Optimal Mode of clearance in critically ill patients with Acute Kidney Injury (OMAKI)--a pilot randomized controlled trial of hemofiltration versus hemodialysis: a Canadian Critical Care Trials Group project.

Abstract:

INTRODUCTION:Among critically ill patients with acute kidney injury (AKI) needing continuous renal replacement therapy (CRRT), the effect of convective (via continuous venovenous hemofiltration [CVVH]) versus diffusive (via continuous venovenous hemodialysis [CVVHD]) solute clearance on clinical outcomes is unclear. Our objective was to evaluate the feasibility of comparing these two modes in a randomized trial. METHODS:This was a multicenter open-label parallel-group pilot randomized trial of CVVH versus CVVHD. Using concealed allocation, we randomized critically ill adults with AKI and hemodynamic instability to CVVH or CVVHD, with a prescribed small solute clearance of 35 mL/kg/hour in both arms. The primary outcome was trial feasibility, defined by randomization of >25% of eligible patients, delivery of >75% of the prescribed CRRT dose, and follow-up of >95% of patients to 60 days. A secondary analysis using a mixed-effects model examined the impact of therapy on illness severity, defined by sequential organ failure assessment (SOFA) score, over the first week. RESULTS:We randomized 78 patients (mean age 61.5 years; 39% women; 23% with chronic kidney disease; 82% with sepsis). Baseline SOFA scores (mean 15.9, SD 3.2) were similar between groups. We recruited 55% of eligible patients, delivered >80% of the prescribed dose in each arm, and achieved 100% follow-up. SOFA tended to decline more over the first week in CVVH recipients (-0.8, 95% CI -2.1, +0.5) driven by a reduction in vasopressor requirements. Mortality (54% CVVH; 55% CVVHD) and dialysis dependence in survivors (24% CVVH; 19% CVVHD) at 60 days were similar. CONCLUSIONS:Our results suggest that a large trial comparing CVVH to CVVHD would be feasible. There is a trend toward improved vasopressor requirements among CVVH-treated patients over the first week of treatment. TRIAL REGISTRATION:ClinicalTrials.gov: NCT00675818.

journal_name

Crit Care

authors

Wald R,Friedrich JO,Bagshaw SM,Burns KE,Garg AX,Hladunewich MA,House AA,Lapinsky S,Klein D,Pannu NI,Pope K,Richardson RM,Thorpe K,Adhikari NK

doi

10.1186/cc11835

subject

Has Abstract

pub_date

2012-10-24 00:00:00

pages

R205

issue

5

eissn

1364-8535

issn

1466-609X

pii

cc11835

journal_volume

16

pub_type

杂志文章,多中心研究,随机对照试验
  • Influence of temperature on thromboelastometry and platelet aggregation in cardiac arrest patients undergoing targeted temperature management.

    abstract:BACKGROUND:Coagulation can be visualised using whole blood coagulation analyses such as thromboelastometry and platelet aggregation tests; however, the role of temperature in the analyses is ambiguous. The aim was to examine whether temperature influences the whole blood coagulation tests. METHODS:We included 40 patie...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-016-1302-9

    authors: Jeppesen AN,Kirkegaard H,Ilkjær S,Hvas AM

    更新日期:2016-04-30 00:00:00

  • Clinical review: clinical management of atrial fibrillation - rate control versus rhythm control.

    abstract::Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the critically ill and is associated with adverse outcomes. Although there are plausible benefits from conversion and maintenance of sinus rhythm (the so-called 'rhythm-control' strategy), recent randomized trials have failed to demonstrate th...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc2827

    authors: Lim HS,Hamaad A,Lip GY

    更新日期:2004-08-01 00:00:00

  • Prediction of ventilation weaning outcome: children are not little adults.

    abstract::Prediction of ventilation weaning outcome in children is important, as unsuccessful extubation increases both morbidity and mortality. Adult weaning criteria are poor predictors of weaning outcome in children for several possible reasons: the length of mechanical ventilation is generally much shorter, and the weaning ...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章

    doi:10.1186/cc3950

    authors: Schindler MB

    更新日期:2005-01-01 00:00:00

  • Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood.

    abstract:INTRODUCTION:As a result of drug sequestration and increased volume of distribution, the extracorporeal membrane oxygenation (ECMO) procedure might lead to a decrease in drug concentrations during a patient's treatment. The aim of this study was to evaluate sedative, antibiotic and immunosuppressive drug loss in ECMO c...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-015-0772-5

    authors: Lemaitre F,Hasni N,Leprince P,Corvol E,Belhabib G,Fillâtre P,Luyt CE,Leven C,Farinotti R,Fernandez C,Combes A

    更新日期:2015-02-12 00:00:00

  • Inhaled nitric oxide and the risk of renal dysfunction in patients with acute respiratory distress syndrome: a propensity-matched cohort study.

    abstract:BACKGROUND:Inhaled nitric oxide (iNO) is a rescue therapy for severe hypoxemia in patients with acute respiratory distress syndrome (ARDS). Pooled data from clinical trials have signaled a renal safety warning for iNO therapy, but the significance of these findings in daily clinical practice is unclear. We used primary...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-016-1566-0

    authors: Ruan SY,Wu HY,Lin HH,Wu HD,Yu CJ,Lai MS

    更新日期:2016-11-30 00:00:00

  • Presence of Candida cell wall derived polysaccharides in the sera of intensive care unit patients: relation with candidaemia and Candida colonisation.

    abstract:INTRODUCTION:Prompt diagnosis of candidaemia and invasive candidosis is crucial to the early initiation of antifungal therapy. The poor sensitivity of blood cultures (BCs) has led to the development of fungal glycan tests as a diagnostic adjunct. We analysed the performance of tests for the detection of circulating β-D...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc13953

    authors: Poissy J,Sendid B,Damiens S,Ichi Ishibashi K,François N,Kauv M,Favory R,Mathieu D,Poulain D

    更新日期:2014-06-29 00:00:00

  • Markers of collagen synthesis and degradation are increased in serum in severe sepsis: a longitudinal study of 44 patients.

    abstract:INTRODUCTION:Sepsis-related multiple organ dysfunction is a common cause of death in the intensive care unit. The effect of sepsis on markers of tissue repair is only partly understood. The aim of this study was to measure markers of collagen synthesis and degradation during sepsis and investigate the association with ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc7780

    authors: Gäddnäs F,Koskela M,Koivukangas V,Risteli J,Oikarinen A,Laurila J,Saarnio J,Ala-Kokko T

    更新日期:2009-01-01 00:00:00

  • Choosing wisely - when to mend a broken heart with ECMO?

    abstract::Refractory cardiac shock in the cardiac surgical intensive care unit confers significant morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) has become a common intervention for refractory cardiogenic shock when other therapies have failed. However, it is difficult to predict who will benefit from this...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章

    doi:10.1186/cc13736

    authors: Stephens R,Fan E

    更新日期:2014-02-20 00:00:00

  • Physiology of the Respiratory Drive in ICU Patients: Implications for Diagnosis and Treatment.

    abstract::This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-020-2776-z

    authors: Jonkman AH,de Vries HJ,Heunks LMA

    更新日期:2020-03-24 00:00:00

  • The practice of intensive care in Latin America: a survey of academic intensivists.

    abstract:BACKGROUND:Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, tr...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-018-1956-6

    authors: Castro R,Nin N,Ríos F,Alegría L,Estenssoro E,Murias G,Friedman G,Jibaja M,Ospina-Tascon G,Hurtado J,Marín MDC,Machado FR,Cavalcanti AB,Dubin A,Azevedo L,Cecconi M,Bakker J,Hernandez G,Latin-American Intensive Care Net

    更新日期:2018-02-21 00:00:00

  • Using an expiratory resistor, arterial pulse pressure variations predict fluid responsiveness during spontaneous breathing: an experimental porcine study.

    abstract:INTRODUCTION:Fluid responsiveness prediction is difficult in spontaneously breathing patients. Because the swings in intrathoracic pressure are minor during spontaneous breathing, dynamic parameters like pulse pressure variation (PPV) and systolic pressure variation (SPV) are usually small. We hypothesized that during ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc7760

    authors: Dahl MK,Vistisen ST,Koefoed-Nielsen J,Larsson A

    更新日期:2009-01-01 00:00:00

  • Pulse contour analysis: is it able to reliably detect changes in cardiac output in the haemodynamically unstable patient?

    abstract::Three pulse contour systems for monitoring cardiac output - LiDCO Plus™, PiCCO Plus™ and FloTrac™ - were compared in postcardiac surgery patients. None of the three methods demonstrated good trending ability according to concordance analysis. Pulse contour systems remain unreliable in the haemodynamically unstable pat...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章

    doi:10.1186/cc9381

    authors: Critchley LA

    更新日期:2011-01-19 00:00:00

  • Measuring the anticoagulant effect of low molecular weight heparins in the critically ill.

    abstract::Antithrombotic prophylaxis in critically ill patients frequently fails. Venous thromboembolism is associated with adverse clinical outcomes, including a prolonged intensive care unit stay and death. A potential mechanism by which critically ill patients may be predisposed to antithrombotic failure is the inability to ...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章,评审

    doi:10.1186/cc4978

    authors: Crowther M,Lim W

    更新日期:2006-01-01 00:00:00

  • Clinical review: Vasopressin and terlipressin in septic shock patients.

    abstract::Vasopressin (antidiuretic hormone) is emerging as a potentially major advance in the treatment of septic shock. Terlipressin (tricyl-lysine-vasopressin) is the synthetic, long-acting analogue of vasopressin, and has comparable pharmacodynamic but different pharmacokinetic properties. Vasopressin mediates vasoconstrict...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc2945

    authors: Delmas A,Leone M,Rousseau S,Albanèse J,Martin C

    更新日期:2005-04-01 00:00:00

  • Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial.

    abstract:INTRODUCTION:Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/cc6999

    authors: Pérez-Bárcena J,Llompart-Pou JA,Homar J,Abadal JM,Raurich JM,Frontera G,Brell M,Ibáñez J,Ibáñez J

    更新日期:2008-01-01 00:00:00

  • Long-term survival after intensive care unit discharge in Thailand: a retrospective study.

    abstract:INTRODUCTION:Economic evaluations of interventions in the hospital setting often rely on the estimated long-term impact on patient survival. Estimates of mortality rates and long-term outcomes among patients discharged alive from the intensive care unit (ICU) are lacking from lower- and middle-income countries. This st...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc13036

    authors: Luangasanatip N,Hongsuwan M,Lubell Y,Limmathurotsakul D,Teparrukkul P,Chaowarat S,Day NP,Graves N,Cooper BS

    更新日期:2013-10-03 00:00:00

  • Protocols in the management of critical illness.

    abstract::Care of the critically ill patient is becoming increasingly complex. Protocols, which standardize care of patients with similar diseases, represent a potential solution to managing multiple simultaneous problems in critically ill patients. In this article, we examine the advantages and disadvantages to care protocoliz...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc10578

    authors: Chang SY,Sevransky J,Martin GS

    更新日期:2012-01-01 00:00:00

  • Whole blood thromboelastometry: another Knight at the Roundtable?

    abstract::Thromboelastography and thromboelastometry represent viscoelastic diagnostic methodologies with promising application to diseases of altered coagulation. Their use in trauma-induced coagulopathy as a means of assessing the real-time status of the patient's functional coagulation profile in addition to its impact on ef...

    journal_title:Critical care (London, England)

    pub_type: 评论,社论

    doi:10.1186/cc10569

    authors: Bluth MH,Kashuk JL

    更新日期:2011-01-01 00:00:00

  • Influence of insulin on glucose metabolism and energy expenditure in septic patients.

    abstract:INTRODUCTION:It is recognized that administration of insulin with glucose decreases catabolic response in sepsis. The aim of the present study was to compare the effects of two levels of insulinaemia on glucose metabolism and energy expenditure in septic patients and volunteers. METHODS:Glucose uptake, oxidation and s...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc2868

    authors: Rusavy Z,Sramek V,Lacigova S,Novak I,Tesinsky P,Macdonald IA

    更新日期:2004-08-01 00:00:00

  • Greening critical care.

    abstract::Climate change and environmental stewardship are phrases that have been defining the past few decades and promoting change in our societies. The sensitivities of intensive care as a specialty make the process of greening an intensive care unit a challenge, but not one that is insurmountable. This paper discusses oppor...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc9409

    authors: Chapman M,Chapman A

    更新日期:2011-01-01 00:00:00

  • Cerebral microdialysis for detection of bacterial meningitis in aneurysmal subarachnoid hemorrhage patients: a cohort study.

    abstract:INTRODUCTION:Bacterial meningitis (BM) is a severe complication in patients with aneurysmal subarachnoid haemorrhage (SAH). Clinical signs of meningitis are often masked by SAH-related symptoms, and routine cerebrospinal fluid (CSF) analysis fails to indicate BM. Microdialysis (MD) is a technique for monitoring cerebra...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc7689

    authors: Schlenk F,Frieler K,Nagel A,Vajkoczy P,Sarrafzadeh AS

    更新日期:2009-01-01 00:00:00

  • Estimation of the diaphragm neuromuscular efficiency index in mechanically ventilated critically ill patients.

    abstract:BACKGROUND:Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain resp...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-018-2172-0

    authors: Jansen D,Jonkman AH,Roesthuis L,Gadgil S,van der Hoeven JG,Scheffer GJ,Girbes A,Doorduin J,Sinderby CS,Heunks LMA

    更新日期:2018-09-27 00:00:00

  • Initial therapy affects duration of diarrhoea in critically ill patients with Clostridioides difficile infection (CDI).

    abstract:BACKGROUND:Critically ill patients in the intensive care unit (ICU) are at high risk for developing Clostridioides difficile infections (CDI). Risk factors predicting their mortality or standardized treatment recommendations have not been defined for this cohort. Our goal is to determine outcome and mortality associate...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-019-2648-6

    authors: Manthey CF,Dranova D,Christner M,Drolz A,Kluge S,Lohse AW,Fuhrmann V

    更新日期:2019-12-09 00:00:00

  • Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial.

    abstract:INTRODUCTION:Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducing the blood glucose level below 6 mmol/l had a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/cc8202

    authors: Žuran I,Poredos P,Skale R,Voga G,Gabrscek L,Pareznik R

    更新日期:2009-01-01 00:00:00

  • Correlation between high blood IL-6 level, hyperglycemia, and glucose control in septic patients.

    abstract:INTRODUCTION:The aim of the present study was to investigate the relationship between the blood IL-6 level, the blood glucose level, and glucose control in septic patients. METHODS:This retrospective observational study in a general ICU of a university hospital included a total of 153 patients with sepsis, severe seps...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc11301

    authors: Nakamura M,Oda S,Sadahiro T,Watanabe E,Abe R,Nakada TA,Morita Y,Hirasawa H

    更新日期:2012-12-12 00:00:00

  • Argon neuroprotection.

    abstract::Certain noble gases, though inert, exhibit remarkable biological properties. Notably, xenon and argon provide neuroprotection in animal models of central nervous system injury. In the previous issue of Critical Care, Loetscher and colleagues provided further evidence that argon may have therapeutic properties for neur...

    journal_title:Critical care (London, England)

    pub_type: 评论,信件

    doi:10.1186/cc8847

    authors: Sanders RD,Ma D,Maze M

    更新日期:2010-01-01 00:00:00

  • Remifentanil for analgesia-based sedation in the intensive care unit.

    abstract::Providing effective analgesia and adequate sedation is a generally accepted goal of intensive care medicine. Due to its rapid, organ independent and predictable metabolism the short acting opioid remifentanil might be particularly useful for analgesia-based sedation in the intensive care unit (ICU). This hypothesis wa...

    journal_title:Critical care (London, England)

    pub_type: 评论,社论

    doi:10.1186/cc2421

    authors: Kuhlen R,Putensen C

    更新日期:2004-02-01 00:00:00

  • Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers.

    abstract:INTRODUCTION:Mobilisation of patients in the intensive care unit (ICU) is an area of growing research. Currently, there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses. METHODS:The objectives of the study were to (1) quantify and benchmark baseline lev...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,多中心研究

    doi:10.1186/s13054-015-1033-3

    authors: Harrold ME,Salisbury LG,Webb SA,Allison GT,Australia and Scotland ICU Physiotherapy Collaboration.

    更新日期:2015-09-14 00:00:00

  • Starling curves and central venous pressure.

    abstract::Recent studies challenge the utility of central venous pressure monitoring as a surrogate for cardiac preload. Starting with Starling's original studies on the regulation of cardiac output, this review traces the history of the experiments that elucidated the role of central venous pressure in circulatory physiology. ...

    journal_title:Critical care (London, England)

    pub_type: 历史文章,杂志文章,评审

    doi:10.1186/s13054-015-0776-1

    authors: Berlin DA,Bakker J

    更新日期:2015-02-16 00:00:00

  • Statistics review 4: sample size calculations.

    abstract::The present review introduces the notion of statistical power and the hazard of under-powered studies. The problem of how to calculate an ideal sample size is also discussed within the context of factors that affect power, and specific methods for the calculation of sample size are presented for two common scenarios, ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc1521

    authors: Whitley E,Ball J

    更新日期:2002-08-01 00:00:00