scholarly journals Selection and Receipt of Kidney Replacement in Critically Ill Older Patients with AKI

2019 ◽  
Vol 14 (4) ◽  
pp. 496-505 ◽  
Author(s):  
Sean M. Bagshaw ◽  
Neill K.J. Adhikari ◽  
Karen E.A. Burns ◽  
Jan O. Friedrich ◽  
Josée Bouchard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Older Patients ◽  
Patient Specific ◽  
Clinical Frailty Scale ◽  
Related Quality ◽  
Kidney Replacement Therapy ◽  
Charlson Comorbidity Score

Background and objectivesOlder patients in the intensive care unit are at greater risk of AKI; however, use of kidney replacement therapy in this population is poorly characterized. We describe the triggers and outcomes associated with kidney replacement therapy in older patients with AKI in the intensive care unit.Design, setting, participants, & measurementsOur study was a prospective cohort study in 16 Canadian hospitals from September 2013 to November 2015. Patients were ≥65 years old, were critically ill, and had severe AKI; exclusion criteria were urgent kidney replacement therapy for a toxin and ESKD. We recorded triggers for kidney replacement therapy (primary exposure), reasons for not receiving kidney replacement therapy, 90-day mortality (primary outcome), and kidney recovery.ResultsOf 499 patients, mean (SD) age was 75 (7) years old, Charlson comorbidity score was 3.0 (2.3), and median (interquartile range) Clinical Frailty Scale score was 4 (3–5). Most were receiving mechanical ventilation (64%; n=319) and vasoactive support (63%; n=314). Clinicians were willing to offer kidney replacement therapy to 361 (72%) patients, and 229 (46%) received kidney replacement therapy. Main triggers for kidney replacement therapy were oligoanuria, fluid overload, and acidemia, whereas main reasons for not receiving therapy were anticipated recovery (67%; n=181) and therapy not consistent with patient preferences for care (24%; n=66). Ninety-day mortality was similar in patients who did and did not receive kidney replacement therapy (50% versus 51%; adjusted hazard ratio, 0.78; 95% confidence interval, 0.58 to 1.06); however, decisions to offer kidney replacement therapy varied significantly by patient mix, acuity, and perceived benefit. There were no differences in health-related quality of life or rehospitalization among survivors.ConclusionsMost older, critically ill patients with severe AKI were perceived as candidates for kidney replacement therapy, and approximately one half received therapy. Both willingness to offer kidney replacement therapy and reasons for not starting showed heterogeneity due to a range in patient-specific factors and clinician perceptions of benefit.

scholarly journals Retrospective frailty determination in critical illness from a review of the intensive care unit clinical record

2019 ◽  
Vol 47 (4) ◽  
pp. 343-348 ◽  
Author(s):  
Jai N Darvall ◽  
Tristan Boonstra ◽  
Jen Norman ◽  
Donal Murphy ◽  
Michael Bailey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Scale Score ◽  
Clinical Record ◽  
Next Of Kin ◽  
Clinical Frailty Scale ◽  
Rater Reliability ◽  
Charlson Comorbidity Score ◽  
Future Work

Frailty is one of the major challenges for intensive care, affecting one-third of intensive care unit patients and being associated with a range of poor health outcomes. Determination of frailty in critical illness using the Clinical Frailty Scale has recently been adopted by the Australian and New Zealand Intensive Care Society, but it is not known whether this is able to be measured from the clinical record without interviewing patients or their relatives. The aims of this retrospective cohort study were to test whether a Clinical Frailty Scale score could be assigned in an intensive care unit population from the clinical record, and to assess the inter-rater reliability of frailty measured in this manner. A total of 144 patients were enrolled. Of these, 137 (95%) were able to have a Clinical Frailty Scale score assigned, and 22 (15%) were scored as frail (Clinical Frailty Scale ≥5). Cohen’s kappa coefficient for inter-rater reliability between assessors was 0.67, confirming substantial agreement. Consistent with other critically ill cohorts, frailty was associated on multivariate analysis with age, Charlson comorbidity score, dependence with activities of daily living, and limitation of medical treatment, indicating validity of this approach to frailty measurement. Our results imply that frailty measurement is possible and feasible from the intensive care unit clinical record, which is of importance as routine measurement and reporting of frailty in intensive care units in our region increases. Future work should seek to validate an assigned Clinical Frailty Scale score with that obtained directly from patients or their next of kin.

scholarly journals Pharmacokinetics of Levofloxacin and Ciprofloxacin during Continuous Renal Replacement Therapy in Critically Ill Patients

2001 ◽  
Vol 45 (10) ◽  
pp. 2949-2954 ◽  
Author(s):  
Rebecca S. Malone ◽  
Douglas N. Fish ◽  
Edward Abraham ◽  
Isaac Teitelbaum
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Effective Drug ◽  
Continuous Venovenous Hemofiltration ◽  
Drug Concentrations

ABSTRACT The pharmacokinetics of intravenously administered levofloxacin and ciprofloxacin were studied in intensive care unit patients during continuous venovenous hemofiltration (CVVH; four patients received levofloxacin, and five received ciprofloxacin) or hemodiafiltration (CVVHDF; six patients received levofloxacin, and five received ciprofloxacin). Levofloxacin clearance was substantially increased during both CVVH and CVVHDF, while ciprofloxacin clearance was affected less. The results of this study suggest that doses of levofloxacin of 250 mg/day and ciprofloxacin of 400 mg/day are sufficient to maintain effective drug concentrations in the plasma of patients undergoing CVVH or CVVHDF.

Effect of timing of renal replacement therapy on outcomes of critically ill patients in the intensive care unit

Nephrology ◽  
2018 ◽  
Vol 23 (5) ◽  
pp. 405-410 ◽  
Author(s):  
Yanli Jia ◽  
Li Jiang ◽  
Ying Wen ◽  
Meiping Wang ◽  
Xiuming Xi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Safety of Bedside Placement of Tunneled Hemodialysis Catheters in the Intensive Care Unit: Translating from the COVID-19 Experience

2021 ◽  
Vol 10 (24) ◽  
pp. 5766
Author(s):  
Mohammad Ahsan Sohail ◽  
Tarik Hanane ◽  
James Lane ◽  
Tushar J. Vachharajani
Keyword(s):  
Intensive Care Unit ◽  
Blood Flow ◽  
Intensive Care ◽  
Replacement Therapy ◽  
Case Series ◽  
Central Venous Catheters ◽  
Fluoroscopic Guidance ◽  
Central Venous ◽  
Anatomic Landmarks ◽  
Kidney Replacement Therapy

Background: Critically ill patients with coronavirus disease 2019 (COVID-19) and kidney dysfunction often require tunneled hemodialysis catheter (TDC) placement for kidney replacement therapy, typically under fluoroscopic guidance to minimize catheter-related complications. This entails transportation of patients outside the intensive care unit to a fluoroscopy suite, which may potentially expose many healthcare providers to COVID-19. One potential strategy to mitigate the risk of viral transmission is to insert TDCs at the bedside, using ultrasound and anatomic landmarks only, without fluoroscopic guidance. Methods: We reviewed all COVID-19 patients in the intensive care unit who underwent right internal jugular TDC insertion at the bedside between April and December 2020. Outcomes included catheter placement-related complications such as post-procedural bleeding, air embolism, dysrhythmias, pneumothorax/hemothorax, and catheter tip malposition. TDC insertion was considered successful if the catheter was able to achieve blood flow sufficient to perform either a single intermittent or 24 h of continuous hemodialysis treatment. Results: We report a retrospective, single-center case series of 25 patients with COVID-19 who had right internal jugular TDCs placed at the bedside, 10 of whom underwent simultaneous insertion of small-bore right internal jugular tunneled central venous catheters for infusion. Continuous veno-venous hemodialysis was utilized for kidney replacement therapy in all patients, and a median catheter blood flow rate of 200 mL/min (IQR: 200–200) was achieved without any deviation from the dialysis prescription. No catheter insertion-related complications were observed, and none of the catheter tips were malpositioned. Conclusions: Bedside right internal jugular TDC placement in COVID-19 patients, using ultrasound and anatomic landmarks without fluoroscopic guidance, may potentially reduce the risk of COVID-19 transmission among healthcare workers without compromising patient safety or catheter function. Concomitant insertion of tunneled central venous catheters in the right internal jugular vein for infusion may also be safely accomplished and further help limit personnel exposure to COVID-19.

scholarly journals Clinical Characteristics and 30-Day Outcomes of Intermittent Hemodialysis for Acute Kidney Injury in an African Intensive Care Unit

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Arthur Kwizera ◽  
Janat Tumukunde ◽  
Lameck Ssemogerere ◽  
Emmanuel Ayebale ◽  
Peter Agaba ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Low Income ◽  
Clinical Characteristics ◽  
Kidney Injury ◽  
Intermittent Hemodialysis

Introduction. Acute kidney injury (AKI) is a common occurrence in the intensive care unit (ICU). Studies have looked at outcomes of renal replacement therapy using intermittent haemodialysis (IHD) in ICUs with varying results. Little is known about the outcomes of using IHD in resource-limited settings where continuous renal replacement therapy (CRRT) is limited. We sought to determine outcomes of IHD among critically ill patients admitted to a low-income country ICU.Methods. A retrospective review of patient records was conducted. Patients admitted to the ICU who underwent IHD for AKI were included in the study. Patients’ demographic and clinical characteristics, cause of AKI, laboratory parameters, haemodialysis characteristics, and survival were interpreted and analyzed. Primary outcome was mortality.Results. Of 62 patients, 40 had complete records. Median age of patients was 38.5 years. Etiologic diagnoses associated with AKI included sepsis, malaria, and ARDS. Mortality was 52.5%. APACHE II (OR 4.550; 95% CI 1.2–17.5,p=0.028), mechanical ventilation (OR 13.063; 95% CI 2.3–72,p=0.003), and need for vasopressors (OR 16.8; 95% CI 3.4–82.6,p=0.001) had statistically significant association with mortality.Conclusion. IHD may be a feasible alternative for RRT in critically ill haemodynamically stable patients in low resource settings where CRRT may not be available.

scholarly journals Clinical characteristics and outcome of critically ill COVID-19 patients with Acute Kidney Injury: A single centre cohort study

2020 ◽  
Author(s):  
Richard Lowe ◽  
Matteo Ferrari ◽  
Myra Nasim-Mohi ◽  
Alexander Jackson ◽  
Ryan Meacham ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Ventilatory Support ◽  
Kidney Injury ◽  
Hospital Length Of Stay

Abstract BackgroundAcute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes.MethodsWe reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 3rd March 2020 until 10th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 15th of June 2020.ResultsA total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 9 days. The mortality was 25% for the AKI group compared to 7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in 92% of patients. Conclusion Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay.

scholarly journals FEASIBILITY OF AN INTENSIVE CONTROL INSULIN-NUTRITION GLUCOSE MODEL ‘ICING’ WITH MALAYSIAN CRITICALLY-ILL PATIENT

2016 ◽  
Vol 8 (2) ◽  
pp. 40
Author(s):  
Normy Norfiza Abdul Razak ◽  
Nurhamim Ahamad ◽  
Fatanah Suhaimi ◽  
Ummu Jamaluddin ◽  
Azrina M. Ralib
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Metabolic Model ◽  
Model Fit ◽  
Patient Specific ◽  
Critically Ill Patient ◽  
Near Future ◽  
Fitting Error ◽  
Promising Avenue

<p class="lead">A clinically verified patient-specific glucose-insulin metabolic model known as ICING is used to account for time-varying insulin sensitivity. ICING was developed and validated from critically-ill patients with various medical conditions in the intensive care unit in Christchurch Hospital, New Zealand. Hence, it is interesting and vital to analyse the compatibility of the model once fitted to Malaysian critically-ill data. Results were assessed in terms of percentage of model-fit error, both by cohort and per-patient analysis. The ICING model accomplished median fitting error of&lt;1% over data from 63 patients. Most importantly, the median per-patients is at a low fitting error of 0.34% and per cohort is 0.35%. These results provide a promising avenue for near future simulations of developing tight glycaemic control protocol in the Malaysian intensive care unit.</p>

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