Tag: RRT

Upvote Story 10
Pediatric critical care nephrology is a complex and highly specialized field, presenting challenges and management strategies that are often quite distinct from those seen in adult practice. Therefore, it is high time to address all the topics in the field of critical care nephrology in children in a unique book which is the first of its kind. This book covers the basics as well as... Read More | Comment
Upvote Story 7
Use of renal replacement therapy (RRT) in sepsis varied widely among nationally sampled hospitals without associated differences in mortality. Improving renal replacement standards for the initiation of therapy for sepsis may reduce healthcare costs without increasing mortality. We identified 293,899 hospitalizations with sepsis and acute kidney injury at 440 hospitals, of which 6.4% (n = 18,885) received renal replacement therapy. After risk and reliability adjustment,... Read More | Comment
Upvote Story 9
There’s nothing better than feeling confident and relaxed on exam day! Knowing that years of late night study sessions and unpaid clinical rotations are coming to an end just feels….well, absolutely fantastic! Of course, the truth is, that feeling doesn’t come without a focused, disciplined approach. Studying is important, but studying years of respiratory school notes is not the answer. Our RRT Board exam series... Read More | Comment
Upvote Story 7
Among critically ill patients with Acute Kidney Injury (AKI), early Renal Replacement Therapy (RRT) compared with delayed initiation of RRT reduced mortality over the first 90 days. Further multicenter trials of this intervention are warranted. Among 231 patients (mean age, 67 years; men, 146 [63.2%]), all patients in the early group (n = 112) and 108 of 119 patients (90.8%) in the delayed group received RRT. The... Read More | Comment
Upvote Story 6
Despite the administration of intravenous fluids to critically ill patients being a near-universal intervention, the available evidence base guiding their safe and appropriate use is scarce and derived mainly from academically driven, investigator-initiated trials. These trials have proved that HES, the most frequently administered colloid solution, has an unacceptable safety profile and offers no benefits other than a clinically unimportant volume-sparing effect. Several unresolved questions... Read More | Comment
Upvote Story 5
Early initiation of renal replacement therapy (RRT) effect on survival and renal recovery of critically ill patients is still uncertain. We aimed to systematically review current evidence comparing outcomes of early versus late initiation of RRT in critically ill patients. Pooled analysis of randomized trials indicates early initiation of RRT is not associated with lower mortality rates. The potential benefit of reduced mortality associated with... Read More | Comment
Upvote Story 10
Sepsis is one of the most frequent causes of acute kidney injury (AKI) in critically ill patients, with initial organ impairment often followed by dysfunction in other systems. Renal dysfunction may therefore represent one facet in the evolution towards multiple organ dysfunction syndrome (MODS) or, alternatively, may be indicative of system-wide endothelial damage caused by hyperinflammation and a positive fluid balance. Whilst numerous biomarkers have... Read More | Comment
Upvote Story 6
In patients with sepsis, recovery by hospital discharge is associated with long-term survival similar to patients without AKI. Of the 1742 patients who survived to hospital discharge, stage 2–3 AKI occurred in 262 (15%), of which 111 (42.4%) recovered. Compared to recovered patients, patients without recovery were older (75 ±14 vs 69 ±15 years, p Read More | Comment
Upvote Story 8
Deleterious hemodynamic effects of severe lactic acidosis are largely suggested by experimental data, although not fully confirmed by human studies. Pending the effectiveness of an etiological treatment, there is no efficient and validated symptomatic therapy at hand to correct a life-threatening metabolic acidosis. Upcoming research in this field should be focused on the optimal strategy to treat severe metabolic acidosis, including symptomatic therapy. Alkalinization with... Read More | Comment
Upvote Story 6
We developed a prioritized list of 13 QIs for continuous renal replacement therapy (CRRT) care. Future work should focus on developing validated benchmarks for these QIs and implementing them into CRRT programs. We conducted a modified three stage Delphi process. This consisted of two web-based rounds followed by an in-person meeting. We recruited an interdisciplinary panel of critical care nephrology experts and knowledge users. In... Read More | Comment
Upvote Story 8
Dr. Fraser, MD, speaks with Bruce A. Mueller, PharmD, FCCP, FASN, about his talk presented at the 47th Critical Care Congress in San Antonio, Texas, entitled “Artificial Kidney Meets Mechanical Lung: Comanaging the Patient with Renal and Respiratory Failure.” Dr. Mueller discusses the concepts of drug dosing during renal replacement therapy. Dr. Mueller is a Professor and Associate Dean at University of Michigan College of... Read More | Comment
Upvote Story 5
Early RRT initiation strategy was not associated with any improvement of 60-day mortality in patients with severe acute kidney injury and septic shock or Acute Respiratory Distress Syndrome (ARDS). Unnecessary and potentially risky procedures might often be avoided in these fragile populations. Subgroups were defined according to baseline characteristics: sepsis status (Sepsis-3 definition), ARDS status (Berlin definition), Simplified Acute Physiology Score 3 (SAPS 3), and... Read More | Comment
Upvote Story 20
Despite wide adoption of rapid response teams across the United States, predictors of in-hospital mortality for patients receiving rapid response team calls are poorly characterized. Identification of patients at high risk of death during hospitalization could improve triage to intensive care units and prompt timely reevaluations of goals of care. Patients who die following rapid response team calls differ significantly from surviving peers. Recognition of... Read More | Comment
Upvote Story 6
Standards of practice should be established for postoperative IV solutions that are used to hydrate patients, particularly children. The standards should acknowledge that the administration of solutions with saline in maintenance parenteral fluids is an important measure that can be taken to prevent hyponatremia in children, who tend to experience increased ADH production.15 If appropriate, criteria should include a schedule of when laboratory studies are... Read More | Comment