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https://www.readbyqxmd.com/read/29664506/continuous-venovenous-hemofiltration-in-neonates-with-hyperammonemia-a-case-series
#1
Felipe Cavagnaro Santa María, Jorge Roque Espinosa, Pamela Guerra Hernández
INTRODUCTION: Neonatal hyperammonemia secondary due to inborn errors of metabolism is a rare condition with a high rate of neurological sequelae and mortality. Initial medical management is often insufficient to stop the progressive increase of ammonia, with the consequent deterioration of the patient. For this reason, depurative techniques have been implemented, including peritoneal dialysis, intermittent hemodialysis and continuous renal replacement therapy (CRRT). OBJECTIVE: To describe our experience with continuous extracorporeal dialysis in severely ill neonates with hyperammonemia...
February 2018: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/29663999/-analysis-of-high-risk-factors-of-intensive-care-unit-acquired-weakness-in-patients-with-sepsis
#2
Xiaofan Yu, Xiaohong Wan, Linjun Wan, Qingqing Huang
OBJECTIVE: To investigate high risk factors of intensive care unit-acquired weakness (ICUAW) in patients with sepsis. METHODS: A retrospective study was conducted. 164 patients with mechanical ventilation (MV) who were diagnosed sepsis and multiple organ dysfunction syndrome (MODS), admitted to intensive care unit (ICU) of the Second Affiliated Hospital of Kunming Medical University from January 1st, 2015 to September 30th, 2017 were enrolled. The general situation, the basic diseases (hypertension, diabetes), body mass index (BMI), protopathy diseases, the level of albumin before ICU admission, the MV time, whether to use glucocorticoid and continuous renal replacement therapy (CRRT) or not, nutrition supply (nutritional way, nutrition initiation time, amino acid/protein supply, nutritional status on ICU 3 days and 7 days), myoglobin, the length of ICU stay, the length of hospital stay, and acute physiology and chronic health evaluation II (APACHE II) score were collected...
April 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29627837/combination-of-mean-platelet-volume-platelet-count-ratio-and-the-apache-ii-score-better-predicts-the-short-term-outcome-in-patients-with-acute-kidney-injury-receiving-continuous-renal-replacement-therapy
#3
Junhui Li, Yingchuan Li, Xiaohua Sheng, Feng Wang, Dongsheng Cheng, Guihua Jian, Yongguang Li, Liang Feng, Niansong Wang
BACKGROUND/AIMS: Both the Acute physiology and Chronic Health Evaluation (APACHE II) score and mean platelet volume/platelet count Ratio (MPR) can independently predict adverse outcomes in critically ill patients. This study was aimed to investigate whether the combination of them could have a better performance in predicting prognosis of patients with acute kidney injury (AKI) who received continuous renal replacement therapy (CRRT). METHODS: Two hundred twenty-three patients with AKI who underwent CRRT between January 2009 and December 2014 in a Chinese university hospital were enrolled...
March 29, 2018: Kidney & Blood Pressure Research
https://www.readbyqxmd.com/read/29597227/from-continuous-renal-replacement-therapies-to-multiple-organ-support-therapy
#4
Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco, Gaetano La Manna
The incidence of the multiple organ dysfunction syndrome (MODS) is rapidly increasing in intensive care units (ICU). It usually combines with sepsis and is the most frequent cause of death in the ICU patients. The nature of the ICU patients has changed in the last years. It includes a variety of patients with severe cases due to major surgical interventions, trauma, hemodynamic instability, sepsis, and so on but also older people than previous times. All these situations can easily lead to MODS. In the prior years, the only available and efficient therapy was renal replacement therapy (RRT) for treating acute renal failure, but the development of technology also gives us devices to support the other systems...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597226/pediatric-continuous-renal-replacement-therapy-for-40-years-of-continuous-renal-replacement-therapy
#5
Stuart L Goldstein
The provision of continuous renal replacement therapy (CRRT) to pediatric patients presents numerous clinical and technical challenges that have been addressed over the past 40 years. Children provide an informative population for acute kidney injury and CRRT study, as pediatric subspecialists practice with a preventive perspective and children often do not have the multiple severe chronic comorbidities that confound adult studies. In addition, the relatively small number of patients treated at any one pediatric center has engendered successful multicenter collaboration to advance the clinical and technical studies of CRRT provision...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597225/continuous-renal-replacement-therapy-quality-control-and-performance-measures
#6
Bo Shen, Jiarui Xu, Yimei Wang, Wuhua Jiang, Jie Teng, Xiaoqiang Ding
Continuous renal replacement therapy (CRRT) is one of the most predominant forms of renal replacement therapy (RRT) currently in use now, this therapy being the initial RRT modality in most critically ill patients. However, in general, the quality of CRRT is still suboptimal. The quality of CRRT is affected by many factors, including the optimal prescription and precision delivery, the CRRT providers' professional level, and the CRRT device used. Establishment of a comprehensive quality control system covering all the aspects and procedures of CRRT is essential...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597224/ensuring-quality-of-care-through-monitoring-of-continuous-renal-replacement-therapies
#7
Mitchell H Rosner
The continuous renal replacement therapy (CRRT) has offered life-saving treatment for kidney failure. Technological advances coupled with findings from clinical trials have allowed for refinements both in the therapy and in the way it is applied to patients. However, outcomes for patients requiring CRRT remain suboptimal. The use of information technology coupled with structured quality improvement programs offers a methodology for studying the delivery of CRRT with an eye toward improving outcomes. Furthermore, integration of information from the CRRT treatment can be combined with real-time data from other patient-monitoring sources to create "feedback" loops where more timely changes in the CRRT prescription can occur...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597222/clinical-complications-of-continuous-renal-replacement-therapy
#8
Florent Sigwalt, Axelle Bouteleux, François Dambricourt, Théo Asselborn, Florent Moriceau, Thomas Rimmelé
The various complications of continuous renal replacement therapy (CRRT) are mostly preventable. Hemodynamic disturbances are dominated by hypotension due to the modification of volume status, myocardial dysfunction, cardiac arrhythmia, or modification of systemic vascular resistances, which are correlated with body temperature changes. Metabolic complications remain at the forefront and have profoundly changed with the use of regional citrate anticoagulation (RCA). RCA may lead to two distinct situations: citrate overload and citrate accumulation, respectively, responsible for metabolic alkalosis and metabolic acidosis...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597221/technical-complications-of-continuous-renal-replacement-therapy
#9
Zaccaria Ricci, Stefano Romagnoli
Continuous renal replacement therapy (CRRT) is commonly applied in critically ill patients affected by severe acute kidney injury for solute and volume control and to optimize acid-base and electrolytes balance. Although CRRT represents a life-saving procedure for these patients, it is a representation of a non-physiologic artificial kidney and the potential benefits of the treatment could be hampered by clinical and technical side effects. Different parts of the CRRT system can be a source of technical complications...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597220/extra-renal-indications-for-continuous-renal-replacement-therapy
#10
Suvi T Vaara, Rinaldo Bellomo
Continuous renal replacement therapy (CRRT) has many potential indications that extend beyond the traditional removal of uremic waste products. Many of these stem from the capacity of CRRT to remove middle-sized molecules and its suitability for haemodynamically unstable patients. Using CRRT for immunomodulation to remove circulating plasma cytokines has created great enthusiasm and, in the past, immunomodulation was a frequently reported indication for commencing CRRT. Unfortunately, recent evidence from randomized controlled trials has been discouraging, and CRRT cannot be recommended for immunomodulation...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597219/advances-in-machine-technology
#11
William R Clark, Gianluca Villa, Mauro Neri, Claudio Ronco
Continuous renal replacement therapy (CRRT) machines have evolved into devices specifically designed for critically ill over the past 40 years. In this chapter, a brief history of this evolution is first provided, with emphasis on the manner in which changes have been made to address the specific needs of the critically ill patient with acute kidney injury. Subsequently, specific examples of technology developments for CRRT machines are discussed, including the user interface, pumps, pressure monitoring, safety features, and anticoagulation capabilities...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597218/membranes-and-sorbents
#12
William R Clark, Dayong Gao, Anna Lorenzin, Claudio Ronco
For continuous renal replacement therapy (CRRT), the extracorporeal filter provides solute depuration, fluid removal, and control of electrolyte and acid-base balance in critically ill patients with acute kidney injury (AKI). The membranes comprising CRRT filters are almost exclusively based on hollow fiber designs and, while adapted from the chronic hemodialysis field, have features that are specific to the requirements of CRRT nevertheless. In addition, these devices have evolved through the 40 years of CRRT in response to changes in clinical practice and the desire to extend the solute removal spectrum...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597217/prescription-and-delivery-of-the-right-continuous-renal-replacement-therapies-dose
#13
Gianluca Villa, Mauro Neri, Claudio Ronco, Jorge Cerdá
This chapter focuses on the definitions and impact of prescription and delivery of the right dose of treatment in patients on continuous renal replacement therapy (CRRT). We define "dose" and the concepts of efficiency, intensity, and efficacy; differentiate their multiple components; and describe the practical application of those concepts to direct patient care. In the article, we emphasize the effects of delivered dose variation on solute control, and list the main factors affecting CRRT dose delivery...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29597215/evolution-of-vascular-access-and-anticoagulation
#14
Patrick M Honore, Herbert D Spapen
Continuous renal replacement therapy (CRRT) is an important and widely used adjuvant treatment in critically ill patients. However, any CRRT protocol can be adhered to only when the technique is correctly installed and functioning properly. Within this context, an appropriate vascular access and a safe and effective circuit anticoagulation method are key requisites. The right internal jugular (RIJ) vein is the preferred route for insertion with the tip of the catheter placed in the right atrium. Both femoral veins offer a valuable alternative access, but catheters must be longer to avoid recirculation and circuit blood flow is lower as compared with that of the RIJ approach...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29596307/resistance-training-prevents-muscle-loss-induced-by-caloric-restriction-in-obese-elderly-individuals-a-systematic-review-and-meta-analysis
#15
REVIEW
Amanda V Sardeli, Tiemy R Komatsu, Marcelo A Mori, Arthur F Gáspari, Mara Patrícia T Chacon-Mikahil
It remains unclear as to what extent resistance training (RT) can attenuate muscle loss during caloric restriction (CR) interventions in humans. The objective here is to address if RT could attenuate muscle loss induced by CR in obese elderly individuals, through summarized effects of previous studies. Databases MEDLINE, Embase and Web of Science were used to perform a systematic search between July and August 2017. Were included in the review randomized clinical trials (RCT) comparing the effects of CR with (CRRT) or without RT on lean body mass (LBM), fat body mass (FBM), and total body mass (BM), measured by dual-energy X-ray absorptiometry, on obese elderly individuals...
March 29, 2018: Nutrients
https://www.readbyqxmd.com/read/29575788/acute-kidney-injury-in-critically-ill-patients-a-prospective-randomized-study-of-tidal-peritoneal-dialysis-versus-continuous-renal-replacement-therapy
#16
Abdullah Al-Hwiesh, Ibrahiem Abdul-Rahman, Fredric Finkelstein, Jose Divino-Filho, Hatem Qutub, Nadia Al-Audah, Abdalla Abdelrahman, Nazeeh El-Fakhrany, Mohammed Nasr El-Din, Tamer El-Salamony, Abdulsalam Noor, Mohammed Al-Shahrani, Khalid Al-Otaibi
Few studies have discussed the role of peritoneal dialysis (PD) in managing acute kidney injury (AKI) in critically ill patients. The present study compares the outcome of AKI in intensive care unit (ICU) patients randomized to treatment with tidal PD (TPD) or continuous venovenous hemodiafiltration (CVVHDF). One hundred and twenty-five ICU patients with AKI were randomly allotted to CVVHDF, (Group A, N = 62) or TPD, (group B, N = 63). Cause and severity of renal injury were assessed at the time of initiating dialysis...
March 25, 2018: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/29572184/predictive-utilities-of-neutrophil-gelatinase-associated-lipocalin-ngal-in-severe-sepsis
#17
Wei Chang, Shang Zhu, Chun Pan, Jian-Feng Xie, Song-Qiao Liu, Hai-Bo Qiu, Yi Yang
BACKGROUND: We aim to investigate the predictive value of plasma neutrophil gelatinase-associated lipocalin (pNGAL) in patients with severe sepsis. METHODS: A total of 124 patients were enrolled in this observational study. Blood samples were obtained at admission, on day 2 and day 7. Receiver operating characteristic (ROC) curves were generated to assess the utility of pNGAL in prediction of 28-day mortality and need for CRRT. Cox regression curves were built with and without pNGAL for 28-day mortality prediction to determine NGAL's contributive predictive value...
March 20, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/29572042/population-pharmacokinetics-of-daptomycin-in-critically-ill-patients
#18
A Soraluce, E Asín-Prieto, A Rodríguez-Gascón, H Barrasa, J Maynar, E Carcelero, D Soy, A Isla
Daptomycin has shown activity against a wide range of Gram-positive bacteria, however, the approved dosages usually seem insufficient for critically ill patients. The aim of this study was to develop a population pharmacokinetic model for daptomycin in critically ill patients and to estimate the success of the therapy by applying pharmacokinetic/pharmacodynamic (PK/PD) criteria. Sixteen intensive care unit patients were included, four of whom underwent continuous renal replacement therapies (CRRT). Blood and, when necessary, effluent samples were drawn after daptomycin administration at previously defined time points...
March 20, 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29562937/cerebral-microembolism-in-the-critically-ill-with-acute-kidney-injury-comet-aki-trial-study-protocol-for-a-randomized-controlled-clinical-trial
#19
Gabor Erdoes, Dominik E Uehlinger, Beatrice Kobel, Monika P Stucki, Roland Wiest, Frank Stueber, Niklaus Fankhauser, Stephan M Jakob, Joerg C Schefold
BACKGROUND: Microembolism is a frequent pathological event during extracorporeal renal replacement therapy (RRT). Some previous data indicate that microemboli are generated in patients who are undergoing RRT and that these may contribute to increased cerebrovascular and neurocognitive morbidity in patients with end-stage renal disease. The current trial aims to quantify the microembolic load and respective qualitative composition that effectively reaches the intracerebral circulation in critically ill patients treated with different RRT modalities for acute kidney injury (AKI)...
March 21, 2018: Trials
https://www.readbyqxmd.com/read/29558000/hemolytic-uremic-syndrome-with-dual-caution-in-an-infant-cobalamin-c-defect-and-complement-dysregulation-successfully-treated-with-eculizumab
#20
Ulkem Kocoglu Barlas, Hasan Serdar Kıhtır, Nilufer Goknar, Melike Ersoy, Nihal Akcay, Esra Sevketoglu
BACKGROUND: Hemolytic uremic syndrome (HUS) is a clinical syndrome characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. Atypical hemolytic uremic syndrome (aHUS) is a devastating disease with significant mortality and high risk of progression to end-stage kidney disease. It is mostly caused by dysregulation of the alternative complement pathway. Cobalamin C (Cbl C) defect is a genetic disorder of cobalamin metabolism and is a rare cause of HUS. CASE-DIAGNOSIS/TREATMENT: We present a 6-month-old male infant who was admitted to the pediatric intensive care unit (PICU) due to restlessness, severe hypertension, anemia, respiratory distress, and acute kidney injury...
March 20, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
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