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https://www.readbyqxmd.com/read/29132411/an-isolated-elevation-in-blood-urea-level-is-not-uraemia-and-not-an-indication-for-renal-replacement-therapy-in-the-icu
#1
EDITORIAL
Jack Mackenzie, Bobby Chacko
The decision to initiate renal replacement therapy (RRT) and the optimal timing for commencement is a difficult decision faced by clinicians when treating acute kidney injury (AKI) in the intensive care setting. Without clinically significant ureamic symptoms or emergent indications (electrolyte abnormalities, volume overload) the timing of RRT initiation remains contentious and inconsistent across health providers. Current trends of initiating RRT in the ICU are often based on isolated blood urea levels without clear guidelines demonstrating an upper limit for treatment...
November 13, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29074117/intensive-care-unit-admission-after-endovascular-aortic-aneurysm-repair-is-primarily-determined-by-hospital-factors-adds-significant-cost-and-is-often-unnecessary
#2
Caitlin W Hicks, Husain N Alshaikh, Devin Zarkowsky, Ian C Bostock, Besma Nejim, Mahmoud B Malas
BACKGROUND: A large proportion of endovascular aortic aneurysm repair (EVAR) patients are routinely admitted to the intensive care unit (ICU) for postoperative observation. In this study, we aimed to describe the factors associated with ICU admission after EVAR and to compare the outcomes and costs associated with ICU vs non-ICU observation. METHODS: All patients undergoing elective infrarenal EVAR in the Premier database (2009-2015) were included. Patients were stratified as ICU vs non-ICU admission according to location on postoperative day 0...
October 23, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29040243/toxic-shock-syndrome-still-a-timely-diagnosis
#3
Kira L Gossack-Keenan, April J Kam
BACKGROUND: Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. After improved patient education and tampon labeling, the incidence of menstrual TSS has declined. CASE: A previously healthy 14-year-old girl presented to an urgent care center with a 2-day history of fever, erythematous maculopapular rash, vomiting, diarrhea, and malaise...
October 16, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29025142/community-acquired-acute-kidney-injury-findings-from-a-large-population-cohort
#4
J Holmes, J Geen, B Phillips, J D Williams, A O Phillips
Background: The extent of patient contact with medical services prior to development of community acquired-acute kidney injury (CA-AKI)is unknown. Aim: We examined the relationship between incident CA-AKI alerts, previous contact with hospital or primary care and clinical outcomes. Design: A prospective national cohort study of all electronic AKIalerts representing adult CA-AKI. Methods: Data were collected for all cases of adult (≥18 years of age) CA-AKI in Wales between 1 November 2013 and 31 January 2017...
July 21, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/28973124/association-of-acute-kidney-injury-with-concomitant-vancomycin-and-piperacillin-tazobactam-treatment-among-hospitalized-children
#5
Kevin J Downes, Carter Cowden, Benjamin L Laskin, Yuan-Shung Huang, Wu Gong, Matthew Bryan, Brian T Fisher, Stuart L Goldstein, Theoklis E Zaoutis
Importance: β-Lactam antibiotics are often coadministered with intravenous (IV) vancomycin hydrochloride for children with suspected serious infections. For adults, the combination of IV vancomycin plus piperacillin sodium/tazobactam sodium is associated with a higher risk of acute kidney injury (AKI) compared with vancomycin plus 1 other β-lactam antibiotic. However, few studies have evaluated the safety of this combination for children. Objective: To assess the risk of AKI in children during concomitant therapy with vancomycin and 1 antipseudomonal β-lactam antibiotic throughout the first week of hospitalization...
October 2, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28954604/untapped-potential-in-australian-hospitals-for-organ-donation-after-circulatory-death
#6
Sandeep S Rakhra, Helen I Opdam, Laura Gladkis, Byron Arcia, Michael A Fink, John Kanellis, Peter S Macdonald, Gregory I Snell, David V Pilcher
OBJECTIVE: To determine the potential for organ donation after circulatory death (DCD) in Australia by applying ideal and expanded organ suitability criteria, and to compare this potential with actual DCD rates. DESIGN: Retrospective cohort study. Setting, methods: We analysed DonateLife audit data for patients aged 28 days to 80 years who died between July 2012 and December 2014 in an intensive care unit or emergency department, or who died within 24 hours of discharge from either, in the 75 Australian hospitals contributing data to DonateLife...
September 2, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28952972/acute-opiate-overdose-an-update-on-management-strategies-in-emergency-department-and-critical-care-unit
#7
Rukma Parthvi, Abhinav Agrawal, Sameer Khanijo, Adey Tsegaye, Arunabh Talwar
BACKGROUND: Opioids are natural, semisynthetic, or synthetic substances that act on opioid receptors in the central nervous system. Clinically, they are prescribed for pain management. Opioid overdose (OOD) occurs when the central nervous system and respiratory drive are suppressed because of excessive consumption of the drug. Symptoms of OOD include drowsiness, slow breathing, pinpoint pupils, cyanosis, loss of consciousness, and death. Due to their addictive potential and easy accessibility opioid addiction is a growing problem worldwide...
September 13, 2017: American Journal of Therapeutics
https://www.readbyqxmd.com/read/28885936/vancomycin-vs-vancomycin-piperacillin-tazobactam-associated-acute-kidney-injury-in-noncritically-ill-patients-at-a-tertiary-care-military-treatment-facility
#8
Caleb W Anderson, Kathy S Cazares, Michael B Lustik, Shivam M Patel, Troy M Denunzio
BACKGROUND: Broad-spectrum antibiotics are often used as initial empiric therapy in patients at risk for infections by multidrug-resistant organisms. Emerging literature and anecdotal reports within Tripler Army Medical Center indicate an increased incidence of vancomycin-associated acute kidney injury when used in combination with piperacillin-tazobactam. This is a retrospective, single-center study comparing the incidence of acute kidney injury in noncritically ill patients receiving either vancomycin or vancomycin in combination with piperacillin-tazobactam in a 206-bed tertiary care military training facility...
September 2017: Military Medicine
https://www.readbyqxmd.com/read/28799580/risk-prediction-of-acute-kidney-injury-by-timp-2-%C3%A2-igfbp7
#9
REVIEW
M Kimmel, M Schanz, M D Alscher
Acute kidney injury (AKI) is a common syndrome with increased mortality, a heavy burden of illness and high cost. The Kidney Disease Improving Global Outcomes (KDIGO) criteria for staging of AKI have been validated in large patient cohorts and classify AKI into three stages. In order to achieve prevention or early therapy, the focus of scientific interest is early detection and risk prediction of AKI. The combination of the two cell cycle arrest markers [TIMP-2]·[IGFBP7] in the urine shows good results in the risk prediction of AKI in different clinical settings (intensive care medicine, sepsis, cardiac surgery, emergency department)...
June 2017: Drugs of Today
https://www.readbyqxmd.com/read/28721327/two-catastrophes-in-one-patient-drug-reaction-with-eosinophilia-and-systemic-symptoms-and-toxic-shock-syndrome
#10
Moayed Ibrahim, Diana L Nunley
A 70-year-old, immunocompromised patient presented to the emergency room (ER) five weeks after she was started on clopidogrel. She complained of skin eruption, mouth ulcers, fatigue, and myalgia over the past two weeks. Labs showed severe hyponatremia, acute kidney injury, rhabdomyolysis, hyperkalemia, and elevated liver enzymes. She was treated with steroids and discharged after her condition improved. However, a month later, she returned to the ER, complaining of nausea, vomiting, diarrhea, dizziness, chills, and shortness of breath over the past two days...
June 15, 2017: Curēus
https://www.readbyqxmd.com/read/28697503/update-of-sepsis-in-the-intensive-care-unit
#11
Kelly Roveran Genga, James A Russell
Sepsis, the most common cause of admission to an intensive care unit (ICU), has had an increased incidence and prevalence over the last years with a simultaneous decrease in its short-term mortality. Sepsis survivors are more frequently discharged from hospital and often experience long-term outcomes such as late mortality, immune dysfunction, secondary infections, impaired quality of life, and unplanned readmissions. Early recognition and management of sepsis have challenged emergency care and critical care physicians and nurses...
2017: Journal of Innate Immunity
https://www.readbyqxmd.com/read/28620491/pseudo-thrombotic-thrombocytopenic-purpura-presenting-as-multi-organ-dysfunction-syndrome-a-rare-complication-of-pernicious-anemia
#12
Saroj Kandel, Nibash Budhathoki, Shanta Pandey, Bikash Bhattarai, Aam Baqui, Ramesh Pandey, Divya Salhan, Danilo Enriquez, Joseph Quist, Frances M Schmidt
OBJECTIVE: We present a rare case of pernicious anemia presented as multi-organ dysfunction syndrome, later found to have pseudo-thrombotic thrombocytopenic purpura. METHODS: An 86-year-old female presented with respiratory distress, altered mental status, acute renal failure and was intubated in emergency room. She was found to have severe anemia, thrombocytopenia, high lactate, high lactate dehydrogenase and low haptoglobin. Peripheral smear revealed multilobulated neutrophils with schistocytes, poikilocytes and anisocytes...
2017: SAGE open medical case reports
https://www.readbyqxmd.com/read/28587919/patient-reported-outcomes-measurement-system-promis-%C3%A2-for-patients-with-urolithiasis-initial-report
#13
Michael S Borofsky, Giulia I Lane, Suzanne M Neises, Andrew J Portis
PURPOSE: Health related quality of life is increasingly important in quality improvement efforts for medical conditions. However, it has proved challenging to measure health related quality of life for urolithiasis, given the distinct chronic and acute phases of this disease. We evaluated the use of PROMIS® (Patient-Reported Outcomes Measurement System) to assess the patient experience through acute stone episode stages. MATERIALS AND METHODS: PROMIS pain measures (intensity and interference) were obtained from patients at a subspecialty kidney stone clinic...
November 2017: Journal of Urology
https://www.readbyqxmd.com/read/28501384/acute-heart-failure-in-the-emergency-department-the-safe-simeu-epidemiological-study
#14
Andrea Fabbri, Giulio Marchesini, Giorgio Carbone, Roberto Cosentini, Annamaria Ferrari, Mauro Chiesa, Alessio Bertini, Federico Rea
BACKGROUND: Patients with acute heart failure (AHF) have high rates of attendance to emergency departments (EDs), with significant health care costs. OBJECTIVES: We aimed to describe the clinical characteristics of patients attending Italian EDs for AHF and their diagnostic and therapeutic work-up. METHODS: We carried out a retrospective analysis on 2683 cases observed in six Italian EDs for AHF (January 2011 to June 2012). RESULTS: The median age of patients was 84 years (interquartile range 12), with females accounting for 55...
August 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28487870/volume-related-weight-gain-as-an-independent-indication-for-renal-replacement-therapy-in-the-intensive-care-units
#15
REVIEW
Tibor Fülöp, Lajos Zsom, Mihály B Tapolyai, Miklos Z Molnar, László Rosivall
Attempts to identify specific therapies to reverse acute kidney injury (AKI) have been unsuccessful in the past; only modifying risk profile or addressing the underlying disease processes leading to AKI proved efficacious. The current thinking on recognizing AKI is compromised by a "kidney function percent-centered" viewpoint, a paradigm further reinforced by the emergence of serum creatinine-based automated glomerular filtration reporting over the last two decades. Such thinking is, however, grossly corrupted for AKI and poorly applicable in critically ill patients in general...
2017: Journal of Renal Injury Prevention
https://www.readbyqxmd.com/read/28460592/anticoagulation-and-transfusions-management-in-veno-venous-extracorporeal-membrane-oxygenation-for-acute-respiratory-distress-syndrome-assessment-of-factors-associated-with-transfusion-requirements-and-mortality
#16
Gennaro Martucci, Giovanna Panarello, Giovanna Occhipinti, Veronica Ferrazza, Fabio Tuzzolino, Diego Bellavia, Filippo Sanfilippo, Cristina Santonocito, Alessandro Bertani, Patrizio Vitulo, Michele Pilato, Antonio Arcadipane
PURPOSE: We describe an approach for anticoagulation and transfusions in veno-venous-extracorporeal membrane oxygenation (VV-ECMO), evaluating factors associated with higher transfusion requirements, and their impact on mortality. METHODS: Observational study on consecutive adults supported with VV-ECMO for acute respiratory distress syndrome (ARDS). We targeted an activated partial thromboplastin time of 40 to 50 seconds and a hematocrit of 24% to 30%. Univariate and multiple analyses were done to evaluate factors associated with transfusion requirements and the influence of increasing transfusions on mortality during ECMO...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28455097/severity-of-acute-kidney-injury-in-the-post-lung-transplant-patient-is-associated-with-higher-healthcare-resources-and-cost
#17
Albert P Nguyen, Rodney A Gabriel, Eugene Golts, Erik B Kistler, Ulrich Schmidt
OBJECTIVE: Perioperative risk factors and the clinical impact of acute kidney injury (AKI) and failure after lung transplantation are not well described. The incidences of AKI and acute renal failure (ARF), potential perioperative contributors to their development, and postdischarge healthcare needs were evaluated. DESIGN: Retrospective. SETTING: University hospital. PARTICIPANTS: Patients undergoing lung transplantation between January 1, 2011 and December 31, 2015...
February 5, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28431865/statin-use-and-other-factors-associated-with-mortality-after-major-lower-extremity-amputation
#18
Charles DeCarlo, Larry Scher, Saadat Shariff, John Phair, Evan Lipsitz, Karan Garg
OBJECTIVE: Above-knee amputations (AKAs) and below-knee amputations (BKAs) are associated with high postoperative mortality rates. In this study, we examined factors associated with 30-day, 90-day, and 1-year mortality in patients who underwent a major lower extremity amputation. METHODS: We queried a prospectively collected institutional database for all patients who underwent AKA or BKA with primary or secondary closure, during a 5-year period, between November 2009 and November 2014...
July 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28407811/saline-versus-balanced-crystalloids-for-intravenous-fluid-therapy-in-the-emergency-department-study-protocol-for-a-cluster-randomized-multiple-crossover-trial
#19
Wesley H Self, Matthew W Semler, Jonathan P Wanderer, Jesse M Ehrenfeld, Daniel W Byrne, Li Wang, Leanne Atchison, Matthew Felbinger, Ian D Jones, Stephan Russ, Andrew D Shaw, Gordon R Bernard, Todd W Rice
BACKGROUND: Prior studies in critically ill patients suggest the supra-physiologic chloride concentration of 0.9% ("normal") saline may be associated with higher risk of renal failure and death compared to physiologically balanced crystalloids. However, the comparative effects of 0.9% saline and balanced fluids are largely unexamined among patients outside the intensive care unit, who represent the vast majority of patients treated with intravenous fluids. METHODS/DESIGN: This study, entitled Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED), is a pragmatic, cluster, multiple-crossover trial at a single institution evaluating clinical outcomes of adults treated with 0...
April 13, 2017: Trials
https://www.readbyqxmd.com/read/28332367/value-of-serum-cystatin-c-measurement-in-the-diagnosis-of-sepsis-induced-kidney-injury-and-prediction-of-renal-function-recovery
#20
Ah Young Leem, Moo Suk Park, Byung Hoon Park, Won Jai Jung, Kyung Soo Chung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Se Kyu Kim, Joon Chang, Joo Han Song
PURPOSE: Acute kidney injury (AKI) is common in critically ill patients. Serum cystatin C has emerged as a reliable marker of AKI. We sought to assess the value of serum cystatin C for early detection and prediction of renal function recovery in patients with sepsis. MATERIALS AND METHODS: Sepsis patients (113 AKI patients and 49 non-AKI patients) admitted to the intensive care unit (ICU) were included. Serum creatinine and cystatin C levels and glomerular filtration rate were measured on days 0, 1, 3, and 7...
May 2017: Yonsei Medical Journal
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