Plasma sodium during the recovery of renal function in critically ill adult patients: Multicenter prospective cohort study.

Background: Sodium increases during acute kidney injury (AKI) recovery. Both hypernatremia and positive fluid balances are associated with increased mortality. We aimed to evaluate the association between daily fluid balance and daily plasma sodium during the recovery from AKI among critical patients.

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study.

Background: Post intensive care syndrome is defined as the presence of any impairment affecting the physical, psychiatric, or cognitive domains as a result of critical illnesses.

Objectives: To explore functional, cognitive and psychological outcomes at 30 days post hospital discharge among survivors of COVID-19-associated acute respiratory distress syndrome, who required mechanical ventilation.

Methods: Prospective cohort study.

Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically Ill Patients.

Objectives: To investigate the association between the concentration of the causative anions responsible for the main types of metabolic acidosis and the outcome.

Design: Prospective observational study.

Setting: Teaching ICU.

Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock.

Objectives: To evaluate the prevalence of myocardial dysfunction and its prognostic value in patients with severe sepsis and septic shock.

Methods: Adult septic patients admitted to an intensive care unit were prospectively studied using transthoracic echocardiography within the first 48 hours after admission and thereafter on the 7th-10th days. Echocardiographic variables of biventricular function, including the E/e' ratio, were compared between survivors and non-survivors.

Has Stewart approach improved our ability to diagnose acid-base disorders in critically ill patients?

The Stewart approach-the application of basic physical-chemical principles of aqueous solutions to blood-is an appealing method for analyzing acid-base disorders. These principles mainly dictate that pH is determined by three independent variables, which change primarily and independently of one other. In blood plasma in vivo these variables are: (1) the PCO2; (2) the strong ion difference (SID)-the difference between the sums of all the strong (i.

[Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment].

Objective: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients.

Urinary strong ion difference is a major determinant of plasma chloride concentration changes in postoperative patients.

Objective: To show that alterations in the plasma chloride concentration ([Cl-]plasma) during the postoperative period are largely dependent on the urinary strong ion difference ([SID]urine=[Na+]urine+[K+]urine-[Cl-]urine) and not on differences in fluid therapy.

Methods: Measurements were performed at intensive care unit admission and 24 hours later in a total of 148 postoperative patients. Patients were assigned into one of three groups according to the change in [Cl-]plasma at the 24 hours time point: increased [Cl-]plasma (n=39), decreased [Cl-]plasma (n=56) or unchanged [Cl-]plasma (n=53).

Fluids in the postoperative period: effects of lack of adjustment to body weight.

Objective: To compare the differences in fluid and electrolyte balance in patients with low and high weight in the first postoperative day.

Methods: Over a period of 18 months, we prospectively evaluated 150 patients in the first 24 hours after surgery, in a university-affiliated hospital intensive care unit. Patients with low weight (< 60 kg) and high body weight (> 90 Kg) were compared in terms of fluid intake and output.

Alterations in urinary strong ion difference in critically ill patients with metabolic acidosis: a prospective observational study.

Background And Objective: The correct renal response to metabolic acidosis should be a negative shift in the urinary strong ion difference ([SID](urinary) = [Na(+)](urinary) + [K(+)](urinary) - [Cl(-)](urinary)). Our hypothesis was that the failure to decrease the [SID](urinary) is frequently present and leads to a more severe metabolic acidosis.

Design, Setting And Participants: Prospective observational study conducted in the medical/surgical intensive care unit of a teaching hospital between 1 January 2006 and 30 April 2007.

Severe hyperlactatemia with normal base excess: a quantitative analysis using conventional and Stewart approaches.

Introduction: Critically ill patients might present complex acid-base disorders, even when the pH, PCO2, [HCO3-], and base excess ([BE]) levels are normal. Our hypothesis was that the acidifying effect of severe hyperlactatemia is frequently masked by alkalinizing processes that normalize the [BE]. The goal of the present study was therefore to quantify these disorders using both Stewart and conventional approaches.

Comparison of three different methods of evaluation of metabolic acid-base disorders.

Objectives: The Stewart approach states that pH is primarily determined by Pco2, strong ion difference (SID), and nonvolatile weak acids. This method might identify severe metabolic disturbances that go undetected by traditional analysis. Our goal was to compare diagnostic and prognostic performances of the Stewart approach with a) the traditional analysis based on bicarbonate (HCO3) and base excess (BE); and b) an approach relying on HCO3, BE, and albumin-corrected anion gap (AGcorrected).