17 research outputs found
Early course of microcirculatory perfusion in the eye and digestive tract during experimental sepsis
Ultrafiltration rate is an important determinant of microcirculatory alterations during chronic renal replacement therapy
Background: Hemodialysis (HD) with ultrafiltration (UF) in chronic renal replacement therapy is associated with hemodynamic instability, morbidity and mortality. Sublingual Sidestream Dark Field (SDF) imaging during HD revealed reductions in microcirculatory blood flow (MFI). This study aims to determine underlying mechanisms. Methods: The study was performed in the Medical Centre Leeuwarden and the Lithuanian University of Health Sciences. Patients underwent 4-h HD session with linear UF. Nine patients were subject to combinations of HD and UF: 4 h of HD followed by 1 h isolated UF and 4 h HD with blood-volume-monitoring based UF. Primary endpoint: difference in MFI before and after intervention. During all sessions monitoring included blood pressure, heartrate and SDF-imaging. Trial registration number: NCT01396980. Results: Baseline characteristics were not different between the two centres as within the HD/UF modalities. MFI was not different before and after HD with UF. Total UF did not differ between modalities. Median MFI decreased significantly during isolated UF [2.8 (2.5-2.9) to 2.5 (2.2-2.8), p = 0.03]. Baseline MFI of each UF session was correlated with MFI after the intervention (r s = 0.52, p = 0.006). Conclusion: During HD with UF or isolated HD we observed no changes in MFI. This indicates that non-flow mediated mechanisms are of unimportance. During isolated UF we observed a reduction in MFI in conjunction with a negative intravascular fluid balance. The correlation between MFI before and after intervention suggests that volume status at baseline is a factor in microvascular alterations. In conclusion we observed a significant decrease of sublingual MFI, related to UF rate during chronic renal replacement therapy
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
A worldwide perspective of sepsis epidemiology and survival according to age: Observational data from the ICON audit
Purpose: To investigate age-related differences in outcomes of
critically ill patients with sepsis around the world.
Methods: We performed a secondary analysis of data from the prospective
ICON audit, in which all adult ( >16 years ) patients admitted to
participating ICUs between May 8 and 18, 2012, were included, except
admissions for routine postoperative observation. For this sub-analysis,
the 10,012 patients with completed age data were included. They were
divided into five age groups - <= 50, 51-60, 61-70, 71-80, >80 years.
Sepsis was defined as infection plus at least one organ failure.
Results: A total of 2963 patients had sepsis, with similar proportions
across the age groups (<= 50 = 25.2%: 51-60 = 30.3%; 61-70 = 32.8%;
71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and
in patients >80 years was almost twice that of patients <= 50 years
(493% vs 25.2%, p < .05). The maximum rate of increase in mortality
was about 0.75% per year, occurring between the ages of 71 and 77
years. In multilevel analysis, age > 70 years was independently
associated with increased risk of dying.
Conclusions: The odds for death in ICU patients with sepsis increased
with age with the maximal rate of increase occurring between the ages of
71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved