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Author(s): Greet De Vlieger [sup.1], Lui Forni [sup.2], Antoine Schneider [sup.3] Author Affiliations: (1) grid.5596.f, 0000 0001 0668 7884, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular [...]

Author(s): Michael Darmon [sup.1] [sup.2], David Schnell [sup.3], Antoine Schneider [sup.4] Author Affiliations: (1) grid.413328.f, 0000 0001 2300 6614, Medical ICU, Saint-Louis University Hospital, AP-HP, , 1 Avenue Claude Vellefaux, [...]

Purpose We compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation. Methods This multicenter feasibility trial randomized 100 AKI patients 1:1 in seven ICUs in Europe and Australia. Restrictive fluid management included targeting negative or neutral daily fluid balance by minimizing fluid input and/or enhancing urine output with diuretics administered at the discretion of the clinician. Fluid boluses were administered as clinically indicated. The primary endpoint was cumulative fluid balance 72 h from randomization. Results Mean (SD) cumulative fluid balance at 72 h from randomization was - 1080 mL (2003 mL) in the restrictive fluid management arm and 61 mL (3131 mL) in the usual care arm, mean difference (95% CI) - 1148 mL (- 2200 to - 96) mL, P = 0.033. Median [IQR] duration of AKI was 2 [1-3] and 3 [2-7] days, respectively (median difference - 1.0 [- 3.0 to 0.0], P = 0.071). Altogether, 6 out of 46 (13%) patients in the restrictive fluid management arm and 15 out of 50 (30%) in the usual care arm received renal replacement therapy (RR 0.42; 95% CI 0.16-0.91), P = 0.043. Cumulative fluid balance at 24 h and 7 days was lower in the restrictive fluid management arm. The dose of diuretics was not different between the groups. Adverse events occurred more frequently in the usual care arm. Conclusions In critically ill patients with AKI, a restrictive fluid management regimen resulted in lower cumulative fluid balance and less adverse events compared to usual care. Larger trials of this intervention are justified., Author(s): Suvi T. Vaara [sup.1] [sup.2] [sup.3], Marlies Ostermann [sup.4], Laurent Bitker [sup.2] [sup.5], Antoine Schneider [sup.6], Elettra Poli [sup.6], Eric Hoste [sup.7], Jan Fierens [sup.7], Michael Joannidis [sup.8], Alexander [...]

Author(s): Greet De Vlieger [sup.1], Lui Forni [sup.2], Antoine Schneider [sup.3] Author Affiliations: (1) grid.5596.f, 0000 0001 0668 7884, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular [...]

Author(s): Elettra C. Poli [sup.1], Thomas Rimmelé [sup.2] [sup.3], Antoine G. Schneider [sup.1] Author Affiliations: (1) 0000 0001 0423 4662, grid.8515.9, Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, [...]

The article discusses the optimal timing for discontinuing continuous renal replacement therapy (CRRT) in children with severe acute kidney injury (AKI). The authors highlight the lack of guidance on this topic and the need for better criteria for stopping CRRT. They present data from a study that identified factors associated with successful liberation from CRRT in children, including higher vasoactive-inotropic scores, shorter CRRT duration, and higher urine output prior to CRRT initiation. The authors also discuss the challenges of managing CRRT in children and the potential implications of prolonged CRRT. Further research is needed to determine the best criteria for discontinuing CRRT in pediatric patients. [Extracted from the article]

Author(s): Kianoush B. Kashani [sup.1] [sup.2], Antoine G. Schneider [sup.3], Zaccaria Ricci [sup.4] Author Affiliations: (1) grid.66875.3a, 0000 0004 0459 167X, Division of Nephrology and Hypertension, Department of Medicine, Mayo [...]

Author(s): Antoine Schneider [sup.1], Marlies Ostermann [sup.2] Author Affiliations: (1) 0000 0001 0423 4662, grid.8515.9, Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), , Lausanne, Switzerland (2) 0000 0001 [...]

Author(s): Antoine Schneider [sup.1], Ian Baldwin [sup.2] [sup.3] [sup.4], Bertrand Souweine [sup.5] [sup.6] Author Affiliations: (1) 0000 0001 0423 4662, grid.8515.9, Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), [...]

Author(s): Miet Schetz [sup.1], Antoine Schneider [sup.2] Author Affiliations: (1) 0000 0001 0668 7884, grid.5596.f, Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, Clinical Department, KU Leuven [...]

Patients with serious thermal burn injuries require immediate and specialized care in order to minimize morbidity and mortality. Optimal fluid resuscitation, nutritional support, pulmonary care, burn wound care, and infection control practices represent key aspects of patient care in burn centers. When severely burned, the patient usually presents a systemic inflammatory response syndrome, soon balanced by a counter anti-inflammatory response syndrome. These may lead to immune dysregulation/exhaustion favoring infectious complications that dramatically impair the prognosis of burn patients. This narrative review provides an overview of the main concepts, current understanding, and potential applications of extracorporeal blood purification techniques for burn patient management. Current understanding of burn patients' immune responses is reported. Hypotheses and data on the potential value of immunoregulation are reviewed. Finally, how extracorporeal blood purification may be of interest in this specific population is discussed. [ABSTRACT FROM AUTHOR]

As highlighted by the last international consensus definition for sepsis and septic shock (sepsis-3), sepsis comes from a complex relationship between a pathogen and a dysregulated host response. To date, the treatment of sepsis is based on antimicrobial treatment, source control, and organ support. Extracorporeal blood purification therapies have been proposed as adjuvant therapies to modulate the dysregulated inflammatory response. These therapies aim mostly at removing inflammatory mediators (cytokines) and endotoxins from the blood. However, so far, they failed to clearly demonstrate an improvement in patient survival when evaluated in randomized trials. Recently, new devices directly targeting the primary determinants of sepsis, e.g., the pathogen itself and the host immune cells, have been developed. This short review aimed at presenting new blood purification devices that have recently been developed to target pathogens and immune cells. For each, we will present the mechanism of action of the therapy and discuss the related literature. [ABSTRACT FROM AUTHOR]

Introduction: The measurement of renal functional reserve (RFR) can unmask glomerular hyperfiltration in residual nephrons, but its determination is time-consuming. In this study, we assessed whether contrast-enhanced ultrasound (CEUS) is a valuable alternative to the gold standard inulin clearance and whether L-arginine or protein shakes lead to similar changes in glomerular filtration rate (GFR) as animal proteins in men and women. Methods: Changes in GFR and renal microperfusion were studied in 25 healthy subjects (8 men, 17 women) by simultaneously performing inulin clearance and CEUS (perfusion index, PI) before and 1 and 2 h after different protein loads (L-arginine, protein shake or meat). The Doppler parameters – renal resistive index (RRI) and pulsatility index (PuI) – were also measured. Results: None of the oral protein loads induced significant changes in CEUS-assessed PI. Only meat increased inulin clearance (from 111.2 ± 16.0 to 149.8 ± 27.2 mL/min, p < 0.05) and mobilized RFR, while L-arginine decreased GFR (106.7 ± 45.3 to 86.3 ± 42.6 mL/min, p < 0.05). Protein shakes had a neutral effect. There were no correlations between changes in inulin clearance and PI. At Doppler, RRI and PuI increased after meat intake (from 0.647 ± 0.029 to 0.694 ± 0.050 a.u., p < 0.05 and from 1.130 ± 0.087 to 1.318 ± 0.163 a.u., p < 0.05, respectively), but their changes also did not correlate with changes in inulin clearance. Results were similar in both sexes. Conclusions: CEUS is not a valuable alternative for inulin clearance to measure RFR. Meat ingestion leads to modest changes in renal Doppler parameters and to glomerular hyperfiltration in both women and men, while protein shakes and L-arginine do not. [ABSTRACT FROM AUTHOR]

Introduction: Omni® (B Braun, Melsungen, Germany) is able to run continuous renal replacement therapy (CRRT) in continuous veno-venous hemofiltration (CVVH), hemodialysis (CVVHD), and hemodiafiltration (CVVHDF) modes. However, to date, there is no validated protocol to guide the use of Omni® in CVVHDF mode with regional citrate anticoagulation (RCA). Methods: We designed a protocol for CVVHDF-RCA tailored for Omni®. This protocol was tested in patients included in an observational study conducted in our center between January and March 2021. For all study patients, we collected baseline characteristics, laboratory results, CRRT circuit lifespan as well as plasma and effluent samples at 12, 24, 48, and 72 h of CRRT circuit initiation. At each study time point, we computed urea, creatinine, and β2-microglobulin clearance as well as effluent/blood ratios. Data from circuits in CVVHDF-RCA mode are compared with those in standard therapy (CVVHD-RCA) with the same device. Results: We analyzed ten circuits (5 patients) in CVVHDF-RCA mode and 32 (13 patients) in CVVHD-RCA mode. No adverse events related to the therapy were observed. In CVVHDF-RCA mode, median circuit running time was 68 (IQR 8.1) hours versus 46 (IQR 9.0) in CVVHD mode, p = 0.053. Therapy adaptations (dialysate rate and/or blood flow) were required in one (10%) circuit (15.6% in CVVHD mode, p = 0.56). Compared to CVVHD, CVVHDF was able to achieve similar clearance and effluent/blood ratio for urea, creatinine, and β2-microglobulin across the entire duration of circuit lifetime. Conclusion: The proposed protocol for CVVHDF-RCA for Omni® was associated with similar circuit lifetime, number of required adaptations and clearances to standard CVVHD-RCA. It appears to be safe and feasible. [ABSTRACT FROM AUTHOR]