scholarly journals A multicenter comparison of dialysis membranes in the treatment of acute renal failure requiring dialysis.

1998 ◽  
Vol 9 (2) ◽  
pp. 257-266
Author(s):  
J Himmelfarb ◽  
N Tolkoff Rubin ◽  
P Chandran ◽  
R A Parker ◽  
R L Wingard ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Complement Activation ◽  
Severity Of Illness ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Dialysis Membrane ◽  
Significant Difference ◽  
Initiation Of Dialysis ◽  
Discharge From Hospital

The mortality of patients with acute renal failure (ARF) remains high, and in several large studies approaches 60%. This mortality is particularly high in patients with ARF who require dialysis and has not changed substantially over several years, despite the introduction of major advances in monitoring and treatment. Increasing prevalence of comorbidities has been suggested as the major factor in this persistently high mortality. This study investigates the potential role of the dialysis membrane on patient outcome in a prospective multicenter study of 153 patients with ARF requiring dialysis. The membrane assignment was made in alternating order and was limited to membranes with low complement activation (Biocompatible [BCM]) and cellulosic, high complement activation (Bioincompatible [BICM]). Both types of membranes were low-flux membranes. Patients were dialyzed with the assigned membrane until recovery, discharge from hospital, or death. The severity of illness of each patient was assessed using the APACHE II score at the time of initiation of dialysis. A logistic regression analysis was used to adjust for the APACHE II score. The results of the study showed a statistically significant difference in survival (57% in patients on BCM, 46% in patients on BICM; P = 0.03) and in recovery of renal function (64% in patients on BICM and 43% in patients on BICM; P = 0.001). These differences were particularly marked in the patients who were nonoliguric (>400 ml/d of urine output) at initiation of the study. In the subset of patients who were nonoliguric at the start of dialysis, a larger fraction (70%) became oliguric after initiating dialysis on a BICM membrane, in contrast to 44% who were initiated on a BCM membrane (P = 0.03). It is concluded that the biocompatibility of the dialysis membrane plays a role in the outcome of patients with ARF, particularly those who are nonoliguric at the time of initiation of dialysis.

Risk Factors to Predict Renal Failure and Death in the Medical Intensive Care Unit

1996 ◽  
Vol 11 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Laurie A. Ward ◽  
George N. Coritsidis ◽  
Christos P. Carvounis
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Failure Group ◽  
Medical Intensive Care ◽  
Normal Albumin

The ability to predict outcomes based on admission criteria has important implications, both prognostically and for assessing interventions on comparable groups. Use of severity of disease scoring systems such as the APACHE II score for predicting mortality has become widespread. There is no comparable formula for acute renal failure. We prospectively evaluated 115 consecutive admissions to the medical intensive care unit to define risk for renal failure from admission data and to assess the impact of admission hypoalbuminemia levels on outcome. Diagnosis, age, serum creatinine and albumin levels, urinary electrolyte concentrations and osmolality, daily serum creatinine levels, and urine output were recorded. Admission APACHE II score was calculated. Admission hypoalbuminemia (57% of patients) was associated with both acute renal failure and death (odds ratios, 16.19 and 8.06, respectively). The Glasgow coma score distinguished between patients in whom acute renal failure developed and in those it did not. Low urine osmolality (<400 mOsm/kg) was the most significant factor in predicting mortality (odds ratio, 9.87). Mortality was lowest in the normal albumin group (2%), intermediate in the low albumin/no renal failure group (12%), and highest in the low albumin/acute renal failure group (53%). The APACHE II score was accurate in 3 of 14 deaths in the hypoalbuminemic population and in the one normal albumin patient who died. We conclude that at admission, hypoalbuminemia, urinary hypo-osmolality, and abnormal creatinine levels are predictive of acute renal failure and death, diagnosis, and mental status impact on the risk for acute renal failure. APACHE II lacks predictive value in hypoalbuminemic patients.

scholarly journals Evaluation of Acute Renal Failure After Acinetobacter Baumannii-based Ventilator-associated Event: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Fatih Turan AYILGAN ◽  
Mehmet Salih SEVDI ◽  
Serdar DEMIRGAN ◽  
Funda GUMUS OZCAN ◽  
Kerem ERKALP ◽  
...  
Keyword(s):  
Septic Shock ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Acinetobacter Baumannii ◽  
Clinical Response ◽  
Total Duration ◽  
Response To Therapy ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Bacterial Eradication

Abstract Background: Ventilator-associated event (VAE) is the major complication caused mechanical ventilation (MV). We aimed to evaluate whether acute renal failure (ARF) has developed in patients who had been followed-up due to diagnosis of VAE with Acinetobacter baumannii (AcB), and whether renal replacement therapy (RRT) was used, and its relationship with mortality in patients who developed colistin during their treatment.Methods: Retrospective evaluation of the hospital electronic information system records of 2,622 patients were conducted in three years. Patients who had AcB-related VAE and underwent parental colistin treatment were evaluated according to age, gender, diagnosis for intensive care unit (ICU) administration, Acute Physiology and Chronic Health Evaluation (APACHE) II score, colistin dose and treatment duration, requirement for additional antibiotics, total time required for MV, total duration of ICU stay, presence of septic shock, requirement for percutaneous dilatation tracheostomy (PDT), ARF staging according to Kidney Disease Improving Global Outcomes criteria, requirement for RRT and mortality.Results: Total number of VAE cases was 85 (3.19%). AcB-related VAE was detected in 28 patients (32.9%). Bacterial eradication was achieved in 14 patients (50%), clinical response was received in 14 patients (50%), mean colistin dose was 298.2±85.5 mg/day, mean duration of colistin treatment was 14.3±8.6 days. ARF was detected as Stage-I in eight patients (28.6%), Stage-II in four (14.3%) and Stage-III in eight patients (28.6%). There was no difference between patients in need of RRT and those who did not, in terms of age, gender and body mass index. APACHE II score, bacterial eradication, presence of septic shock, clinical response to therapy, daily dose of colistin, duration of colistin treatment, MV duration, PDT requirement and time were similar in groups receiving RRT or not.Conclusion: Colistin treatment of AcB-related VAE caused ARF in 71.5% of the patients and led to serious conditions in 25% of patients requiring RRT.

scholarly journals Comparison of outcomes of high-flow nasal cannula and noninvasive positive-pressure ventilation in patients with hypoxemia and various APACHE II scores after extubation

2021 ◽  
Vol 15 ◽  
pp. 175346662110042
Author(s):  
Xiaoke Shang ◽  
Yanggan Wang
Keyword(s):  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Abdominal Distension ◽  
Apache Ii ◽  
Positive Pressure ◽  
Apache Ii Score ◽  
Subgroup Ii ◽  
Significant Difference ◽  
Group A ◽  
Group B

Aims: The study aimed to compare and analyze the outcomes of high-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NPPV) in the treatment of patients with acute hypoxemic respiratory failure (AHRF) who had extubation after weaning from mechanical ventilation. Methods: A total 120 patients with AHRF were enrolled into this study. These patients underwent tracheal intubation and mechanical ventilation. They were organized into two groups according to the score of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II); group A: APACHE II score <12; group B: 12⩽ APACHE II score <24. Group A had 72 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (36 patients in each subgroup). Group B had 48 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (24 patients in each subgroup). General information, respiratory parameters, endpoint event, and comorbidities of adverse effect were compared and analyzed between the two subgroups. Results: The incidence of abdominal distension was significantly higher in patients treated with NPPV than in those treated with HFNC in group A (19.44% versus 0, p = 0.005) and group B (25% versus 0, p = 0.009). There was no significant difference between the HFNC- and NPPV-treated patients in blood pH, oxygenation index, partial pressure of carbon dioxide, respiratory rate, and blood lactic acid concentration in either group ( p > 0.05). Occurrence rate of re-intubation within 72 h of extubation was slightly, but not significantly, higher in NPPV-treated patients ( p > 0.05). Conclusion: There was no significant difference between HFNC and NPPV in preventing respiratory failure in patients with AHRF with an APACHE II score <24 after extubation. However, HFNC was superior to NPPV with less incidence of abdominal distension. The reviews of this paper are available via the supplemental material section.

Oral Health Status and Development of Ventilator-Associated Pneumonia: A Descriptive Study

2006 ◽  
Vol 15 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Cindy L. Munro ◽  
Mary Jo Grap ◽  
R.K. Elswick ◽  
Jessica McKinney ◽  
Curtis N. Sessler ◽  
...  
Keyword(s):  
Health Status ◽  
Oral Health ◽  
Dental Plaque ◽  
Severity Of Illness ◽  
Oral Health Status ◽  
Microbial Colonization ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Ventilator Associated Pneumonia ◽  
Time Correlations

• Background Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health. • Objective To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea. • Methods A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4. • ResultsDental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P &lt; .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P&lt;.001), and interaction of day 1 CPIS and plaque (P=.01). • Conclusions Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.

Biocompatible dialysis membrane in acute renal failure: The best choice

1996 ◽  
Vol 22 (8) ◽  
pp. 833-834 ◽  
Author(s):  
F. Brivet ◽  
P. Loirat ◽  
D. Kleinknecht ◽  
P. Landais ◽  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Dialysis Membrane

scholarly journals Assessment of Outcome over a 10-year Period of Patients Admitted to a Multidisciplinary Adult Intensive Care Unit with Haematological and Solid Tumours

2005 ◽  
Vol 33 (1) ◽  
pp. 26-35 ◽  
Author(s):  
J. L. Moran ◽  
P. J. Solomon ◽  
P. J. Williams
Keyword(s):  
Mechanical Ventilation ◽  
Cox Model ◽  
Severity Of Illness ◽  
Cohort Effect ◽  
Solid Tumours ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Over Time

The risk factors for time to mortality, censored at 30 days, of patients admitted to an adult teaching hospital ICU with haematological and solid malignancies were assessed in a retrospective cohort study. Patients, demographics and daily ICU patient data, from admission to day 8, were identified from a prospective computerized database and casenote review in consecutive admissions to ICU with haematological and solid tumours over a 10-year period (1989–99). The cohort, 108 ICU admissions in 89 patients was of mean age (±SD) 55±14 years; 43% were female. Patient diagnoses were leukaemia (35%), lymphoma (38%) and solid tumours (27%). Median time from hospital to ICU admission was five days (range 0–67). On ICU admission, 50% had septic shock and first day APACHE II score was 28±9. Forty-six per cent of patients were ventilated. ICU and 30-day mortality were 39% and 54% respectively. Multivariate Cox model predictors (P<0.05), using only ICU admission day data were: Charlson comorbidity index (CCI), time to ICU admission (days) and mechanical ventilation. For daily data (admission through day 8), predictors were: cohort effect (2nd vs 1st five-year period); CCI; time to ICU admission (days); APACHE II score and mechanical ventilation. Outcomes were considered appropriate for severity of illness and demonstrated improvement over time. Ventilation was an independent outcome determinant. Controlling for other factors, mortality has improved over time (1st vs 2nd five year period). Analysis restricted to admission data alone may be insensitive to particular covariate effects.

Protective Effect of Prostaglandin [PGE2] in Glycerol-Induced Acute Renal Failure in Rats

1978 ◽  
Vol 55 (5) ◽  
pp. 505-507 ◽  
Author(s):  
R. Werb ◽  
W. F. Clark ◽  
R. M. Lindsay ◽  
E. O. P. Jones ◽  
D. I. Turnbull ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Prostaglandin E2 ◽  
Serum Creatinine Concentration ◽  
Sprague Dawley ◽  
Glomerular Permeability ◽  
Creatinine Concentration ◽  
Significant Difference ◽  
Group B

1. Acute renal failure was induced in female Sprague—Dawley rats by the subcutaneous injection of glycerol. 2. Four groups of rats were studied; all animals received a glycerol challenge. Group A (control) were sham-operated only, group B received an infusion of sodium chloride solution (150 mmol/l; saline) for 24 h, group C received an infusion containing prostaglandin E2 (PGE2, 1.7 μmol/l) in saline and group D a solution containing PGE2 (3.4 μmol/l) in saline. 3. All rats were killed 48 h after glycerol challenge. The degree of renal impairment was assessed by serum creatinine concentration, which did not differ in sham-operated animals and the group receiving saline alone. The group of rats receiving the lower dose of PGE2 has a significantly lower mean serum creatinine concentration than the saline-infused control rats (P < 0.0025). Creatinine concentration was further lowered by the higher dose of PGE2 but there was not a significant difference in the number of rats showing severe tubular necrosis histologically. 4. The study demonstrates that intravenous infusion of prostaglandin E2 has a protective influence on glycerol-induced renal failure in the rat; the protection afforded may be due to the vasodilator effect of PGE2 and/or an effect on glomerular permeability.

Dialysis Membrane and Modality in Acute Renal Failure: Understanding Discordant Meta-Analyses

2003 ◽  
Vol 16 (5) ◽  
pp. 356-360 ◽  
Author(s):  
Geoffrey S. Teehan ◽  
Orfeas Liangos ◽  
Joseph Lau ◽  
Andrew S. Levey ◽  
Brian J. G. Pereira ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Dialysis Membrane ◽  
Meta Analyses
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