scholarly journals Pulmonary Artery Catheterization was not Associated with Survival Benefits in Critically Ill Patients with Cardiac Disease: An Analysis of the MIMIC-IV Database

2021 ◽  
Author(s):  
Jie Wu ◽  
Shiyu Zhou ◽  
Hongbin Hu ◽  
Yuan Zhang ◽  
Sheng An ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Critically Ill ◽  
Cardiac Disease ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Multivariate Regression ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Surgical Patients ◽  
Pulmonary Artery Catheterization

Abstract Background: It is not clear whether pulmonary artery catheter (PAC) placement is beneficial for critically ill patients with heart disease. This study aims to investigate the association of PAC use with 28-day mortality in that population.Methods: The MIMIC-IV database was employed to identify critically ill patients with cardiac disease with or without PAC insertion. The primary outcome was 28-day mortality. Multivariate regression was modeled to examine the association between PAC and outcomes. Additionally, we examined the effect modification by cardiac surgeries. Propensity score matching (PSM) was conducted to validate our findings.Results: No improvement in 28-day mortality was observed among the PAC group compared to the non-PAC group (odds ratio=1.18, 95% CI=1.00-1.38, P=0.049). When stratified by cardiac surgeries, the results were consistent. Patients in the PAC group had fewer ventilation-free days and vasopressor-free days than those in the non-PAC group after surgery stratification. In surgical patients, PAC insertion was not associated with the occurrence of acute kidney injury (AKI), and was associated with a higher daily fluid input (mean difference=0.13, 95% CI=0.05-0.20, P=0.001). In non-surgical patients, the PAC group had a higher risk of AKI occurrence (odds ratio=1.94, 95% CI=1.32-2.84, P=0.001).Conclusion: PAC placement was not associated with survival benefits in critically ill patients with cardiac diseases, either in surgical and non-surgical patients.

scholarly journals Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam, Cefepime, or Meropenem

2019 ◽  
Vol 63 (5) ◽  
Author(s):  
Adam M. Blevins ◽  
Jennifer N. Lashinsky ◽  
Craig McCammon ◽  
Marin Kollef ◽  
Scott Micek ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Kidney Injury ◽  
University Hospital ◽  
Increased Risk ◽  
Kdigo Guidelines

ABSTRACT Critically ill patients are frequently treated with empirical antibiotic therapy, including vancomycin and β-lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received a combination of vancomycin and piperacillin-tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies were conducted predominately in the non-critically ill population. A retrospective cohort study that included 2,492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rates of any AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, were 39.3% for VPT patients, 24.2% for VC patients, and 23.5% for VM patients (P < 0.0001 for both comparisons). Similarly, the incidences of stage 2 and stage 3 AKI were also significantly higher for VPT patients than for the patients in the other groups. The rates of stage 2 and stage 3 AKI, respectively, were 15% and 6.6% for VPT patients, 5.8% and 1.8% for VC patients, and 6.6% and 1.3% for VM patients (P < 0.0001 for both comparisons). In multivariate analysis, the use of vancomycin in combination with piperacillin-tazobactam was found to be an independent predictor of AKI (odds ratio [OR], 2.161; 95% confidence interval [CI], 1.620 to 2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI compared to critically ill patients receiving either VC or VM.

scholarly journals Fluctuations in Serum Chloride and Acute Kidney Injury among Critically Ill Patients: A Retrospective Association Study

2019 ◽  
Vol 8 (4) ◽  
pp. 447 ◽  
Author(s):  
Tak Kyu Oh ◽  
In-Ae Song ◽  
Young-Tae Jeon ◽  
You Hwan Jo
Keyword(s):  
Acute Kidney Injury ◽  
Confidence Interval ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Icu Admission ◽  
Serum Chloride ◽  
Increased Risk ◽  
The Difference

Exposure to dyschloremia among critically ill patients is associated with an increased risk of acute kidney injury (AKI). We aimed to investigate how fluctuations in serum chloride (Cl−) are associated with the development of AKI in critically ill patients. We retrospectively analyzed medical records of adult patients admitted to the intensive care unit (ICU) between January 2012 and December 2017. Positive and negative fluctuations in Cl− were defined as the difference between the baseline Cl- and maximum Cl- levels and the difference between the baseline Cl− and minimum Cl− levels measured within 72 h after ICU admission, respectively. In total, 19,707 patients were included. The odds of developing AKI increased 1.06-fold for every 1 mmol L−1 increase in the positive fluctuations in Cl− (odds ratio: 1.06; 95% confidence interval: 1.04 to 1.08; p < 0.001) and 1.04-fold for every 1 mmol L−1 increase in the negative fluctuations in Cl− (odds ratio: 1.04; 95% confidence interval: 1.02 to 1.06; p < 0.001). Increases in both the positive and negative fluctuations in Cl- after ICU admission were associated with an increased risk of AKI. Furthermore, these associations differed based on the functional status of the kidneys at ICU admission or postoperative ICU admission.

Early Use of the Pulmonary Artery Catheter and Outcomes in Patients with Shock and Acute Respiratory Distress Syndrome

2018 ◽  
pp. 55-59
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Control Group ◽  
Pulmonary Artery Catheterization ◽  
Catheter Group ◽  
Improved Outcomes ◽  
Pulmonary Artery Catheters ◽  
And Control

This case focuses on how pulmonary artery catheters are used in critically ill patients by asking the question: Do critically ill patients benefit from early insertion of a pulmonary artery catheter to help guide management? In critically ill patients, pulmonary artery catheterization did not lead to improved outcomes compared with standard care without catheterization. There were no significant differences in mortality between patients in the pulmonary artery catheter group and control group. There were also no significant differences between patients in the pulmonary artery catheter group and patients in the control group with respect to organ system failure or the need for mechanical ventilation, dialysis, or vasoactive medications. This trial, along with other trials of pulmonary artery catheterization, demonstrates the importance of evaluating widely used technologies that have never been adequately assessed.

Variation in Risk and Mortality of Acute Kidney Injury in Critically Ill Patients: A Multicenter Study

2015 ◽  
Vol 41 (1) ◽  
pp. 81-88 ◽  
Author(s):  
Nattachai Srisawat ◽  
Florentina E. Sileanu ◽  
Raghavan Murugan ◽  
Rinaldo Bellomo ◽  
Paolo Calzavacca ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Disease Incidence ◽  
Kidney Injury ◽  
Severity Of Illness ◽  
Process Of Care ◽  
Residual Confounding

Background: Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers. Methods: In this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality. Results: Of the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers. Conclusions: In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.

Pulmonary artery catheterization in critically ill patients

1994 ◽  
Vol 22 (4) ◽  
pp. 573-579 ◽  
Author(s):  
OLIVIER MIMOZ ◽  
ALAIN RAUSS ◽  
NOURREDINE REKIK ◽  
CHRISTIAN BRUN-BUISSON ◽  
FRANÇOIS LEMAIRE ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pulmonary Artery Catheterization
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