Renal insufficiency, acute Archives - Critical Care Science (CCS)
Abstract
Rev Bras Ter Intensiva. 2010;22(4):399-402
DOI 10.1590/S0103-507X2010000400014
Ophidian accidents are not rare in Brazil. Its frequency is of about 30,000 cases/year in Brazil, although ranging between different regions. The gender Bothrops, which includes snakes popularly known as 'jararaca', is by far the most frequently involved, followed by the gender Crotalus, mainly represented by the rattlesnake. Other genders as Micrurus and Lachesis have lower epidemiological relevance. Critical cases are uncommon, and the most severe complications include renal failure and blood coagulation disorders. Adult respiratory distress syndrome and multi-organ systems failure are described, although rare. This report is aims to describe a case involving a Bothrops ophidian accident progressing to adult respiratory distress syndrome and multi-organ and systems failure, and to discuss the therapy used.
Abstract
Rev Bras Ter Intensiva. 2010;22(4):399-402
DOI 10.1590/S0103-507X2010000400014
Ophidian accidents are not rare in Brazil. Its frequency is of about 30,000 cases/year in Brazil, although ranging between different regions. The gender Bothrops, which includes snakes popularly known as 'jararaca', is by far the most frequently involved, followed by the gender Crotalus, mainly represented by the rattlesnake. Other genders as Micrurus and Lachesis have lower epidemiological relevance. Critical cases are uncommon, and the most severe complications include renal failure and blood coagulation disorders. Adult respiratory distress syndrome and multi-organ systems failure are described, although rare. This report is aims to describe a case involving a Bothrops ophidian accident progressing to adult respiratory distress syndrome and multi-organ and systems failure, and to discuss the therapy used.
Abstract
Rev Bras Ter Intensiva. 2009;21(4):359-368
DOI 10.1590/S0103-507X2009000400005
OBJECTIVE: To correlate the RIFLE classification with mortality and length of stay both in the intensive care unit and hospital. METHODS: A prospective, observational, longitudinal cohort study, approved by the Institution's Ethics Committee. Data were collected for all patients staying longer than 24 hours in the intensive care unit of Hospital Universitário Polydoro Ernani de São Thiago - Universidade Federal de Santa Catarina from September 2007 to March 2008, followed-up either until discharge or death. Patients were divided in two groups: with or without acute kidney injury. The acute kidney injury group was additionally divided according to the RIFLE and sub-divided according to the maximal score in Risk, Injury of Failure. Loss and End-stage classes were not included in the study. APACHE II and SOFA were also evaluated. The t Student and Chi-Square tests were used. A P<0.05 was considered statistically significant. RESULTS: The sample included 129 patients, 52 (40.3%) with acute kidney injury according to RIFLE. Patients were more severely ill in this group, with higher APACHE and SOFA scores (P<0.05). Compared to the without kidney injury group, the kidney injury severity caused increased intensive care unity (Risk 25%; Injury 37.5%; Failure 62.5%) and in-hospital (Risk 50%; Injury 37.5%; Failure 62.5%) mortality, and longer intensive care unit stay (P<0.05). CONCLUSION: The RIFLE system, according to the severity class, was a marker for risk of increased intensive care unit and in-hospital mortality, and longer intensive care unit stay. No relationship with in-hospital length of stay was found.
Abstract
Rev Bras Ter Intensiva. 2009;21(4):359-368
DOI 10.1590/S0103-507X2009000400005
OBJECTIVE: To correlate the RIFLE classification with mortality and length of stay both in the intensive care unit and hospital. METHODS: A prospective, observational, longitudinal cohort study, approved by the Institution's Ethics Committee. Data were collected for all patients staying longer than 24 hours in the intensive care unit of Hospital Universitário Polydoro Ernani de São Thiago - Universidade Federal de Santa Catarina from September 2007 to March 2008, followed-up either until discharge or death. Patients were divided in two groups: with or without acute kidney injury. The acute kidney injury group was additionally divided according to the RIFLE and sub-divided according to the maximal score in Risk, Injury of Failure. Loss and End-stage classes were not included in the study. APACHE II and SOFA were also evaluated. The t Student and Chi-Square tests were used. A P<0.05 was considered statistically significant. RESULTS: The sample included 129 patients, 52 (40.3%) with acute kidney injury according to RIFLE. Patients were more severely ill in this group, with higher APACHE and SOFA scores (P<0.05). Compared to the without kidney injury group, the kidney injury severity caused increased intensive care unity (Risk 25%; Injury 37.5%; Failure 62.5%) and in-hospital (Risk 50%; Injury 37.5%; Failure 62.5%) mortality, and longer intensive care unit stay (P<0.05). CONCLUSION: The RIFLE system, according to the severity class, was a marker for risk of increased intensive care unit and in-hospital mortality, and longer intensive care unit stay. No relationship with in-hospital length of stay was found.
Abstract
Rev Bras Ter Intensiva. 2009;21(3):269-275
DOI 10.1590/S0103-507X2009000300006
OBJECTIVE: Infection is one of the main complications of dialysis procedures to correct renal injury, with a significant impact on morbidity mortality in chronic and critically acute dialysis patients. The objective of this work was to review literature on infection in patients submitted to hemodyalisis. METHODS: A survey of publications from 1990 to March 2008 was carried out in the database COCHRANE, PubMed/MEDLINE, Latin-American and Caribbean literature on Health Sciences and Nursing database. In Health Science (DECS) and Medical Subject Headings Section (MeSH) from |PubMed/MEDLINE the following descriptors were used: infection; cross infection; bacteremia; renal dialysis; renal failure;acute renal failure; hemofiltation; hemodiafiltration; renal replacement therapy. RESULTS: Thirty three articles were selected. Most publications were American, from 2001 to 2005 and mainly about vascular access-related infection. Studies diverged on the definition of infection and nomenclature, hindering comparisons. Fiver articles covered different infection topographies, 16 studied vascular access-related infections in the different types of vascular accesses, nine specifically focused on temporary central catheters for hemodialysis and only three studied infections in intensive care unit patients. Temporary central catheters for hemodialysis were identified as the principal risk factor. CONCLUSION: There is a need for studies about infection incidence in critically ill, submitted to dialysis with temporary catheters, due to acute renal injury to define a causal relationship and risk factors to orient adequate prevention and control measures.
Abstract
Rev Bras Ter Intensiva. 2009;21(3):269-275
DOI 10.1590/S0103-507X2009000300006
OBJECTIVE: Infection is one of the main complications of dialysis procedures to correct renal injury, with a significant impact on morbidity mortality in chronic and critically acute dialysis patients. The objective of this work was to review literature on infection in patients submitted to hemodyalisis. METHODS: A survey of publications from 1990 to March 2008 was carried out in the database COCHRANE, PubMed/MEDLINE, Latin-American and Caribbean literature on Health Sciences and Nursing database. In Health Science (DECS) and Medical Subject Headings Section (MeSH) from |PubMed/MEDLINE the following descriptors were used: infection; cross infection; bacteremia; renal dialysis; renal failure;acute renal failure; hemofiltation; hemodiafiltration; renal replacement therapy. RESULTS: Thirty three articles were selected. Most publications were American, from 2001 to 2005 and mainly about vascular access-related infection. Studies diverged on the definition of infection and nomenclature, hindering comparisons. Fiver articles covered different infection topographies, 16 studied vascular access-related infections in the different types of vascular accesses, nine specifically focused on temporary central catheters for hemodialysis and only three studied infections in intensive care unit patients. Temporary central catheters for hemodialysis were identified as the principal risk factor. CONCLUSION: There is a need for studies about infection incidence in critically ill, submitted to dialysis with temporary catheters, due to acute renal injury to define a causal relationship and risk factors to orient adequate prevention and control measures.
Abstract
Rev Bras Ter Intensiva. 2008;20(3):278-285
DOI 10.1590/S0103-507X2008000300011
Tumor lysis syndrome is characterized by the massive destruction of malignant cells and the release in the extra-cellular space of their content. While Tumor lysis syndrome may occur spontaneously before treatment, it usually develops shortly after the initiation of cytotoxic chemotherapy. These metabolites can overwhelm the homeostatic mechanisms with development of hyperuricaemia, hyperkalaemia, hyperphosphataemia, and hypocalcaemia. These biological manifestations may lead to clinical manifestations including, acute kidney injury, seizure, or sudden death that require intensive care. Since clinical tumor lysis syndrome is associated with a poor prognosis both prevention of tumor lysis syndrome and prevention of clinical consequences of tumor lysis syndrome are mandatory. The objective of this review is to describe pathophysiological mechanisms, biological and clinical manifestations of tumor Lysis syndrome, and to provide upto-date guidelines to ensure prevention of tumor lysis syndrome. Review of selected studies on tumor lysis syndrome published at the PubMed database www.pubmed.gov during the last 20 years. Additional references were retrieved from the studies initially selected. Tumor lysis syndrome is a frequent and life-threatening complication of the newly diagnosed malignancies. Preventive measures, including hydration, uricolytic agents, eviction of factors predisposing to acute kidney injury and, in the more severe patients, on prophylactic renal replacement therapy, are required to prevent or limit clinical consequences of Tumor lysis syndrome. However optimal timing and modalities of prevention remains unknown and may be modified by the changing spectrum of patients at risk of tumor lysis syndrome. Development and validation of risk based strategies is required to limit the high morbidity and mortality of this complication.
Abstract
Rev Bras Ter Intensiva. 2008;20(3):278-285
DOI 10.1590/S0103-507X2008000300011
Tumor lysis syndrome is characterized by the massive destruction of malignant cells and the release in the extra-cellular space of their content. While Tumor lysis syndrome may occur spontaneously before treatment, it usually develops shortly after the initiation of cytotoxic chemotherapy. These metabolites can overwhelm the homeostatic mechanisms with development of hyperuricaemia, hyperkalaemia, hyperphosphataemia, and hypocalcaemia. These biological manifestations may lead to clinical manifestations including, acute kidney injury, seizure, or sudden death that require intensive care. Since clinical tumor lysis syndrome is associated with a poor prognosis both prevention of tumor lysis syndrome and prevention of clinical consequences of tumor lysis syndrome are mandatory. The objective of this review is to describe pathophysiological mechanisms, biological and clinical manifestations of tumor Lysis syndrome, and to provide upto-date guidelines to ensure prevention of tumor lysis syndrome. Review of selected studies on tumor lysis syndrome published at the PubMed database www.pubmed.gov during the last 20 years. Additional references were retrieved from the studies initially selected. Tumor lysis syndrome is a frequent and life-threatening complication of the newly diagnosed malignancies. Preventive measures, including hydration, uricolytic agents, eviction of factors predisposing to acute kidney injury and, in the more severe patients, on prophylactic renal replacement therapy, are required to prevent or limit clinical consequences of Tumor lysis syndrome. However optimal timing and modalities of prevention remains unknown and may be modified by the changing spectrum of patients at risk of tumor lysis syndrome. Development and validation of risk based strategies is required to limit the high morbidity and mortality of this complication.
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