Injury Intensive Care Unit Research Articles

Model comparison of estimated glomerular filtration rate for acute kidney injury in intensive care unit

Acute kidney injury (AKI) is common in critically ill patients and often associated with higher mortality. It is commonly diagnosed using plasma creatinine, a fluid excreted by glomerular filtration. In this study, we analysed the highly nonlinear and complex behaviour within human systems of estimating glomerular filtration rate in critically ill patients to estimate AKI outcome by developing an application program that describes various numerical mathematical models estimated glomerular filtration rate (eGFR). The program was developed to collect numerous clinical patient data and perform computations of the governing equations that may provide clinicians with rapid estimation of GFR which allow prediction of recovery or worsening of renal function at bedside. Data collection using the application program was conducted at the intensive care unit in Kuantan, Malaysia from January to August 2016. It was found that the eGFR by CKD-EPI shows the best correlation with kinetic GFR (keGFR) equations compared to other mathematical methods for Malaysian ICU patients. It is endeavoured that more patient data would be collected using this mobile application, to develop a more accurate GFR estimation model suitable for Asian populations since creatinine based equations are often derived based on white populations.

Incidence of brain death among patients with brain injury in intensive care unit: a retrospective study

Incidence of brain death among patients with brain injury in intensive care unit: a retrospective study

Epidemiological overview - 18 years of ICU hospitalization due to trauma in Brazil.

ABSTRACTOBJECTIVE Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015.METHODS This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation.RESULTS Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3).CONCLUSION An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.

Predictors of mortality in children with acute kidney injury in intensive care unit

Background Acute kidney injury (AKI) can increase the morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Previous published studies have mostly been conducted in high-income countries. Evaluations of possible predictors of mortality in children with AKI in low- and middle-income countries have been limited, particularly in Indonesia.
 Objective To assess possible predictors of mortality in children with AKI in the PICU.
 Methods We conducted a retrospective cohort study at Dr. Sardjito Hospital, Yogyakarta, Indonesia. All children with AKI admitted to PICU for more than 24 hours from 2010 to 2016 were eligible and consecutively recruited into the study. Logistic regression analysis was used to identify independent predictors.
 Results Of the 152 children with AKI recruited, 119 died. In order to get a P value of <0.25, multivariate analysis is run to degree AKI, ventilator utilization, primary infection disease, MOF and age.Multivariate analysis showed that ventilator use, severe AKI, and infection were independently associated with mortality in children with AKI, with odds ratios (OR) of 19.2 (95%CI 6.2 to 59.7; P<0.001), 8.6 (95%CI 2.7 to 27.6; P<0.001), and 0.2 (95%CI 0.1 to 0.8; P=0.02), respectively.
 Conclusion The use of mechanical ventilation and the presence of severe AKI are associated with mortality in children with AKI admitted to the PICU. Interestingly, the presence of infection might be a protective factor from mortality in such patients.

Nurses 'Performance Regarding Patient with Traumatic Head Injury In Intensive care unit

Nurses 'Performance Regarding Patient with Traumatic Head Injury In Intensive care unit

The Effect of Oral Administration of Amantadine on Neurological Outcome of Patients With Diffuse Axonal Injury in ICU.

Traumatic brain injury is a major cause of death and disability in adults. This study investigated the effect of oral administration of amantadine on the neurological outcomes of patients with diffuse axonal injury (DAI) in the intensive care unit (ICU). This double-blind clinical trial was conducted in the ICU of Imam Hospital in Urmia. Patients with DAI were intubated and received mechanical ventilation in the ICU. They were divided into 2 groups: patients receiving amantadine (A) and placebo (P). The acquired data were analyzed using SPSS, P < .05 significant level. Findings showed no significant difference between the 2 groups in age and sex. There was no significant difference between the mean Glasgow Coma Scale (GCS) at the time of admission and discharge, and the mean Glasgow Outcome Scale (GOS) of the patients in 2 groups. No significant difference was observed in the duration of mechanical ventilation, hospitalization, and mortality in both groups (P > .05) in ICU. However, there was a significant difference between the mean GCS at the time of admission and discharge and death. Also, significant differences existed between the mean GOS in discharged and deceased patients (P = .001). This study showed no significant difference between the mean GCS at the time of admission and discharge and the mean GOS of the discharged patients and the mortality rate in the 2 groups. However, there were clear statistical differences between these variables in discharged and deceased patients. It is recommended that further studies are conducted with a larger sample size.

Neurocritical care for traumatic brain injury in intensive care unit of Dr H. Andi Abdurahman Noor Hospital, Indonesia

Neurocritical care for traumatic brain injury in intensive care unit of Dr H. Andi Abdurahman Noor Hospital, Indonesia

Individualized Pharmacokinetic Dosing of Vancomycin Reduces Time to Therapeutic Trough Concentrations in Critically Ill Patients.

Dosing vancomycin in critically ill patients often results in subtherapeutic and supratherapeutic trough concentrations. In this retrospective study, we compared the time to goal trough attainment and incidence of acute kidney injury in intensive care unit (ICU) patients whose vancomycin was dosed by a pharmacy pharmacokinetic (PK) dosing and monitoring service to the standard of care. Three-hundred fifty adult ICU patients at a Level 1 trauma, teaching hospital who received vancomycin for >24 hours from February 1, 2016, to November 30, 2016, were screened. Patients were included in the PK group if consecutive serum concentrations were used to calculate individualized PK and determine a dosing regimen. Patients who were dosed using troughs only were then matched 1-to-1 to the PK group by date of vancomycin initiation and included in the traditional group. Fifty patients were included in each group. Baseline characteristics were similar, except the PK group had more patients under the care of the neuromedical ICU service (42% vs 18%; P = .02) and fewer patients with a corrected creatinine clearance <30 mL/min/1.73 m2 (22% vs 46%; P = .02). Attainment of goal trough concentrations for the PK and traditional groups were 84.4% and 29.4% by 48 hours (P = .0001), 88.4% and 60.7% by 72 hours (P = .009), and 92.9% and 77.8% by 96 hours (P = .1), respectively. Incidence of acute kidney injury between the PK and traditional groups was not statistically significant (8.3% vs 14%; P = .5). Utilization of individualized pharmacokinetic dosing of vancomycin in critically ill patients resulted in faster goal trough attainment without an increase in nephrotoxicity.

Current practice of diagnosis and management of acute kidney injury in intensive care unit in resource limited settings

PurposeIn a resource limited settings, there is sparse information about the management of acute kidney injury (AKI) based on systemic data collection. This survey aimed to described the current management of AKI in intensive care units (ICUs) across Thailand. Materials and methodsQuestionnaires were distributed to 160 physicians involved in the intensive care between January and December 2014 across Thailand. Distribution was done through an online survey platform or telephone interview. ResultsThe response rate was 80.6% (129 physicians). AKI diagnosis was mostly made by using KDIGO criteria (36.7%). A common diagnostic investigation of AKI was urinalysis (86%). Nephrologists had a major role (86.4%) in deciding the initiation and selection of renal replacement therapy (RRT) modality. Intermittent hemodialysis is the preferable mode of RRT (72.0%), followed by continuous renal replacement therapy (CRRT, 12%), sustained low efficiency dialysis (10.0%) and peritoneal dialysis (6.0%). Catheter insertion was predominantly performed by nephrologist (51.1%) with ultrasound guidance. The right internal jugular vein was the most common site of insertion (70.4%). The most common indication for CRRT was hemodynamic instability. ConclusionsAmid increasing concern of AKI in the ICU, our study provides the insight into the management of AKI in resource limited settings.

Clinical Profile of Acute Kidney Injury in Intensive Care Unit

Clinical Profile of Acute Kidney Injury in Intensive Care Unit

Clinical profile and outcome of acute kidney injury in intensive care unit of a teaching hospital

Objectives: Acute kidney injury is one of the most common cause of hospitalization in developing countries. Causes of AKI are multifactorial. Most of AKI are community acquired. The objective of the study was to identify the clinical profile and outcome of acute kidney disease.&#x0D; Subject and Methodology: 30 patients from Chitwan Medical College outpatient clinic were included in the study from November 2014 to April 2015. A brief history and clinical examinations were taken from all patients along with laboratory tests for Renal function tests, urine output, metabolic parameters and hematological profile.&#x0D; Results: 19 males (63.3% and 11 females (36.7%) were studied. The main causes for AKI were sepsis (46.6%) followed by hepatic causes (16.6%), gastroenteritis (10%) and others (10.2%). Out of 30 patients, 19 recovered (63.3%) and were discharged and 11(36.7%) died. Most of the deaths were in injury (37.5%) and failure (42.8%) stages of RIFLE criteria. Out of 19 recovered 16(84.21%) patients did not need any renal replacement therapy whereas 3(15.8%) patients had to undergo hemodialysis.&#x0D; Conclusion: Early identification of kidney injury may lead to lesser renal replacement therapy and better prognosis. However late presentations of AKI have higher hospital mortality rate.

Acute kidney injury in intensive care unit, hospital Universiti Sains Malaysia: A descriptive study.

Acute kidney injury (AKI) was frequently encountered complication among intensive care unit (ICU) patients and recognized as a major public health problem. The present study aimed to determine the basic features of AKI patients admitted to ICU. A retrospective cohort study was conducted among 106 AKI patients admitted to ICU, Hospital Universiti Sains Malaysia from January 1, 2007 until the end of December 2013. The AKI patients ranged from 18 to 80 years old with the mean (standard deviation) of 58.93 (15.76) years, 60.4% were male and 91.5% were Malay ethnicity. Hypertension and diabetes were in 38.1% and 28.8%, respectively. The median (interquartile range) length of ICU stay was 4.50 (9.00) days. Eighty-two patients (79.6%) were classified as the Acute Kidney Injury Network (AKIN)-I, 12 (11.7%) as AKIN-II, and nine (8.7%) as AKIN-III. Sepsis was the common etiology among AKI patients (74.3%). Twenty-four patients (22.9%) required dialysis and 90.5% were mechanically ventilated. In conclusion, AKI developed more in male patients, Malay ethnicity, presented with comorbid, caused by sepsis, admitted to ICU, required mechanical ventilation, and need for renal replacement therapy.

How Useful is Extravascular Lung Water Measurement in Managing Lung Injury in Intensive Care Unit?

Context:The primary goal of septic shock management is optimization of organ perfusion, often at the risk of overloading the interstitium and causing pulmonary edema. The conventionally used end points of resuscitation do not generally include volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).Aims:This study aimed to assess the prognostic value of EVLWI and PVPI by calculating their correlation with the severity of lung injury.Settings and Design:This prospective observational study included twenty mechanically ventilated critically ill patients with Acute Physiology and Chronic Health Evaluation score (APACHE II) >20.Subjects and Methods:EVLWI and PVPI were measured using transpulmonary thermodilution, and simultaneously, PaO2:FiO2 ratio, alveolar-arterial gradient of oxygen (AaDO2), and chest radiograph scores from two radiologists were obtained.Statistical Analysis:The correlation of EVLWI and PVPI with chest radiograph scores, PaO2:FiO2 ratio, and AaDO2 were calculated. The inter-observer agreement between the two radiologists was tested using kappa test.Results:EVLWI and PVPI correlated modestly with PaO2:FiO2 (r = −0.32, P = 0.0004; r = −0.39, P = 0.0001). There was a better correlation of EVLWI and PVPI with PaO2:FiO2 ratio (r = −0.71, P < 0.0001; r = −0.58, P = 0.0001) in the acute respiratory distress syndrome (ARDS) subgroup. The EVLWI values correlated significantly with corresponding chest radiograph scores (r = 0.71, P < 0.0001 for observer 1 and r = 0.68, P < 0.0001 for observer 2).Conclusions:EVLWI and PVPI may have a prognostic significance in the assessment of lung injury in septic shock patients with ARDS. Further research is required to reveal the usefulness of EVLWI as an end point of fluid resuscitation in the management of septic shock with ARDS.

A Study on Acute Kidney Injury in Intensive Care Setting

A Study on Acute Kidney Injury in Intensive Care Setting

Impact of dialysis practice patterns on outcomes in acute kidney injury in Intensive Care Unit.

Aim:Recent advances in dialysis therapy have made an impact on the clinical practice of renal replacement therapy (RRT) in acute kidney injury (AKI) in Intensive Care Unit (ICU). We studied the impact of RRT practice changes on outcomes in AKI in ICU over a period of 8 years.Subjects and Methods:AKI patients requiring RRT in ICU referred to a nephrologist during two different periods (period-1: Between May 2004 and May 2007, n = 69; period-2: Between August 2008 and May 2011, n = 93) were studied. The major changes in the dialysis practice during the period-2, compared to period-1 were introduction of prolonged intermittent RRT (PIRRT), early dialysis for metabolic acidosis, early initiation of RRT for anuria and positive fluid balance and use of bicarbonate-based fluids for continuous RRT (CRRT) instead of lactate buffer. The primary study outcome was 28-day hospital mortality.Results:The mean age was 53.8 ± 16.1 years and 72.6% were male. Introduction of PIRRT resulted in 37% reduction in utilization of CRRT during period-2 (from 85.5% to 53.7%). The overall mortality was high (68%) but was significantly reduced during period-2 compared to period-1 (59% vs. 79.7%, P = 0.006). Metabolic acidosis but not the mode of RRT, was the significant factor which influenced mortality.Conclusions:Adaption of PIRRT resulted in 37% reduction of utilization of CRRT. The mortality rate was significantly reduced during the period of adaption of PIRRT, possibly due to early initiation of RRT in the latter period for indications such as anuria and metabolic acidosis.

Impact of dialysis practice patterns on outcomes in acute kidney injury in Intensive Care Unit.

Sir, We read with interest the article on outcomes in acute kidney injury (AKI) by Annigeri et al.[1] They have very well compared the change of their practice of dialysis in view of indications and process of dialysis with resultant significant change in mortality. The authors think that some aspects need to be considered in this study. Severe organ edema was chosen as an indication for dialysis. The definition used for this indication is not clearly defined in the manuscript. The comparison of hemodynamics between continuous renal replacement therapy (CRRT) and prolonged intermittent renal replacement therapy (PIRRT) does not add much value to the study as the choice of dialysis was based on the hemodynamics. The authors think an objective assessment of hemodynamics during the dialysis sessions comparing PIRRT and CRRT would have given some more information as studies are available which have tried to explain the hemodynamic effects with the use of vasopressor dependency and vasopressor index.[2] The aim of RRT was targeted to control blood urea nitrogen. This is a target used in chronic renal failure, but its utility in a patient in AKI who is undergoing dialysis for metabolic acidosis and fluid overload is doubtful.[3] The efficacy of PIRRT to achieve the targets should have been compared with CRRT. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Case study of transfusion related acute lung injury in intensive care unit

Transfusion is a common method of treatment of haemorrhagic events of patients treated in the Intensive Care Unit (ICU). Nonetheless, it involves various dangers, in many cases fatal, such as transfusion related acute lung injury (TRALI). This article refers to the case encountered during our traineeship in the ICU. It is about a 47-year-old man, who was transported to us from another tertiary acute care facility intubated due to diabetic coma. After 39 days of treatment in the ICU, the acute diabetes mellitus, the hemodynamic instability and the electrolyte disorders were regulated. However, he started to have diffuse haemorrhagic events due to intestinal necrosis and required transfusion of blood factors. After the transfusion of Platelets (PLT) he developed Acute Respiratory Distress Syndrome (ARDS), which evolved to TRALI and finally the death of the patient occurred.

Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study.

BackgroundContrast medium used for radiologic tests can decrease renal function. However there have been few studies on contrast-associated acute kidney injury in intensive care unit (ICU) patients. The objective of this study was to evaluate the incidence, characteristics, and outcome of contrast-associated acute kidney injury (CA-AKI) patients using the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients in the ICU.MethodsWe conducted a retrospective study of adult patients who underwent contrast-enhanced radiologic tests from January 2011 to December 2012 in a 30-bed medical ICU and a 24-bed surgical ICU.ResultsThe study included 335 patients, and the incidence of CA-AKI was 15.5%. The serum creatinine and estimated glomerular filtration rate values in the CA-AKI patients did not recover even at discharge from the hospital compared with the values prior to the contrast use. Among 52 CA-AKI patients, 55.8% (n = 29) had pre-existing kidney injury and 44.2% (n = 23) did not. The CA-AKI patients were divided into risk (31%), injury (31%), and failure (38%) by the RIFLE classification. The percentage of patients in whom AKI progressed to a more severe form (failure, loss, end-stage kidney disease) increased from 38% to 45% during the hospital stay, and the recovery rate of AKI was 17% at the time of hospital discharge. Because the Acute Physiology and Chronic Health Evaluation (APACHE) II score was the only significant variable inducing CA-AKI, higher APACHE II scores were associated with a higher risk of CA-AKI. The ICU and hospital mortality of patients with CA-AKI was significantly higher than in patients without CA-AKI.ConclusionsCA-AKI is associated with increases in hospital mortality, and can be predicted by the APACHE score.Trial registrationNCT01807195 on March. 06. 2013.

Contrast-enhanced ultrasound: a new vision of microcirculation in the intensive care unit

To gain new insights into renal perfusion and pathogenesis of acute kidney injury in intensive care unit (ICU) patients, we need new techniques to evaluate renal microcirculation. In addition, a bedside technique applicable in the ICU could be extremely useful for physicians to adjust the optimal therapeutic/preventive modalities for kidney perfusion in each patient. Contrast-enhanced ultrasound (CEUS) has been validated to assess and quantify the microcirculation up to capillary perfusion in several organs. In a recent issue, Schneider and colleagues suggest that CEUS is feasible, well tolerated and able to quantify cortical renal microcirculation in patients undergoing cardiac surgery. In addition, CEUS derived-parameters suggest a decrease in renal perfusion occurring within 24 hours of surgery in patients at risk of acute kidney injury. This study opens up new possibilities for the assessment of cortical renal microcirculation in ICU patients.

Hypothermia Amplifies Somatosensory-evoked Potentials in Uninjured Rats

Temperature fluctuations significantly impact neurological injuries in intensive care units. As the benefits of therapeutic hypothermia continue to unfold, many of these discoveries are generated by studies in animal models undergoing experimental procedures under the influence of anesthetics. We studied the effect of induced hypothermia on neural electrophysiological signals of an uninjured brain in a rodent model while under isoflurane. Fourteen rats were divided into 2 groups (n=7 each), on the basis of electrode placement at either frontal-occipital or primary somatosensory cortical locations. Neural signals were recorded during normothermia (T=36.5 to 37.5°C), mild hypothermia (T=32 to 34°C), and hyperthermia (T=38.5 to 39.5°C). The burst-suppression ratio was used to evaluate electroencephalography (EEG), and amplitude-latency analysis was used to assess somatosensory-evoked potentials (SSEPs). Hypothermia was characterized by an increased burst-suppression ratio (mean±SD) of 0.58±0.06 in hypothermia versus 0.16±0.13 in normothermia, P<0.001 in frontal-occipital; and 0.30±0.13 in hypothermia versus 0.04±0.04 in normothermia, P=0.006 in somatosensory. There was potentiation of SSEP (2.89±1.24 times the normothermic baseline in hypothermia, P=0.02) and prolonged peak latency (N10: 10.8±0.4 ms in hypothermia vs. 9.1±0.3 ms in normothermia; P15: 16.2±0.8 ms in hypothermia vs. 13.7±0.6 ms in normothermia; P<0.001), whereas hyperthermia was primarily marked by shorter peak latencies (N10: 8.6±0.2 ms, P15: 12.6±0.4 m; P<0.001). In the absence of brain injury in a rodent model, hypothermia induces significant increase to the SSEP amplitude while increasing SSEP latency. Hypothermia also suppressed EEGs at different regions of the brain by different degrees. The changes to SSEP and EEG are both reversible with subsequent rewarming.