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3. Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: a post hoc analysis of the EUPHRATES trial

Author

Klein, D. J., Foster, D., Walker, P. M., Bagshaw, S. M., Mekonnen, H., and Antonelli, M.

Subjects
Mortality -- Analysis, Septic shock -- Analysis -- Health aspects, Health care industry
Abstract

Purpose The EUPHRATES trial examined the impact of polymyxin B hemoperfusion (PMX) on mortality in patients with septic shock and endotoxemia, defined as EAA [greater than or equal to] 0.60. No difference was found in 28-day all-cause mortality. However, the trial showed that in some patients with septic shock the burden of endotoxin activity was extreme (EAA [greater than or equal to] 0.9). In a post hoc analysis, we evaluated the impact of PMX use in patients with septic shock and endotoxin activity measured between 0.6-0.89. Methods Post-hoc analysis of the EUPHRATES trial for the 194 patients with EAA [greater than or equal to] 0.6-0.89 who completed two treatments (PMX or sham). The primary end point was mortality at 28 days adjusted for APACHE II score and baseline mean arterial pressure (MAP). Additional end points included changes in MAP, cumulative vasopressor index (CVI), median EAA reduction, ventilator-free days (VFD), dialysis-free days (DFD) and hospital length of stay. Subpopulations analyzed were site and type of infection and those with norepinephrine dose > 0.1 mcg/kg/min at baseline. Results At 28 days, 23 patients of 88 (26.1%) in the PMX group died versus 39 of 106 (36.8%) in the sham group [risk difference 10.7%, OR 0.52, 95% CI (0.27, 0.99), P = 0.047]. When unadjusted for baseline variables, P = 0.11. The 28-day survival time in the PMX group was longer than for the sham group [HR 0.56 (95% CI 0.33, 0.95) P = 0.03]. PMX treatment compared with sham showed greater change in MAP [median (IQR) 8 mmHg (- 0.5, 19.5) vs. 4 mmHg (- 4.0, 11) P = 0.04] and VFD [median (IQR) 20 days (0.5, 23.5) vs. 6 days (0, 20), P = 0.004]. There were no significant differences in other end points. There was a significant difference in mortality in PMX-treated patients with no bacterial growth on culture [PMX, 6/30 (20%) vs. sham, 13/31 (41.9%), P = 0.005]. The median EAA change in the population was - 12.9% (range: increase 49.2%-reduction 86.3%). The mortality in the above median EAA change group was PMX: 6/38 (15.7%) vs. sham 15/49 (30.6%), P = 0.08. Conclusions These hypothesis-generating results, based on an exploratory post hoc analysis of the EUPHRATES trial, suggest measurable responses in patients with septic shock and an EAA [greater than or equal to] 0.6 to 0.89 on changes in mean arterial pressure, ventilator-free days and mortality. Trial registration Clinicaltrials.gov Identifier: NCT01046669. Funding Spectral Medical Incorporated., Author(s): D. J. Klein [sup.1], D. Foster [sup.2], P. M. Walker [sup.2], S. M. Bagshaw [sup.3], H. Mekonnen [sup.4], M. Antonelli [sup.5] Author Affiliations: (1) 0000 0001 2157 2938, grid.17063.33, [...]

Published
2018
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10. The Effects of the Serious Illness Care Program (SICP) on Health Care Resource Utilization (HRU)

Author

Muscedere, John, Truelove, Amber Hastings, Stockley, Denise, Fowler, Jennifer, Barrie, Carol, Hafid, A., Guenter, D., Gallagher, E., Howard, M., You, J., Nidumolu, A., Lagrotteria, A., Motehayerarani, A., Virk, N., Sinnarajah, A., Human, T., Ying, I., Wong, H., Cummings, G., Pattullo, A., Wang, J., Lee, J., Moffat, D., Grinman, M., Montgomery, C. L., Rolfson, D. B., Stelfox, H. T., Zuege, D., Zygun, D. A., Hudson, D., Opgenorth, D., Bagshaw, S. M., Laur, C., Bell, J., Valaitis, R., Ray, S., Keller, H., Prevett, C., Fang, H., Shkredova, D., Xie, F., Zoratti, M., Gordon, C., Adachi, J., Phillips, S., Richardson, J., Tang, A., Ma, C., Riehm, L., Kendell, C., Urquhart, R., Burge, F., Kotecha, J., Martin, M., Jorgensen, M., Han, H., Dubé, D., Gutman, G., Sussman, T., DeVries, B., Gahagan, J., Brotman, S., Koo, E., Wegier, P., Embuldeniya, G., Ansari, S., Kobewka, D., O’Connor, E., Wu, P., Steinberg, L., Bell, C., Walton, T., Colstello, J., van Walraven, C., Downar, J., Wu, P. E., Costello, J., Wu, R., Frost, D., Kawaguchi, S., Mahtani, R., Toor, H., Goldman, R., Myers, J., Forster, A., Hladkowicz, E., Taljaard, M., Bryson, G., Beaulé, P. E., Gagné, S., Hamilton, G., Huang, A., Joanisse, J. A., Lavallée, L. T., MacDonald, D., Moloo, H., Thavorn, K., Yang, H., Forster, A. J., McIsaac, D. I., Sypes, E. E., de Grood, C., Parsons Leigh, J., Clement, F. M., Niven, D. J., Bitschy, A. M., Donald, E., Ewing, G., Grande, G., Sawatzky, R., Stajduhar, K. I., Parascandalo, F., Yu-Hin Siu, H., Delleman, B., Langevin, J., Mangin, D., Fang, Q., Price, D., Chan, D., Ting Wang, H., Nguyen, Q. D., Menard, C. A., Morinville, A., Hirdes, J. P., Hebert, P., Singh, J., Swinton, M., Morrison, J. M., Laur, C. V., Ebad, M., Dubin, J. A., Chen, H., Curtis, L.J., Bell, J. J., Gramlich, L. M., Keller, H. H., Dionne, J., Duan, E., Clarke, F., Hand, L., Millen, T., Sandu, G., Hodder, J., Santos, M., Shah, S., Trembley, M., Gomes, B., Leclair, L., Montroy, K., Watpool, I., Porteous, R., Acres, S., Foster, D., Auld, F., Williams, V., Marchand, J., Campisi, J., Alam, N., Lebrassier, M., Thompson, P., Hewer, T., Gilles, D., Hunt, M., Georgescu, I., Boyd, T., Lys, J., Marten, N., Campbell, E., Bentall, T., Kavikondala, K., Willems, S., Panchbhaya, Z., Booth, J., Ruddell, S., Richter, B., Tassy, D., Jesso, R., Marinoff, N., Perez, A., Kaur, N., Campbell, T., Lizotte, P., Lavoie, L., Dionne, M., Saunders, L., Zytaruk, N., Heels-Ansdell, D., Johnstone, J., Cook, D., Quinn, K. L., Campitelli, M. A., Diong, C., Daneman, N., Stall, N., Morris, A. M., Detsky, A. S., Jeffs, L., Maxwell, C. J., Bell, C. M., Bronskill, S. E., Alghamdi, M., Baracos, V., Karvellas, C., Churchill, T., Khadaroo, R. G., Moorhouse, P., Sampalli, T., Bedford, L., Edwards, L., Gibson, R., Mallery, L., Taylor, D., Warner, G., Harnish, A., Law, V., Lawson, B. J., Wood, S., Buckler, M., Fernandes, P., Elliott, J., Stolee, P., Ali, G., Dunichand-Hoedl, A., Salim, S. Y., Mazurak, V. C., Baracos, V. E., Heckman, G. A., Hebert, P. C., Costa, A. P., Arthur, S. A., Jones, A., Salam-White, L., Tanner, D., Negm, A. M., Kennedy, C. C., Ioannidis, G., Gajic-Veljanoski, O., Thabane, L., Adachi, J. D., Marr, S., Lau, A., Atkinson, S., Petruccelli, D., DeBeer, J., Winemaker, M., Avram, V., Williams, D., Armstrong, D., Lumb, B., Panju, A., Papaioannou, A., Boucher, A., Haesebaert, J., Freitas, A., Adekpedjou, R., Landry, M., Bourassa, H., Dawn, S., Croteau, J., Légaré, F., Takaoka, A. M., Clarke, F. J., Shears, M. S., Muscedere, J., Cook, D. J., Lee, A., Bouchard, D. R., Sénéchal, M., Mayo, A., Hrubeniuk, T. J., Keshavarz, M., Robertson, C., Read, E. A., Norris, C M., Meyer, S. R., Zibdawi, M., Marshall, H. D., Moody, E. M., Martin-Misener, R., Hawken, E. R., Boyd, J. G., Im, J., Mak, S., Upshur, R., Steinbreg, L., Kuluski, K., Van Damme, J., Delvin, M-E., Medves, J., Woddhouse, K., Sakamoto, M. L., Durepos, P., Ploeg, J., Akhtar-Danesh, N., Punia, H., Kaasalainen, S., Hewston, P., Kennedy, C., Merom, D., Patterson, C., Sztramko, R., Trainor, L., Grenier, A., Woolhouse, M., Petrella, A.F.M., Heath, M., Hyland, B., Fan, M., Hamilton, M., Reding, R., Trbovich, P., O’Reilly, D. M., O’Donnell, S., Bruning, P., Donovan, J., Anoveros-Barrera, A., Coletta, G., Jakubowski, J., Pritchard, J. M., Werner, G. E., Hoben, M., Estabrooks, C. A., Leaker, H. R., Holroyd-Leduc, J., Fox, L., Smallbone, J., Stinchcombe, A., Wilson, K., Kortes-Miller, K., Rees-Milton, K. J., Hulbert, M., Turner, M. E., Berger, C., Anastassiades, T. P., Hopman, W. M., Adams, M. A., Powley, W. L., Holden, R. M., Grewal, K., Sheets, D., Smith, A. P., Trites, M., Kennedy, M., MacDonald, S., Sivarajah, L., Lamarche, L., Giangregorio, A., Radcliffe, S., Ioannidi, G., Negm, A., Connolly, M. S., Klein, J. M., Huber, J. S., Safaraz, S., Foster, A. J., Simpson, J. A., Brunt, K.R., Elfassy, M. D., Munshi, L., Mehta, N., Martinez Guasch, F., Kamen, C., Burry, L., Soong, C., Mehta, S., McKay, S., Yetman, L., Slayter, J., McCollum, A., McGibbon, C. A., Jarrett, P., Robinson, B., Kolyvas, A., McCloskey, R., Gionet, S., Scheme, E., Harris, B., D’Aoust, T. R., Shao, T., Egan, R., Muscedere, J. G., Milne, B., Fitzpatrick, M., Yingwei Peng, P., Parlow, J., and Johnson, A. P.

Subjects
Abstracts
Published
2019

16. Effect of Targeted Polymyxin B Hemoperfusion on 28-Day Mortality in Patients with Septic Shock and Elevated Endotoxin Level: The EUPHRATES Randomized Clinical Trial

Author

Dellinger, R. P., Bagshaw, S. M., Antonelli, Massimo, Foster, D. M., Klein, D. J., Marshall, J. C., Palevsky, P. M., Weisberg, L. S., Schorr, C. A., Trzeciak, S., Walker, P. M., Antonelli M. (ORCID:0000-0003-3007-1670), Dellinger, R. P., Bagshaw, S. M., Antonelli, Massimo, Foster, D. M., Klein, D. J., Marshall, J. C., Palevsky, P. M., Weisberg, L. S., Schorr, C. A., Trzeciak, S., Walker, P. M., and Antonelli M. (ORCID:0000-0003-3007-1670)

Abstract

Importance: Polymyxin B hemoperfusion reduces blood endotoxin levels in sepsis. Endotoxin activity can be measured in blood with a rapid assay. Treating patients with septic shock and elevated endotoxin activity using polymyxin B hemoperfusion may improve clinical outcomes. Objective: To test whether adding polymyxin B hemoperfusion to conventional medical therapy improves survival compared with conventional therapy alone among patients with septic shock and high endotoxin activity. Design, Setting, and Participants: Multicenter, randomized clinical trial involving 450 adult critically ill patients with septic shock and an endotoxin activity assay level of 0.60 or higher enrolled between September 2010 and June 2016 at 55 tertiary hospitals in North America. Last follow-up was June 2017. Interventions: Two polymyxin B hemoperfusion treatments (90-120 minutes) plus standard therapy completed within 24 hours of enrollment (n = 224 patients) or sham hemoperfusion plus standard therapy (n = 226 patients). Main Outcomes and Measures: The primary outcome was mortality at 28 days among all patients randomized (all participants) and among patients randomized with a multiple organ dysfunction score (MODS) of more than 9. Results: Among 450 eligible enrolled patients (mean age, 59.8 years; 177 [39.3%] women; mean APACHE II score 29.4 [range, 0-71 with higher scores indicating greater severity), 449 (99.8%) completed the study. Polymyxin B hemoperfusion was not associated with a significant difference in mortality at 28 days among all participants (treatment group, 84 of 223 [37.7%] vs sham group 78 of 226 [34.5%]; risk difference [RD], 3.2%; 95% CI, -5.7% to 12.0%; relative risk [RR], 1.09; 95% CI, 0.85-1.39; P =.49) or in the population with a MODS of more than 9 (treatment group, 65 of 146 [44.5%] vs sham, 65 of 148 [43.9%]; RD, 0.6%; 95% CI, -10.8% to 11.9%; RR, 1.01; 95% CI, 0.78-1.31; P =.92). Overall, 264 serious adverse events were reported (65.1% treatment group vs 57

Published
2018

17. Association of protein intake with the outcomes of critically ill patients: a post hoc analysis of the PermiT trial

Author

Arabi, Y M, primary, Al-Dorzi, H M, additional, Mehta, S, additional, Tamim, H M, additional, Haddad, S H, additional, Jones, G, additional, McIntyre, L, additional, Solaiman, O, additional, Sakkijha, M H, additional, Sadat, M, additional, Afesh, L, additional, Kumar, A, additional, Bagshaw, S M, additional, and Aldawood, A S, additional

Published
2018
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19. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Author

Villa, Gianluca, Neri, M., Bellomo, R., Cerda, J., De Gaudio, Angelo Raffaele, De Rosa, S., Garzotto, F., Honore, P. M., Kellum, J., Lorenzin, A., Payen, D., Ricci, Z., Samoni, S., Vincent, J. L., Wendon, J., Zaccaria, M., Ronco, C., Bagshaw, S. M., Balducci, A., Baldwin, I., Barbarigo, F., Braganó, P., Braunsky, J., Calletti, F., Chawla, L., Di Somma, S., Doi, K., Dosil Rosende, P., Emmett, M., Fecondini, L., Galavotti, D., Gibney, N., Goldstein, S. L., Guadagni, G., Honorè, P., Hoste, E., Inadome, S., Kashani, K., Katz, N., Kenley, R., Kobayashi, Y., Lannoy, J., Lewington, A., Mariano, F., McCullough, P. A., Mehta, R. L., Menneguerre, J., Mettifogo, M., Ostermann, M., Pani, A., Pirazzoli, P., Pohlmeier, R., Pouchoulin, D., Rosner, M., Seamann, M., Shaw, A., Tolwani, A., Supporting clinical sciences, and Internal Medicine Specializations

Subjects
CRRT machine, HIGH-VOLUME HEMOFILTRATION, INTENSIVE-CARE-UNIT, medicine.medical_treatment, Continuous plasmafiltration coupled with adsorption, continuous veno-venous hemodiafiltration, continuous veno-venous hemodialysis, continuous veno-venous hemofiltration, hemoperfusion, high volume hemofiltration, pressure sensor, pump, terminology, critical care and Intensive care medicine, 030232 urology & nephrology, Review, Continuous veno-venous hemofiltration, Critical Care and Intensive Care Medicine, High volume hemofiltration, 0302 clinical medicine, Continuous veno-venous hemodiafiltration, DIALYSIS, Medicine and Health Sciences, FAILURE, Medicine(all), Acute kidney injury, Acute Kidney Injury, RANDOMIZED CONTROLLED-TRIAL, Terminology, Continuous veno-venous hemodialysis, Renal Replacement Therapy, medicine.symptom, medicine.medical_specialty, Consensus, Critical Care, Pressure sensor, POLYMYXIN-B HEMOPERFUSION, Critical Illness, ACUTE KIDNEY INJURY, Hemodiafiltration, Extracorporeal, EXTRACORPOREAL MEMBRANE-OXYGENATION, Sepsis, 03 medical and health sciences, Hemofiltration, medicine, Extracorporeal membrane oxygenation, Humans, Renal replacement therapy, Intensive care medicine, Septic shock, business.industry, Hemoperfusion, Pump, SEPTIC SHOCK, Organ dysfunction, Généralités, 030208 emergency & critical care medicine, medicine.disease, LIVER SUPPORT, business
Abstract

This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis., 0, SCOPUS: re.j, info:eu-repo/semantics/published

Published
2016

20. Nomenclature for renal replacement therapy in acute kidney injury: Basic principles

Author

Neri, Mauro, Villa, Gianluca, Garzotto, Francesco, Bagshaw, Sean, Bellomo, ELENA MARIA RITA, Cerda, Jorge, Ferrari, Fiorenza, Guggia, Silvia, Joannidis, Michael, Kellum, John, Kim, Jeong Chul, Mehta, Ravindra L., Ricci, Zaccaria, Trevisani, Alberto, Marafon, Silvio, Clark, William R., Vincent, Jean Louis, Ronco, Claudio, Bagshaw, S. M., Balducci, Alessandro, Baldwin, I., Barbarigo, F., Bellomo, R., Braganó, P., Braunsky, J., Calletti, F., Cerda, J., Chawla, L., De Rosa, S., Di Somma, S., Doi, K., Dosil Rosende, P., Emmett, M., Fecondini, L., Galavotti, D., Kellum, J., Garzotto, F., Lorenzin, A., Neri, M., Ronco, C., Goldstein, S. L., Guadagni, G., Honoré, P., Hoste, E., Kashani, K., Katz, N., Kenley, R., Lannoy, J., Lewington, A., Mariano, F., Mccullough, P. A., Mehta, R. L., Menneguerre, J., Mettifogo, M., Ostermann, M., Pani, A., Pirazzoli, P., Pohlmeier, R., Pouchoulin, D., Ricci, Z., Rosner, M., Seamann, M., Shaw, A., Tolwani, A., Villa, G., Vincent, J. L., and Wendon, J.

Subjects
medicine.medical_specialty, CRRT efficiency, medicine.medical_treatment, Critical Illness, 030232 urology & nephrology, Transmembrane pressure, Ultrafiltration, CRRT modalities, Review, 030204 cardiovascular system & hematology, urologic and male genital diseases, Clearance, Convection, CRRT membranes, Diffusion, Dose, Terminology, Critical Care and Intensive Care Medicine, Extracorporeal, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Terminology as Topic, medicine, Humans, Renal replacement therapy, Intensive care medicine, Acute Kidney Injury, Renal Replacement Therapy, business.industry, Critically ill, Consensus conference, Acute kidney injury, Généralités, medicine.disease, Critical illness, business
Abstract

This article reports the conclusions of a consensus expert conference on the basic principles and nomenclature of renal replacement therapy (RRT) currently utilized to manage acute kidney injury (AKI). This multidisciplinary consensus conference discusses common definitions, components, techniques, and operations of the machines and platforms used to deliver extracorporeal therapies, utilizing a "machine-centric" rather than a "patient-centric" approach. We provide a detailed description of the performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment, focusing on continuous renal replacement therapies (CRRT) which are utilized in the management of critically ill patients with AKI. This is a consensus report on nomenclature harmonization for principles of extracorporeal renal replacement therapies. Devices and operations are classified and defined in detail to serve as guidelines for future use of terminology in papers and research., 0, SCOPUS: re.j, info:eu-repo/semantics/published

Published
2016

21. Pathogens and antimicrobial susceptibility profiles in critically ill patients with bloodstream infections: a descriptive study

Author

Savage, R. D., primary, Fowler, R. A., additional, Rishu, A. H., additional, Bagshaw, S. M., additional, Cook, D., additional, Dodek, P., additional, Hall, R., additional, Kumar, A., additional, Lamontagne, F., additional, Lauzier, F., additional, Marshall, J., additional, Martin, C. M., additional, McIntyre, L., additional, Muscedere, J., additional, Reynolds, S., additional, Stelfox, H. T., additional, and Daneman, N., additional

Published
2016
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22. Protocol for the PREHAB study--Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial

Author

Stammers, A. N., primary, Kehler, D. S., additional, Afilalo, J., additional, Avery, L. J., additional, Bagshaw, S. M., additional, Grocott, H. P., additional, Legare, J.-F., additional, Logsetty, S., additional, Metge, C., additional, Nguyen, T., additional, Rockwood, K., additional, Sareen, J., additional, Sawatzky, J.-A., additional, Tangri, N., additional, Giacomantonio, N., additional, Hassan, A., additional, Duhamel, T. A., additional, and Arora, R. C., additional

Published
2015
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30. Reply

Author

Bagshaw, S. M., primary, George, C., additional, Dinu, I., additional, and Bellomo, R., additional

Published
2008
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38. A cluster randomised, crossover, registry-embedded clinical trial of proton pump inhibitors versus histamine-2 receptor blockers for ulcer prophylaxis therapy in the intensive care unit (PEPTIC study): Study protocol

Author

Paul Young, Bagshaw, S. M., Forbes, A., Nichol, A., Wright, S. E., Bellomo, R., Bailey, M. J., Beasley, R. W., Eastwood, G. M., Festa, M., Gattas, D., Haren, F., Litton, E., Mouncey, P., Navarra, L., Pilcher, D., Mackle, D., Mcarthur, C. J., Mcguinness, S. P., Saxena, M. K., Webb, S., and Rowan, K. M.

Subjects
Canada, Cross-Over Studies, Australia, Proton Pump Inhibitors, Length of Stay, Respiration, Artificial, United Kingdom, Intensive Care Units, Histamine H2 Antagonists, Research Design, Clostridium Infections, Humans, Hospital Mortality, Prospective Studies, Registries, Stomach Ulcer, Gastrointestinal Hemorrhage, Ireland, New Zealand
Abstract

The balance of risks and benefits with using proton pump inhibitors (PPIs) versus histamine-2 receptor blockers (HTo describe the study protocol and statistical analysis plan for the Proton Pump Inhibitors versus Histamine-2 Receptor Blockers for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) study.Protocol for a prospective, multicentre, randomised, open-label, cluster crossover, registry-embedded trial to be conducted in 50 ICUs in Australia, Canada, Ireland, New Zealand and the United Kingdom. The PEPTIC study will compare two approaches to stress ulcer prophylaxis in mechanically ventilated adults implemented at the level of the ICU. One approach is to use PPIs as the default therapy and the other approach is to use H2RBs as the default therapy when stress ulcer prophylaxis is prescribed. Each ICU, by random allocation, will use one approach for 6 months and will then switch to the opposite approach for the next 6 months. The PEPTIC study began recruitment in August 2016 and will complete recruitment in January 2019.The primary end point will be in-hospital mortality. Secondary outcomes include clinically significant upper gastrointestinal bleeding,The PEPTIC study will compare the effect on in-hospital mortality of implementing, at the level of the ICU, the use of PPI as the preferred agent for stress ulcer prophylaxis in mechanically ventilated adults in the ICU with using HAustralian and New Zealand Clinical Trials Registry (ANZCTRN 12616000481471).

39. The timing of rapid-response team activations: A multicentre international study

Author

Jones, D., Bellomo, R., Hart, G. K., Parma, A., NOEL GIBNEY, Bagshaw, S. M., Bhatia, G., Leong, T., Eastwood, G., Peck, L., Barret, J., Bucknall, T., Hillman, K., Parr, M., Jäderling, G., Konrad, D., Casamento, A., Doric, A., Street, C., Duke, G., Barbetti, J., Prowle, J., Crosby, D., Licari, E., Farley, K. J., Fedi, M., Fong, C., Atan, R., Ruseckaite, R., Macpartin, M., Stevenson, J., Bengtsson, Å, Ghosh, A., Botha, C., Kaufmann, M., and Macdonald, N.

45. O2, do we know what to do?

Author

Young, P. J., Bagshaw, S. M., Bailey, M., Bellomo, R., Mackle, D., Pilcher, D., Landoni, G., Nichol, A., and Daniel Martin

47. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury

Author

Starrt-Aki Investigators, Jean-Pierre Quenot, Bin Du, Paul J Young, Bruno R. da Costa, Stéphane Gaudry, Sean M. Bagshaw, Michael Joannidis, Eric Hoste, Haibo Qiu, Bram Rochwerg, Daniel F. McAuley, Didier Dreyfuss, Ron Wald, Antoine G. Schneider, Matthew A. Weir, Rinaldo Bellomo, Neill K.J. Adhikari, Kathleen D. Liu, Fernando Thomé, Marlies Ostermann, Suvi T. Vaara, Kevin E. Thorpe, Martin Gallagher, Amanda Y. Wang, Alexander Zarbock, Javier A. Neyra, Shay McGuinness, Francois Lamontagne, Ville Pettilä, Paul M. Palevsky, Orla Smith, Alistair Nichol, Giovanni Landoni, Bagshaw, S. M., Wald, R., Adhikari, N. K. J., Bellomo, R., da Costa, B. R., Dreyfuss, D., Du, B., Gallagher, M. P., Gaudry, S., Hoste, E. A., Lamontagne, F., Joannidis, M., Landoni, G., Liu, K. D., Mcauley, D. F., Mcguinness, S. P., Neyra, J. A., Nichol, A. D., Ostermann, M., Palevsky, P. M., Pettila, V., Quenot, J. -P., Qiu, H., Rochwerg, B., Schneider, A. G., Smith, O. M., Thome, F., Thorpe, K. E., Vaara, S., Weir, M., Wang, A. Y., Young, P., Zarbock, A (STARRT-AKI Investigators), and Zangrillo, A

Subjects
medicine.medical_specialty, medicine.medical_treatment, 610 Medicine & health, 030204 cardiovascular system & hematology, Lower risk, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, 360 Social problems & social services, law, Internal medicine, DIALYSIS, Medicine and Health Sciences, medicine, 030212 general & internal medicine, Renal replacement therapy, Adverse effect, Dialysis, Intention-to-treat analysis, business.industry, MORTALITY, Acute kidney injury, General Medicine, medicine.disease, TRIALS, Relative risk, business, CRITICALLY-ILL PATIENTS
Abstract

Background Acute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy. However, the most effective timing for the initiation of such therapy remains uncertain. Methods We conducted a multinational, randomized, controlled trial involving critically ill patients with severe acute kidney injury. Patients were randomly assigned to receive an accelerated strategy of renal-replacement therapy (in which therapy was initiated within 12 hours after the patient had met eligibility criteria) or a standard strategy (in which renal-replacement therapy was discouraged unless conventional indications developed or acute kidney injury persisted for >72 hours). The primary outcome was death from any cause at 90 days. Results Of the 3019 patients who had undergone randomization, 2927 (97.0%) were included in the modified intention-to-treat analysis (1465 in the accelerated-strategy group and 1462 in the standard-strategy group). Of these patients, renal-replacement therapy was performed in 1418 (96.8%) in the accelerated-strategy group and in 903 (61.8%) in the standard-strategy group. At 90 days, death had occurred in 643 patients (43.9%) in the accelerated-strategy group and in 639 (43.7%) in the standard-strategy group (relative risk, 1.00; 95% confidence interval [CI], 0.93 to 1.09; P=0.92). Among survivors at 90 days, continued dependence on renal-replacement therapy was confirmed in 85 of 814 patients (10.4%) in the accelerated-strategy group and in 49 of 815 patients (6.0%) in the standard-strategy group (relative risk, 1.74; 95% CI, 1.24 to 2.43). Adverse events occurred in 346 of 1503 patients (23.0%) in the accelerated-strategy group and in 245 of 1489 patients (16.5%) in the standard-strategy group (P

Published
2020

49. Timing of continuous renal replacement therapy in severe acute kidney injury patients with fluid overload: A retrospective cohort study.

Author

Lin J, Ji XJ, Wang AY, Liu JF, Liu P, Zhang M, Qi ZL, Guo DC, Bellomo R, Bagshaw SM, Wald R, Gallagher M, and Duan ML

Subjects
Aged, Aged, 80 and over, Humans, Intensive Care Units, Male, Middle Aged, Renal Replacement Therapy, Retrospective Studies, Acute Kidney Injury therapy, Continuous Renal Replacement Therapy, Water-Electrolyte Imbalance
Abstract

Purpose: We aimed to evaluate the association of early versus late initiation of Continuous renal replacement therapy (CRRT) with mortality in patients with fluid overload., Methods: This was a retrospective cohort study of patients with fluid overload (FO) treated with CRRT due to severe acute kidney injury (AKI) between January 2015 and December 2017 in a mixed medical intensive care unit of a teaching hospital in Beijing, China. Patients were divided into early (≤15 h) and late (>15 h) groups based on the median time from ICU admission to CRRT initiation. The primary outcome was all-cause mortality at day 60. Multivariable Cox model analysis was used for analysis., Results: The study patients were male predominant (84/150) with a mean age of 64.8 ± 16.7 years. The median FO value before CRRT initiation was 10.1% [6.2-16.1%]. The 60-day mortality rates in the early vs the late CRRT groups were 53.9% and 73%, respectively. On multivariable Cox modelling, the late initiation of CRRT was independently associated with an increased risk of death at 60 days (HR 1.75, 95% CI 1.11-2.74, p = 0.015)., Conclusions: Early initiation of CRRT was independently associated with survival benefits in severe AKI patients with fluid overload., (Copyright © 2021. Published by Elsevier Inc.)

Published
2021
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50. The furosemide stress test for prediction of worsening acute kidney injury in critically ill patients: A multicenter, prospective, observational study.

Author

Rewa OG, Bagshaw SM, Wang X, Wald R, Smith O, Shapiro J, McMahon B, Liu KD, Trevino SA, Chawla LS, and Koyner JL

Subjects
Acute Kidney Injury urine, Aged, Area Under Curve, Critical Illness mortality, Disease Progression, Female, Humans, Intensive Care Units, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Sodium Potassium Chloride Symporter Inhibitors, Urodynamics, Young Adult, Acute Kidney Injury diagnosis, Acute Kidney Injury mortality, Furosemide pharmacology
Abstract

Purpose: To validate the furosemide stress test (FST) for predicting the progression of acute kidney injury (AKI)., Materials and Methods: We performed a multicenter, prospective, observational study in patients with stage I or II AKI. The FST (1 mg/kg for loop diuretic naïve patients and 1.5 mg/kg in patients previously exposed to loop diuretics) was administered. Subsequent urinary flow rate (UFR) recorded and predictive ability of urinary output was measured by the area under the curve receiver operatic characteristics (AuROC). Primary outcome was progression to Stage III AKI. Secondary outcomes included in-hospital mortality and adverse events., Results: We studied 92 critically ill patients. 23 patients progressed to stage III AKI and had significantly lower UFR (p < 0.0001). The UFR during the first 2 h was most predictive of progression to stage III AKI (AuROC = 0.87), with an ideal cut-off of less than 200mls, with a sensitivity of 73.9% and specificity of 90.0%., Conclusion: In ICU patients without severe CKD with mild AKI, a UFR of less than 200mls in the first 2 h after an FST is predictive of progression to stage III AKI. Future studies should focus on incorporating a FST as part of a clinical decision tool for further management of critically ill patients with AKI., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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