Year in review in Intensive Care Medicine 2010: I. Acute renal failure, outcome, risk assessment and ICU performance, sepsis, neuro intensive care and experimentals

Antonelli, Massimo; Azoulay, Élie; Bonten, Marc J. M.; Chastre, Jean; Citerio, Giuseppe; Conti, Giorgio; Backer, Daniel De; Gerlach, Herwig; Hedenstierna, Göran; Joannidis, Michael; MacRae, Duncan; Mancebo, Jordi; Maggiore, Salvatore Maurizio; Mebazaa, Alexandre; Preiser, Jean-Charles; Pugin, Jérôme; Wernerman, Jan; Zhang, Haibo

doi:10.1007/s00134-010-2112-1

Cited by 4 publications

(2 citation statements)

References 89 publications

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“…The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) definition of delirium involves acute onset, fluctuating course, and two major categories: disturbance of consciousness (including attention and awareness) and cognition (including memory, orientation, language, and perception). This must be the result of a medical condition and can be caused by the illness itself (e.g., serious infection or neoplasm), byproducts of the illness (e.g., metabolic or endocrine dysfunction), or side-effects of the treatment (e.g., sedative drugs or drug withdrawal) [1][2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Detecting pediatric delirium: development of a rapid observational assessment tool

et al. 2012

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Section: Introductionmentioning

confidence: 99%

Detecting pediatric delirium: development of a rapid observational assessment tool

et al. 2012

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“…Consequently, prompt resuscitation of the circulation and optimal perfusion pressure are the primary therapies for critically ill patients with AKI. These methods are based principally on the appropriate management of intravenous fluid replacement and vasopressor administration under strict hemodynamic monitoring [5]. …”

Section: Introductionmentioning

confidence: 99%

Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury

et al. 2012

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IntroductionRenal resistive index (RI), determined by Doppler ultrasonography, directly reveals and quantifies modifications in renal vascular resistance. The aim of this study was to evaluate if mean arterial pressure (MAP) is determinant of renal RI in septic, critically ill patients suffering or not from acute kidney injury (AKI).MethodsThis prospective observational study included 96 patients. AKI was defined according to RIFLE criteria and transient or persistent AKI according to renal recovery within 3 days.ResultsMedian renal RIs were 0.72 (0.68-0.75) in patients without AKI and 0.76 (0.72-0.80) in patients with AKI (P=0.001). RIs were 0.75 (0.72-0.79) in transient AKI and 0.77 (0.70-0.80) in persistent AKI (P=0.84). RI did not differ in patients given norepinephrine infusion and was not correlated with norepinephrine dose. RI was correlated with MAP (ρ= -0.47; P=0.002), PaO2/FiO2 ratio (ρ= -0.33; P=0.04) and age (ρ=0.35; P=0.015) only in patients without AKI.ConclusionsA poor correlation between renal RI and MAP, age, or PaO2/FiO2 ratio was found in septic and critically ill patients without AKI compared to patients with AKI. These findings suggest that determinants of RI are multiple. Renal circulatory response to sepsis estimated by Doppler ultrasonography cannot reliably be predicted simply from changes in systemic hemodynamics. As many factors influence its value, the interest in a single RI measurement at ICU admission to determine optimal MAP remains uncertain.

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Fluid type and the use of renal replacement therapy in sepsis: a systematic review and network meta-analysis

et al. 2015

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Fluid resuscitation, along with the early administration of antibiotics, is the cornerstone of treatment for patients with sepsis. However, whether differences in resuscitation fluids impact on the requirements for renal replacement therapy (RRT) remains unclear. To examine this issue, we performed a network meta-analysis (NMA), including direct and indirect comparisons, that addressed the effect of different resuscitation fluids on the use of RRT in patients with sepsis. The data sources MEDLINE, EMBASE, ACPJC, CINAHL and Cochrane Central Register were searched up to March 2014. Eligible studies included randomized trials reported in any language that enrolled adult patients with sepsis or septic shock and addressed the use of RRT associated with alternative resuscitation fluids. The risk of bias for individual studies and the overall certainty of the evidence were assessed. Ten studies (6664 patients) that included a total of nine direct comparisons were assessed. NMA at the four-node level showed that an increased risk of receiving RRT was associated with fluid resuscitation with starch versus crystalloid [odds ratio (OR) 1.39, 95% credibility interval (CrI) 1.17-1.66, high certainty]. The data suggested no difference between fluid resuscitation with albumin and crystalloid (OR 1.04, 95% CrI 0.78-1.38, moderate certainty) or starch (OR 0.74, 95% CrI 0.53-1.04, low certainty). NMA at the six-node level showed a decreased risk of receiving RRT with balanced crystalloid compared to heavy starch (OR 0.50, 95% CrI 0.34-0.74, moderate certainty) or light starch (OR 0.70, 95% CrI 0.49-0.99, high certainty). There was no significant difference between balanced crystalloid and saline (OR 0.85, 95% CrI 0.56-1.30, low certainty) or albumin (OR 0.82, 95% CrI 0.49-1.37, low certainty). Of note, these trials vary in terms of case mix, fluids evaluated, duration of fluid exposure and risk of bias. Imprecise estimates contributed to low confidence in most estimates of effect. Among the patients with sepsis, fluid resuscitation with crystalloids compared to starch resulted in reduced use of RRT; the same may be true for albumin versus starch.

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Year in review in Intensive Care Medicine 2010: I. Acute renal failure, outcome, risk assessment and ICU performance, sepsis, neuro intensive care and experimentals

Cited by 4 publications

References 89 publications

Detecting pediatric delirium: development of a rapid observational assessment tool

Detecting pediatric delirium: development of a rapid observational assessment tool

Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury

Fluid type and the use of renal replacement therapy in sepsis: a systematic review and network meta-analysis

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