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https://www.readbyqxmd.com/read/28099643/balanced-crystalloids-for-septic-shock-resuscitation
#1
Thiago Domingos Corrêa, Alexandre Biasi Cavalcanti, Murillo Santucci Cesar de Assunção
Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28090226/more-use-of-peritoneal-dialysis-gives-significant-savings-a-systematic-review-and-health-economic-decision-model
#2
Eva Pike, Vida Hamidi, Tove Ringerike, Torbjorn Wisloff, Marianne Klemp
BACKGROUND: Patients with end-stage renal disease (ESRD) are in need of renal replacement therapy as dialysis and/or transplantation. The prevalence of ESRD and, thus, the need for dialysis are constantly growing. The dialysis modalities are either peritoneal performed at home or hemodialysis (HD) performed in-center (hospital or satellite) or home. We examined effectiveness and cost-effectiveness of HD performed at different locations (hospital, satellite, and home) and peritoneal dialysis (PD) at home in the Norwegian setting...
February 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28087104/improved-outcomes-from-extracorporeal-membrane-oxygenation-versus-ventricular-assist-device-temporary-support-of-primary-graft-dysfunction-in-heart-transplant
#3
Koji Takeda, Boyangzi Li, Arthur R Garan, Veli K Topkara, Jiho Han, Paolo C Colombo, Maryjane A Farr, Yoshifumi Naka, Hiroo Takayama
BACKGROUND: Primary graft dysfunction (PGD) is one of the most common causes of early death after orthotopic heart transplantation. Mechanical circulatory support devices are required for severe forms of PGD. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and temporary ventricular assist device (VAD) support have both been reported to be useful for severe PGD. METHODS: Between January 2007 and December 2015, 597 patients received a heart transplant at our center...
December 23, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28078220/hypogonadism-and-testosterone-replacement-therapy-in-end-stage-renal-disease-esrd-and-transplant-patients
#4
REVIEW
Grace Snyder, Daniel A Shoskes
Hypogonadism is a common problem in the end-stage renal disease (ESRD) and renal transplant population. It has widespread systemic effects and has been linked with mortality in dialysis patients and at the time of renal transplant. The etiology is likely multifactorial and most patients are afflicted by various comorbidities that can contribute to hypogonadism. Clinical manifestations are mostly nonspecific. We review the approach to the diagnosis of hypogonadism, focusing on both laboratory values and clinical signs and symptoms...
December 2016: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28078211/a-case-series-of-the-safety-and-efficacy-of-testosterone-replacement-therapy-in-renal-failure-and-kidney-transplant-patients
#5
Ahmad Majzoub, Daniel A Shoskes
BACKGROUND: Hypogonadism is common in patients with renal dysfunction and does not always correct following transplantation. Recent studies show increased mortality for dialysis and transplant patients with low testosterone (T). These patients are often not treated due to concerns over efficacy and complications (both real and imagined). There is surprisingly scant literature supporting the use of T therapy in these patients. We wished to examine the results of T therapy in our patients with renal failure or following transplant...
December 2016: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28066607/risk-factors-and-outcome-of-primary-graft-dysfunction-after-lung-transplantation-in-korea
#6
Sungwoo Moon, Moo Suk Park, Jin Gu Lee, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Se Kyu Kim, Joon Chang, Hyo Chae Paik, Song Yee Kim
BACKGROUND: Primary graft dysfunction (PGD) is a severe, acute and post-transplantation lung injury associated with early morbidity and mortality. We aimed to identify clinical risk factors for PGD, as well as the outcome of PGD after lung transplantation in Korea. METHODS: We retrospectively analyzed lung transplant patients in a South Korean Hospital. The primary outcome was grade 3 PGD, defined according to the International Society for Heart and Lung Transplantation criteria...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28057870/restricted-mean-survival-time-over-15-years-for-patients-starting-renal-replacement-therapy
#7
Cécile Couchoud, Emmanuelle Dantony, Mad-Hélénie Elsensohn, Emmanuel Villar, Cécile Vigneau, Olivier Moranne, Muriel Rabilloud, René Ecochard
BACKGROUND: The restricted mean survival time (RMST) estimates life expectancy up to a given time horizon and can thus express the impact of a disease. The aim of this study was to estimate the 15-year RMST of a hypothetical cohort of incident patients starting renal replacement therapy (RRT), according to their age, gender and diabetes status, and to compare it with the expected RMST of the general population. METHODS: Using data from 67 258 adult patients in the French Renal Epidemiology and Information Network (REIN) registry, we estimated the RMST of a hypothetical patient cohort (and its subgroups) for the first 15 years after starting RRT (cRMST) and used the general population mortality tables to estimate the expected RMST (pRMST)...
January 5, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28057057/is-platelet-transfusion-associated-with-hospital-acquired-infections-in-critically-ill-patients
#8
Cécile Aubron, Andrew W Flint, Michael Bailey, David Pilcher, Allen C Cheng, Colin Hegarty, Antony Martinelli, Michael C Reade, Rinaldo Bellomo, Zoe McQuilten
BACKGROUND: Platelets are commonly transfused to critically ill patients. Reports suggest an association between platelet transfusion and infection. However, there is no large study to have determined whether platelet transfusion in critically ill patients is associated with hospital-acquired infection. METHODS: We conducted a multi-centre study using prospectively maintained databases of two large academic intensive care units (ICUs) in Australia. Characteristics of patients who received platelets in ICUs between 2008 and 2014 were compared to those of patients who did not receive platelets...
January 6, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28056875/turkish-pediatric-atypical-hemolytic-uremic-syndrome-registry-initial-analysis-of-146-patients
#9
Nesrin Besbas, Bora Gulhan, Oguz Soylemezoglu, Z Birsin Ozcakar, Emine Korkmaz, Mutlu Hayran, Fatih Ozaltin
BACKGROUND: Atypical hemolytic uremic syndrome (aHUS) is a devastating disease with significant morbidity and mortality. Its genetic heterogeneity impacts its clinical presentation, progress, and outcome, and there is no consensus on its clinical management. METHODS: To identify the characteristics of aHUS in Turkish children, an industry-independent registry was established for data collection that includes both retrospective and prospective patients. RESULTS: In total, 146 patients (62 boys, 84 girls) were enrolled; 53 patients (36...
January 5, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28035589/caspofungin-population-pharmacokinetics-in-critically-ill-patients-undergoing-continuous-veno-venous-haemofiltration-or-haemodiafiltration
#10
Claire Roger, Steven C Wallis, Laurent Muller, Gilbert Saissi, Jeffrey Lipman, Roger J Brüggemann, Jean-Yves Lefrant, Jason A Roberts
BACKGROUND AND OBJECTIVE: Sepsis and continuous renal replacement therapy (CRRT) can both significantly affect antifungal pharmacokinetics. This study aimed to describe the pharmacokinetics of caspofungin in critically ill patients during different CRRT modes. METHODS: Patients receiving caspofungin and undergoing continuous veno-venous haemofiltration (CVVH) or haemodiafiltration (CVVHDF) were eligible to take part in the study. Blood samples were collected at seven sampling times during a dosing interval...
December 29, 2016: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/28025835/bedside-tunneled-dialysis-catheter-removal-a-lesson-learned-from-nephrology-trainees
#11
REVIEW
Tibor Fülöp, Mihály B Tapolyai, Mohit Agarwal, Arnaldo Lopez-Ruiz, Miklos Z Molnar, Neville R Dossabhoy
Semi-permanent dual-lumen tunneled (or tunneled-cuffed) hemodialysis catheters (TDC) are increasingly utilized during renal replacement therapy, while awaiting permanent access maturation or renal recovery. Although there is a wealth of literature focused on placement, infection prevention, and maintenance of catheter patency, circumstances and indications for TDC removal are less well understood. Timely removal of these catheters is an important management decision, with the length of TDC duration representing the largest cumulative risk factor for catheter-associated blood stream infections...
December 26, 2016: Artificial Organs
https://www.readbyqxmd.com/read/28025746/gender-specific-differences-in-baseline-peak-and-delta-serum-creatinine-the-nacseld-experience
#12
Jacqueline G O'Leary, Florence Wong, K Rajender Reddy, Guadalupe Garcia-Tsao, Patrick S Kamath, Scott W Biggins, Michael B Fallon, Ram M Subramanian, B Maliakkal, Leroy Thacker, Jasmohan S Bajaj
BACKGROUND: Women have lower serum creatinine values than men for similar renal function. AIMS: We aimed to determine the differential effect of baseline, peak, and delta creatinine between genders on outcomes in infected hospitalized cirrhotic patients. METHODS: North American Consortium for the Study of End-Stage Liver Disease is a 15-center consortium of tertiary care hepatology centers prospectively enrolling infected cirrhotic inpatients...
December 26, 2016: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28012962/prolonged-infusion-of-sedatives-and-analgesics-in-adult-intensive-care-patients-a-systematic-review-of-pharmacokinetic-data-reporting-and-quality-of-evidence
#13
REVIEW
Andrew H W Tse, Lowell Ling, Gavin M Joynt, Anna Lee
Although pharmacokinetic (PK) data for prolonged sedative and analgesic agents in intensive care unit (ICU) has been described, the number of publications in this important area appear relatively few, and PK data presented is not comprehensive. Known pathophysiological changes in critically ill patients result in altered drug PK when compared with non-critically ill patients. ClinPK Statement was recently developed to promote consistent reporting in PK studies, however, its applicability to ICU specific PK studies is unclear...
December 21, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28011614/dosing-guidance-for-intravenous-colistin-in-critically-ill-patients
#14
Roger L Nation, Samira M Garonzik, Visanu Thamlikitkul, Evangelos J Giamarellos-Bourboulis, Alan Forrest, David L Paterson, Jian Li, Fernanda P Silveira
BACKGROUND: Intravenous colistin is difficult to use because plasma concentrations for antibacterial effect overlap those causing nephrotoxicity, and there is large inter-patient variability in pharmacokinetics. The aim was to develop dosing algorithms for achievement of a clinically desirable average steady-state plasma colistin concentration (Css,avg) of 2mg/L. METHODS: Plasma concentration-time data from 214 adult critically-ill patients (creatinine clearance 0-236mL/min; 29 receiving renal replacement therapy (RRT)) were subjected to population pharmacokinetic analysis...
December 23, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28011008/outcome-analysis-of-continuous-intraoperative-renal-replacement-therapy-in-the-highest-acuity-liver-transplant-recipients-a-single-center-experience
#15
Michael A Zimmerman, Motaz Selim, Joohyun Kim, Kevin Regner, Kia Saeian, Stephanie Zanowski, Alicia Martin, Lois A Connolly, Kathryn K Lauer, Harvey J Woehlck, Johnny C Hong
BACKGROUND: Orthotopic liver transplantation is the definitive treatment modality for patients with end-stage liver disease. Pre-orthotopic liver transplantation renal dysfunction has a significant negative influence on outcomes post-orthotopic liver transplantation. Intraoperative renal replacement therapy is an adjunctive therapy to address the metabolic challenges during orthotopic liver transplantation in patients with a high acuity of illness. The impact of intraoperative renal replacement therapy on post-orthotopic liver transplantation outcomes, however, is unclear...
December 20, 2016: Surgery
https://www.readbyqxmd.com/read/28007763/early-and-late-patient-outcomes-in-urgent-start-peritoneal-dialysis
#16
Emily J See, Yeoungjee Cho, Carmel M Hawley, Lauren R Jaffrey, David W Johnson
♦ Background: Significant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start. ♦ Methods: This single-center, matched case-control study evaluated patients commencing PD between 2010 and 2015...
December 22, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/27993157/early-phase-cumulative-hypotension-duration-and-severe-stage-progression-in-oliguric-acute-kidney-injury-with-and-without-sepsis-an-observational-study
#17
Junichi Izawa, Tetsuhisa Kitamura, Taku Iwami, Shigehiko Uchino, Masanori Takinami, John A Kellum, Takashi Kawamura
BACKGROUND: Managing blood pressure in patients with acute kidney injury (AKI) could effectively prevent severe-stage progression. However, the effect of hypotension duration in the early phase of AKI remains poorly understood. This study investigated the association between early-phase cumulative duration of hypotension below threshold mean arterial pressure (MAP) and severe-stage progression of oliguric AKI in critically ill patients, and assessed the difference in association with presence of sepsis...
December 19, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27990438/the-experience-of-older-people-in-the-shared-decision-making-process-in-advanced-kidney-care
#18
Nicola Thomas, Karen Jenkins, Breeda McManus, Brian Gracey
Introduction. This qualitative descriptive study was designed to understand the experiences of older people (>70 years) when making a decision about renal replacement therapy. This was a coproduced study, whereby patients and carers were involved in all aspects of the research process. Methods. A Patient and Carer Group undertook volunteer and research training. The group developed the interview questions and interviewed 29 people who had commenced dialysis or made a decision not to have dialysis. Interview data were transcribed and analysed, and common themes were identified...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27988919/diabetes-affects-length-of-stay-and-hospital-costs-for-elderly-patients-with-pneumonia-an-analysis-of-a-hospital-administrative-database
#19
Yusuke Kabeya, Akira Shimada, Nobuhiro Tsukada, Yoshihito Atsumi, Megumu Higaki
OBJECTIVE: The present study investigated the association of having diabetes with length of stay and hospital costs for elderly patients with pneumonia who were admitted to an acute-care hospital in Japan. METHODS: Based on the inpatient administrative claims database of an acute-care hospital in central Tokyo between 2010 and 2013, 753 patients aged ≥ 65 years who were admitted to the hospital presenting with pneumonia and discharged alive were analyzed. The association was analyzed using a negative binomial model, having adjusted for age, sex, body mass index, dyspnea grade, functional evaluation of feeding, use of mechanical ventilation, and use of renal replacement therapy...
December 20, 2016: Tokai Journal of Experimental and Clinical Medicine
https://www.readbyqxmd.com/read/27974496/end-stage-renal-disease-after-occupational-lead-exposure-20%C3%A2-years-of-follow-up
#20
Marie Evans, Andrea Discacciati, Abdul Rashid Quershi, Agneta Åkesson, Carl-Gustaf Elinder
OBJECTIVES: Whether low-level exposure to lead may give rise to chronic kidney disease or end-stage renal disease (ESRD) is debated. In this study, we aimed to specifically investigate if low-level occupational exposure to lead was associated with increased incidence of ESRD. METHODS: The incidence of starting renal replacement therapy as a result of ESRD was examined in a cohort of10 303 lead-workers who had controlled blood lead concentrations due to a compulsory occupational health surveillance programme in Sweden during the time period 1977-1990...
December 14, 2016: Occupational and Environmental Medicine
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