Introduction Malnutrition is common in patients with acute kidney injury (AKI), particularly in those requiring renal replacement therapy (RRT). Use of RRT removes metabolic waste products and toxins, but it will inevitably also remove useful molecules such as micronutrients, which might aggravate malnutrition. The RRT modalities vary in mechanism of solute removal; for example, intermittent hemodialysis (IHD) uses diffusion, continuous veno-venous hemofiltration (CVVH) uses convection, and sustained low-efficiency diafiltration (SLEDf) uses a combination of these. Methods We assessed micronutrient and amino acid losses in 3 different RRT modalities in patients with AKI (IHD, n = 27; SLEDf, n = 12; CVVH, n = 21) after correction for dialysis dose and plasma concentrations. Results Total losses were affected by modality; generally CVVH >> SLEDf > IHD (e.g., amino acid loss was 18.69 ± 3.04, 8.21 ± 4.07, and 5.13 ± 3.1 g, respectively; P < 0.001). Loss of specific trace elements (e.g., copper and zinc) during RRT was marked, with considerable heterogeneity between RRT types (e.g., +849 and +2325 μg/l lost during SLEDf vs. IHD, respectively), whereas effluent losses of copper and zinc decreased during CVVH (effect size relative to IHD, −3167 and −1442 μg/l, respectively). B vitamins were undetectable in effluent, but experimental modeling estimated 40% to 60% loss within the first 15 minutes of RRT. Conclusion Micronutrient and amino acid losses are marked during RRT in patients with AKI, with variation between RRT modalities and micronutrients.

Background: Acute kidney injury (AKI) is commonly defined using the KDIGO system, which includes criteria based on reduced urine output (UO). There is no consensus on whether UO should be measured using consecutive hourly readings or mean output. This makes KDIGO UO definition and staging of AKI vulnerable to inconsistency which has implications both for research and clinical practice. The objective of this study was to investigate whether the way in which UO is defined affects incidence and staging of AKI. Methods: We conducted a retrospective analysis of two single centre observational studies investigating (i) patients undergoing cardiac surgery and (ii) patients admitted to general intensive care units (ICU). AKI was identified using KDIGO serum creatinine (SCr) criteria and two methods of UO (UO cons : UO meeting KDIGO criteria in each consecutive hour; UO mean : mean hourly UO meeting KDIGO criteria). Results: Data from 151 CICU and 150 ICU admissions were analysed. Incidence of AKI using SCr alone was 23.8% in CICU and 32% in ICU. Incidence increased in both groups when UO was considered, with inclusion of UO mean more than doubling reported incidence of AKI (CICU: UO cons 39.7%, UO mean 72.8%; ICU: UO cons 51.3%, UO mean 69.3%). In both groups UO cons led to a larger increase in KDIGO stage 1 but UO mean increased the incidence of KDIGO stage 2. Conclusions: We demonstrate a serious lack of clarity in the internationally accepted AKI definition leading to significant variability in reporting of AKI incidence.

Cardiopulmonary resuscitation (CPR) is an essential life-saving skill shown to save lives and improve outcomes of survivors. Physiotherapists are ethically obliged to ensure the safety of patients and to assist in an emergency if required. The purpose of this study was to explore the knowledge and perceptions of CPR amongst New Zealand physiotherapists. Chi-square statistics were used to test associations between the independent variables of age, sex, years of experience, scope and place of work, and postgraduate qualification against CPR training, beliefs and knowledge. A total of 688 physiotherapists completed the online survey. Only half of respondents (56%) had received formal CPR training in the previous year. One-fifth had used CPR in an emergency, with most applications being successful. Physiotherapists working in private practice, public hospitals and community settings were more likely to have CPR certification compared to other settings (p = 0.004). Significant CPR knowledge gaps existed in older (> 39 years) physiotherapists (p < 0.001). The current low frequency of CPR training and the likelihood of having to perform CPR in an emergency (1 in 5) is a risk for physiotherapists. Future research should focus on a practical assessment of physiotherapists’ CPR skills to assess competency.

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Aims and objectives To determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. Background Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. Design Cross-sectional, multi-centre, survey based study. Methods An online, short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia, and deviations from protocols' instructions. STROBE reporting guidelines were followed. Results Over half of the 40 respondents opined that a patient spending <75% admission time within the target glycaemic levels constituted poor glycaemic control. Professionals with more than five years' experience were more likely to rate a patient spending 50-74% admission time within target glycaemic levels as poor than less experienced colleagues. Physicians were more likely to rate a patient spending <50% admission time within target as poor than nurses. There was general agreement on how professionals would rate most deviations from their protocols. Nurses were more likely to rate insulin infusions restarted late and incorrect dosage of rescue glucose as major deviations than physicians. Most professionals agreed on when they would treat hypoglycaemia.