Critically ill patients often require multiple organ supports; respiratory support in terms of mechanical ventilation (MV) is one of the commonest. But, only providing an organ support contributes less to the complete well being of the patients. Moreover, MV itself can affect various physiological systems, metabolic response, and cause side effects. A very close temporal relationship exists between patients, monitoring and management decision too, and therefore, appropriate information from monitoring can lead to better outcomes. The present review is intended to briefly highlight the current opinions and strategies for non cardio-respiratory monitoring in such critically ill patients.Abbreviations: AKI-Acute Kidney Injury; APACHE-Acute Physiology and Chronic Health Evaluation; BPS-Behavioral Pain Scale; CAM-ICU-Confusion Assessment Method for the Intensive Care Unit; CPOT–Critical Care Pain Observation Tool; EVLWI-Extra vascular lung water index; FDA-Food and Drug Administration; ISO-International Organization for Standardization; ICU-Intensive Care Unit; LOS-Length of stay; MODS-Multiple Organ Dysfunction Score; MV-Mechanical Ventilation; PaO2-Partial pressure of arterial oxygen; FiO2-Fraction of inspired oxygen; SAPS-Simplified Acute Physiologic Score; RASS-Richmond Agitation Sedation Scale; SOFA-Sequential Organ Failure Assessment; SAS-Sedation Agitation Scale; UO-Urine outputCitation: Panda CK, Karim HMR, Singha SK. Non-cardio respiratory monitoring of mechanically ventilated critically ill patients. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S150-S159Received: 9 Jul 2018 Reviewed: 1 Oct 2018 Corrected & Accepted: 9 Oct 2018
Chronic kidney disease is one of the leading co-morbidity at present. With the increasing prevalence of diabetes mellitus and hypertension, more and more peoples are developing diabetic and hypertensive nephropathy. As chronic kidney disease patient can present as an asymptomatic stable patient in one end and a multi-organ involved complicated end-stage disease in other ends, their management plan also varies. The serum creatinine levels of as low as 1.5 mg% have been linked to perioperative major cardiac events like myocardial infarction and arrest; these patients poses a challenge to the perioperative team. Moreover, a chance of developing acute kidney injury on the chronic kidney disease is also higher. These patients are also often elderly, with diabetes mellitus and/or hypertension. Therefore, accepting such patient for perioperative care needs systematic and meticulous approach. Preoperative assessment, risk stratification, and optimization play a great role. Both intraoperative and postoperative management needs a tailored approach. The present narrative review is prepared to give the current insight on these aspects.
Abbreviations used: AKI – Acute kidney injury; CKD - Chronic kidney disease; ESRD - End stage renal disease; eGFR: estimated Glomerular Filtration Rate; HD – Hemodilaysis; GFR - Glomerular filtration rate; KDIGO - The Kidney Disease: Improving Global Outcomes, RCRI - Revised Cardiac Risk Index; RRT- Renal Replacement Therapy
Received: 28 Oct 2018Reviewed: 30 Oct 2018Corrected: 7 Nov 2018Accepted: 7 Nov 2018
Citation: Karim HMR, Panda CK, Singha SK. Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S29-S38
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