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Ventilator weaning protocols have been published during the past 20 years. Although patients fulfill weaning criteria, they may still experience extubation failure. Risk factors include respiratory muscle weakness. This is accompanied by peripheral muscle weakness. The aim of the study is to evaluate the possible relation between peripheral (hand) muscle strength and extubation success in ICU patients.

Introduction: Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however, has never been compared with RRT.Methods: Nine Belgian intensive care units (ICUs) included all adult patients consecutively admitted with serum creatinine >2 mg/dl. Included treatment options were conservative treatment and intermittent or continuous RRT. Disease severity was determined using the Stuivenberg Hospital Acute Renal Failure (SHARF) score. Outcome parameters studied were mortality, hospital length of stay and renal recovery at hospital discharge.Results: Out of 1,303 included patients, 650 required RRT (58% intermittent, 42% continuous RRT). Overall results showed a higher mortality (43% versus 58%) as well as a longer ICU and hospital stay in RRT patients compared to conservative treatment. Using the SHARF score for adjustment of disease severity, an increased risk of death for RRT compared to conservative treatment of RR = 1.75 (95% CI: 1.4 to 2.3) was found. Additional correction for other severity parameters (Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)), age, type of AKI and clinical conditions confirmed the higher mortality in the RRT group.Conclusions: The SHARF study showed that the higher mortality expected in AKI patients receiving RRT versus conservative treatment can not only be explained by a higher disease severity in the RRT group, even after multiple corrections. A more critical approach to the need for RRT in AKI patients seems to be warranted. © 2010 Elseviers et al. licensee BioMed Central Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

It is important for ICU physicians to predict the mortality of acute renal failure (ARF) in the first 24–48 hours. For this the SHARF II score at 0 and 48 hours has been developed [1]. This study will look at short-term and long-term morbidity and mortality with different modes of treatment in ARF.

The detection of heart response to fluid administration is still a challenge in clinical practice. Changes in metabolic parameters may be useful to detect changes in cardiac output (CO) after fluid expansion.