Mean Urine Output Research Articles

The correlation between Corrected Flow Time (FTc) Based on Esophageal Doppler Monitoring and Pleth Variability Index (PVI) in the Fluid Therapy in Patients undergoing Total Abdominal Hysterectomy

Background: The occurrence of bleeding during major surgeries is common and requires timely and accurate management in the prevention and treatment of hypovolemia and hemodynamic instability during and after surgery. This study evaluated the correlation and agreement between the two protocols determining the status of the hypovolemia during hysterectomy. Methods: This study was a randomized single-blinded clinical trial. The study population included 30 patients undergoing Total Abdominal Hysterectomy in Shariati Hospital in Tehran between 2015 and 2016. The patients were randomly assigned to two groups using a randomized table of numbers, so that in the FTc group, fluid therapy was performed based on the FTc index and in the PVI group based on the PVI index. The changes in FTc and PVI values were recorded every 5 minutes and the changes in the two indicators from the beginning to the end of the treatment were evaluated. At the beginning and end of the surgery, an arterial blood gas analysis (ABG) was also performed. The amount of bleeding during operation and urinary output were recorded in two groups. Results: There was no significant difference across the two groups in total fluid intake during surgery, mean volume of blood loss, mean urine output, and duration of surgery. The arterial blood gas status was also similar in both groups at the beginning and the end of the operation. We found a strong adverse correlation between FTC and PVI indices at the different time points evaluated within the surgery. In total, there was a strong correlation between the mean FTC and the mean PVI during the first hour (r=-0.765, P < 0.001) and the second hour (r=-0.941, -P < 0.001) of operation. Considering the cut-off point of 350msec for the FTC and 13% for the PVI in predicting hypovolemia, the agreement between the two protocols in fluid therapy during the first hour after surgery was 79.8% and 76.6%. Conclusion: There is a strong and significant correlation between the two FTC (with a cut off of 350) and PVI (with a cut point of 13%) to predict need for fluid therapy.

Fenoldopam Increases Urine Output in Oliguric Critically Ill Surgical Patients.

BackgroundFenoldopam is a short-acting dopamine A1 receptor agonist which mediates vasodilation of the renal arteries, thereby increasing urine output. The objective of this study was to compare the effects of fenoldopam and its synergistic effect on furosemide for improving the urine output in postoperative critically ill patients with acute kidney injury (AKI).MethodsThis is a retrospective study of postoperative critically ill patients with AKI. Patients who received furosemide (control group) were compared with those who received furosemide plus fenoldopam (treatment group) and evaluated at 12 and 24 hours post-treatment. Patients with oliguria and AKI were included in the study, while patients with chronic kidney disease (CKD) were excluded. Glomerular filtration rate, serum creatinine, blood pressure, calculated fluid accumulation, fluid intake, urine output, and total fluid output were used as variables to assess the medication effect.ResultsOf the 126 patients who met the inclusion and exclusion criteria, 87 patients received furosemide alone, and 39 patients received furosemide plus fenoldopam during their first 24 hours of admission to the surgical intensive care unit (SICU). Although not statistically significant, the addition of fenoldopam demonstrated an increase in mean urine output of 1525ml (IQR; 1530-2095) in the first 24 hours (P=0.06). There was also noted an increase in the urine output (p= 0.07) and a decrease in the total fluid accumulation when fenoldopam was co-administered with furosemide when compared to the patients who were only treated with furosemide (p=0.06). There was no significant change in creatinine clearance from baseline in either group. ConclusionFenoldopam may increase urine output in postoperative critically ill patients with acute kidney injury when administered within the first 24 hours of presentation. Based on our results, fenoldopam appears to have a synergistic effect with furosemide in our study population.

568 Echocardiography and impedance cardiography as determinants of successful slow Levosimendan infusion in patients with acute advanced heart failure

Abstract Aims Despite new therapeutic options, patients with heart failure (HF) still progress to advanced stage. Among new therapeutic options, Levosimendan was recently approved in order to treat patients hospitalized for acute decompensated heart failure (ADHF) with severe systolic dysfunction. The pharmacological effects of Levosimendan consist of inotropy, vasodilatation, and cardioprotection through the increase of calcium sensitivity. These effects should be monitored with echocardiography and in particular with speckle tracking and tri-dimensional echocardiography which appear to be useful in LV systolic function detection and monitoring. In this study we aim to evaluate the effect of slow infusion of Levosimendan on the non-invasive measurement of cardiac output, the speckle tracking parameters and the tri-dimensional echocardiography measurements in advanced ADHF patients. Methods and results This is a prospective observational study evaluating Levosimendan efficacy through advanced echocardiography. We enrolled 11 patients with diagnosis of ADHF who respect the recent ESC criteria of ‘advanced heart failure’. Patients underwent to blood sample examination to measure electrolytes, creatinine, and NTproBNP. Patients underwent to advanced echocardiography examination (performed for each patient pre- and post-Levosimendan infusion) with tri-dimensional echocardiography and global longitudinal strain assessment. Furthermore patients underwent to non-invasive cardiac output and cardiac index collection through impedance cardiography pre- and post-Levosimendan infusion. All patients were followed for 30 days after discharge for all cause of mortality and HF re-hospitalization. A total of 11 patients affected by advanced ADHF were included in this study. Mean age was 73.8 ± 4.7 years. 72.7% (n 8) patients were men. 81.9% (n 9) of patients recognize ischaemic heart disease as HF etiology. At admission mean systolic arterial pressure was 100 ± 17 mmHg, mean NTproBNP was 24 445 ± 12 194 pg/ml and mean serum creatinine was 1.55 ± 0.84 mg/dl. At tri-dimensional echocardiography mean LV ejection fraction (LVEF) was 19.7 ± 5.7% and at bi-dimensional echocardiography mean tricuspid anular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP) were, respectively, 12.5 ± 2.7 mm and 48 ± 16 mmHg. Mean LV global longitudinal strain (GLS) was −3.0 ± 1.8. Mean furosemide in-hospital infusion was 306 ± 102 mg/die and mean urine output 1436 ± 496 ml. None developed significant ventricular or supraventricular arrhythmias. All patients were treated with betablockers during infusion. At 30 days of follow-up two patients died and 1 patient was re-hospitalized. Evaluating the differences among our variables pre- and post-Levosimendan infusion, we found that NTproBNP was significantly reduced post-Levosimendan infusion (P = 0.01). Among ICG non-invasive measurement, we found significant differences in stroke volume (SV) and cardiac output (CO) in terms of significant improvement (P = 0.001 for both). Analysing tri-dimensional echocardiography variables, we observed a significant improvement of LVEF (P = 0.003), SV (P = 0.03) and 3-D LV GLS (P = 0.002). Furthermore, we observed a significant reduction in end-systolic volume (ESV) post-Levosimendan infusion (P = 0.02). Among bi-dimensional echocardiography measurements, there was a significant reduction in end-diastolic diameter of right ventricle (EDDRV) and in B-lines count (respectively, P = 0.02 and P = 0.002). Moreover, we observed a significant improvement in TAPSE (P = 0.003) and in LV GLS (P = 0.004). Conclusions Our study showed that slow Levosimendan infusion (12.5 mg at velocity of 0.05–1 mcg/kg/min) without bolus could be considered in advanced ADHF patients to improve cardiac performance without severe adverse events. ICG and echocardiography in-hospital evaluation seemed to be necessary to understand treatment success and patients status improvement as well as cardiac function benefit.

Nalfurafine, a G-Protein-Biased KOR (Kappa Opioid Receptor) Agonist, Enhances the Diuretic Response and Limits Electrolyte Losses to Standard-of-Care Diuretics.

Nalfurafine is a G-protein-biased KOR (kappa opioid receptor) agonist that produces analgesia and lacks central nervous system adverse effects. Here, we examined the cardiovascular and renal responses to intravenous and oral nalfurafine alone and in combination with furosemide, hydrochlorothiazide, or amiloride. We hypothesized that nalfurafine, given its distinct mechanism of vasopressin inhibition, would increase urine output to these diuretics and limit electrolyte loss. Following catheterization, conscious Sprague-Dawley rats received an isotonic saline infusion and were then administered an intravenous bolus of nalfurafine, a diuretic, or a combination. Mean arterial pressure, heart rate, and urine output were recorded for 90 minutes. In another study, rats were placed in metabolic cages and administered drug in an oral volume load. Hourly urine samples were then collected for 5 hours. Intravenous and oral nalfurafine produced a marked diuresis, antinatriuresis, antikaliuresis, and a decrease in mean arterial pressure. Compared with diuretic treatment alone, intravenous coadministration with nalfurafine significantly increased urine output to furosemide and hydrochlorothiazide and decreased sodium and potassium excretion. Notably, mean arterial pressure was reduced with nalfurafine/diuretic combination therapy compared to diuretics alone. Similarly, oral coadministration of nalfurafine significantly increased urine output to hydrochlorothiazide and decreased sodium and potassium excretion, whereas combination with furosemide only limited the amount of sodium excreted. Further, both intravenous and oral coadministration of nalfurafine enhanced the diuresis to amiloride and decreased sodium excretion. Together, these findings demonstrate that nalfurafine enhances the diuresis to standard-of-care diuretics without causing an excessive loss of electrolytes, offering a new approach to treat several cardiovascular conditions.

RENAL FUNCTION AND CLINICAL PROFILE IN CHILDREN WITH CONGENITAL HEART DISEASE – AN OBSERVATIONAL STUDY FROM TERTIARY CARE HOSPITAL IN CENTRAL INDIA.

Purpose: To evaluate the renal function and clinical prole in children with congenital heart disease. Method: After taking informed consent from the parents of 118 children aged 1 month to 14 years were recruited in study. Anthropometry and vitals were noted. Complete physical examination and USG abdomen done to identify any other associated congenital anomaly. Laboratory evaluation of serum creatinine was done on day 1 and day 5. 24 hours urine output was strictly measured till day 5 of admission. Result: The maximum number of cases belonged to age group 1-6 month. Male children were affected more than females (1.5:1) and majority of the children belong to family of lower middle and lower socioeconomic status. Most of the children belong to rural area. Among syndromic features, microcephaly and cleft lip and cleft palate were most frequently observed. Most of the cases had weight /height <-3SD. There was no major signicant difference in mean value of urine output and serum creatinine level in different age groups and in between cyanotic and acyanotic group. Conclusion: Congenital heart disease forms a significant diagnosis in hospitalized children. Larger studies are needed to evaluate newer associations (like male gender and low socioeconomic status). Microcephaly and cleft lip/palate were most observed associated syndromic features. No signicant effect was observed on the mean urine output and serum creatinine level in children with congenital heart disease.

Outcome and Incidence of Acute Kidney Injury among Hospitalized Children

Background and purpose: Data on the epidemiology of acute kidney injury (ARI) in Asia come primarily from studies conducted in large tertiary hospitals with nephrology departments. Little is known about what happens in primary care settings without nephrology, especially in the paediatric population. The aim of this study is to describe the epidemiology, outcome and risk factors of ARF in children admitted in pediatric department. Place and Duration: In the Pediatric Medicine and Nephrology department of Abbasi Shaheed Hospital for one-year duration from August 2020 to August 2021. Methods: We prospectively examined children aged 2 to 14 whose guardians gave the consent for the study and were admitted in the Pediatric ward. We identified children with risk factors for AKI on admission and then tested them for AKI using the 2012 Creatinine-based Modified General Kidney Disease Improvement (KDIGO) criteria to improve overall outcomes. Participants with AKI were followed up to discharge. The subject of interest was the need and access to dialysis and renal recovery on discharge from the hospital. Results: A total of 74.3% (n = 116) out of the 156 patients admitted during the study period were at risk of ARF. Of the 156 registered participants, 51.9% (n = 81) were males with a mean age of 5 years. Although comorbid conditions were rare, sickle cell anaemia and malnutrition were the most common. Most of the children were hypotensive (n = 89; 57.1%), with mean systolic and diastolic blood pressures of 81 mmHg and 42 mmHg, respectively. The mean urine output was 0.79 ml / kg / hr. Thirteen patients (8.33%) had urine dipstick anomalies. Anaemia was common (n = 72, 46.2%) and 32 (20.5%) had severe anaemia. Leucocytosis was detected in 26.3% of patients, and a platelet count below 100,000 / mm3 in 24 (15.4%) patients. In total, 21 of 156 participants had AKI for an incidence of 13.5%. The only patient with an indication for dialysis (uremic encephalopathy and anuria> 24 hours) died without dialysis due to a delay in transfer to a dialysis centre (due to lack of resources). Of the 20 survivors in the AKI group, 15 (71.4%) had complete improvement in kidney function The median hospitalization time was significantly longer in participants with stage 3 AKI. Conclusions: ARF risk factors are very common in children admitted in the hospitals. At least one in 10 children presenting with AKI risk factors will have AKI. AKI is largely caused by community-acquired diseases that can be prevented, such as diarrheal diseases and malaria. Efforts should be made to educate about risk assessment, prevention, early diagnosis and treatment of AKI in children. Keywords: AKI; epidemiology; risk factors and outcome.

PREDICTORS IN-HOSPITAL MORTALITY OF SEPTIC VS NON-SEPTIC ACUTE KIDNEY INJURY PATIENTS: AN OBSERVATIONAL COHORT STUDY

Background: To compare the predictors In-hospital mortality of patients with septic Acute Kidney Injury (S-AKI) and non-septic AKI (NS-AKI). Methods: a cohort study of critically ill patients with AKI admitted to the emergency room at a tertiary hospital from January to June 2019. The primary outcome was hospital mortality. Results: There were 116 patients who met the inclusion criteria. Compared with NS-AKI, patients with S-AKI had significantly lower mean MAP, median eGFR, and urine output. (UO). S-AKI had higher mortality and vasopressor requirements and had a lower renal recovery than NS-AKI (63.2% vs 31.4%, p=0.001; 30.8% vs 13.7%, p=0.031, and 36.9% vs 60.8%, p=0.011, respectively). AKI stage 3 and vasopressor requirements were dependent risk factors for both S-AKI and NS-AKI mortality. Meanwhile, SOFA score > 7 and the need for dialysis are dependent and independent risk factors for mortality in S-AKI. Worsening and/or persistence in UO, serum urea and creatinine levels at 48 h after admission were predictors of mortality in S-AKI and NS-AKI. Improvement in UO in surviving patients was more pronounced in S-AKI than in NS-AKI (50% vs 17.1%, p=0.007). The surviving S-AKI patients had a longer hospital stay than surviving NS-AKI [8 (6-14.5) vs 5 (4 – 8), p=0.004]. S-AKI have higher mortality and vasopressor requirements and have lower renal recovery than NS-AKI. Conclusion: S-AKI have higher mortality and vasopressor requirements and a lower renal recovery than NS-AKI. Independent predictors of mortality in S-AKI were high SOFA scores and the need for dialysis.

Abstract 13956: Nalfurafine, an Orally Active, G Protein-Biased Kappa Opioid Receptor Agonist, Increases the Diuretic Response to Loop and Thiazide Diuretics and Limits Electrolyte Losses

Nalfurafine, a G protein-biased kappa opioid receptor (KOR) agonist that produces analgesia and is devoid of CNS adverse effects, is used in Japan to treat pruritis in dialysis patients. Our lab has shown that in rats, IV nalfurafine produces a marked diuresis, antinatriuresis, antikaliuresis, and decrease in blood pressure. Here, we examined the cardiovascular and renal responses to IV and oral nalfurafine in combination with furosemide or hydrochlorothiazide (HCTZ). We hypothesized that combining nalfurafine with these diuretics would increase urine output, given its distinct mechanism of vasopressin inhibition, and limit electrolyte loss. Following chronic catheterization, conscious Sprague-Dawley rats received an isotonic saline infusion, and after stabilization, were administered an IV bolus diuretic alone or in combination with nalfurafine. Mean arterial pressure (MAP), heart rate (HR), and urine output were recorded for 90-min. In a separate study, rats were placed in metabolic cages, and following 2-hour acclimation, were administered drug in a volume load (20 cc/kg) via oral gavage. Hourly urine samples were then collected for five hours. When compared to diuretic treatment alone, IV co-administration with nalfurafine significantly increased total urine output to furosemide and HCTZ while reducing the amount of sodium and potassium excreted (Table 1). Notably, MAP was reduced with nalfurafine/diuretic combination therapy compared to diuretics alone. Similarly, oral co-administration of nalfurafine significantly increased the urine output to HCTZ and reduced the amount of sodium and potassium excreted, whereas combination with furosemide only limited the amount of sodium excreted (Table 1). Together, these findings demonstrate that nalfurafine enhances the diuresis to standard-of-care diuretics without causing an excessive loss of electrolytes, which may offer a new approach to treat several cardiovascular conditions.

Machine Learning Prediction of Liver Allograft Utilization From Deceased Organ Donors Using the National Donor Management Goals Registry.

Several machine learning classifiers were trained to predict transplantation of a liver graft. We utilized 127 variables available in the DMG dataset. We included data from potential deceased organ donors between April 2012 and January 2019. The outcome was defined as liver recovery for transplantation in the operating room. The prediction was made based on data available 12-18 h after the time of authorization for transplantation. The data were randomly separated into training (60%), validation (20%), and test sets (20%). We compared the performance of our models to the Liver Discard Risk Index. Of 13 629 donors in the dataset, 9255 (68%) livers were recovered and transplanted, 1519 recovered but used for research or discarded, 2855 were not recovered. The optimized gradient boosting machine classifier achieved an area under the curve of the receiver operator characteristic of 0.84 on the test set, outperforming all other classifiers. This model predicts successful liver recovery for transplantation in the operating room, using data available early during donor management. It performs favorably when compared to existing models. It may provide real-time decision support during organ donor management and transplant logistics.

Association Between Urine Output and Mortality in Critically Ill Patients: A Machine Learning Approach.

Current definitions of acute kidney injury use a urine output threshold of less than 0.5 mL/kg/hr, which have not been validated in the modern era. We aimed to determine the prognostic importance of urine output within the first 24 hours of admission to the ICU and to evaluate for variance between different admission diagnoses. Retrospective cohort study. One-hundred eighty-three ICUs throughout Australia and New Zealand from 2006 to 2016. Patients greater than or equal to 16 years old who were admitted with curative intent who did not regularly receive dialysis. ICU readmissions during the same hospital admission and patients transferred from an external ICU were excluded. One hundred and sixty-one thousand nine hundred forty patients were included with a mean urine output of 1.05 mL/kg/hr and an overall in-hospital mortality of 7.8%. A urine output less than 0.47 mL/kg/hr was associated with increased unadjusted in-hospital mortality, which varied with admission diagnosis. A machine learning model (extreme gradient boosting) was trained to predict in-hospital mortality and examine interactions between urine output and survival. Low urine output was most strongly associated with mortality in postoperative cardiovascular patients, nonoperative gastrointestinal admissions, nonoperative renal/genitourinary admissions, and patients with sepsis. Consistent with current definitions of acute kidney injury, a urine output threshold of less than 0.5 mL/kg/hr is modestly predictive of mortality in patients admitted to the ICU. The relative importance of urine output for predicting survival varies with admission diagnosis.

Balanced forced-diuresis as a renal protective approach in cardiac surgery: Secondary outcomes of electrolyte changes.

ObjectivesForced‐diuresis during cardiopulmonary bypass (CPB) can be associated with significant electrolyte shifts. This study reports on the serum electrolyte changes during balanced forced‐diuresis with the RenalGuard® system (RG) during CPB.MethodsPatients at risk of acute kidney injury (AKI)—(history of diabetes &/or anaemia, e‐GFR 20–60 ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore >5)—were randomized to either RG (study group) or managed as per current practice (control group).ResultsThe use of RG reduced AKI rate (10% for RG and 20.9% in control, p = .03). Mean urine output was significantly higher in the RG group during surgery (2366 ± 877 ml vs. 765 ± 549 ml, p < .001). The serum potassium levels were maintained between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for the controls. Median potassium supplemental dose was 60 (0–220) mmol (RG group) as compared to 30 (0–190) mmol for control group over first 24 h (p < .001). On Day 1 post‐op, there were no significant differences in the serum sodium, potassium, calcium, magnesium, phosphate, and chloride levels between the two groups. Otherwise, postoperative clinical recovery was also similar.ConclusionsBalanced forced‐diuresis with the RG reduced AKI rates after on‐pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.

A Case and Brief Review of Bilious Ascites and Abdominal Compartment Syndrome from Pancreatitis-Induced Post-Roux-En-Y Gastric Remnant Leak

This is a case of a 55-year-old man with Roux-en-Y gastric bypass surgery 15 years prior who presented with acute pancreatitis and developed distributive shock, bacteremia, acute respiratory distress syndrome, anuric acute renal failure, and a distended abdomen with increasing ascitic fluid on imaging. An elevated bladder pressure, lactic acidosis, and anuria raised concern for abdominal compartment syndrome. Paracentesis was done and four liters of bilious ascitic fluid were drained. Intra-abdominal pressure was measured and improved from 27 cmH2O to 13 cmH2O with paracentesis. Mean arterial pressure and urine output also improved. The patient developed recurrent loculated intra-abdominal fluid collections, though ultrasound, CT scans with and without contrast, MRCP, ERCP, upper GI fluoroscopy, and small bowel enteroscopy failed to reveal a source of the bilious output. Ultimately, a gastrostomy tube was placed and delivery of contrast material through the tube revealed active extravasation from the remnant stomach. This case underscores the importance of considering post-surgical leak regardless of how remotely a Roux-en-Y surgery took place, confirms the importance of pursuing early gastrostomy tube placement and contrast administration when post-Roux-en-Y gastric remnant leaks are suspected, and demonstrates the role of paracentesis in critically ill patients with abdominal compartment syndrome.

Nalfurafine Combined with Standard‐of‐Care Diuretics Increases Diuresis and Limits Electrolyte Losses

Kappa opioid receptor (KOR) agonists produce a variety of beneficial effects, including a water diuresis, but their translation into the clinic has been hindered by psychotomimetic adverse effects. Nalfurafine is a novel, G protein biased KOR agonist that has been shown to produce several desired effects of KOR agonists, while avoiding central adverse effects. To more fully explore the clinical potential of this drug, this study examined the cardiovascular and renal responses to i.v. nalfurafine alone or in combination with the clinically used diuretics: furosemide, hydrochlorothiazide (HCTZ), and amiloride. Following chronic instrumentation, conscious Sprague-Dawley rats were continuously infused i.v. with isotonic saline; after stabilization, rats were administered i.v. bolus nalfurafine, diuretics, diuretics combined with nalfurafine, or vehicle, and mean arterial pressure (MAP), heart rate (HR), and urine output were recorded for 90 min. IV nalfurafine produced a marked diuresis, antinatriuresis, antikaliuresis, and decrease in MAP without eliciting a change in HR. As compared to diuretic treatment alone, co-administration of nalfurafine notably increased the total urine output to furosemide and HCTZ while reducing the amount of sodium and potassium excreted. When combined with amiloride, nalfurafine also increased the diuresis and decreased the amount of sodium excreted. In contrast to these diuretics administered alone, MAP was reduced with nalfurafine combination therapy. Together, these findings demonstrate that nalfurafine has a clinically important action to augment the diuresis to classical diuretics without causing excessive loss of electrolytes characteristic of these drugs. Combination therapy of nalfurafine with loop/thiazide diuretics may offer a new approach to treat several cardiovascular conditions such as hypertension, volume overloaded states, and electrolyte abnormalities.

Transurethral Thulium: YAG laser vapoenucleation of the prostate

Laser prostate surgery is currently considered as being an alternative to other surgical approaches like mono or bipolar transurethral resection and classical open surgery. The implementation of transurethral Thulium: YAG laser vapoenucleation of the prostate opens up new avenues in the treatment of benign prostatic hyperplasia. Therefore, the use of Th uVEP and the subsequent fragmentation of vapoenucleated adenomatous nodules may completely change the surgical approach in the treatment of benign prostatic hyperplasia. The study included 23 patients with benign prostatic hyperplasia, who underwent minim invasive surgical treatment via transurethral Thulium: YAG laser vapoenucleation within the Urology Clinic of „Nicolae Testemitanu” SUMPh. The patients tolerated the surgical procedure well. Patients, with mean age of 62.4±3 years, were assessed at 3, 6, and 12 months aft er the surgery. A constant improvement of the IPSS and QoL scores was determined. A 15-point IPSS and 2-point Qol decrease was registered. No signifi cant decrease in IIFE-5 score was reported. The highest Qmax and Qmean increase was registered at 12 months: 150% and 139.4% respectively. The mean urine output increased to 59ml or 47.9%. The mean prostate volume decreased to 41±5cm3 (-4.1%), whereas the volume of residual urine showed a decrease of about 66±18ml (-77%). Given the excellent effi cacy of minimally invasive ThuVEP, it might be recommended as a surgical method of choice in the treatment of benign prostatic hyperplasia.

Effect of intraoperative dexmedetomidine on renal function in patients undergoing cardiopulmonary bypass graft surgery under cardiopulmonary bypass

IntroductionThis study is aimed to evaluate the effect of intraoperative dexmedetomidine on renal function in patients undergoing cardiopulmonary bypass graft surgery (CABG)by using cardiopulmonary bypass (CBP).MethodsThis randomized clinical trial study was performed on 58 patients who were candidates for CABG. In the dexmedetomidine group, dexmedetomidine infusion at a dose of 0.5 μg / kg / h without a loading dose and in the control group placebo was initiated. After the end of surgery and ICU admission and on days 2 and 3 postoperatively, serum BUN, Cr, and eGFR levels, also urine output, Inotrope usage, and PRBC consumption were recorded. ResultNo significant differences were observed in any of the steps in serum creatinine levels between the two groups (P>0.05). A significant difference in serum BUN levels was observed between the two groups except for the third day (P0.05). There was a significant difference between the mean urine output in the two groups only on the second day (P=0.04). There was no significant difference in PRBC intake and inotrope usage between the two groups (P>0.05).ConclusionThe findings indicate that dexmedetomidine does not affect the renal function of patients undergoing coronary artery bypass graft surgery. According to the findings, dexmedetomidine can increase the urine output of patients during surgery. However, it has no positive effect on the postoperative period.

PREDIALYSIS SYSTOLIC PRESSURE AND MORTALITY

Objective: This study aimed to verify the impact of predialysis systolic pressure (PDSP) on patients’ mortality. Design and method: We reviewed files of incident patients, in one reference center of hemodialysis, between January 2009 and June 2010. Arterial pressure was measured by sphygmomanometer before initiating the patient's first dialysis session. We considered: as “high PDSP” a SP equals or over 180 mmHg; as “low PDSP” a PS equals or less than 100 mmHg. Univariate and multivariate analysis were performed to study PDSP association with absolute mortality at five years. Odds ratio (OR) was subject to a 95% confidence interval. We used Kaplan Meier method for survival curves. Results: One hundred eleven patients were included. Sex ratio was 1.7 M/W. At dialysis initiation: mean age was 55 ± 14.9 years. Sixty nine patients (62%) were hypertensive; all of them were under antihypertensive agents. MAP, SP and DP were respectively 98.8 ± 16.3 mmHg, 139.4 ± 25.4 mmHg and 79.1 ± 14 mmHg. Mean urinary output was 1156 ± 542 ml/day and initial serum creatinine 887 ± 271 μmol/l. In univariate analysis, absolute mortality at five years was associated with low PDSP (p = 0.001, OR = 4.8). This association was pronounced among orderlies (p = 0.001) and diabetic patients (p = 0.001). High PDSP was also associated with absolute mortality at five years (p = 0.03; OR = 1.67). In multivariate study, neither low nor high PDSP were associated to mortality. Survival was decreased for patients with low PDSP (log-rank p = 0.001) (Figure 1) and high PDSP (log-rank p = 0.03) (Figure 2). Conclusions: These results suggest the presence of a “U” curve relationship between PDSP and mortality. Further studies, with larger populations, are needed to determine the potential use of low PDSP as a mortality risk factor.

Acute kidney injury in neonatal sepsis: prevalence, and outcome

Background: Acute kidney injury (AKI) is an acute and reversible increment in serum creatinine levels regardless of associated or not with a decrease in urine output. AKI is very common among septic neonates. The high mortality among septic neonates with AKI stresses the need for screening them for renal failure. Early recognition of risk factors for AKI may reduce the risk of its occurrence. Objective:This study aimed to evaluate AKI's prevalence and outcome in neonates with neonatal sepsis in our hospital. Patients and methods: This study was an observational cross-section study carried out on all neonates ≥ 28 weeks admitted to our hospital in 6 months duration. History, examinations, and urine output were assessed and followed up regularly. Laboratory investigations included CBC, CRP, ESR, urine analysis, Urea and Creatinine, and Blood culture. Results: AKI presented in 67.2% of septic neonates based on oliguria while raised serum creatinine, shown in 4.5% of cases. Mean urine output was (1.26 ± 0.6) ml/kg/hr, 60 % of patients with AKI were males, 38% were preterm, 47% were LBW, and mortality was 51.1%. Conclusion: more than two-third of neonates with sepsis had AKI. Gestational age and weight were less in cases with AKI, with more than half of them were full-term and ≥ 2.5 kg. Gender was not a significant risk factor for AKI in sepsis. Mortality was significantly higher in AKI, mainly in full-term and low birth weight. Dead neonates with AKI were less anemic, less leucopenic, and more thrombocytopenic than living.

Comparative Study of Slow Infusion versus Bolus Doses of Albumin and Furosemide Infusion to Mobilize Refractory Ascites in Decompensated Chronic Liver Disease.

Combined use of furosemide with albumin is an approved therapy to overcome diuretic resistance in treatment of ascites in decompensated chronic liver disease. Bolus dosing of diuretics has its own limitations due to pre-existing hypotension, post diuretic sodium retention and braking phenomenon. Slow albumin and furosemide Infusion has been shown to mobilize large ascites with improved diuresis and hemodynamic stability in decompensated chronic liver disease. This study was undertaken to compare efficacy and safety of infusion therapy vs bolus therapy in term the management of refractory ascites. Decompensated chronic liver disease patients with refractory ascites were randomly assigned into two groups of 15 each - Bolus therapy (intravenous albumin and furosemide as boluses) and Infusion therapy (furosemide infusion at 2mg/hour and albumin at 2g/hour for three days). Diuresis, natriuresis, change in abdominal girth and body weight, and hemodynamic stability (change in SBP) were compared between the two groups. Infusion therapy, as compared to bolus therapy, showed a significantly better diuresis (mean urinary output increment 483ml vs 243ml, p <0.001), natriuresis (mean urinary sodium excretion increment 35.2 mEq/L vs 16.6 mEq/L, p = 0.004),decrease in abdominal circumference (6.1cm vs 3.0cm, p<0.001) and decrease in body weight (5.53 Kg vs 2.86 Kg, p < 0.001). The complications of renal impairment were also lower in the Infusion group. Infusion of furosemide and albumin is a potential safer and effective therapeutic option in the management of refractory ascites with better natriuresis, higher urine output, and higher decrement in abdominal circumference and body weight, and lesser side effects.

Treatment outcomes of bumetanide continuous infusion: A systematic review and meta-analysis.

The clinical use of continuous bumetanide infusion for acute heart failure and volume overload is common. However, there is not enough supporting evidence for the use of continuous bumetanide infusion. Thus, we conducted this systematic review and meta-analysis aiming to describe the treatment outcomes of continuous bumetanide infusion. We searched Ovid MEDLINE, EMBASE and the Cochrane Library for eligible publications. Inclusion criteria were patients age ≥18 years with bumetanide infusion for heart failure, acute kidney injury (AKI) or volume overload. From 1564 citations, three studies (n = 94 patients) were included in the systematic review and meta-analysis. The mean dose of bumetanide was 1.08 ± 0.43 mg/hour with a mean treatment duration of 45.09 ± 10.12 hours. Mean urine output in response to continuous bumetanide infusion was 1.88 mL/kg/hour (95% confidence interval [CI], 1.72-2.05). The incidence of AKI with continuous bumetanide infusion was 24.7% (95% CI, 8.2-54.6). By using Pearson's correlation coefficient, increasing doses of bumetanide were correlated with increased urine output (P = .026) and increased incidence of AKI (P < .01). There was no correlation between increasing urine output and the incidence of AKI (P = .739). In conclusion, with available evidence, continuous bumetanide infusion may be used in the treatment of acute heart failure or volume overload with close monitoring for new-onset or worsening AKI.

Balanced Chest Drainage Prevents Post-Pneumonectomy Pulmonary Oedema

Pneumonectomy in the adult patient is associated with a mortality of 1-9%. Death is often due to post pneumonectomy pulmonary oedema (PPPO). The use of balanced chest drainage system (BCD) in the setting of post pneumonectomy has been reported to be of benefit in the prevention of PPPO. This study seeks to compare the incidence of PPPO in patients who underwent pneumonectomy and whose empty pleural space was managed either with CRD or BCD. This retrospective observational cohort study involved 98 patients who were operated on by one surgeon at Liverpool Hospital, Sydney, Australia from 1997 to 2019. The patients were divided into two groups according to the era in which they had their pneumonectomy. Group 1 consisted of 18 patients managed with clamp-release drainage between 1997 and 2002. Group 2 consisted of 80 patients managed with balanced chest drainage between 2003 and 2019. The primary outcomes of interest were the development of PPPO and death. Demographic and clinico-pathological variables between the groups were compared including whether the phrenic nerve was sacrificed, volume of infused intraoperative fluid, duration of single lung ventilation, intraoperative tidal volumes, agents of anaesthetic induction and maintenance, mean urine output in the first 4 postoperative hours, institution of a postoperative 1.5 L fluid restriction, total chest drainage, day of chest drain removal, presence of radiological postoperative mediastinal shift, post-pneumonectomy pulmonary oedema and death. Group characteristics were compared using t-test and chi-squared for continuous and categorical variables respectively. Univariate and multivariate analysis was also undertaken using the Firth method of logistic regression for rare occurrences in a stepwise fashion. Through univariate analysis, balanced chest drainage, postoperative fluid restriction and intraoperative fluid infusion showed significant effect on PPPO. Through multivariate analysis, balanced chest drainage was found to have independent protective value for PPPO and mortality. Compared with clamp-release drainage, balanced chest drainage results in a lower incidence of post-pneumonectomy pulmonary oedema and death.