scholarly journals Técnicas continuas de depuración extrarrenal. ¿Precoces o tardías? ¿Cuál es el momento idóneo para su inicio?

2020 ◽  
Vol 12 (4) ◽  
pp. 1
Author(s):  
Alvaro San Antonio Gil ◽  
JL Hermoso Martínez ◽  
JM Redondo Enríquez ◽  
MP Martín González-Haba
Keyword(s):  
Septic Shock ◽  
Late Onset ◽  
Kidney Injury ◽  
Study Groups ◽  
Critical Care Units ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies ◽  
The Impact ◽  
Late Group ◽  
The Ideal

El desarrollo de insuficiencia renal aguda (IRA) constituye una problemática frecuente en las unidades de cuidados críticos (UCI), concretamente en las subpoblaciones ingresadas con diagnóstico de sepsis o shock séptico. En la literatura, las indicaciones de aplicación de TCRR están claras (tanto de origen renal como extrarrenal). Sin embargo, no parece claro en ningún estudio publicado previamente el momento ideal del inicio de dichas técnicas, ni la repercusión que esto tiene en la morbimortalidad. El objetivo de este ensayo clínico es analizar si existen diferencias en la mortalidad entre 2 grupos de pacientes con lesión renal aguda y shock séptico, según el inicio precoz o tardío de las TCRR. Es abierto (no hay enmascaramiento), pudiendo caer en sesgo de medición durante la medición de los datos. Los grupos de estudio fueron homogéneos, con aleatorización al azar. Sin embargo, no especifican el tipo de modalidad de TCRR utilizada. El tamaño muestral calculado inicialmente según la potencia conferida al estudio no fue alcanzado finalmente. Las mediciones fueron objetivas. Sin embargo, no aclaran por qué designan como precoz al inicio de las TCRR en las primeras 12 horas desde el desarrollo de LRA y tardío a 48 horas después. Resultados: No hay diferencias de mortalidad a los 90 días (P=0.38, no significativo). Sin embargo, en el grupo tardío un 38% no recibieron TCRR, y 17 % lo recibieron precozmente. El grupo tardío presentó de forma significativa menos días con TCRR. No hubo diferencias en días de ventilación mecánica, vasopresores ni estancia en UCI. ABSTRACT Continuous renal-replacement therapies (CRRT). Early or late? What is the ideal time to start? The development of acute kidney injury (AKI) is a frequent problem in critical care units (ICUs), specifically in subpopulations admitted with a diagnosis of sepsis or septic shock. In the literature, the indications for the application of CRRT are clear (both of renal and extrarenal origin). However, it seems unclear in any previously published study the ideal time of the beginning of these techniques, nor the impact this has on morbidity and mortality. The objective of this clinical trial is to analyze whether there are differences in mortality between 2 patients groups with AKI and septic shock, depending on the early or late onset of CRRT. It is open (no masking), and may fall into measurement bias during the measurement of the data. The study groups were homogeneous and randomized. However, they do not specify the type of CRRT mode used. The sample size initially calculated according to the power conferred on the study was not finally reached. The measurements were objective. Nonetheless, they do not clarify why they designate the early CRRT as early in the first 12 hours after the development of AKI and late 48 hours later. Results: There are no mortality differences at 90 days (P = 0.38, not significant). It seems that in the late group 38% did not receive CRRT, and 17% received it early. The late group presented significantly fewer days with CRRT. There were no differences in days of mechanical ventilation, vasopressors or ICU stay.  

scholarly journals Changes in hemodynamics, renal blood flow and urine output during continuous renal replacement therapies

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
S. N. Fernández ◽  
M. J. Santiago ◽  
R. González ◽  
J. López ◽  
M. J. Solana ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Index ◽  
Renal Blood Flow ◽  
Urine Output ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies ◽  
The Impact

AbstractContinuous renal replacement therapies (CRRT) affect hemodynamics and urine output. Some theories suggest a reduced renal blood flow as the cause of the decreased urine output, but the exact mechanisms remain unclear. A prospective experimental study was carried out in 32 piglets (2–3 months old) in order to compare the impact of CRRT on hemodynamics, renal perfusion, urine output and renal function in healthy animals and in those with non-oliguric acute kidney injury (AKI). CRRT was started according to our clinical protocol, with an initial blood flow of 20 ml/min, with 10 ml/min increases every minute until a goal flow of 5 ml/kg/min. Heart rate, blood pressure, central venous pressure, cardiac output, renal blood flow and urine output were registered at baseline and during the first 6 h of CRRT. Blood and urine samples were drawn at baseline and after 2 and 6 h of therapy. Blood pressure, cardiac index and urine output significantly decreased after starting CRRT in all piglets. Renal blood flow, however, steadily increased throughout the study. Cisplatin piglets had lower cardiac index, higher vascular resistance, lower renal blood flow and lower urine output than control piglets. Plasma levels of ADH and urine levels of aquaporin-2 were lower, whereas kidney injury biomarkers were higher in the cisplatin group of piglets. According to our findings, a reduced renal blood flow doesn’t seem to be the cause of the decrease in urine output after starting CRRT.

Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

2021 ◽  
Author(s):  
Mariana Chumbita ◽  
Pedro Puerta-Alcalde ◽  
Carlota Gudiol ◽  
Nicole Garcia-Pouton ◽  
Júlia Laporte-Amargós ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Kidney Injury ◽  
Bloodstream Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Prospective Cohorts ◽  
Independent Risk Factors ◽  
The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

scholarly journals Sepsis Code: dodging mortality in a tertiary hospital

2021 ◽  
Author(s):  
Rosa Méndez ◽  
Angels Figuerola ◽  
Marta Chicot ◽  
Ana Barrios ◽  
Natalia Pascual ◽  
...  
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Health Personnel ◽  
Analytical Study ◽  
Statistical Significance ◽  
Tertiary Hospital ◽  
Critical Care Units ◽  
Multidisciplinary Group ◽  
Sepsis And Septic Shock ◽  
The Impact

Background. In the hospital of La Princesa, the “Sepsis Code” (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. Material and methods. A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. Results. We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines. Conclusions. The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis.

scholarly journals Intensity of Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock: A Systematic Review and Meta-Analysis

2011 ◽  
Vol 39 (3) ◽  
pp. 373-383 ◽  
Author(s):  
J. Latour-Pérez ◽  
E. Palencia-Herrejón ◽  
V. Gómez-Tello ◽  
A. Baeza-Román ◽  
M. á. García-García ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Meta Analysis ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies ◽  
Sepsis And Septic Shock

International Survey on the Management of Acute Kidney Injury and Continuous Renal Replacement Therapies: Year 2018

2018 ◽  
Vol 47 (1-3) ◽  
pp. 113-119 ◽  
Author(s):  
Kumar Digvijay ◽  
Mauro Neri ◽  
Weixuan Fan ◽  
Zaccaria Ricci ◽  
Claudio Ronco
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Cost Benefit ◽  
Fundamental Aspect ◽  
Daily Routine ◽  
Clinical Approach ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies ◽  
Heparin Anticoagulation ◽  
Novel Biomarkers

Introduction: Definition, prevention, and management of acute kidney injury (AKI) and the optimal prescription and delivery of renal replacement therapy (RRT) are currently matters of ongoing discussion. Due to the lack of definitive published literature, a wide gap might exist between routine clinical practice and available recommendations. The aim of this survey was to explore the clinical approach to AKI and RRT in a broad population of nephrologists and intensivists participating in the 36th International course on AKI and Continuous RRT (CRRT), held in Vicenza in June 2018. The responses of the 369 participants to a questionnaire on several aspects of critical care nephrology were analyzed and detailed. Results: Approximately 450 participants attended the course; of these, 369 (82%) correctly filled the survey forms. According to the reported answers, the average incidence of AKI in respondents’ intensive care units (ICU) was 26.8% (SD ±15.99) and AKI requiring dialysis was 13% (SD ±29.7). Sixty-four percent of participants defined AKI as an increase in serum creatinine (SCr) up to 0.99 mg/dL (SD ±0.88 mg/dL); 2.4% defined AKI as an increase in urea nitrogen up to 83.6 mg/dL (SD ±36.6 mg/dL); 33.6% defined AKI as decreased urine output to less than 1 mL/kg/h (SD ±0.6 mL/kg/h). The most common answer to classify AKI was Kidney Disease: Improving Global Outcomes (KDIGO; 41%) criteria. Most of the participants (25%) think novel biomarkers should replace SCr on daily routine laboratory screening, and Cystatin C was the most commonly used biomarker (19%). The use of diuretics in AKI patients was high (62%). Continuous RRT (59%) and heparin anticoagulation (42%) appeared to be the most common approaches in ICU. Conclusions: KDIGO appeared to be widely applied. The use of novel biomarkers has also emerged in recent years even if some consistent cost-benefit evidence is still lacking. There is a trend of increased awareness about AKI and extracorporeal treatments seem to be increasingly applied, when compared to previous surveys. Educational efforts and AKI management standardization still appear to be a fundamental aspect to harmonize therapeutic approaches and improve patients’ outcomes.

scholarly journals Timing of continuous renal replacement therapies in acute kidney injury patients after cardiac surgery

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
P Cardenas Campos ◽  
J Sabater Riera ◽  
G Moreno Gonzalez ◽  
VF Corral Velez ◽  
JM Vazquez Reveron ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies
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