The value of combined hemodynamic, respiratory and intra-abdominal pressure monitoring in predicting acute kidney injury after major intraabdominal surgeries

Kopitkó, Csaba; Medve, László; Gyökeres, T

doi:10.1080/0886022x.2019.1587467

Cited by 22 publications

(23 citation statements)

References 27 publications

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“…Besides, our finding regarding inappropriate positive fluid balance and renal failure only generate a hypothesis, it may not necessarily be a cause-effect relationship. Furthermore, this study was not able to assess other possible causes of renal failures, such as intra-abdominal hypoperfusion and increased airway pressures [ 39 ], also long-term complications and mortality, because some complications may have occurred after the study period.…”

Section: Study Limitationsmentioning

confidence: 99%

The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients

et al. 2021

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Background and objectives Patients who develop post-operative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after non-cardiac surgery and the possible risk factors for this complication. Methods A multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after non-cardiac surgery was conducted to assess whether they developed AKI. The patients who developed AKI were then compared to non-AKI patients. Results A total of 29 ICUs participated, of which 904 high-risk surgical patients were involved in the study. The occurrence of AKI in the post-operative period was 15.8%, and the mortality rate of post-operative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51–5.62; p = 0.001), and a higher length of ICU and hospital stay ( p < 0.001). Independent factors for the risk of developing AKI were pre-operative anemia (OR = 7.01; 95% CI 1.69–29.07), elective surgery (OR = 0.45; 95% CI 0.21–0.97), SAPS 3 (OR = 1.04; 95% CI 1.02–1.06), post-operative vasopressor use (OR = 2.47; 95% CI 1.34–4.55), post-operative infection (OR = 8.82; 95% CI 2.43–32.05) and the need for reoperation (OR= 7.15; 95% CI 2.58–19.79). Conclusion AKI was associated with the risk of death in surgical patients and those with anemia before surgery, who had a higher SAPS 3, needed a post-operative vasopressor, or had a post-operative infection or needed reoperation were more likely to develop AKI post-operatively.

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Section: Study Limitationsmentioning

confidence: 99%

The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients

et al. 2021

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“…Lebih dari 45% pasien dengan syok sepsis menderita AKI dan semuanya memiliki luaran yang buruk, termasuk lama rawat ICU dan rumah sakit, gagal ginjal kronik, penyakit ginjal stadium akhir, dan peningkatan mortalitas. 2 Sepsis terkait cedera ginjal akut (S-AKI) adalah komplikasi yang sering pada pasien sakit kritis. Pengenalan dini sangat penting untuk memberi pengobatan yang mendukung dan membatasi perkembangan lebih lanjut.…”

Section: Pendahuluanunclassified

“…Peritonitis ini diklasifikasikan berdasar atas integritas anatomi kavum abdominal. [1][2][3][4][5] Peritonitis primer berhubungan dengan organ kavum abdominal yang masih intak. Peritonitis ini juga dikenal sebagai peritonitis bakteri spontan dan diterapi tanpa intervensi bedah.…”

Section: Pembahasanunclassified

“…Inilah alasan dilakukan resusitasi sebelum tindakan apapun seperti pada kasus ini. [2][3][4][8][9][10][11] Setelah diresusitasi dilakukan laparatomi dan ditemukan tumor yang kemudian direseksi dan dilakukan anastomosis dan ileocolostomy selama 4 jam. Pascaoperasi pasien ditransfer ke ICU dalam keadaan terintubasi ETT oral.…”

Section: Pembahasanunclassified

“…Kematian akibat gagal organ ganda akan sangat mungkin pada pasien dengan kasus seperti ini. 2,5,8 Manajemen peritonitis umumnya kompleks dan memerlukan pendekatan multidisipliner. Ahli bedah dan intensivis harus bekerja sama dengan praktisi penunjang nutrisi, terapi respirasi, penyakit infeksi, dan radiologi.…”

Section: Pembahasanunclassified

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Penatalaksanaan Syok Sepsis dengan Penyulit Cedera Ginjal Akut pada Pasien Peritonitis Sekunder

Najamuddin¹,

Nurdin²,

Muchtar³

2020

jap

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Peritonitis akibat infeksi intraabdominal, khususnya peritonitis sekunder merupakan salah satu penyebab syok sepsis dengan tingkat morbiditas dan mortalitas yang tinggi. Perkembangan dalam pemahaman fisiologi, pemantauan, dan tunjangan sistem kardiopulmonal, serta penggunaan obat-obat baru secara rasional membuat mortalitas stabil pada kisaran 30%. Kasus ini mengenai seorang pasien perempuan usia 67 tahun masuk rumah sakit dengan diagnosis peritonitis generalisata karena suspek perforasi Hollow viscous. Setelah menjalani operasi laparatomi untuk source control, pasien dirawat di ICU selama 5 hari. Selama perawatan pasien mengalami edema paru, sepsis, anemia, hipokalemia, hipoalbuminemia, serta acute kidney injury (AKI). Pada pasien dilakukan tindakan ventilasi mekanik selama 4 hari yang diiringi dengan pemantauan analisis gas darah arteri dan furosemid untuk tata laksana edema paru dan fluid overload. Resusitasi dan pemeliharaan cairan sambil memantau hemodinamik konvensional dan melalui ICON, balance kumulatif, fluid overload, tekanan vena sentral, serta urine output. Terapi antimikrob diberikan berdasar atas pedoman terapi infeksi intraabdominal dan antibiogram ICU rumah sakit. Kondisi perfusi dipantau dengan kadar laktat dan SCVO2. Respons antibiotik dan perbaikan sepsis dipantau dengan pemeriksaan prokalsitonin dan leukosit. Perbaikan AKI dipantau dengan produksi urine serta kadar ureum dan kreatinin. Penatalaksanaan peritonitis sekunder dengan komplikasi sepsis dengan penyulit AKI telah berhasil dilakukan di ICU. Peritonitis sekunder memiliki tingkat mortalitas yang cukup tinggi, namun dengan source control yang adekuat dan manajemen di ICU yang agresif maka diperoleh hasil yang baik seperti pada kasus ini.

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Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry

Khanna

Minear²,

Kurz³

et al. 2022

J Clin Monit Comput

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Intra-abdominal hypertension (IAH) is frequently present in the critically ill and is associated with increased morbidity and mortality. Conventionally, intermittent ‘spot-check’ manual measurements of bladder pressure in those perceived as high risk are used as surrogates for intra-abdominal pressure (IAP). True patterns of IAH remain unknown. We explored the incidence of IAH in cardiac surgery patients and describe the intra-and postoperative course of IAP using a novel, high frequency, automated bladder pressure measurement system. Sub-analysis of a prospective, multicenter, observational study (NCT04669548) conducted in three large academic medical centers. Continuous urinary output (CUO) and IAP measurements were observed using the Accuryn Monitoring System (Potrero Medical, Hayward, CA). Data collected included demographics, hemodynamic support, and high-frequency IAP and CUO. One Hundred Thirty-Seven cardiac surgery patients were analyzed intraoperatively and followed 48 h postoperatively in the intensive care unit. Median age was 66.4 [58.3, 72.0] years, and 61% were men. Median Foley catheter dwell time was 56.0 [46.8, 77.5] hours, and median baseline IAP was 6.3 [4.0, 8.1] mmHg. 93% (128/137) of patients were in IAH grade I, 82% (113/137) in grade II, 39% (53/137) in grade III, and 5% (7/137) in grade IV for at least 12 cumulative hours. For maximum consecutive duration of IAH, 84% (115/137) of patients spent at least 12 h in grade I, 62% (85/137) in grade II, 18% (25/137) in grade III, and 2% (3/137) in grade IV IAH. During the first 48 h after cardiac surgery, IAH is common and persistent. Improved and automated monitoring of IAP will increase the detection of IAH—which normally would remain undetected using traditional intermittent monitoring methods.

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The value of combined hemodynamic, respiratory and intra-abdominal pressure monitoring in predicting acute kidney injury after major intraabdominal surgeries

Cited by 22 publications

References 27 publications

The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients

The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients

Penatalaksanaan Syok Sepsis dengan Penyulit Cedera Ginjal Akut pada Pasien Peritonitis Sekunder

Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry

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