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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

Comparison of intraosseous and intramuscular drug administration for induction of anaesthesia in domestic pigeons

The aim of the present study was to assess the feasibility of intraosseous anaesthetic drug administration in domestic pigeons and to compare this method with an intramuscular technique for clinical parameters (induction quality and recovery of anaesthesia), heart-respiratory rate and cloacal temperature. Sixteen clinically healthy mature pigeons (7 mate and 9 female) were included into the study. The birds were allocated into two groups as group I and II. Pigeons in group I received 50 mg/kg ketamine by intraosseous route (10) and birds in group II received intramuscular (IM) ketamine application at a dose of 50 mg/kg. Heart rate (HR), respiratory rate (RR) and cloacal temperature (CT) were measured before (0 min) and 1, 3, 5, 10, 15, 20 and 30 min after anaesthetic drug administration. Clinical and anaesthetic effect of the ketamine used in different route were assessed. Statistical assessment performed between the groups revealed that RR in IM group was higher than in 10 group between 1 and 3 min (p < 0.001 and p < 0.01, respectively), whereas in 15 min it was higher in 10 group than IM (p < 0.01) (Fig. 1A). Compared to baseline values, there was a decrease for HR within 3 to 15 min for both groups. However, this was statistically different between 5, 10 and 15 min for IM group. No significant alterations were recorded for CT during the anaesthesia for both groups. The anaesthetic effect of the ketamine started 1 to 3 min (1.8 +/- 0.4) after injection for Group I and 5 to 10 min (7.5 +/- 0.8) for Group II. The recovery time ranged from 50 to 75 min (62 +/- 15) for Group I and 80 to 100 min (90 +/- 12) for the Group II. Intraosseous and intramuscular ketamine administration resulted in a satisfactory anaesthesia, in pigeons. However, intraosseous drug administration provided a more rapid and effective anaesthesia and might be useful for the birds requiring urgent anaesthesia. (C) 2007 Published by Elsevier Ltd