Subject(s)
Creatinine/blood , Creatinine/urine , Glomerular Filtration Rate/physiology , Renal Elimination/physiology , Algorithms , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/therapeutic use , Critical Illness , Drug Monitoring , Female , Glomerular Filtration Rate/drug effects , Half-Life , Humans , Kidney/drug effects , Kidney/physiopathology , Male , Renal Elimination/drug effects , Sepsis/drug therapy , Sepsis/urine , Severity of Illness Index , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/urineABSTRACT
OBJECTIVE: The aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT. METHODS: A non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters. INCLUSION CRITERIA: patients aged ≥ 16 years admitted to Intensive Care Units (ICUs) and subjected to RRT. RESULTS: A total of 261 critically ill patients were recruited, of which 35% had renal dysfunction prior to admission. The main reason for starting RRT was oliguria; the most widely used RRT modality was hemodiafiltration; and the median prescribed dose at baseline was 35mL/kg/h. The median time of RRT onset from ICU admission was one day. The mortality rate at 30 and 90 days was 46% and 54%, respectively, and was associated to greater severity scores and a later onset of RRT. At discharge, 85% of the survivors had recovered renal function. CONCLUSIONS: Current practice in RRT in Catalonia abides with the current clinical practice guidelines. Mortality related to RRT is associated to later onset of such therapy. The renal function recovery rate at hospital discharge was 85% among the patients subjected to RRT.
Subject(s)
Renal Replacement Therapy/statistics & numerical data , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Critical Care/methods , Critical Care/standards , Critical Illness , Female , Guideline Adherence , Hemodiafiltration/methods , Hemodiafiltration/standards , Hemodiafiltration/statistics & numerical data , Hospital Mortality , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Oliguria/epidemiology , Oliguria/therapy , Practice Guidelines as Topic , Recovery of Function , Renal Replacement Therapy/methods , Renal Replacement Therapy/standards , Spain/epidemiology , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Arthroplasty, Replacement, Hip/adverse effects , Embolism, Fat/complications , Foramen Ovale, Patent/complicationsABSTRACT
No disponible
Subject(s)
Humans , Hemofiltration/methods , Renal Dialysis/methods , Hemodiafiltration/methods , Renal Insufficiency/therapyABSTRACT
El síndrome de la embolia grasa es una entidad frecuente en las Unidades de Cuidados Intensivos (UCI). En el caso del paciente politraumatizado con afectación neurológica, lo habitual es que la lesión neurológica sea por el propio traumatismo craneal, pero en algunos casos es secundario al síndrome de la embolia grasa, incluso pueden asociarse. Ante todo paciente politraumatizado que presente un deterioro neurológico conviene establecer un diagnóstico precoz.En ocasiones las pruebas neurorradiológicas habituales no muestran alteraciones en este síndrome de la embolia grasa cerebral. Recientemente hemos tenido ocasión de asistir a dos pacientes polifracturados que presentaron una sintomatología compatible con embolismo graso cerebral, siendo la tomografía computarizada (TC) normal en ambos casos. Para corroborar la sospecha diagnóstica se realizó una gammagrafía cerebral tomográfica (SPECT = Photon Single Emission Computed Tomography) que fue claramente demostrativa de lesión cerebral, sugiriendo que es una exploración a tener en cuenta en el diagnóstico y control evolutivo del embolismo graso cerebral. (AU)
