Understanding urine output in critically ill patients

Legrand, Matthieu; Payen, Didier

doi:10.1186/2110-5820-1-13

Cited by 82 publications

(71 citation statements)

References 68 publications

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“…The primary outcome measure was AKI as defined by the AKI Network based on changes in serum creatinine concentrations [27] Urine output was not used to identify AKI in this study to exclude the effect of diuretic administration [28]. The serum creatinine measured on the third postoperative day, compared with the most recent preoperative measurement, was used to identify AKI to minimize the dilutional effects in relation to cardiopulmonary bypass [29].…”

Section: Methodsmentioning

confidence: 99%

Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury

Thomson¹,

Meeran²,

Valencia³

2014

Journal of Critical Care

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Section: Methodsmentioning

confidence: 99%

Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury

Thomson¹,

Meeran²,

Valencia³

2014

Journal of Critical Care

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“…In the absence of severe volume depletion or volume overload, however, physical examination results and clinical judgment have not been shown to be reliable predictors of volume status, [19][20][21][22][23][24][25] nor have specific objective measures that frequently help inform clinical judgment, such as systolic blood pressure, 26,27 shock index, 28 and urine output. 29,30 In sum, neither of the approaches to fluid resuscitation used in the ARISE trial-CVP and clinical judgment-has been shown to reliably predict volume status. A study comparing the utility of 2 variables that are unable to accurately predict the outcome in question would not be expected to result in meaningful intergroup differences.…”

Section: Answermentioning

confidence: 99%

Taking the “Goal-Directed” Out of Early Goal-Directed Therapy for Sepsis?

Crager

2015

Annals of Emergency Medicine

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“…An increase in intraabdominal pressure during laparoscopic surgery, mechanical ventilation with positive end-expiratory pressure, and pain and surgical stress with release of an antidiuretic hormone are all factors inducing antidiuresis. 25 even a minor surgical injury can impair renal fluid elimination after fluid loading. 26 In a randomized controlled trial, urine output and postoperative creatinine serum concentration were not affected in obese patients undergoing laparoscopic surgery, who were randomly assigned to intraoperatively receive high (10 ml·kg −1 ·h −1 ; n = 55) or low (4 ml·kg −1 ·h −1 ; n = 52) volumes of Ringer's lactate.…”

Section: How Should Fluid Administration With Urine Output Be Guided mentioning

confidence: 99%

Case Scenario: Hemodynamic Management of Postoperative Acute Kidney Injury

Legrand

Payen

2013

Anesthesiology

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A cute kidney injury (AKI) is associated with poor outcome both in critically ill patients and after major surgery. 1 The occurrence of AKI has been associated with poor short-term and long-term outcome, increased risk of chronic renal failure, and increased risk of death.2 Several risk factors of postoperative AKI have been identified, and may help identifying patients with the highest risk of AKI. However, recognizing contributors to AKI (e.g., systemic inflammation, systemic hemodynamics alterations, nephrotoxic agents, and others) remains a challenge for anesthesiologists and intensivists because these factors are often associated and AKI multifactorial.The early diagnosis of AKI remains another issue. Interest in the development and validation of AKI biomarkers has increased among the medical community. In this article, we analyze the risk factors of and contributors to AKI after major surgery, and specifically discuss the strategy of fluid management and potential negative outcome associated with inappropriate fluid administration, with a case scenario intended to illustrate the current knowledge of perioperative AKI. We emphasize hemodynamic management for the prevention and correction of acute renal failure. Case ReportA 59-yr-old woman with a history of diabetes and hypertension underwent abdominal surgery for recurrent ovarian cancer. She had received systemic chemotherapy during the 18 months preceding the surgery, including paclitaxel, carboplatin, bevacizumab, doxorubicin, and cyclophosphamide, and had remained asymptomatic since then. The surgery included an ovarian resection and peritoneal carcinosis cytoreduction. The only preoperative medication was an angiotensin-converting enzyme inhibitor to treat arterial hypertension. The preoperative creatinine clearance was estimated at 80 ml/min (Modification of Diet in Renal Disease formula). Because she was asymptomatic (no dyspnea or recent change in her clinical status), left ventricular function was not preoperatively assessed.The known large fluid losses associated with peritoneal carcinosis cytoreduction, intraoperative oliguria, and hypotension led to the infusion of a total of 24 ml·kg −1 ·h −1 of crystalloids during the 9-h surgery (half saline and half Ringer's lactate solutions). Perioperative maintenance of mean arterial pressure at 70 mmHg was achieved by intravenous infusion of neosynephrine (0.35 μg·kg −1 ·min −1 ). In the recovery room, cold extremities and discrete knee mottles were noted, which motivated a switch to norepinephrine infusion (0.2-0.3 μg·kg −1 ·min −1 ). Because of oliguria during the surgical procedure and anuria in the immediate postoperative period, with urine output less than 0.5 ml·kg −1 ·h −1 , the patient was transferred to the postoperative intensive care unit (Icu). Blood analysis showed a metabolic acidosis, with a chloride concentration of 114 mM and bicarbonates of 12 mM, with a normal anion gap (14 mM). Serum alanine aminotransferase and alanine transaminase were increased (245 and 257 u, respectively), and s...

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Understanding urine output in critically ill patients

Cited by 82 publications

References 68 publications

Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury

Goal-directed therapy after cardiac surgery and the incidence of acute kidney injury

Taking the “Goal-Directed” Out of Early Goal-Directed Therapy for Sepsis?

Case Scenario: Hemodynamic Management of Postoperative Acute Kidney Injury

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