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Oh C, Hong B. At the Right Place, at the Right Time. Reply to Vetrugno et al. Comparison between FlowTrac and Pulmonary Arterial Catheter in Off-Pump Cardiac Surgery Patients: "Why Did We Miss Our Appointment?". Comment on "Oh et al. Comparison between Fourth-Generation FloTrac/Vigileo System and Continuous Thermodilution Technique for Cardiac Output Estimation after Time Adjustment during Off-Pump Coronary Artery Bypass Graft Surgery: A Retrospective Cohort Study. J. Clin. Med. 2022, 11, 6093". J Clin Med 2023; 12:5772. [PMID: 37762714 PMCID: PMC10531544 DOI: 10.3390/jcm12185772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
We thank Vetrugno et al. for their interest and comments [...].
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Affiliation(s)
- Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
- Big Data Center, Biomedical Research Institute, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
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Baek SH, Chin HJ, Na KY, Chae DW, Kim S. Optimal systolic blood pressure in noncritically ill patients with acute kidney injury: A retrospective cohort study. Kidney Res Clin Pract 2019; 38:356-364. [PMID: 31474093 PMCID: PMC6727888 DOI: 10.23876/j.krcp.19.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022] Open
Abstract
Background Few data showed the optimal blood pressure (BP) in noncritically ill patients with acute kidney injury (AKI) relative to mortality or severe AKI. We therefore sought to analyze the data that exist for the ideal target range for BP in noncritically ill patients with AKI. Methods We performed a retrospective cohort study involving 1,612 hospitalized patients who were diagnosed with AKI using the Kidney Disease: Improving Global Outcomes definition based on serum creatinine measurements for a period of 1 year. The average systolic BP (SBP) was categorized into 10-mmHg increments (within 48 hours after the development of AKI). The primary outcome was a composite of severe AKI or 90-day mortality. Results The composite outcome rate in patients was 18.7% (302/1,612). The relationship between BP and the composite outcome followed a U-shaped curve, with an increased event rate observed at both low and high BP values. The average SBP after AKI predicted the composite outcome after adjusting for baseline variables (reference SBP: 120–129 mmHg; < 100 mmHg: hazard ratio [HR] 1.84, P = 0.015; 100–109 mmHg: HR 1.56, P = 0.038; 110–119 mmHg: HR 1.15, P = 0.483; 130–139 mmHg: HR 1.51, P = 0.045; ≥ 140 mmHg: HR 1.73, P = 0.005). Conclusion Among noncritically ill patients with AKI, a U-shaped curve association was observed between the average SBP within 48 hours after AKI and the composite primary outcome of this study, with the lowest event rate for SBP ranging from approximately 110 to 129 mmHg.
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Affiliation(s)
- Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Langston C. Managing Fluid and Electrolyte Disorders in Kidney Disease. Vet Clin North Am Small Anim Pract 2017; 47:471-490. [DOI: 10.1016/j.cvsm.2016.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Hutchinson KM, Shaw SP. A Review of Central Venous Pressure and Its Reliability as a Hemodynamic Monitoring Tool in Veterinary Medicine. Top Companion Anim Med 2016; 31:109-121. [PMID: 27968811 DOI: 10.1053/j.tcam.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/04/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To review the current literature regarding central venous pressure (CVP) in veterinary patients pertaining to placement (of central line), measurement, interpretation, use in veterinary medicine, limitations, and controversies in human medicine. ETIOLOGY CVP use in human medicine is a widely debated topic, as numerous sources have shown poor correlation of CVP measurements to the volume status of a patient. Owing to the ease of placement and monitoring in veterinary medicine, CVP remains a widely used modality for evaluating the hemodynamic status of a patient. A thorough evaluation of the veterinary and human literature should be performed to evaluate the role of CVP measurements in assessing volume status in veterinary patients. DIAGNOSIS Veterinary patients that benefit from accurate CVP readings include those suffering from hypovolemic or septic shock, heart disease, or renal disease or all of these. Other patients that may benefit from CVP monitoring include high-risk anesthetic patients undergoing major surgery, trending of fluid volume status in critically ill patients, patients with continued shock, and patients that require rapid or large amounts of fluids. THERAPY The goal of CVP use is to better understand a patient's intravascular volume status, which would allow early goal-directed therapy. PROGNOSIS CVP would most likely continue to play an important role in the hemodynamic monitoring of the critically ill veterinary patient; however, when available, cardiac output methods should be considered the first choice for hemodynamic monitoring.
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Affiliation(s)
| | - Scott P Shaw
- VCA, Specialty Regional Medical Director; Northeast Los Angeles, CA, USA
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Raimundo M, Crichton S, Syed Y, Martin JR, Beale R, Treacher D, Ostermann M. Low Systemic Oxygen Delivery and BP and Risk of Progression of Early AKI. Clin J Am Soc Nephrol 2015. [PMID: 26209157 DOI: 10.2215/cjn.02780314] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The optimal hemodynamic management of patients with early AKI is unknown. This study aimed to investigate the association between hemodynamic parameters in early AKI and progression to severe AKI and hospital mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study retrospectively analyzed the data of all patients admitted to the adult intensive care unit in a tertiary care center between July 2007 and June 2009 and identified those with stage 1 AKI (AKI I) per the AKI Network classification. In patients in whom hemodynamic monitoring was performed within 12 hours of AKI I, hemodynamic parameters in the first 12 hours of AKI I and on the day of AKI III (if AKI III developed) or 72 hours after AKI I (if AKI III did not develop) were recorded. Risk factors for AKI III and mortality were identified using univariate and multivariate logistic regression analyses. RESULTS Among 790 patients with AKI I, 210 (median age 70 years; 138 men) had hemodynamic monitoring within 12 hours of AKI I; 85 patients (41.5%) progressed to AKI III and 91 (43%) died in the hospital. AKI progressors had a significantly higher Sequential Organ Failure Assessment score (8.0 versus 9.6; P<0.001), lower indexed systemic oxygen delivery (DO2I) (median 325 versus 405 ml/min per m(2); P<0.001), higher central venous pressure (16 versus 13; P=0.02), and lower mean arterial blood pressure (MAP) (median 71 versus 74 mmHg; P=0.01) in the first 12 hours of AKI I compared with nonprogressors. Multivariate analysis confirmed that raised lactate, central venous pressure, and Sequential Organ Failure Assessment score as well as mechanical ventilation were independently associated with progression to AKI III; higher DO2I and MAP were independently associated with a lower risk of AKI III but not survival. The associations were independent of sepsis, heart disease, recent cardiac surgery, or chronic hypertension. CONCLUSIONS Higher DO2I and MAP in early AKI were independently associated with a lower risk of progression.
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Affiliation(s)
- Mario Raimundo
- Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom; Santa Maria Hospital, North Lisbon Hospital Center, Lisbon, Portugal; and
| | - Siobhan Crichton
- Division of Health and Social Care Research, King's College London, London, United Kingdom
| | - Yadullah Syed
- Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom
| | - Jonathan R Martin
- Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom
| | - Richard Beale
- Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom
| | - David Treacher
- Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom;
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Fidalgo P, Bagshaw SM. Chronic Kidney Disease in the Intensive Care Unit. MANAGEMENT OF CHRONIC KIDNEY DISEASE 2014. [PMCID: PMC7124091 DOI: 10.1007/978-3-642-54637-2_32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Murray PT, Mehta RL, Shaw A, Ronco C, Endre Z, Kellum JA, Chawla LS, Cruz D, Ince C, Okusa MD. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney Int 2013; 85:513-21. [PMID: 24107851 PMCID: PMC4198530 DOI: 10.1038/ki.2013.374] [Citation(s) in RCA: 276] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 06/19/2013] [Accepted: 06/27/2013] [Indexed: 12/31/2022]
Abstract
Over the last decade there has been considerable progress in the discovery and development of biomarkers of kidney disease, and several have now been evaluated in different clinical settings. While there is a growing literature on the performance of various biomarkers in clinical studies, there is limited information on how these biomarkers would be utilized by clinicians to manage patients with acute kidney injury (AKI). Recognizing this gap in knowledge, we convened the 10th Acute Dialysis Quality Initiative (ADQI) meeting to review the literature on biomarkers in AKI and their application in clinical practice. We asked an international group of experts to assess four broad areas for biomarker utilization for AKI: risk assessment, diagnosis and staging; differential diagnosis; prognosis and management and novel physiological techniques including imaging. This article provides a summary of the key findings and recommendations of the group, to equip clinicians to effectively use biomarkers in AKI.
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Affiliation(s)
- Patrick T Murray
- Department of Medicine, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Ravindra L Mehta
- Department of Medicine, UCSD Medical Center, University of California San Diego, San Diego, California, USA
| | - Andrew Shaw
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Claudio Ronco
- Renal Division, St Bortolo Hospital, International Renal Research Institute, Vicenza, Italy
| | - Zoltan Endre
- 1] Department of Nephrology, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia [2] Christchurch Kidney Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - John A Kellum
- Department of Critical Care Medicine, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lakhmir S Chawla
- Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Center, Washington, DC, USA
| | - Dinna Cruz
- 1] Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy [2] International Renal Research Institute (IRRIV), Vicenza, Italy
| | - Can Ince
- Department of Intensive Care Adults, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Mark D Okusa
- Division of Nephrology and Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, Virginia, USA
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