Acetylcysteine did not reduce kidney injury in at-risk patients having vascular angiography

2012 ◽  
Vol 156 (2) ◽  
pp. JC1
Author(s):  
Mohammad G. Saklayen
Keyword(s):  
At Risk ◽  
Kidney Injury ◽  
Vascular Angiography ◽  
Risk Patients

scholarly journals Renal protection in cardiovascular surgery

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 331 ◽  
Author(s):  
Nora Di Tomasso ◽  
Fabrizio Monaco ◽  
Giovanni Landoni
Keyword(s):  
At Risk ◽  
Renal Damage ◽  
Scientific Evidence ◽  
Fluid Management ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Major Surgery ◽  
Renal Protection ◽  
Patients At Risk ◽  
Risk Patients

Acute kidney injury (AKI) is one of the most relevant complications after major surgery and is a predictor of mortality. In Western countries, patients at risk of developing AKI are mainly those undergoing cardiovascular surgical procedures. In this category of patients, AKI depends on a multifactorial etiology, including low ejection fraction, use of contrast media, hemodynamic instability, cardiopulmonary bypass, and bleeding. Despite a growing body of literature, the treatment of renal failure remains mainly supportive (e.g. hemodynamic stability, fluid management, and avoidance of further damage); therefore, the management of patients at risk of AKI should aim at prevention of renal damage. Thus, the present narrative review analyzes the pathophysiology underlying AKI (specifically in high-risk patients), the preoperative risk factors that predispose to renal damage, early biomarkers related to AKI, and the strategies employed for perioperative renal protection. The most recent scientific evidence has been considered, and whenever conflicting data were encountered possible suggestions are provided.

scholarly journals 992 Short Term Effectiveness of Interventions Aimed at Preventing Post-Operative Acute Kidney Injury (AKI) In Patients Undergoing Elective Lower Limb Arthroplasty

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
V Jaitley ◽  
E Phoenix
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Lower Limb ◽  
Kidney Injury ◽  
Nice Guidelines ◽  
Improve Compliance ◽  
Patients At Risk ◽  
Risk Patients ◽  
Nephrotoxic Drugs

Abstract Introduction Acute kidney injury (AKI) is a potentially avoidable complication in patients undergoing elective lower limb arthroplasty. The National Institute for Health and Care Excellence (NICE) offers guidelines to identity and manage AKI. This is a closed loop audit aiming to assess i) adherence to NICE guidelines and ii) whether simple interventions will improve compliance. Method We closed the loop on a departmental audit carried out in 2017. NICE guidelines were applied to stratify patients at risk of post-operative AKI. High risk patients included those on nephrotoxic drugs and with pre-existing co-morbidities. We then applied the AKIN criteria to identify post-operative AKI. We presented this data at our departmental trauma meeting. Following this we implemented the following interventions i) poster & ii) aid memoir on patient admission proformas to identity those at risk. Results In 2017, post-operative AKI incidence was found to be 11.7%. Following intervention, in 2019 the incidence was 10% at 1 month and 5% at 7 months. Additionally, 80% of AKIs were identified on day 1 post-arthroplasty, compared to only 30% in 2017. Conclusions This audit showed that simple interventions reduced the incidence of post-operative AKI. Moving forward, we plan to assess long term effectiveness including the effect of junior doctor rotations.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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