The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

Healing and expression of growth factors (TGF-β and PDGF) in canine radial ostectomy gap containing platelet-rich plasma

Objectives: To evaluate bone healing in an experimental radial ostectomy in dogs treated with autologous platelet-rich plasma (PRP), through histological, densitometric, radiographic studies, as well as expression of growth factors in the ostectomy gap. Methods: Twenty-one dogs were randomly divided into either a control or a PRP group. All underwent unilateral ostectomy of the radius to generate a gap of 2.0 mm, that was stabilized with external skeletal fixation. The ostectomy gap was either filled with PRP or left empty as a control. The radiographic and densitometric studies were performed after surgery, then at intervals until 60 days during the post-surgery period. Histological and immunohistochemical evaluations were performed at seven or 60 days post-surgery. Analyses were performed using a statistical analysis system, and the level of significance was set at p <0.05. Results: The median radiographic healing score in the PRP group increased significantly between day 0 and day 60. Furthermore, at 60 days, the median healing score and the proportion of healed ostectomies in the control group (score 1; 1/6 healed) and the PRP group (score 5; 4/5 healed) were significantly different. There were differences between groups in radiographic and densitometric values at days 45 and 60. The histological evaluation showed advanced bone healing at 60 days in the PRP group and signs of delayed union in the control group. Clinical relevance: Platelet-rich plasma can be used as an adjuvant therapy because it may promote better bone healing of a radial ostectomy treated with external skeletal fixation in dogs

Fitorremediação de solos contaminados com tebuthiuron utilizando-se espécies cultivadas para adubação verde Phytoremediation of tebuthiuron-contaminated soils using species cultivated for green manure

O emprego da fitorremediação na despoluição de solos contaminados com compostos orgânicos, inclusive herbicidas, vem sendo pesquisado ultimamente. Como o tebuthiuron pode causar sério impacto ambiental, por ser muito utilizado, apresentar longo efeito residual no solo e possibilidade de contaminação do lençol de água subterrâneo, desenvolveu-se este trabalho com o objetivo de avaliar a capacidade de sete espécies vegetais na despoluição de solos contaminados com esse herbicida. As espécies avaliadas neste experimento foram: Cajanus cajan, Canavalia ensiformes, Dolichos lablab, Pannisetum glaucum, Estizolobium deeringianum, Estizolobium aterrimum e Lupinus albus. Elas foram semeadas e cultivadas, por 60 dias, em vasos cujo solo recebeu quatro doses do tebuthiuron (0,0; 0,5; 1,0; e 1,5 kg ha-1). As testemunhas foram constituídas por vasos sem planta, aos quais foram aplicadas as mesmas doses de herbicidas. Aos 60 dias após a semeadura, colheu-se a parte aérea de todas as plantas, sendo semeada, nos mesmos vasos, Avena strigosa, utilizada como planta indicadora, para realização do bioensaio. Depois de 60 dias da semeadura da espécie bioindicadora, esta foi colhida, sendo avaliadas as seguintes características: altura de plantas, sintomas de toxicidade e biomassa seca da parte aérea das plantas. Até a dose de 0,5 kg ha-1 de tebuthiuron, a espécie que melhor fitorremediou esse herbicida no solo foi L. albus. Quando o solo foi tratado com 1,0 kg ha-1 de tebuthiuron, C. ensiformes foi a espécie que melhor fitorremediou o herbicida. Isso foi concluído com base na maior altura de plantas, biomassa seca da parte aérea e menor toxicidade de A. strigosa, quando foi cultivada em sucessão a essas plantas remediadoras. Nenhuma das espécies avaliadas cresceu em solo que recebeu a maior dose de tebuthiuron (1,5 kg ha-1).<br>Phytoremediation of soil contaminated by organic compounds, including herbicides, is being widely investigated. The frequent use of tebuthiuron can cause serious environmental impacts such as long-term residual effect on soil and likely underground water contamination. Thus, this work aimed to evaluate the phytoremediation potential of seven plant species in soils treated with this herbicide. The experiment evaluated the following species: Cajanus cajan, Canavalia ensiformes, Dolichos lablab, Pannisetum glaucum, Estizolobium deeringianum, Estizolobium aterrimum and Lupinus albus, sown and cultivated for 60 days in vases treated with tebuthiuron at 0.0, 0.5, 1.0, and 1.5 kg ha-1. The control treatments were constituted by vases without plants, submitted to the same herbicide doses. Sixty days after sowing, the aerial part of all the plants was harvested and Avena strigosa was sown in the same vases for bioassay. Sixty days after it was sown, A. strigosa was harvested and the characteristics plant height, phytotoxicity symptoms and dry biomass of the aerial part of the plant were evaluated. Up to a tebuthiuron dose of 0.5 kg ha-1, L. albus presented the best phytoremediation results. When tebuthiuron was applied at 1.0 kg ha-1, C. ensiformes presented the best phytoremediation results. Such results were based on plant height, dry biomass of the aerial part and lower A. strigosa phytotoxicity when cultivated after these remediating plants. None of the species evaluated grew in soil receiving the highest dose of tebuthiuron (1.5 kg ha-1)

Assessment of the worldwide burden of critical illness: The Intensive Care Over Nations (ICON) audit

Background Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality.Methods 730 participating centres in 84 countries prospectively collected data on all adult (&gt;16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country.Findings 10 069 patients were included from ICUs in Europe (5445 patients; 54.1%), Asia (1928; 19.2%), the Americas (1723; 17.1%), Oceania (439; 4.4%), the Middle East (393; 3.9%), and Africa (141; 1.4%). Overall, 2973 patients (29.5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16.2% (95% CI 15.5-16.9) across the whole population and 25.8% (24.2-27.4) in patients with sepsis. Hospital mortality rates were 22.4% (21.6-23.2) in the whole population and 35.3% (33.5-37.1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0.19, p=0.002) and between-hospital variations (var=0.43, p&lt;0.0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income.Interpretation This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death

Higher Fluid Balance Increases the Risk of Death from Sepsis: Results from a Large International Audit∗

Objectives: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. Design: Observational cohort study. Setting: Seven hundred and thirty ICUs in 84 countries. Patients: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission. Measurements and Main Results: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock. Conclusions: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death

Correction to collaborators in acknowledgments in: Decision-making on withholding or withdrawing life support in the ICU: A worldwide perspective

The authors have reported to CHEST that the collaborators from the ICON Investigators were omitted from the Acknowledgments in “Decision-Making on Withholding or Withdrawing Life Support in the ICU: A Worldwide Perspective” (Chest. 2017;152(2):321-329). https://doi.org/10.1016/j.chest.2017.04.17