoush Kashani
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Epidemiology and outcomes of acute kidney injury in cardiac intensive care unit patients

2020 ◽  
Vol 60 ◽  
pp. 127-134
Author(s):  
Jacob C. Jentzer ◽  
Thomas Breen ◽  
Mandeep Sidhu ◽  
Gregory W. Barsness ◽  
Kianoush Kashani
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Abstract 15752: Acute Kidney Injury and Shock Severity for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mitchell R Padkins ◽  
Thomas Breen ◽  
Gregory W Barsness ◽  
Kianoush Kashani ◽  
Jacob C Jentzer
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Kidney Injury ◽  
Cardiac Intensive Care Unit ◽  
Severe Stage ◽  
Cardiac Intensive Care ◽  
One Year

Introduction: Acute kidney injury (AKI) is a highly prevalent risk factor for mortality among patients with cardiogenic shock (CS). We sought to assess the incidence and prognostic relevance of AKI as a function of shock severity in unselected Cardiac Intensive Care Unit (CICU) patients, as measured by the Society for the Cardiovascular Angiography and Interventions (SCAI) shock stage. Methods: We retrospectively reviewed admissions to the Mayo Clinic from 2007 to 2015 and stratified patients by the SCAI shock stage. AKI was defined and staged based on changes in serum creatinine during hospitalization as per KDIGO guidelines. Predictors of in-hospital mortality were analyzed using Kaplan-Meier survival analysis, and one-year mortality was analyzed using Cox proportional-hazards analysis. Results: The final study population included 10,004 unique patients with a mean age of 67 years and 37% females. The percentage of patients with SCAI shock stages A, B, C, D, and E were 47%, 30%, 15%, 7%, and 1%, respectively. AKI of any severity occurred in 51% of patients during hospitalization, including severe (stage 2/3) AKI in 16%. The incidence of AKI and severe AKI increased with the SCAI shock stage. Hospital mortality occurred in 8% of patients and increased as a function of the AKI stage and SCAI shock stage. AKI was associated with increased hospital mortality after multivariable adjustment (adjusted OR per AKI stage 1.17, 95% CI 1.05-1.30, p=0.005). Twenty-one percent of patients died within one year of CICU admission, and worse AKI was associated with increased one-year mortality (adjusted HR per AKI stage 1.11, 95% CI 1.05-1.18, p=<0.001). Hospital survivors with AKI of any severity had higher mortality compared with patients who did not have AKI (p<0.001). Conclusions: AKI was increasingly common in CICU patients with higher shock severity. In-hospital and one-year mortality risk increased as a function of the severity of AKI and the SCAI shock stage. This analysis emphasizes the importance of AKI as a complication of shock and as a predictor of adverse outcomes in CICU patients.

Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

2007 ◽  
Vol 17 (S4) ◽  
pp. 116-126 ◽  
Author(s):  
Stacie B. Peddy ◽  
Mary Fran Hazinski ◽  
Peter C. Laussen ◽  
Ravi R. Thiagarajan ◽  
George M. Hoffman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Paediatric Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

scholarly journals Postoperative hypotension in patients discharged to the intensive care unit after non-cardiac surgery is associated with adverse clinical outcomes

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Nathan J. Smischney ◽  
Andrew D. Shaw ◽  
Wolf H. Stapelfeldt ◽  
Isabel J. Boero ◽  
Qinyu Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Kidney Injury ◽  
Intraoperative Hypotension ◽  
Cerebrovascular Events ◽  
Acute Kidney Injury Stage

Abstract Background The postoperative period is critical for a patient’s recovery, and postoperative hypotension, specifically, is associated with adverse clinical outcomes and significant harm to the patient. However, little is known about the association between postoperative hypotension in patients in the intensive care unit (ICU) after non-cardiac surgery, and morbidity and mortality, specifically among patients who did not experience intraoperative hypotension. The goal of this study was to assess the impact of postoperative hypotension at various absolute hemodynamic thresholds (≤ 75, ≤ 65 and ≤ 55 mmHg), in the absence of intraoperative hypotension (≤ 65 mmHg), on outcomes among patients in the ICU following non-cardiac surgery. Methods This multi-center retrospective cohort study included specific patient procedures from Optum® healthcare database for patients without intraoperative hypotension (MAP ≤ 65 mmHg) discharged to the ICU for ≥ 48 h after non-cardiac surgery with valid mean arterial pressure (MAP) readings. A total of 3185 procedures were included in the final cohort, and the association between postoperative hypotension and the primary outcome, 30-day major adverse cardiac or cerebrovascular events, was assessed. Secondary outcomes examined included all-cause 30- and 90-day mortality, 30-day acute myocardial infarction, 30-day acute ischemic stroke, 7-day acute kidney injury stage II/III and 7-day continuous renal replacement therapy/dialysis. Results Postoperative hypotension in the ICU was associated with an increased risk of 30-day major adverse cardiac or cerebrovascular events at MAP ≤ 65 mmHg (hazard ratio [HR] 1.52; 98.4% confidence interval [CI] 1.17–1.96) and ≤ 55 mmHg (HR 2.02, 98.4% CI 1.50–2.72). Mean arterial pressures of ≤ 65 mmHg and ≤ 55 mmHg were also associated with higher 30-day mortality (MAP ≤ 65 mmHg, [HR 1.56, 98.4% CI 1.22–2.00]; MAP ≤ 55 mmHg, [HR 1.97, 98.4% CI 1.48–2.60]) and 90-day mortality (MAP ≤ 65 mmHg, [HR 1.49, 98.4% CI 1.20–1.87]; MAP ≤ 55 mmHg, [HR 1.78, 98.4% CI 1.38–2.31]). Furthermore, we found an association between postoperative hypotension with MAP ≤ 55 mmHg and acute kidney injury stage II/III (HR 1.68, 98.4% CI 1.02–2.77). No associations were seen between postoperative hypotension and 30-day readmissions, 30-day acute myocardial infarction, 30-day acute ischemic stroke and 7-day continuous renal replacement therapy/dialysis for any MAP threshold. Conclusions Postoperative hypotension in critical care patients with MAP ≤ 65 mmHg is associated with adverse events even without experiencing intraoperative hypotension.

scholarly journals Acute Kidney Injury and Associated Factors in Intensive Care Units at a Tertiary Hospital in Northern Tanzania

2021 ◽  
Vol 8 ◽  
pp. 205435812110279
Author(s):  
Neema W. Minja ◽  
Huda Akrabi ◽  
Karen Yeates ◽  
Kajiru Gad Kilonzo
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Associated Factors ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Tertiary Hospital ◽  
Baseline Serum ◽  
Northern Tanzania ◽  
Acute Kidney Injury Stage

Background: Acute kidney injury (AKI) is a recognized complication in critically ill patients. The epidemiology of AKI varies worldwide, depending on the diagnostic criteria used and the setting. The International Society of Nephrology has called for a reduction in preventable deaths from AKI to zero by the year 2025. It is suspected that the majority of AKI cases are in limited-resource countries, but the true burden of AKI in these settings remains unknown. Objective: We aimed to determine, using standardized KDIGO (Kidney Disease Improving Global Outcomes) criteria, the prevalence of AKI, associated factors, and clinical characteristics of adult (≥18 years) patients admitted to intensive care units (ICUs) at a tertiary hospital in Tanzania. Design: Prospective observational study from November 2017 to May 2018. Methods: In all, 320 patients admitted to medical and surgical ICUs were consecutively enrolled. Baseline, clinical, and laboratory data were collected on admission and during their ICU stay. Serum creatinine and urine output were measured, and KDIGO criteria were used to determine AKI status. Results: More than half (55.3%) of ICU patients were diagnosed with AKI. Of these, 80% were diagnosed within 24 hours of admission. Acute kidney injury stage 3 accounted for 35% of patients with AKI. Patients with AKI were older, more likely to have cardiovascular comorbidities, and with higher baseline serum levels of creatinine, potassium, universal vital assessment admission scores, and total white cell count ≥12. Sepsis (odds ratio [OR] = 3.81; confidence interval [CI] = 1.21-11.99), diabetes (OR = 2.54; CI = 1.24-5.17), and use of vasopressors (OR = 3.78; CI = 1.36-10.54) were independently associated with AKI in multivariable logistic regression. Less than one-third of those who needed dialysis received it. There was 100% mortality in those who needed dialysis but did not receive (n = 19). Limitations: Being based at a referral center, the findings do not represent the true burden of AKI in the community. Conclusion: The prevalence of AKI was very high in ICUs in Northern Tanzania. The majority of patients presented with AKI and were severely ill, suggesting late presentation, underscoring the importance of prioritizing prevention and early intervention. Further studies should explore locally suitable AKI risk scores that could be used to identify high-risk patients in the community health centers from where patients are referred.

scholarly journals Establishing Pediatric Cardiac Intensive Care Unit in a Low Resource Setting: Bangladesh Perspective and Dhaka Shishu (Children) Hospital Paediatric Cardiac Intensive Care Unit Model

2017 ◽  
Vol 39 (3) ◽  
pp. 141-147 ◽  
Author(s):  
Manzoor Hussain ◽  
Mohammad Abdullah Al Mamun ◽  
Nurul Akhtar Hasan ◽  
Rezoana Rima ◽  
Abdul Jabbar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Disease ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Critically Ill Children ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Advances in technology and training in paediatric cardiology have improved longterm outcome and promised better quality of life. Bangladesh is facing multitude of health problems and congenital heart disease is one of them. With facilities for accurate diagnosis and scope of complete correction, more and more children are undergoing cardiac intervention and surgical treatment for congenital heart diseases. So there is increasing demand for dedicated personnel for the specialized intensive care of these critically ill children. A dedicated team dictating specialized intensive care has translated into better outcomes in several centers. Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill neonatal and paediatric patients with congenital and acquired heart disease worldwide. The majority of developed centers have dedicated paediatric cardiac intensive care units to care for paediatric cardiac patients. In developing countries with limited resources, pediatric cardiac intensive care is yet to take root as a distinctive discipline. Congenital heart surgery, together with transcatheter interventions, has resulted in marked improvement in cardiac care in Bangladesh. So, we need to establish more and more dedicated paediatric cardiac center and cardiac intensive care units to care for paediatric cardiac patients.Bangladesh J Child Health 2015; VOL 39 (3) :141-147

Role of Sildenafil in the Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) - Should it Be Withdrawn from Market of Bangladesh due to Threat of being Misuses

2020 ◽  
Vol 35 (2) ◽  
pp. 100-104
Author(s):  
Maksudur Rahman ◽  
Mohammad Abdullah Al Mamun ◽  
MAK Azad Chowdhury ◽  
Abu Sayeed Munsi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cardiac Intensive Care Unit ◽  
Cross Sectional ◽  
Cardiac Intensive Care ◽  
Hospital Protocol

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104

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