Abstract:
BACKGROUND:Acute kidney injury (AKI) affects a large proportion of the critically ill and is associated with worse patient outcomes. Early identification of AKI can lead to earlier initiation of supportive therapy and better management. In this study, we evaluate the impact of computerized AKI decision support tool integrated with the critical care clinical information system (CCIS) on patient outcomes. Specifically, we hypothesize that integration of AKI guidelines into CCIS will decrease the proportion of patients with Stage 1 AKI deteriorating into higher stages of AKI. METHODS:The study was conducted in two intensive care units (ICUs) at University Hospitals Bristol, UK, in a before (control) and after (intervention) format. The intervention consisted of the AKIN guidelines and AKI care bundle which included guidance for medication usage, AKI advisory and dashboard with AKI score. Clinical data and patient outcomes were collected from all patients admitted to the units. AKI stage was calculated using the Acute Kidney Injury Network (AKIN) guidelines. Maximum AKI stage per admission, change in AKI stage and other metrics were calculated for the cohort. Adherence to eGFR-based enoxaparin dosing guidelines was evaluated as a proxy for clinician awareness of AKI. RESULTS:Each phase of the study lasted a year, and a total of 5044 admissions were included for analysis with equal numbers of patients for the control and intervention stages. The proportion of patients worsening from Stage 1 AKI decreased from 42% (control) to 33.5% (intervention), p = 0.002. The proportion of incorrect enoxaparin doses decreased from 1.72% (control) to 0.6% (intervention), p < 0.001. The prevalence of any AKI decreased from 43.1% (control) to 37.5% (intervention), p < 0.05. CONCLUSIONS:This observational study demonstrated a significant reduction in AKI progression from Stage 1 and a reduction in overall development of AKI. In addition, a reduction in incorrect enoxaparin dosing was also observed, indicating increased clinical awareness. This study demonstrates that AKI guidelines coupled with a newly designed AKI care bundle integrated into CCIS can impact patient outcomes positively.
journal_name
Crit Carejournal_title
Critical care (London, England)authors
Bourdeaux C,Ghosh E,Atallah L,Palanisamy K,Patel P,Thomas M,Gould T,Warburton J,Rivers J,Hadfield Jdoi
10.1186/s13054-020-03343-1subject
Has Abstractpub_date
2020-11-23 00:00:00pages
656issue
1eissn
1364-8535issn
1466-609Xpii
10.1186/s13054-020-03343-1journal_volume
24pub_type
杂志文章相关文献
CRITICAL CARE文献大全abstract:BACKGROUND:Patients with infective endocarditis (IE) have an elevated risk of renal dysfunction because of extensive systemic inflammation and use of nephrotoxic antibiotics. In this randomized, placebo-controlled trial, we investigated whether perioperative sodium bicarbonate administration could attenuate postoperati...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13054-016-1591-z
更新日期:2017-01-05 00:00:00
abstract:INTRODUCTION:Glutamine supplementation has beneficial effects on morbidity and mortality in critically ill patients, possibly in part through an attenuation of the proinflammatory cytokine response and a stimulation of heat shock protein (HSP)70. We infused either alanine-glutamine or saline during endotoxin challenge ...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc7696
更新日期:2009-01-01 00:00:00
abstract::Storage time and residual leukocytes in red blood cell (RBC) units may be deleterious by increasing the accumulation of leukocyte-derived cytokines and by raising the adhesion of RBCs to endothelium. Leukodepleted RBC transfusion may reduce the incidence of infection and organ dysfunction. However, the influence of le...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc13811
更新日期:2014-04-01 00:00:00
abstract:INTRODUCTION:Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to desc...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc4928
更新日期:2006-01-01 00:00:00
abstract::High mobility group box protein 1 (HMGB1) has been shown to participate in acute inflammatory reactions, including acute lung injury and sepsis. There is also evidence that circulating levels of HMGB1 are increased after severe trauma and are associated with clinically important outcome parameters, including mortality...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc8141
更新日期:2009-01-01 00:00:00
abstract:: ...
journal_title:Critical care (London, England)
pub_type: 评论,信件
doi:10.1186/s13054-019-2310-3
更新日期:2019-01-17 00:00:00
abstract:INTRODUCTION:Sepsis-induced immunosuppression may result in death. The mechanisms of immune suppression include loss of macrophage and monocyte expression of the major histocompatibility complex, increased anti-inflammatory cytokine expression and decreased expression of proinflammatory cytokines. In this study, we sou...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc10464
更新日期:2011-01-01 00:00:00
abstract::Hypotension during intermittent hemodialysis is common, and has been attributed to acute volume shifts, shifts in osmolarity, electrolyte imbalance, temperature changes, altered vasoregulation, and sheer hypovolemia. Although hypovolemia may intuitively seem a likely cause for hypotension in intensive care patients, i...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-016-1307-4
更新日期:2016-06-09 00:00:00
abstract::Since the inception of blood banking, refinements in laboratory processes have allowed for progressively longer storage times of red blood cells. Whilst advantageous for the logistics of stock management, the clinical impact of the duration of red blood cell storage prior to transfusion remains uncertain, and a topic ...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc8878
更新日期:2010-01-01 00:00:00
abstract::Two international multicentre randomised controlled trials of drotrecogin alfa (activated) (DrotAA), the Recombinant Human Activated Protein C Worldwide Evaluation of Severe Sepsis (PROWESS) and Administration of Drotrecogin Alfa (Activated) in Early Stage Severe Sepsis (ADDRESS) trials, have produced inconsistent res...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc4947
更新日期:2006-01-01 00:00:00
abstract::Prone ventilation (PV) is a ventilatory strategy that frequently improves oxygenation and lung mechanics in critical illness, yet does not consistently improve survival. While the exact physiologic mechanisms related to these benefits remain unproven, one major theoretical mechanism relates to reducing the abdominal e...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc9099
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:We sought to determine the effects of alternative resuscitation strategies on microcirculatory perfusion and examine any association between microcirculatory perfusion and mortality in sepsis. METHODS:This was a prospective, formally designed substudy of participants in the Protocolized Care in Early Septic...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/s13054-018-2240-5
更新日期:2018-11-20 00:00:00
abstract:INTRODUCTION:The objective of this study was to evaluate the effects of two different mean arterial blood pressure (MAP) targets on needs for resuscitation, organ dysfunction, mitochondrial respiration and inflammatory response in a long-term model of fecal peritonitis. METHODS:Twenty-four anesthetized and mechanicall...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc12495
更新日期:2013-01-30 00:00:00
abstract::Barriers to the use of selective digestive decontamination include concerns about emergence of resistant organisms, over-estimation of current performance in preventing ventilator-associated pneumonia (VAP), alternative methods of preventing VAP, and misunderstanding of mechanisms of action. A definitive cluster-rando...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc13165
更新日期:2013-12-19 00:00:00
abstract:BACKGROUND:Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease and rapidly escalating epidemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pathogenesis of COVID-19 remains to be elucidated. We aimed to clarify correlation of systemic inflammation with disease s...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-020-03255-0
更新日期:2020-08-27 00:00:00
abstract:INTRODUCTION:Currently, little is known about the immunological characteristics of patients with avian influenza A (H7N9) virus infection. METHODS:The numbers and percentages of peripheral blood immune cells were measured in 27 patients with laboratory-confirmed H7N9 virus infection and 30 healthy controls (HCs). The ...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc13788
更新日期:2014-03-24 00:00:00
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
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:Admission blood glucose (BG) level is a predictor of mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, limited data are available relating admission BG to mortality in patients with STEMI complicated by cardiogenic shock, and it is not known whether diabetic status has...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/cc13035
更新日期:2013-10-03 00:00:00
abstract::Tracheal reintubation is a common event in critical care. Elmer and colleagues provide the first comparison of complication rates of initial and subsequent reintubation(s) during the same hospitalization. Their work shows an increased risk of complications associated with reintubation, in particular hypoxemia and hypo...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/s13054-015-0841-9
更新日期:2015-03-27 00:00:00
abstract::Despite continuous advances in technologic and pharmacologic management, the mortality rate from septic shock remains high. Care of patients with sepsis includes measures to support the circulatory system and treat the underlying infection. There is a substantial body of knowledge indicating that fluid resuscitation, ...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc2940
更新日期:2005-08-20 00:00:00
abstract:INTRODUCTION:Correct bedside measurement of intra-abdominal pressure (IAP) is important. The bladder method is considered as the gold standard for indirect IAP measurement, but the instillation volumes reported in the literature vary substantially. The aim of this study was to evaluate the effect of instillation volume...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc4962
更新日期:2006-01-01 00:00:00
abstract:INTRODUCTION:Partial pressure of end-tidal carbon dioxide (PetCO2) during cardiopulmonary resuscitation (CPR) correlates with cardiac output and consequently has a prognostic value in CPR. In our previous study we confirmed that initial PetCO2 value was significantly higher in asphyxial arrest than in ventricular fibri...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc9417
更新日期:2011-01-01 00:00:00
abstract::The forced oscillation technique (FOT) is a method for non-invasively assessing respiratory mechanics that is applicable both in paralysed and non-paralysed patients. As the FOT requires a minimal modification of the conventional ventilation setting and does not interfere with the ventilation protocol, the technique i...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc972
更新日期:2001-01-01 00:00:00
abstract:INTRODUCTION:Many patients experience 'relocation stress' when they are transferred from an intensive care unit (ICU) to step-down (high dependency) or general ward care, and much has been written about the psychological causes. This qualitative analysis of in-depth, narrative interviews with former ICU patients explor...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc6795
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:Ventilation according to the open lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pre...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc4944
更新日期:2006-01-01 00:00:00
abstract::In sepsis, inflammation and thrombosis are both the cause and the result of interactions between circulating (for example, leukocytes and platelets), endothelial and smooth muscle cells. Microparticles are proinflammatory and procoagulant fragments originating from plasma membrane generated after cellular activation a...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc9231
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:The first FDA-approved test to assess risk for acute kidney injury (AKI), [TIMP-2]•[IGFBP7], is clinically available in many parts of the world, including the USA and Europe. We sought to understand how the test is currently being used clinically. METHODS:We invited a group of experts knowledgeable on the u...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-019-2504-8
更新日期:2019-06-20 00:00:00
abstract::In this article we review recent advances made in the pathophysiology, diagnosis, and treatment of inhalation injury. Historically, the diagnosis of inhalation injury has relied on nonspecific clinical exam findings and bronchoscopic evidence. The development of a grading system and the use of modalities such as chest...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/s13054-015-1077-4
更新日期:2015-10-28 00:00:00
abstract:BACKGROUND:The dysregulated host immune response that defines sepsis varies as a function of both the immune status of the host and the distinct nature of the pathogen. The degree to which immunocompromising comorbidities or immunosuppressive medications affect the immune response to infection is poorly understood beca...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-018-2025-x
更新日期:2018-04-25 00:00:00
abstract:INTRODUCTION:Diabetes mellitus (DM) is one of the most common chronic co-morbid medical conditions in the USA and is frequently present in patients with sepsis. Previous studies reported that people with DM and severe sepsis are less likely to develop acute lung injury (ALI). We sought to determine whether organ dysfun...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7717
更新日期:2009-01-01 00:00:00