Article
Critical Care Medicine
Nina Inkinen, Sakari Jukarainen, Renske Wiersema, Meri Poukkanen, Ville Pettily, T. Suvi Vaara
Summary: The study found that patients with acute kidney injury (AKI) received more fluids but had lower fluid output compared to critically ill non-AKI patients. Smaller volumes of fluid input and higher fluid output were associated with better recovery from AKI.
JOURNAL OF CRITICAL CARE
(2021)
Article
Critical Care Medicine
David M. Selewski, Katja K. Gist, Rajit L. Basu, Stuart Goldstein, Michael E. Zappitelli, Danielle Soranno, Cherry M. Mammen, Scott J. Sutherland, David Askenazi, Zaccaria Ricci, Ayse M. Akcan-Arikan, Stephen E. Gorga, Scott Gillespie, Robert Woroniecki
Summary: This study aims to evaluate the epidemiology and outcomes associated with fluid overload (FO) in critically ill children, as well as assess the association of FO at clinically relevant thresholds and time points with outcomes. The study found that early mild-to-moderate FO is associated with adverse outcomes.
CRITICAL CARE MEDICINE
(2023)
Article
Urology & Nephrology
Meiping Wang, Bo Zhu, Li Jiang, Xuying Luo, Na Wang, Yibing Zhu, Xiuming Xi
Summary: Different trajectories of fluid balance in critically ill patients with acute kidney injury are associated with clinical outcomes. High fluid balance above or below a certain range is associated with increased risk of mortality. A J-shaped relationship was observed between maximum fluid overload and 28-day mortality, with the lowest risk at a maximum FO of 2.8% L/kg.
Article
Critical Care Medicine
Suvi T. Vaara, Marlies Ostermann, Laurent Bitker, Antoine Schneider, Elettra Poli, Eric Hoste, Jan Fierens, Michael Joannidis, Alexander Zarbock, Frank van Haren, John Prowle, Tuomas Selander, Minna Backlund, Ville Pettila, Rinaldo Bellomo, Rinaldo Bellomo, Rinaldo Bellomo, Suvi Vaara, Laurent Bitker, Glenn Eastwood, Frank van Haren, Liam Byrne, Mary Nourse, Samantha Adam, Clare Robertson, Josie Russell-Brown, Shakira Spiller, Eric Hoste, Jan Fierens, Pieter Nepuydt, Daisy Vermeiren, Ingrid Herck, Druwe Patrick, Luc De Crop, Stephanie Bracke, Marlies Ostermann, Andy Retter, Sara Campos, Gill Arbane, Andrea Kelly, Neus Grau Novellas, Rosario Lim, Martina Marotti, Aneta Bociek, Tim Jones, Christopher Whitton, Andrew Slack, Luigi Camporota, Simon Sparkes, Duncan Wyncoll, Suvi Vaara, Minna Backlund, Ville Pettila, Jonna Heinonen, Leena Pettila, Sari Sutinen, Elina Lappi, Antoine Schneider, Elettra Poli, Marco Altarelli, Michel Thibault, Philippe Eckert, Madeleine Schnorf, John Prowle, Ryan Haines, Richard Cashmore, Alex Fowler, Filipa Dos Santos, Amaia Garcia, Maria Fernandez, Tim Martin, Ruzena Uddin
Summary: In critically ill patients with AKI, a restrictive fluid management strategy resulted in lower cumulative fluid balance and reduced need for renal replacement therapy compared to usual care, with less adverse events reported in the restrictive fluid management group. Larger trials of this intervention are warranted to further evaluate its effectiveness.
INTENSIVE CARE MEDICINE
(2021)
Article
Medicine, General & Internal
Markus Huber, Marc A. Furrer, Francois Jardot, Dominique Engel, Christian M. Beilstein, Fiona C. Burkhard, Patrick Y. Wuethrich
Summary: The use of norepinephrine and intraoperative fluid administration have been found to increase the risk of acute kidney injury (AKI) after cystectomy. A study on 1488 patients showed that the overall incidence of AKI was 21.6%, and it increased by 0.6% per year since 2000. Decreased intraoperative fluid balance combined with increased norepinephrine administration were associated with an increased risk of AKI, though other factors may also contribute to the observed increase in AKI incidence.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Critical Care Medicine
Celeste G. Dixon, Sameer Thadani, Julie C. Fitzgerald, Ayse Akcan-Arikan, Nadir Yehya
Summary: This study aimed to explore the association between acute kidney injury (AKI) and poor outcomes in pediatric patients with acute respiratory distress syndrome (ARDS), and found that fluid overload (FO), creatinine, and urine output were related to the occurrence of AKI in a temporal manner. A retrospective cohort study revealed that AKI was associated with increased mortality and decreased ventilator-free days (VFDs), regardless of the timing of onset. A group of patients with "Cryptic AKI" was identified by adjusting creatinine levels, and their outcomes were similar to those who met AKI criteria by traditional means. Increases in FO, FO-adjusted creatinine, and ANGPT2 occurred prior to meeting conventional AKI criteria, providing important insights for clinical practice.
CRITICAL CARE MEDICINE
(2023)
Article
Critical Care Medicine
Nina Inkinen, Ville Pettila, Miia Valkonen, Maija Serlo, Minna Backlund, Johanna Hastbacka, Anni Pulkkinen, Tuomas Selander, Suvi T. Vaara
Summary: This study compared the effect of a follow-up approach without fluid bolus to a 500 mL fluid bolus on urine output in critically ill patients with oliguria. The results showed that the follow-up approach improved urine output less frequently but resulted in lower cumulative fluid balance.
Article
Medicine, General & Internal
Jin Lin, Hai Zhou Zhuang, De Yuan Zhi, Zhili Qi, Jing Bai, Lei Dong, Shuai Liu, Meili Duan
Summary: Cumulative fluid balance plays an important role in the mortality rate of patients with septic AKI requiring CRRT, with patients having positive CFB showing higher mortality rates.
FRONTIERS IN MEDICINE
(2021)
Article
Pediatrics
David T. Selewski, Matthew F. Barhight, Erica C. Bjornstad, Zaccaria Ricci, Marcelo de Sousa Tavares, Ayse Akcan-Arikan, Stuart L. Goldstein, Rajit Basu, Sean M. Bagshaw
Summary: This study proposes harmonized terminology for fluid balance and fluid overload in clinical practice and research, and provides recommendations for clinical practice and future research.
PEDIATRIC NEPHROLOGY
(2023)
Article
Anesthesiology
Xin Chen, Jiarui Xu, Yang Li, Bo Shen, Wuhua Jiang, Zhe Luo, Chunsheng Wang, Jie Teng, Xiaoqiang Ding, Wenlv Lv
Summary: The study found an exponential increase between 24-hour fluid balance and the occurrence of acute kidney injury, and a U-shaped association between 48-hour fluid balance and the progression of acute kidney injury. Both excessively negative and positive 48-hour cumulative fluid balance increased the risk of acute kidney injury progression.
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
(2021)
Article
Medicine, General & Internal
Maria Olinda Nogueira Avila, Paulo Novis Rocha, Caio A. Perez, Tassia Nery Faustino, Paulo Benigno Pena Batista, Luis Yu, Dirce Maria T. Zanetta, Emmanuel A. Burdmann
Summary: The study suggests that positive fluid balance may serve as an early biomarker for detecting AKI in critically ill patients. A 100ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI, and positive fluid balance categorized using different thresholds was consistently linked to subsequent AKI detection. Increased fluid balance appeared 4 to 6 days before AKI onset according to the mixed effects model.
Article
Gastroenterology & Hepatology
Kavish R. Patidar, Mobasshir A. Naved, Ananth Grama, Mohammad Adibuzzaman, Arzina Aziz Ali, James E. Slaven, Archita P. Desai, Marwan S. Ghabril, Lauren Nephew, Naga Chalasani, Eric S. Orman
Summary: This study investigated hospitalized patients with cirrhosis and acute kidney injury in the US and found that acute kidney disease developed in 1 in 3 patients, which was associated with worse survival and chronic kidney disease.
JOURNAL OF HEPATOLOGY
(2022)
Article
Medicine, General & Internal
Xiaoyang Cui, Xu Huang, Xin Yu, Ying Cai, Ye Tian, Qingyuan Zhan
Summary: This study assessed the incidence and clinical characteristics of AKI in ARDS patients and found that age, diabetes, CKD, disease severity, lactate levels, and ECMO support were risk factors for AKI. Early AKI was related to underlying disease and severity of hospital admission, while late AKI was related to nephrotoxic drugs. The mortality rate was significantly higher in ARDS patients with AKI.
FRONTIERS IN MEDICINE
(2022)
Letter
Medicine, General & Internal
Dominique Vodovar, Bruno Megarbane, Stephane Gaudry, Didier Dreyfuss, Paul M. Palevsky
Summary: This article discusses the importance and effectiveness of using extracorporeal kidney-replacement therapy in poisonings, even in the absence of acute kidney injury, to rapidly remove toxicants and save lives.
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Article
Multidisciplinary Sciences
Huizhen Ma, Xiaoning Zhang, Ling Liu, You Huang, Si Sun, Ke Chen, Qi Xin, Pengfei Liu, Yuxing Yan, Yili Wang, Yuan Li, Haile Liu, Ruoli Zhao, Kexin Tan, Xinzhu Chen, Xun Yuan, Yonghui Li, Ying Liu, Haitao Dai, Changlong Liu, Hao Wang, Xiao-Dong Zhang
Summary: To address the issue of low bioactivity in most near-infrared-II (NIR-II) fluorophores, researchers have developed atomically precise Au-22 clusters with strong NIR-II fluorescence and high catalytic activities. The newly developed Au21Cu1 clusters show significantly higher antioxidant, catalase-like, and superoxide dismutase-like activities than Au-22 clusters, with negligible fluorescence loss. These clusters can be used for three-dimensional imaging of cisplatin-induced renal injury and inhibit oxidative stress and inflammation in a mouse model.
Review
Cardiac & Cardiovascular Systems
Hugh Fleet, David Pilcher, Rinaldo Bellomo, Tim G. Coulson
Summary: Postoperative atrial fibrillation (POAF) is common after cardiac surgery and associated with increased hospital length of stay, patient morbidity and mortality. The reporting of factors associated with POAF is inconsistent and often contradictory. Existing POAF prediction models have low discrimination, potential bias, and limited clinical applicability. Large cohort studies are needed to prospectively collect AF relevant data and validate the findings in external data sets.
Article
Anesthesiology
Rahul Costa-Pinto, Fumitaka Yanase, Lucy M. Kennedy, Lachie J. Talbot, Jeremy P. M. Flanagan, Helen Opdam, Louise M. Ellard, Rinaldo Bellomo, Daryl A. Jones
Summary: Postoperative 'enhanced care' models, such as the recovery high dependency unit introduced in this study, provide a cost-effective and efficient option for managing high-risk surgical patients. The study found a relatively low rate of intensive care unit admissions and medical emergency team calls post-discharge to the ward in patients who received care in the recovery high dependency unit. This model may be worth considering and evaluating in other institutions for the care of their higher risk surgical patients.
ANAESTHESIA AND INTENSIVE CARE
(2023)
Article
Hematology
Anna Lorenzin, Massimo de Cal, Matteo Marcello, David Sorbo, Sabrina Copelli, Claudio Ronco, Silvia de Rosa, Monica Zanella
Summary: Sepsis is a common complication in critically ill patients, and extracorporeal therapies such as hemoperfusion can be used to control infection and provide organ support. This study aimed to determine the amount of vancomycin adsorbed by a sorbent cartridge during hemoperfusion and to establish strategies for maintaining effective plasma levels in critically ill patients.
BLOOD PURIFICATION
(2023)
Article
Hematology
Matteo Marcello, Anna Lorenzin, Massimo De Cal, Michela Zorzi, Marco Salvatore La Malfa, Valentina Fin, Alessandra Sandini, Francesco Fiorin, Rinaldo Bellomo, Silvia De Rosa, Claudio Ronco, Monica Zanella
Summary: We conducted an ex vivo study to assess the quantitative capacity of a novel adsorptive cartridge to remove bilirubin from plasma. The results showed that the device has good adsorption capacity for bilirubin and can guide the frequency and duration of clinical treatment.
BLOOD PURIFICATION
(2023)
Review
Anesthesiology
Angela A. Frentiu, Kevin Mao, Carla Borg Caruana, Dev Raveendran, Luke A. Perry, Jahan C. Penny-Dimri, Dhruvesh M. Ramson, Reny Segal, Rinaldo Bellomo, Julian A. Smith, Zhengyang Liu
Summary: RED CELL DISTRIBUTION WIDTH (RDW) is a biomarker that can predict erythropoietic dysfunction and adverse outcomes after cardiac surgery. This systematic review and meta-analysis aimed to determine the prognostic value of RDW in cardiac surgery patients. The authors included 26 studies involving 48,092 patients and found that elevated preoperative RDW was associated with increased short- and long-term mortality, postoperative atrial fibrillation (POAF), and acute kidney injury (AKI). However, more research is needed to investigate the role of RDW in risk stratification of patients undergoing cardiac surgery.
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
(2023)
Article
Infectious Diseases
Rahul Costa-Pinto, Sarah Klink, Hannah Rotherham, Padeepa Perera, Liam Finlay, Karen Urbancic, Karl Vaz, Jason Trubiano, Rinaldo Bellomo
Summary: Our study found no significant liver or cardiac side effects associated with the use of voriconazole in critically ill patients with suspected COVID-19-associated pulmonary aspergillosis. These findings provide reassurance for clinicians when initiating therapy for such patients.
Article
Urology & Nephrology
Sabrina Milan Manani, Maria Mattiotti, Matteo Marcello, Grazia Maria Virzi, Maddalena Gnappi, Davide Marturano, Ilaria Tantillo, Claudio Ronco, Monica Zanella
Summary: A case of Contrast Induced Encephalopathy (CIE) in a Peritoneal Dialysis patient is reported. The patient experienced mental confusion and aphasia after a Percutaneous Angioplasty procedure. Recovery was achieved through medical intervention and additional dialysis.
Article
Hematology
Kyle Christopher White, Kevin B. Laupland, Emily See, Ary Serpa-Neto, Rinaldo Bellomo
Summary: The effect of CRRT commencement on urine output was investigated in a retrospective cohort study. It was found that starting CRRT was associated with a significant decrease in urine output that continued over the first 24 hours.
BLOOD PURIFICATION
(2023)
Article
Cardiac & Cardiovascular Systems
Anna Lorenzin, Luca Sgarabotto, Maria Laura Bacci, Alberto Elmi, Domenico Ventrella, Camilla Aniballi, Monica Zanella, Alessandra Brendolan, Luca Di Lullo, Claudio Ronco
Summary: This study presents a new miniaturized device called AD1 for extracorporeal ultrafiltration, designed for patients with fluid overload. The device operates at low pressure and flow regimes and has a user-friendly interface. The in vivo tests showed that it is safe, reliable, and accurate, opening up possibilities for clinical trials in various settings.
CARDIORENAL MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Luca Sgarabotto, Amir Kazory, Alessandra Brendolan, Luca Di Lullo, Monica Zanella, Claudio Ronco
Summary: AD 1 is a portable device that can be used to treat patients with fluid overload. It generates ultrafiltrate using a polysulfone mini-filter based on blood flow and gravity. Further studies are needed to evaluate whether gentle ultrafiltration and treatment of volume overload will improve clinical outcomes.
CARDIORENAL MEDICINE
(2023)
Article
Hematology
Krish Vasudev, Amir Kazory, Claudio Ronco, Deepti Bhattacharya, Abhilash Koratala
Summary: Twitter polls help identify knowledge gaps among POCUS learners, leading to improvements in POCUS-related curricula and the development of targeted educational materials to facilitate remote learning.
BLOOD PURIFICATION
(2023)
Article
Cardiac & Cardiovascular Systems
Amir Kazory, Claudio Ronco
Summary: Symptoms and signs of congestion are the main reasons for hospitalization of acute heart failure patients. Loop diuretics are recommended, but their response is variable. Blockade of nephron has been proposed as a more effective strategy. Two large-scale trials examined this hypothesis, targeting the proximal and distal tubules respectively. Results were discussed in the context of previous studies and ultrafiltration.
CARDIORENAL MEDICINE
(2023)
Review
Critical Care Medicine
Brigitta Fazzini, Tobias Maerkl, Christos Costas, Manfred Blobner, Stefan J. Schaller, John Prowle, Zudin Puthucheary, Henning Wackerhage
Summary: The aim of this study was to synthesize data on the rate of muscle loss in critically ill patients and identify the methods used to measure muscle size. The study found that critically ill patients lose nearly 2% of skeletal muscle per day during the first week of ICU admission. The overall prevalence of ICU-acquired weakness was 48%.
Article
Gastroenterology & Hepatology
Agata Ludwiczak, Timothy J. Stephens, John Prowle, Rupert Pearse, Magda Osman
Summary: This study examined the systematic misalignment in postoperative expectations between high-risk patients and doctors, with patients expecting better surgical outcomes. Despite this misalignment, both patients and doctors strongly preferred surgical treatment, possibly due to the perception of non-surgical options as 'doing nothing'.
COLORECTAL DISEASE
(2023)
Article
Critical Care Medicine
Marcus Young, Natasha E. Holmes, Kartik Kishore, Sobia Amjad, Michele Gaca, Ary Serpa Neto, Michael C. Reade, Rinaldo Bellomo
Summary: The use of natural language processing (NLP) can help identify behavioral disturbance phenotypes with different characteristics, prevalence, trajectory, treatment, and outcomes. In critically ill patients, those with an agitated phenotype are more likely to receive antipsychotic medications and have a higher risk of mortality compared to patients with a non-agitated or combined phenotype.