Early acute kidney injury based on serum creatinine or cystatin C in intensive care unit after major trauma

Background: Acute kidney injury [AKI] is a common problem in critically ill patients and is independently associated with increased morbidity and mortality. Recently, serum cystatin C has been shown to be superior to creatinine in early detection of renal function impairment. We compared estimated GFR based on serum cystatin C with estimated GFR based on serum creatinine for early detection of renal dysfunction according to the RIFLE criteria

Methods: During 9months, three hundred post trauma patients that were referred to the intensive care unit of a referral trauma hospital were recruited. Serum creatinine and serum cystatin C were measured and the estimated GFR within 24 hours of ICU admission was calculated. The primary outcome was the incidence of AKI according to the RIFLE criteria within 2[nd] to 7[th] day of admission

Results: During the first week of ICU admission, 21% of patients experienced AKI. After adjusting for major confounders, only the patients with first day's serum cystatin level higher than 0.78mg/l were at higher risk of first week AKI [OR=6.14, 95% CI: 2.5-14.7, P<0.001]. First day's serum cystatin C and injury severity score were the major risk factors for ICU mortality [OR=3.54, 95% CI: 1.7-7.4, P=0.001] and [OR=4.6, 95% CI: 1.5-14, P=0.007], respectively

Conclusion: Within 24 hours after admission in ICU due to multiple trauma, high serum cystatin C level may have prognostic value in predicting early AKI and mortality during ICU admission. However, such correlation was not seen neither with creatinine nor cystatin C based GFR

impact of operative fluids on the prevention of postoperative anesthetic complications in ambulatory surgery - High Dose vs Low Dose

Adequate control of postoperative [postop.] nausea, vomiting, dizziness and thirst, and early return to normal activity are important anesthetic goals in the context of ambulatory surgery. This study, investigated the impact of different preoperative fluid therapies or regimens on preventing postop. nausea, vomiting, dizziness and thirst. In a prospective randomized double-blind study, from June 2002 to November 2003, two hundred ASA grade I-II ambulatory surgical patients received 20 ml/kg of intravenous isotonic electrolyte solution [0.9% sodium chloride] [group A] or 2 ml/kg of same [group B] [n = 100 in each group], over 30 minutes before induction of anesthesia. A standard general anesthetic technique and postop. analgesia were used throughout the operation. Adverse postop. outcomes [nausea, vomiting, dizziness, and thirst] were assessed at 30 and 60 minutes postop. and at discharge. The incidence of postop. vomiting and thirst significantly decreased in group A compared to group B [p = 0.0 14 and p = 0.029, respectively]. There was no difference in the incidence of nausea and dizziness between the two groups. We conclude that preoperative high dose hydration [20 ml/kg bolus] can efficiently decrease the incidence of postop. thirst and vomiting within the first 60 minutes, it was superior to low dose hydration and therefore, we recommend it in ambulatory surgeries