Urine Output Based Fluid Management in the Critically Ill: assessing hypovolemia and preventing hypervolemia

Intravenous fluids have become commonplace in medical care, and are used to hydrate patients who are either not allowed or temporarily unable to eat, restore or maintain intravascular volume, or as a dilutive agent for intravenous medication. In the critically ill, there appears to be a mismatch between intravenous fluid administration and fluid loss via urine output, which leads to fluid overload and related adverse events. The main aim of this thesis is to investigate whether additional fluid administration aimed at improving urine output has the desired effect, whether this effect can be predicted, and whether this effect impacts patients’ outcome

Neutrophil Gelatinase-Associated Lipocalin as a Diagnostic Marker for Acute Kidney Injury in Oliguric Critically Ill Patients: A Post-Hoc Analysis

__Background:__ Oliguria occurs frequently in critically ill patients, challenging clinicians to distinguish functional adaptation from serum-creatinine-defined acute kidney injury (AKIsCr). We investigated neutrophil gelatinase-associated lipocalin (NGAL)'s ability to differentiate between these 2 conditions. __Methods:__ This is a post-hoc analysis of a prospective cohort of adult critically ill patients. Patients without oliguria within the first 6 h of admission were excluded. Plasma and urinary NGAL were measured at 4 h after admission. AKIsCr was defined using the AKI network criteria with pre-admission serum creatinine or lowest serum creatinine value during the admission as the baseline value. Hazard ratios for AKIsCr occurrence within 72 h were calculated using Cox regression and adjusted for risk factors such as sepsis, pre-admission serum creatinine, and urinary output. Positive predictive values (PPV) and negative predictive values (NPV) were calculated for the optimal cutoffs for NGAL. __Results:__ Oliguria occurred in 176 patients, and 61 (35%) patients developed AKIsCr. NGAL was a predictor for AKIsCr in univariate and multivariate analysis. When NGAL was added to a multivariate model including sepsis, pre-admission serum creatinine and lowest hourly urine output, it outperformed the latter model (plasma p = 0.001; urinary p = 0.048). Cutoff values for AKIsCr were 280 ng/ml for plasma (PPV 80%; NPV 79%), and 250 ng/ml for urinary NGAL (PPV 58%; NPV 78%). __Conclusions:__ NGAL can be used to distinguish oliguria due to the functional adaptation from AKIsCr, directing resources to patients more likely to develop AKIsCr

PENGARUH PENAMBAHAN SEMEN, ABU SEKAM DAN SERAT FIBER TERHADAP PENINGKATAN KUAT GESER TANAH LEMPUNG

Tanah merupakan suatu unsur penting dalam mendukung kegiatan pembangunan di dunia konstriksi sipil. Salah satu jenis tanah yang sering di temukan di sumatra selatan ini ialah tanah lempung. Tanah lempung merupakan jenis tanah berbutir halus yang sangat di pengaruhi oleh kadar air. Setiap tanah lempung mempunyai nilai daya dukung yang berbeda beda, Oleh karna itu di perlukan analisa untuk menguji pengaruh penambahan bahan campuran terhadap tanah lempung. Untuk melihat pengaruh penambahan bahan campuran terhadap tanah dilakukan sebuah pengujian, dalam pengujian ini di ambil sampel tanah dari daerah kabupaten banyuasin serta ditambah bahan campuran berupa serat fiber, abu sekam dan semen. Untuk variasi pengujian campuran tanah, serat fiber 0,1%, abu sekam 2,5% dan semen terdiri dari 2,5%, 5% dan 7,5% serta air biasa. Hasil pengujian menunjukkan dengan penambahan bahan campuran serat fiber, abu sekam dan semen dapat memperbaiki sifat fisis dan mekanis tanah lempung. Untuk pengujian sifat fisis dan mekanis yang dilakukan, persentase optimum yang baik digunakan untuk stabilisasi tanah lempun

Moving Towards Sustainability—Bringing the Threads Together

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Activity of the Eta-Aquariid and Orionid meteor showers

We present a multi-instrumental, multidecadal analysis of the activity of the Eta-Aquariid and Orionid meteor showers for the purpose of constraining models of 1P/Halley's meteoroid streams. The interannual variability of the showers' peak activity and period of duration is investigated through the compilation of published visual and radar observations prior to 1985 and more recent measurements reported in the International Meteor Organization (IMO) Visual Meteor DataBase, by the IMO Video Meteor Network and by the Canadian Meteor Orbit Radar (CMOR). These techniques probe the range of meteoroid masses from submilligrams to grams. The Eta-Aquariids and Orionids activity duration, shape, maximum zenithal hourly rates (ZHR) values, and the solar longitude of annual peaks since 1985 are analyzed. When available, annual activity profiles recorded by each detection network were measured and are compared. Observations from the three detection methods show generally good agreement in the showers' shape, activity levels, and annual intensity variations. Both showers display several activity peaks of variable location and strength with time. The Eta-Aquariids are usually two to three times stronger than the Orionids, but the two showers display occasional outbursts with peaks two to four times their usual activity level. CMOR observations since 2002 seem to support the existence of an ~12 year cycle in Orionids activity variations; however, additional and longer term radar and optical observations of the shower are required to confirm such periodicity.Comment: Accepted for publication in Astronomy & Astrophysics (date of acceptance: 10/06/2020

Targeting urine output and 30-day mortality in goal-directed therapy: A systematic review with meta-analysis and meta-regression.

Background: Oliguria is associated with a decreased kidney- and organ perfusion, leading to orga

Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis

INTRODUCTION: In Europe, vitamin D deficiency is highly prevalent varying between 40% and 60% in the healthy general adult population. The consequences of vitamin D deficiency for sepsis and outcome in critically ill patients remain controversial. We therefore systematically reviewed observational cohort studies on vitamin D deficiency in the intensive care unit.METHODS: Fourteen observational reports published from January 2000 to March 2014, retrieved from Pubmed and Embase, involving 9,715 critically ill patients and serum 25-hydroxyvitamin D3 (25 (OH)-D) concentrations, were meta-analysed.RESULTS: Levels of 25 (OH)-D less than 50 nmol/L were associated with increased rates of infection (risk ratio (RR) 1.49, 95% (confidence interval (CI) 1.12 to 1.99), P = 0.007), sepsis (RR 1.46, 95% (CI 1.27 to 1.68), P <0.001), 30-day mortality (RR 1.42, 95% (CI 1.00 to 2.02), P = 0.05), and in-hospital mortality (RR 1.79, 95% (CI 1.49 to 2.16), P <0.001). In a subgroup analysis of adjusted data including vitamin D deficiency as a risk factor for 30-day mortality the pooled RR was 1.76 (95% CI 1.37 to 2.26, P <0.001).CONCLUSIONS: This meta-analysis suggests that vitamin D deficiency increases susceptibility for severe infections and mortality of the critically ill