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I nuovi fenotipi del danno renale acuto

Il danno renale acuto in cardiochirurgia

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Oxygen- and carbon dioxide-related measurements

DO2- and VCO2-related measurements were performed using a dedicated software system provided by Dideco (Sorin Group). Data were collected at 10-minute intervals during CPB. Data required to calculate DO2 and VCO2 were arterial Hb (g/dL), pump flow (L/minute/m2), arterial O2 saturation, gas flow into the oxygenator (L/minute) and expiratory CO2 tension (mmHg) measured at the site of the oxygenator exhaled gas port with a Datex-Ohmeda capnograph (GE Healthcare, Little Chalfont, UK)), or with a ventilator-integrated capnograph.



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Background: Recent studies have suggested that early goal-directed resuscitation of patients with septic shock and conservative fluid management of patients with acute lung injury (ALI) can improve outcomes. Because these may be seen as potentially conflicting practices, we set out to determine the influence of fluid management on the outcomes of patients with septic shock complicated by ALI.

Methods: A retrospective analysis was performed at Barnes-Jewish Hospital (St. Louis, MO) and in the medical ICU of Mayo Medical Center (Rochester, MN). Patients hospitalized with septic shock were enrolled into the study if they met the American-European Consensus definition of ALI within 72 h of septic shock onset. Adequate initial fluid resuscitation (AIFR) was defined as the administration of an initial fluid bolus of > 20 mL/kg prior to and achievement of a central venous pressure of > 8 mm Hg within 6 h after the onset of therapy with vasopressors. Conservative late fluid management (CLFM) was defined as even-to- negative fluid balance measured on at least 2 consecutive days during the first 7 days after septic shock onset.

Results: The study cohort was made up of 212 patients with ALI complicating septic shock. Hospital mortality was statistically lowest for those achieving both AIFR and CLFM and higher for those achieving only CLFM, those achieving only AIFR, and those achieving neither (17 of 93 patients [18.3%] vs 13 of 31 patients [41.9%] vs 30 of 53 patients [56.6%] vs 27 of 35 [77.1%], respectively; p < 0.001).

Conclusions: Both early and late fluid management of septic shock complicated by ALI can influence patient outcomes. (CHEST 2009; 136:102–109)



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Background. Despite the frequent use of renal replace- ment therapy (RRT) for patients with acute kidney injury (AKI) in the intensive care unit (ICU), there is no accepted consensus on the optimal indications and timing. Methods. The aim of this paper is to identify optimal trig- gers for RRT in critically ill patients with AKI.Results. We examined data from 2 randomized controlled trials, 2 prospective studies and 13 retrospective trials and found large variation in the different parameters and cut- offs for initiation of RRT. No single biochemical parameter was adequate to define the optimal indication and time to commence RRT. Degree of fluid overload, oliguria and associated non-renal organ failure appeared to be more appropriate parameters for initiation of RRT. We propose a clinical algorithm based on regular assessment of the patient’s condition and trends in these parameters. It is intended to aid the process of deciding when to start RRT in critically ill adult patients with AKI.Conclusion. Available evidence suggests that the decision when to start RRT in critically ill patients with AKI should be based on trends in the patient’s severity of illness, pres- ence of oliguria and fluid overload and associated non-renal organ failure rather than specific serum creatinine or urea values.



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release  1
pubblicata il  19 marzo 2013 
da S. Morabito
((Roma, Italia))
Parole chiave: danno renale acuto
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