Supervivencia de circuitos de técnicas de depuración extrarrenal continua en pacientes críticos con o sin anticoagulación convencional: estudio observacional prospectivo

Fundamento. El objetivo del presente estudio es describir la eficacia, seguridad y viabilidad, en pacientes críticos con técnica de depuración extrarrenal continua (TDEC) y diferente riesgo de hemorragia, de un sistema de anticoagulación convencional con perfusión continua de heparina no fraccionada (HNF) frente a no anticoagular usando lavados son suero fisiológico. Material y métodos. Se trata de un estudio observacional prospectivo realizado en la Unidad de Cuidados Intensivos (UCI) desde octubre de 2013 hasta abril de 2016. Se incluyeron 61 pacientes que presentaron insuficiencia renal aguda (IRA) con requerimientos de TDEC y un total de 122 circuitos. Tanto los pacientes como los circuitos fueron divididos para su análisis en dos grupos: anticoagulados (AC) y no anticoagulados (No AC). La variable principal fue la supervivencia de los circuitos. Además se recogieron diferentes parámetros analíticos al comienzo del tratamiento y en el momento de coagulación del circuito. Resultados. La distribución de pacientes anticoagulados y no anticoagulados fue similar. No se han encontrado diferencias significativas en la supervivencia de los circuitos entre ambos grupos (30,5 horas AC vs 34,9 horas No AC). Los pacientes con mayor morbilidad (trombopenia severa, coagulopatía, etc.) pertenecían al grupo que no recibió anticoagulación, sino lavados con suero fisiológico. Conclusiones. En pacientes críticos con alto riesgo de sangrado las TDEC son viables sin anticoagulación más el empleo de lavados periódicos con suero fisiológico se comporta como una medida viable, segura y eficaz obteniendo una supervivencia de los circuitos similar a la de pacientes anticoagulados con HNF, evitando los riesgos y costes asociados a la anticoagulación.Background. The aim of this study was to describe the efficacy, security and viability of an anticoagulation system with continuous infusion of unfractionated heparin (UFH) versus one without any type of anticoagulant using 0.9% physiological saline washings, in critically ill patients with continuous renal replacement therapy (CRRT) and different risks of bleeding. Methods. From October 2013 to April 2015 we conducted an observational prospective study in the intensive care unit (ICU). Sixty-one patients with acute kidney injury (AKI) and requiring CRRT were included, with 122 filters. Patients and filters were divided in two groups: anticoagulated (AC) and not anticoagulated (No AC). The main outcome measure was filter life span. Different analytical parameters were also collected at the beginning of treatment and at the moment of circuit coagulation Results. The number of patients was similar in both groups. We did not find statistically significant differences between the two groups in filter life span (30.5 hours AC vs 34.9 hours No AC). Patients with increased morbidity (severe thrombocytopenia, coagulopathy, etc.) were included in the group that did not received anticoagulation but saline flushes. Conclusions. CRRT without anticoagulation with saline flushes is a viable, safe and effective strategy in critically ill patients with high risk of bleeding. This approach achieves a circuit life span similar to that observed in anticoagulated patients with UFH; avoiding the risks and costs associated with anticoagulation

Upstream migration of anadromous and potamodromous brown trout: patterns and triggers in a 25-year overview

Producción CientíficaRiver fragmentation and alterations in flow and thermal regimes are the main stressors affecting migrating fish, which could be aggravated by climate change and increasing water demand. To assess these impacts and define mitigation measures, it is vital to understand fish movement patterns and the environmental variables affecting them. This study presents a long-term (1995–2019) analysis of upstream migration patterns of anadromous and potamodromous brown trout in the lower River Bidasoa (Spain). For this, captures in a monitoring station were analyzed using Survival Analysis and Random Forest techniques. Results showed that most upstream movements of potamodromous trout occurred in October–December, whereas in June–July for anadromous trout, although with differences regarding sex and size. Both, fish numbers and dates varied over time and were related to the environmental conditions, with different influence on each ecotype. The information provided from comparative studies can be used as a basis to develop adaptive management strategies to ensure freshwater species conservation. Moreover, studies in the southern distribution range can be crucial under climate warming scenarios, where species are expected to shift coldwards.Proyecto de innovación docente de la Universidad de Valladolid (PIF-UVa 2017)Ministerio de Ciencia, Innovación y Universidades (grant PTQ2018-010162)Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Supervivencia de circuitos de técnicas de depuración extrarrenal continua en pacientes críticos con o sin anticoagulación convencional: estudio observacional prospectivo

Fundamento. El objetivo del presente estudio es describir la eficacia, seguridad y viabilidad, en pacientes críticos con técnica de depuración extrarrenal continua (TDEC) y diferente riesgo de hemorragia, de un sistema de anticoagulación convencional con perfusión continua de heparina no fraccionada (HNF) frente a no anticoagular usando lavados son suero fisiológico. Material y métodos. Se trata de un estudio observacional prospectivo realizado en la Unidad de Cuidados Intensivos (UCI) desde octubre de 2013 hasta abril de 2016. Se incluyeron 61 pacientes que presentaron insuficiencia renal aguda (IRA) con requerimientos de TDEC y un total de 122 circuitos. Tanto los pacientes como los circuitos fueron divididos para su análisis en dos grupos: anticoagulados (AC) y no anticoagulados (No AC). La variable principal fue la supervivencia de los circuitos. Además se recogieron diferentes parámetros analíticos al comienzo del tratamiento y en el momento de coagulación del circuito. Resultados. La distribución de pacientes anticoagulados y no anticoagulados fue similar. No se han encontrado diferencias significativas en la supervivencia de los circuitos entre ambos grupos (30,5 horas AC vs 34,9 horas No AC). Los pacientes con mayor morbilidad (trombopenia severa, coagulopatía, etc.) pertenecían al grupo que no recibió anticoagulación, sino lavados con suero fisiológico. Conclusiones. En pacientes críticos con alto riesgo de sangrado las TDEC son viables sin anticoagulación más el empleo de lavados periódicos con suero fisiológico se comporta como una medida viable, segura y eficaz obteniendo una supervivencia de los circuitos similar a la de pacientes anticoagulados con HNF, evitando los riesgos y costes asociados a la anticoagulación.Background. The aim of this study was to describe the efficacy, security and viability of an anticoagulation system with continuous infusion of unfractionated heparin (UFH) versus one without any type of anticoagulant using 0.9% physiological saline washings, in critically ill patients with continuous renal replacement therapy (CRRT) and different risks of bleeding. Methods. From October 2013 to April 2015 we conducted an observational prospective study in the intensive care unit (ICU). Sixty-one patients with acute kidney injury (AKI) and requiring CRRT were included, with 122 filters. Patients and filters were divided in two groups: anticoagulated (AC) and not anticoagulated (No AC). The main outcome measure was filter life span. Different analytical parameters were also collected at the beginning of treatment and at the moment of circuit coagulation Results. The number of patients was similar in both groups. We did not find statistically significant differences between the two groups in filter life span (30.5 hours AC vs 34.9 hours No AC). Patients with increased morbidity (severe thrombocytopenia, coagulopathy, etc.) were included in the group that did not received anticoagulation but saline flushes. Conclusions. CRRT without anticoagulation with saline flushes is a viable, safe and effective strategy in critically ill patients with high risk of bleeding. This approach achieves a circuit life span similar to that observed in anticoagulated patients with UFH; avoiding the risks and costs associated with anticoagulation