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V Schwenger, D Kindgen-Milles, C Willam, A Jörres, W Druml, D Czock, S J Klein, M Oppert, M Schmitz, J T Kielstein, A Zarbock, M Joannidis, S John
BACKGROUND: Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients. The incidence of AKI in ICU patients exceeds 50% and the associated morbidity and mortality rates increase with severity of AKI. In addition, long-term consequences of AKI are underestimated and several studies show impaired long-term outcome after AKI. In about 5-25% of ICU patients with AKI renal replacement therapy (RRT) is required. OBJECTIVES: To assist in indication, timing, modality and application of renal replacement therapy of adult patients, current recommendations from the renal sections of the DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) and DIVI (Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin) are stated...
March 15, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Sebastian J Klein, Anna K Brandtner, Georg F Lehner, Hanno Ulmer, Sean M Bagshaw, Christian J Wiedermann, Michael Joannidis
PURPOSE: Acute kidney injury (AKI) frequently occurs in critically ill patients and often precipitates use of renal replacement therapy (RRT). However, the ideal circumstances for whether and when to start RRT remain unclear. We performed evidence synthesis of the available literature to evaluate the value of biomarkers to predict receipt of RRT for AKI. METHODS: We conducted a PRISMA-guided systematic review and meta-analysis including all trials evaluating biomarker performance for prediction of RRT in AKI...
March 14, 2018: Intensive Care Medicine
Muhammad Yousaf, Sheher Bano, Muhammad Attaur-Rehman, Chaudhary Muhammad Junaid Nazar, Aayesha Qadeer, Salma Khudaidad, Syed Waqar Hussain
Objective To compare hospital-wide code rates and mortality before and after the implementation of a rapid response team (RRT). Study design A prospective cohort design with historical controls. Place of study This study was conducted at Shifa International Hospital, Islamabad, from January 21, 2016, to January 20, 2017. Materials and methods The triggers for the rapid response team (RRT) were displayed on each floor. The in-house staff was trained on when and how to activate the rapid response team (RRT). Data were collected on a specified data collection form...
January 9, 2018: Curēus
Lindsay L Juriga, David J Murray, John R Boulet, James J Fehr
BACKGROUND: Simulation is frequently used to recreate many of the crises encountered in patient care settings. Teams learn to manage these crises in an environment that maximizes their learning experiences and eliminates the potential for patient harm. By designing simulation scenarios that include conditions associated with diagnostic errors, teams can experience how their decisions can lead to errors. The purpose of this study was to assess how trauma teams (TrT) and pediatric rapid response teams (RRT) managed scenarios that included a diagnostic error...
November 27, 2017: Diagnosis
Shannon M Fernando, Peter M Reardon, Sean M Bagshaw, Damon C Scales, Kyle Murphy, Jennifer Shen, Peter Tanuseputro, Daren K Heyland, Kwadwo Kyeremanteng
BACKGROUND: Rapid Response Teams (RRTs) are groups of healthcare providers that are used by many hospitals to respond to acutely deteriorating patients admitted to the wards. We sought to identify outcomes of patients assessed by RRTs outside standard working hours. METHODS: We used a prospectively collected registry from two hospitals within a single tertiary care-level hospital system between May 1, 2012, and May 31, 2016. Patient information, outcomes, and RRT activation information were stored in the hospital data warehouse...
March 14, 2018: Critical Care: the Official Journal of the Critical Care Forum
Nilgun Çakar, Z Birsin Ozcakar, Fatih Ozaltin, Mustafa Koyun, Banu Celikel Acar, Elif Bahat, Bora Gulhan, Emine Korkmaz, Ayşe Yurt, Songül Yılmaz, Oğuz Soylemezoglu, Fatoş Yalcinkaya
BACKGROUND: There are limited data on infants with atypical hemolytic uremic syndrome (aHUS). The aim of this study was to determine the clinical and laboratory features, and to evaluate treatment modalities and outcomes in infants with aHUS. MATERIALS AND METHODS: Relevant data on patients with onset of aHUS at age <2 years were obtained from the Turkish Pediatric aHUS Registry. RESULTS: Among the 146 patients included in the Registry, 53 (36%) (23 male and 30 female) were enrolled for the study...
March 13, 2018: Nephron
Joonas Tirkkonen, Heini Huhtala, Sanna Hoppu
AIM: Study the incidence and reasons behind in-hospital cardiac arrests (IHCAs) after rapid response team (RRT) reviews. METHODS: We conducted a matched case-control study at Tampere University Hospital, Finland. Data on adult patients who were triaged to remain on general ward after first (index) RRT review without treatment limitations but who suffered an IHCA within the following 48 hours were prospectively collected for 5.3 years. These cases were matched (age +/- 3 years, sex, surgical/medical ward, admission year) at a 1:4 ratio to controls (no ICHA after RRT review)...
March 6, 2018: Resuscitation
David E Leaf, Edward D Siew, Michele F Eisenga, Karandeep Singh, Finnian R Mc Causland, Anand Srivastava, T Alp Ikizler, Lorraine B Ware, Adit A Ginde, John A Kellum, Paul M Palevsky, Myles Wolf, Sushrut S Waikar
BACKGROUND AND OBJECTIVES: Dysregulated mineral metabolism is a common and potentially maladaptive feature of critical illness, especially in patients with AKI, but its association with death has not been comprehensively investigated. We sought to determine whether elevated plasma levels of the osteocyte-derived, vitamin D-regulating hormone, fibroblast growth factor 23 (FGF23), are prospectively associated with death in critically ill patients with AKI requiring RRT, and in a general cohort of critically ill patients with and without AKI...
March 8, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Yaowalak Panyasing, Roongtham Kedkovid, Roongroje Thanawongnuwech, Apisit Kittawornrat, Ju Ji, Luis Giménez-Lirola, Jeffrey Zimmerman
Early recognition and rapid elimination of infected animals is key to controlling incursions of classical swine fever virus (CSFV). In this study, the diagnostic characteristics of 10 CSFV assays were evaluated using individual serum (n = 601) and/or oral fluid (n = 1417) samples collected from -14 to 28 days post inoculation (DPI). Serum samples were assayed by virus isolation (VI), 2 commercial antigen-capture enzyme-linked immunosorbent assays (ELISA), virus neutralization (VN), and 3 antibody ELISAs...
March 2018: Veterinary Microbiology
Tessa L Walters, T Edward Kim, Edward R Mariano, Geoffrey Kenton Lighthall
BACKGROUND: The Perioperative Surgical Home (PSH) is an anesthesiologist-led, coordinated care model that may improve patient experience and safety. We hypothesized that PSH will decrease activation of the rapid response system for surgical inpatients. METHODS: This retrospective study was performed at an academic Veterans Affairs hospital with a PSH. Data from both medical and surgical cohorts admitted to a single ward were analyzed for the Pre-PSH (July 2006 to October 2010) and Post-PSH (November 2011 to May 2015) epochs...
March 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
James A Tumlin, Raghavan Murugan, Adam M Deane, Marlies Ostermann, Laurence W Busse, Kealy R Ham, Kianoush Kashani, Harold M Szerlip, John R Prowle, Azra Bihorac, Kevin W Finkel, Alexander Zarbock, Lui G Forni, Shannan J Lynch, Jeff Jensen, Stew Kroll, Lakhmir S Chawla, George F Tidmarsh, Rinaldo Bellomo
OBJECTIVE: Acute kidney injury requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of angiotensin II on the outcomes of acute kidney injury requiring renal replacement therapy. DESIGN: Post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial...
March 3, 2018: Critical Care Medicine
Ryan K Shields, M Hong Nguyen, Liang Chen, Ellen G Press, Barry N Kreiswirth, Cornelius J Clancy
Ceftazidime-avibactam was used to treat 77 patients with carbapenem-resistant Enterobacteriaceae (CRE) infections at our center. Thirty- and 90-day survival rates were 81% and 69%, respectively; rates were higher than predicted by SAPS II and SOFA scores at the onset of infection. Clinical success was achieved in 55% of patients, but varied by site of infection. Success rates were lowest for pneumonia (36%) and higher for bacteremia (75%) and urinary tract infections (88%). By multivariate analysis, pneumonia ( P =0...
March 5, 2018: Antimicrobial Agents and Chemotherapy
Sarah Seiler-Mussler, Anne S Limbach, Insa E Emrich, John W Pickering, Heinz J Roth, Danilo Fliser, Gunnar H Heine
BACKGROUND AND OBJECTIVES: In patients with CKD, elevated plasma parathyroid hormone (PTH) levels are associated with greater cardiovascular morbidity and mortality. However, the reference method for PTH measurement is disputed. It has been argued that measurement of nonoxidized PTH better reflects biologically active PTH than measurements with conventional assays. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: PTH and nonoxidized PTH levels were measured at study baseline in 535 patients with CKD with an eGFR range between 89 and 15 ml/min per 1...
March 5, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Johannes Fauser, Georgios Sakas, Anirban Mukhopadhyay
PURPOSE: Interventions at the otobasis operate in the narrow region of the temporal bone where several highly sensitive organs define obstacles with minimal clearance for surgical instruments. Nonlinear trajectories for potential minimally invasive interventions can provide larger distances to risk structures and optimized orientations of surgical instruments, thus improving clinical outcomes when compared to existing linear approaches. In this paper, we present fast and accurate planning methods for such nonlinear access paths...
March 3, 2018: International Journal of Computer Assisted Radiology and Surgery
W A C Kristine Koekkoek, C H Coralien van Setten, Laura E Olthof, J C N Hans Kars, Arthur R H van Zanten
BACKGROUND & AIMS: Optimal protein intake during critical illness is unknown. Conflicting results on nutritional support during the first week of ICU stay have been published. We addressed timing of protein intake and outcomes in ICU patients requiring prolonged mechanical ventilation. METHODS: We retrospectively collected nutritional and clinical data on the first 7 days of ICU admission of adult critically ill patients, who were mechanically ventilated in our ICU for at least 7 days and admitted between January 1st 2011 and December 31st 2015...
February 17, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Fatma Zehra Oztek-Celebi, Sare Gulfem Ozlu, Ozlem Aydog
BACKGROUND: Acute kidney injury (AKI) is an important clinical condition which is associated with increased mortality and morbidity. This study was performed to identify the factors that influence AKI stage, undergoing renal replacement therapy (RRT) and mortality. METHODS: This study was retrospectively conducted on 219 children with AKI who had been referred to paediatric nephrology division of Dr. Sami Ulus Teaching Hospital during their inpatient treatment from 2008 to 2012...
February 27, 2018: Nephrology
Ryan W Haines, Shih-Pin Lin, Russell Hewson, Christopher J Kirwan, Hew D Torrance, Michael J O'Dwyer, Anita West, Karim Brohi, Rupert M Pearse, Parjam Zolfaghari, John R Prowle
Acute Kidney Injury (AKI) complicating major trauma is associated with increased mortality and morbidity. Traumatic AKI has specific risk factors and predictable time-course facilitating diagnostic modelling. In a single centre, retrospective observational study we developed risk prediction models for AKI after trauma based on data around intensive care admission. Models predicting AKI were developed using data from 830 patients, using data reduction followed by logistic regression, and were independently validated in a further 564 patients...
February 26, 2018: Scientific Reports
Fabienne Aregger, Dominik E Uehlinger, Gerhard Fusch, Aldin Bahonjic, Rene Pschowski, Michael Walter, Joerg C Schefold
BACKGROUND: Acute kidney injury (AKI) is often observed in critically ill patients and is associated with high morbidity and mortality. Non-recovery from AKI has a negative impact on the prognosis of affected patients and early risk stratification seems key to improve clinical outcomes. We analyzed metabolites of a conserved key inflammatory pathway (i.e. tryptophan degradation pathway) in serial urine samples of patients with AKI. METHODS: One hundred twelve ICU patients with AKI were included in a prospective observational analysis...
February 26, 2018: BMC Nephrology
Ana Isabel Morales García, Margarita Martínez Atienza, María García Valverde, Juan Fontes Jimenez, Antonio Martínez Morcillo, M Angustias Esteban de la Rosa, Pablo de Diego Fernández, Miguel García González, Rafael Fernández Castillo, Irene Argüelles Toledo, Juan Antonio Bravo Soto, Rafael Esteban de la Rosa
INTRODUCTION: Although autosomal dominant polycystic kidney disease is the most common hereditary kidney disease, available data tend to be limited to after initiation of renal replacement therapy. OBJECTIVE: To ascertain an overview of autosomal dominant polycystic kidney disease within the health area of Granada in southern Spain. MATERIAL AND METHODS: From January 2007 to December 2016, we collected clinical, family and demographic information about all patients with autosomal dominant polycystic kidney disease, irrespective of whether or not they were treated with RRT, in the Granada health area...
March 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Dieter Adelmann, Andrea Olmos, Linda L Liu, John R Feiner, Garrett R Roll, Lyle Burdine, Mehdi Tavakol, Shareef Syed, Babak J Orandi, Claus U Niemann
BACKGROUND: Renal failure is common among patients undergoing liver transplantation. Liver allocation based on the MELD score has increased the number of recipients who require perioperative RRT. Although renal replacement therapy (RRT) can be continued intraoperatively, the risks and benefits of intraoperative RRT are not well defined. The aim of this study is to report the intraoperative management of patients with pretransplant renal failure at a transplant center with extremely infrequent utilization of intraoperative RRT...
February 20, 2018: Transplantation
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